Countdown Number 3
Positive Living – an example from Zimbabwe
HOPE Zimbabwe is mobilizing people for HIV counseling and testing and thereafter continue to work on follow up services like positive living clubs, home based care and so on. People are counseled and advised to become open about their status as this is a way to lessen the burden of always thinking about an HIV positive status.
4,076 Positive Living members went through courses in the period between January to June 2010; on how to live positively with HIV. These people have gone on to form each a positive living club with 20 people living positively giving a total number of 400 people participating in the positive living clubs. The club members meet regularly twice per week and have started nutritional and herbal gardens to improve their nutrition and health. A manual for Positive Living Courses is being used during these courses and is introduced to other people in the community.
45 nutrition gardens have been established with 675 members involved. The nutritional gardens have managed to supply vegetables, tomatoes and onions to 350 orphans and 120 positive living people and the elderly. In addition they are having small family gardens at their homes.
A testimony from TCE Namibia
TCE Namibia Otjozondjupa Region is covering a total population of 100,000 people. The Area, funded by Centers for Disease Control, started its operations in 2010. Here is a testimony from one of the Passionates who is HIV positive.
Passionate from Tsaraxhaibes Location
My name is Iringa*. I am staying in Tsaraxhaibes Location in Otjiwarongo. I am HIV positive and Emma* my baby is also HIV positive.
I have suffered for so long I had nothing to eat and milk to give to my baby. I went to the doctor to find out what this situation was about but the doctor did not give me the information I wanted. I had suffered a lot and wanted to get some assistance for me and my baby.
When I saw the TCE Field Officer entering in my yard I was stressed and wanted to chase her out; but my heart told me to cool down and then I decided to listen to her.
The information given to me by the TCE Field Officer was sounding good and helpful then I decided to share my problem with her.
The TCE Field Officer helped me a lot. They took our cards - for me and my baby - to the doctor and escorted me to the doctor. The doctor changed his attitude towards me after the TCE Field Officer explained to him the whole situation. She did not stop there; she continued knocking on the door of social workers and Ministry of Gender to make sure I got help as soon as possible.
After four days everything was done and I was called to sign the papers for the Government Grant. I'm now receiving assistance from the government.
I am so grateful. If I did not meet the TCE Field Officer and was not open about my status and be honest with her by this time I do not even know where I will be. From here I would like to encourage my fellow Tsara – xaibes (1 of the Otjiwarongo locations) residents to put their trust in the TCE Field Officers and listen to them because they keep their word and keep their promises. The Field Officer continues to provide continuous counseling to me and I have been able to solve a lot of issues together with her. My next step is to find two people so I get a TRIO that I can be together with in the fight against the HIV virus.
I am going back home to talk to my brother that is in the same situation as I was before I met the TCE Field Officer to tell him to open up and listen to what the TCE Field Officer has for him. My God bless you TCE people and keep it up so you will make a difference on many people as you did with me.
* Not the real names
Countdown Number 4
The TB treatment Supporter in TCE Mazabuka – Zambia
The TCE project in Mazabuka Zambia has 55 Field officers who go around in people's homes providing HIV counselling and testing.
The project has made some links with the District Medical Office, the District TB/HIV/AIDS Focal Point Person, District AIDS Task Force, Traditional Leadership, Health Centres, the Community AIDS Taskforce and the community on how to sustain the TB program in the community.
The TB supporters are well trained with TB information and reporting systems, every month they write and submitted reports to health centres and TCE. They have a passionate heart for their communities because they are volunteers and they can work for a long time without being paid. They are linked to health centres which give them social support to go ahead with their work. They know that TCE programs will continue with them in the forefront of the activities.
They received bicycles as a motivational token. They also received TB kits, and badges, certificates after training and T-Shirts for easy identification which they will continue using. The Local leaders are involved in the programs and they encourage TB supporters to go ahead with their work in spite of challenges.
They are in partnership with other existing NGOs that give them social support and other materials. They are working with the committees which were formed during the 3 years of the TCE programs. These TB supporters are supervised and monitored by the Health centres staffs.
