Village-to-Village HIV Testing and Counseling Brings Services to Rural Communities in Malawi

[Mr. Kalima Danger and his wife, Mrs. Mkalira Kalima, were both tested and learned of their HIV-positive status]Mr. Kalima Danger and his wife, Mrs. Mkalira Kalima, were both tested and learned of their HIV-positive statusThe Salima district of Malawi is underserved by health facilities. The US Agency for International Development (USAID)-funded Basic Support for Institutionalizing Child Survival (BASICS) project decided it was necessary to implement village-to-village HIV testing and counseling in the Traditional Authority Msosa, Salima district, to bring HIV testing and counseling closer to people in the rural villages. Currently, there are only two health centers in the Msosa area, and they are at least twenty kilometers from most of the population.

The BASICS project, supported by Management Sciences for Health (MSH), oriented over 100 community leaders from 40 targeted villages in the area on issues surrounding HIV, HIV testing and counseling, and prevention of mother-to-child transmission of HIV. The leaders were informed of their roles and responsibilities in supporting village-to-village HIV testing and counseling services.

The BASICS project conducted focus groups to discuss why couples do not use HIV testing and counseling, as well as potential solutions to this problem. They mobilized community campaigns to encourage the use of HIV testing and counseling services, which included: interactive drama, bands, poems, and speeches by local leaders.

In an 11 month period (July 2009- May 2010), 46 villages implemented HIV testing and counseling services, 4,300 people received HIV testing and counseling services, four HIV testing and counseling providers were deployed per village, and a clinician was assigned to immediately assess those who tested positive for antiretroviral therapy eligibility.

In September 2009, BASICS visited Nyambalo village to conduct a HIV testing and counseling program. With encouragement from the Group Village Head, over 200 people accessed HIV testing and counseling during the three day campaign.

Mr. Kalima Danger and his wife, Mrs. Mkalira Kalima, (pictured above) were both tested during the event and learned of their HIV-positive status. They were both immediately assessed and placed on antiretroviral therapy.

Before testing, the couple suffered from a series of illnesses, they thought was due to malaria or another infection. As a result, Mr. and Mrs. Danger's productivity on their farm significantly decreased and they had begun to worry about feeding their three children.

After a few months of antiretroviral treatment, they both noticed a positive change in their health. They now say they feel as healthy as ever and are able to tend to the farm as they did before.

The couple now acts as community advocates. They educate their neighbors on the importance of knowing their status and provide information on prevention and treatment.

Stigma surrounding HIV has practically ceased in their village, due to advocacy and support from the Global Village Head. According to the Global Village Head, it is now officially 'illegal' to insult HIV-positive community members. Such behavior will result in direct punishment from the technical authority (usually in the form of a fine of one to two chickens).


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