Scaling HIV prevention and treatment in Ntcheu
Ntcheu – Sixty-two-year-old Mary Yotamu hails from Group Village head MandalaT/A Champiti in the mountainous Ngoni-tribe dominated Ntcheu district. She is single but has been married twice in her lifetime, a commendable feat for a woman born and brought up in a tribal setting known for its passionate affection for beer drinking, meat eating and womanising. Her first marriage ended when her husband died in 2000. Her second marriage hit the rocks last year.
Both her married lives share one thing – living with the human immunodeficiency virus (HIV), the virus that causes AIDS. Meanwhile, during her first marriage, Yotamu did not know she had the virus. Neither did she know that the cause of the death of her husband was the same virus until, she begun to waste away and could not find any medical drugs to heal her.
She got married to her second husband, who supported her during her illness and was always by her side when she was down. From 2001, Yotamu and her new husband spent time, money and the little energy that propelled her visiting traditional healers where she acquired different herbal medicines and concoctions to reverse her health status but to no avail.
It was not until 2005, when Yotamu met John Kathewera ‑ the co-ordinator of Champiti Support Group, who advised the couple to go for HIV voluntary testing and counselling at Ntcheu district hospital 16 kilometres away from her village. She tested positive and was immediately initiated on anti -retroviral therapy (ART), a drug cocktail that prolongs the lives of HIV-infected persons by inhibiting the progression of the body condition to Acquired Immune Deficiency Syndrome (AIDS).
However, her husband tested negative but unlike many men in such marriage situations, stayed close to her until they parted ways last year for reasons Yotamu did not want to disclose.
Kathewera is one of the first people who publicly declared their sero status in the district. He disclosed his condition in 1996 and started the support group in 1998. Since then, he has been championing the fight against the pandemic in the district.
Ntcheu District HTC co-ordinator, Chimango Limani, says despite several interventions in HIV prevention and treatment in the district, the transmission of the virus is on the increase because of multiple concurrent partners, increasing early sex debutantes and early marriages. He says the prevalence rate in the district has risen from 10 percent in 2011 to 12.6 percent.
“One of the major reasons is that HIV interventions here are mostly urban-based, where most NGOs operate, leaving the rural [population] without adequate information on prevention, treatment and care,” says the district co-ordinator. There has been low uptake of female condoms in the district because of lack of information in societies where different myths surround the use of the female condoms, he says.
Meanwhile, Andrew Phiri, Community Services Officer, says one of the drivers of the HIV pandemic in the district is increasing divorce rates within marriages of people below the age of 30. “There are increased cases in our courts of divorces of people between the ages of 15-35 years of age,” he says, pointing out that this mostly affects women, who resort to unconventional ways of economic survival.
Phiri says divorces in the district mostly happen after the harvest season while marriages are more stable during gardening periods. He, however, points out that the legal system has started couples counselling on, among others, the dangers of wanton change of spouses before granting divorces.
“We also advise the police to first find out the health conditions of detainees so that those on drugs can access treatment or collect treatment from their homes before incarceration in police cells,” says Phiri. He says the courts also visit prisons to encourage authorities to take sick inmates to hospital.
“On the other hand, we also encourage hospital officials to visit prisons and provide ARVs,” he says. The impact of HIV and AIDS in Ntcheu has further been stamped on the society because of side effects of ARVs on people living with the virus.
Kathewera says a number of people in the district have been deformed by the effects of Stavudine contained in the regime of drugs that was being used before the World Health Organisation advised nations to adopt a new regimen.
“Meanwhile, because the drugs are provided by donor partners we have advised government not to destroy the current drug stock pile but instead use the new regimen on the deformed and pregnant women before rolling out to the whole population which may end in wasting donor resources,” he says.