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A bit about the kingdom in the sky
The Mountain Kingdom of Lesotho, also known as "The kingdom in the sky" as two-thirds of its land area contains spectacular mountains, was hot and dry during the December month when I visited.
Since May 2009, CMT has partnered with the Adventist Relief Agency (ADRA) Lesotho to increase capacity of ADRA's outreach programme in promoting and supporting community preparedness for antiretroviral treatment efforts within Lesotho. The treatment literacy programme is meant to:
generate a pool of Treatment Literacy Prevention Practitioners (TLPPs) equipped with treatment literacy related skills and knowledge for cascading of treatment literacy at community level
serve as crucial interactive platform for experience sharing on community preparedness and treatment literacy in the country.
The Lesotho government launched its national programme to provide free antiretroviral therapy in 2004, and by December 2005 around 8,400 people were receiving treatment. Lesotho's attempts to provide national antiretroviral treatment have been held back by huge shortages in healthcare staff. The report produced by Medecins Sans Frontier (MSF) in 2007, entitled Confronting the Health Care Worker Crisis to Expand Access to HIV/AIDS Treatment in Southern Africa, found that Lesotho, similar to its neighbouring countries, had skilled health professional travelling abroad seeking higher wages, leaving a shortage of trained staff in the country.
This shortage of health care staff meant that Lesotho's target to treat 27,000 people by 2005, or even half of that would not be attained. By December 2007 only 22,000 Basotho were able to access treatment.
In recent years Lesotho has made significant progress in treatment scale-up. By the end of 2008, the number of people receiving antiretroviral drugs was double that of 2007. A total of 104 sites were providing antiretroviral therapy, which included sites in remote parts of the country.
The government of Lesotho has shown a progressive and dynamic approach to combating the spread of HIV. Unfortunately plans have been set back by financial constraints, severe shortages of health workers and the logistical nightmare of reaching parts of the population in mountainous and isolated rural areas.
Nevertheless, with technical assistance, Lesotho has been able to strengthen local communities to implement services, and improve rights for all. These measures are urgently needed in order for Lesotho to reduce the number of people becoming infected with HIV, and increase access to treatment and care for those living with the virus. The CMT partnership with ADRA-Lesotho will extend until the end of 2011, and the goal is to educate Basotho about the importance of accessing treatment, to encourage treatment and to supporting those living with HIV.
The CMT/ADRA outreach programme only began in December 2009 in Lesotho and by January 2010 the requests for treatment literacy sessions was plentiful. Currently the sessions are conducted for male and female prisons, female support groups, schools, mobile clinic sites, youth groups and for the local chiefs. ADRA has since been bombarded with requests coming from other schools, the police service, the correctional service department, and even a musical choir.
The first Treatment Literacy training for the chiefs in Lesotho
The excitement of the TLPPs is just as high. Many of the ones I met were so optimistic, confident and eager for more training. A few of them shared with me their encounters in the communities and it became very clear that the audiovisual kits are a hit. In particular where literacy levels are low, "there are far more questions asked by the participants when we use audio visual kits than when we just train without" explained a TLPP by the name of ‘Malikotsi. "When are other kits coming?" asked another.
Ntate Alfred Thotolo, doing his thing - Training
The TLPPS have indicted that one of their biggest challenge lies in accessing the very remote areas. Many of the mountain people who live in Lesotho travel only on foot or by horse, because of the rugged terrain. This does not seem to have deterred the TLPPs, "work continues" said one of them, "we reach where we can and do our job!"
Puleng Phooko
HIV and AIDS support groups in Thyolo district,
Malawi
The pillar in communities
Thyolo district is in the southern region of Malawi and home to 600,000 inhabitants. It is estimated that almost 21 percent of these inhabitants are HIV positive; the United States Agency for International Development (USAID) estimates that Malawi has an adult HIV prevalence of 14,1 percent (in 2005) and the United Nations have since indicated that the prevalence has dropped to a little under 12 percent (in 2007). Thus, Thyolo district became a point of intervention for the Malawian ministry of health, and together with its partner in the region, Médecins Sans Frontières (MSF), universal access of antiretroviral treatment (ART) was achieved.
In a recent interview conducted with the MSF head of mission, Marielle Bemelmans, during the Fifth IAS Conference on Pathogenesis, Treatment and Prevention in Cape Town, South Africa, she confirmed that eight in 10 people who need ART are getting it. This means that 14,000 people have been receiving ART since the roll-out of this programme, and 80 percent of these people are still alive and on treatment.
One way in which this scaled up process to achieve universal access was employed, was to decentralise the health system in Thyolo, meaning that district health centres and health posts took on services such as testing and counselling, treatment initiation and a standard first-line regimen of drugs. This decentralised approach naturally brought services closer to the community and physical access or proximity to service and treatment has encouraged family and community support. Increased family and community support has, in turn, sparked community involvement.
The Thyolo branch of the National Association for People Living with HIV and Aids in Malawi (Napham) has already established 88 support groups in 522 villages, and has 8,000 members in the district. Villages are often not more than three kilometres apart, and therefore support groups in villages are well attended, at least twice a month. Support groups are facilitated by Napham volunteers, and health talks cover positive living, side-effects of treatment, testing, discordant couples, prevention of mother-to-child transmission (PMTCT), and condoms and prevention.
The support groups are much more than mere living-with-HIV support groups; up to 60 members congregate in each group on a regular basis, learning about life from one another and even cooking together, and sharing recipes. The Napham support groups have become part of the Thyolo fabric, and in a silver lining manner, it has become the positive by-product of a community largely HIV positive. One member in Kapichi, Rosina Mpola, explained that: "When fetching water, other women used to drop the buckets and leave the spot. Even if I went to talk to a group of women, talking and laughing - they would just stop. My support group helps me." From Mapanga to Khonjeni, women especially regard these support groups as crucial to their livelihood, and to this end many groups have even begun income-generating projects for their respective communities.
MSF recognised the strength and value in these support groups and has embarked on a further strategy to address HIV and AIDS in Thyolo. This strategy includes training three members from each support group - a youth, a mother that is part of PMTCT programme, and another person who is on ART - to train fellow community members in all matters relating to HIV and AIDS. In this endeavour, MSF is partnering with the Community Media Trust (CMT), a non-governmental organisation from South Africa that develops and produces treatment literacy and the well-known television programmes Siyayinqoba Beat It! and Siyayinqoba Beat It! Live. CMT will develop, produce and implement treatment literacy in audiovisual and print media, and in Chichewa (the regional language). The treatment literacy series will be tailor-made for Malawi, including not only cultural and traditional aspects specific to Thyolo, but also Malawian protocol in treating and living with HIV and AIDS in Malawi.
This treatment literacy project will span almost three years, and the ultimate goal will be to educate each and every person living in Thyolo - every one of the 600,000 inhabitants. MSF and CMT believe that Thyolo too can reduce its HIV prevalence rate in line with the rest of Malawi.
Suné Kitshoff