The TB TRAINING PACKAGE
Community TB treatment supporters have very big role to play in making sure that the patient takes every dose of anti TB drugs as directed until the end of treatment. A good relationship between the patient and community TB treatment supporters has been helping to motivate the patient to come for treatment. They have been trained to have a positive attitude towards patients. The training was organized by DAPP TCE in partnership with ZNAN/GF as funding agencies. The purpose of the training was to equip the Passionates from our operation areas with counselling and TB treatment support skills when dealing with the HIV infected and TB patients. The training time period was 5 days.
• Tuberculosis (TB)
• TB documentation and tools
• Sputum follow –ups
• TB management
• TB and HIV
• Basic Counselling skills
• Risk Management
RESPOSIBILITIES OF TB TREATMENT SUPPORTERS
• Door to door information giving on TB
• Tracing the defaulters
• Giving health talks at the health centres
• Supporting TB patients on treatment to adhere
• Mobilizing people for community rallies
• Supporting TB patients who are bed ridden
• Educating the family members to take care of the TB patients
• Compiling reports at the end of the month and submit to the field officers.
• Promoting nutrition programs in the community
• Distributing condoms and they are in charge of condom outlets
• Mobilization for VCT
• Forming support groups
• Starting up income generating activities
• Forming Trios
• Supporting vulnerable and orphaned children
• Assisting the health centres in distributing food for TB patients and people on ARVS
• They referrer TB suspects for screening
Humana People to People, a high degree of public engagement
Countdown Number 5
The Passion for People Movement
Experiences of working with Passionates in TCE Mazabuka, Zambia
The people working in TCE Zambia understands that the Passionates (community volunteers) are the mainstay of the TCE program; therefore they are very important and must be recognized. TCE Mazabuka has been working with more than 7.000 Passionates during the 4 years the project has been in operation. The leadership of TCE have passion for the work they do to save lives of people in the operation area. If the leadership do not have a focus of what they want to achieve it becomes a challenge to achieve good results. The Passionates vary from District partners to village members and this has contributed to the great achievements of the project. The recruitment process of Field Officers contributes to a good mobilization of Passionates, because the Field Officers themselves are Passionate and therefore they recruit people they see can be able to mobilize others. All the people at the project know who are Passionates and their role to achieve control of HIV in an area.
How we recruitment the Passionates
At District level the TCE Troop Commanders are responsible of mobilizing Passionate to fight the spread of HIV together with the TCE Field Officers. We target all the influential departments and offices within the District. This helps in the process mobilizing the community – particular in the upstart.
The Field Officers in their own fields identify people, who have a passion heart and mobilize them to be Passionates. The Troops Commanders in TCE also makes sure that each Field Officer reaches the target of Passionates and they have to make sure they are active.
The Troop Commanders and Specials Forces in the TCE program mobilises influential people in the community to become Passionates.
The training of the Passionates – and how we go much out of it:
The project has funds to support 5 low cost trainings of Passionate per year and the Troop of 50 Field Officers agreed that it was not enough to train all the mobilized Passionates. The Field Officers mobilized the community and trained some of the Passionates as trainers to organize training of the new mobilized Passionates. They did the training with their own resources in their communities. The Field Officers agreed that they would assist in facilitation, knowing each other's strengths and distances to the training site since there is no money for this in the budget. The project will support them in printing the certificates for all the people trained. Is organised that when TCE receives funding from other partners to train the community people in different areas the priority is to train the active Passionates. The TCE leadership participates in some of the training to inspire Passionates. The TCE Special Forces gives a lot of support in making sure the Passionates are happy with the training and encourage them to continue working to support their communities. With funding from ZNAN - Zambia National AIDS Network the project trained Passionates in TB and ART as adherence supporters. The Passionates are also trained by other stakeholders identified by the project for them to be fully equipped in their work.
Responsibilities of the Passionates
The Passionates have clear responsibilities that they agree with the Field Officers during the training. Before they finish the training they make plans on how they will be working and targets are agreed.
The Passionates are responsible to make sure all the people are registered in the area and that they have talked to the Field Officer one to one.
They support the Field officer to achieve their results achieved in their field
They follow up on all the people who are on ARV and/or TB treatment, pregnant women in the PMTCT program, babies born from positive mothers and orphans, who need support.
The Passionates provide home based care to patients in homes and train the families on how to take care of the patient.
