HIV & AIDS

Three decades ago, life in the lakeside village of Zambo was calm.

A couple from Malawi receives counseling from a Community-Based Distribution Agent (CBDA)

In Kasungu District, Malawi, trained Community-Based Distribution Agents (CBDAs) gather for their final and perhaps most challenging training: couples counseling.

With HIV, couples often do not freely discuss issues and concerns. “Where communication has been a problem for couples, CBDAs in underserved areas will help in risk reduction,” explains Jane Ngwira, MSH’s Kasungu District Coordinator.

A Health Surveillance Assistant offers HIV-Testing and Counseling (HTC) in a Resthouse Room at Sombi

 

Picture trees, water, mountains, mud, birds and fish. This is Lake Chirwa -- the second largest of the five lakes in Malawi and the main habitat of small fish called Matemba. The lake offers a trading opportunity for fishermen from many walks of life.

Lying in the southern region of Malawi, Lake Chirwa is a wetland for people of three districts: Phalombe, Zomba and Machinga. All these people have frequent contact with Mozambique as they lie near the bordering frontiers. The lake lies some 50km from Zomba District Health Office.

Lucia Afiki and Esther Goodson are living positively with HIV. They are counselors for family planning and HIV & AIDS at Salima District Hospital in Malawi, where they openly tell their clients that they are HIV-positive. “When we are open with them about our status,” says Afiki, “people say, ‘Come closer, we want to learn from you.’” Goodson adds: “They say, ‘What should I do to look as good as you?’” The counselors tell them to visit a doctor and join a support group. This is an approach that saves lives. It also transforms social norms about health and gender.

Fatima preparing bean cakes for her business, Nigeria

 

HIV-positive women in Nigeria are the primary caregivers for their own families and other people living with HIV. This disproportionately high burden of care has detrimental effects not only on their health but also on their economic well-being.

The MSH-led, USAID-funded, Prevention Organization Systems AIDS Care and Treatment (ProACT) project in Nigeria has helped establish HIV support groups whose participants are 80 percent women. These groups have started providing income-generating opportunities for participants through savings and loan associations, registered with the Nigerian State Ministry of Commerce and Cooperative Societies.

Mary Umoh, colleague and friend -- and one of the winners of an internal MSH abstract contest for staff -- traveled from Nigeria to Rome to present her poster at the 6th International AIDS Society Conference on HIV Pathogenesis, Treatment and Prevention (IAS 2011).

The USAID-funded Strengthening Pharmaceutical Systems (SPS) program has been providing technical assistance to health facilities in the Northern Cape of South Africa, in partnership with the Provincial Department of Health, since 2005.

SPS addresses various areas, including: Pharmacy and Therapeutics Committees (PTCs), medicine supply management, patient adherence to antiretroviral treatment (ART), infection prevention and control, HIV/AIDS pharmaceutical management, pharmacovigilance, quantification, and compliance with the legislation relating to the supply of medicine.

About the Northern Cape, South Africa

Northern Cape

Northern Cape, South Africa

Northern Cape is the largest province in South Africa --- 372,889 square kilometers (km²) --- with a population of 1.15 million. It represents 30.5 percent of the total surface area of South Africa.

Mary's 120 square foot house, purchased in 1992 (Mala Persaud/GHARP II)

Mary* was married at the young age of 13 in her hometown, Crabwood Creek, Region 6, Guyana. At age 15, after she gave birth to her first child, her husband deserted them. Mary was left to provide for herself and her child. She tried a few odd jobs, but they did not work out. In 1989, at age 15, she turned to commercial sex work. At this time, Mary had never heard of condoms and had never used one. Her earnings were adequate, as much as $300 some weeks. However, heeding the advice of many of her older friends, she chose to leave sex work in 1992, spent her savings on a 120 square feet house, and started fishing to support herself and son.

From Alima Twaibu’s village in Nhkotakota district, it is 10 km to the nearest Health Center or 16 km to the District Hospital. With more than 80% of the population living in rural areas, the majority of Malawians experience similar challenges to accessing care. People have to walk long distances to receive services when they are sick. And when time away from work or paying for transport competes with other basic expenses, the decision to seek preventive services like family planning and HIV testing and counseling (HTC) is even more difficult. Fortunately for her neighbors and surrounding communities, Alima is an experienced Community-Based Distribution Agent (CBDA).

Mother and children, Salima, Malawi, April 2011

Malawi leads the developing world as the first to propose an approach to prevention of mother to child transmission (PMTCT) of HIV that addresses the health of the mother. Recently my MSH colleague Erik Schouten and his colleagues in Malawi wrote a commentary in the Lancet about Malawi’s innovative, public health approach to PMTCT. Malawi calls its model “B+” because it complements the World Health Organization’s (WHO) B option, whereby a mother’s CD4 cell count, a measure of the volume of HIV circulating in her blood, determines her eligibility for lifelong antiretroviral therapy (ART).

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