They recruit more Passionates and organize for the training
They organize events like Open days/Open Sunday
Provide counselling to individuals and family members
Gives health talks at clinics and community events
Help clinic staff to do other non-clinical duties
Running condom outlets and distributing condoms
Identify vulnerable people and help them
The Passionates report every week to the Field Officers and the clinic they are attached to. The Passionates that have other responsibilities report monthly direct to the TCE Special Forces responsible for ZNAN funded activities and a time sheet is submitted and approved by the nurse in charge or the clinic officer. The Passionates at District level reports in the monthly stakeholders meetings or in briefing meetings with TCE Management. These are some of the reports submitted:
TB monthly report and ART monthly report
Weekly tasks done and Monthly time sheets
The Passionate are monitored by the Field Officers and all the people in management responsible for field visits.
The Passionates meet every week to evaluate their work together with the field officer. Reports are submitted and analysed and follow up is done during field visits. The staff members at the local clinics are responsible for their reporting for work and work in the field.
Passionate Gatherings are organized to share experiences and learn from each other. This is a time to let the whole District and the World understand, what the Passion for People movement is. This is the time for the TCE leadership to meet the Passioantes and exchange experiences and also be together with the people in the Positive Living support groups, as they do a wonderful work here and need to be supported. It is very important for the Passionates to come together, as it gives them strength to go on fighting HIV.
Example of a TCE Passionate gathering in Zimbabwe:
A group of 25 Passionates from the former TCE areas namely; Bindura, Mt. Darwin, Guruve and Zvimba district met together in Zvimba TCE office on the 24th of November. It was a remarkable event, because the Passionates from different former TCE areas were presenting their achievements for the past 10 years since the start of the first TCE area in year 2000. Many TCE Passionates have continued to work in the Passion for People movement after the 3 year TCE campaign keeping up the fight against the HIV and AIDS. They have mobilized the people in the community to stay HIV negative and if positive counselled them to use condoms and support them to live longer.
Truly, it was an eye opener for the new Passionates from Zvimba. The TCE programme still exists in the old areas, through the TCE Passionates long after the funding has ended.
The Passionate gathering exchanged experiences on the work against HIV and AIDS and planned for the World AIDS Day
TCE also measures its impact by the number of people who actively fight HIV beyond the 3 years of TCE campaign as the Field Officers are training the people so they have capacity to plan and implement various activities in order to continuously keep control of the Epidemic after the 3 year TCE campaign. During this special gathering, Passionates learned a lot through the sharing of experiences and challenges.
Countdon Number 6
WORLD AIDS DAY COUNT DOWN NUMBER 6
Partnership to help people in high risk of HIV infection
Humana People to People partner has partnered with international donors and companies to reach out to the general population and also to the people in high risk with HIV prevention, HIV testing and counselling for behaviour change.
An example from the cooperation between DAPP/TCE and Zambia Sugar Company
The TCE Mazabuka project reaches every single person in Mazabuka district including the 17.500 people around the sugar plantations, where many of the people work for the sugar Estates and the sugar Factory. Among this particular population there are a high number migrant workers, truck drivers and sex workers. These groups of people targeted require special attention since their behaviour and attitudes are different from the general population in the district.
Reaching out to the Sex workers
TCE Field Officers has mobilized commercial sex workers and migrant workers to be involved in the fight against HIV and AIDS. There are 20 sex workers who have been recruited and trained as peer educators. They have a role to mobilize 200 other sex workers and also truck drivers from Zambia sugar, to practice safer sex and plan to change their behaviour. The sex workers were recruited from different lodges and brothels where they stay looking for sex partners. They go into bars and lodges and talk to their peers about prevention of HIV through use of condoms. They give information about HIV/AIDS and also target their former sex partners. They encourage these people to go for HIV testing and thereafter agree with them about positive living if tested HIV positive. The sex workers have gone through counselling and testing themselves. They are also limiting their alcohol intake, but the aim is to eventually stop drinking as they have realized that they are putting themselves at risk when drunk. The peer educators get an allowance every month from the project. This is a small token that helps them to pay rentals and buy food for themselves.
Reaching out to Migrant workers
Another group, which is at high risk, is the migrant workers. TCE has partnered with Zambia Sugar Company, which is one of the biggest companies in the District. Zambia sugar employs more than 16.000 people. Some of the workers are permanent and some are seasonal workers. The company hires seasonal workers who are coming from other Provinces even other countries to work in different departments. The common migrant workers are the Cane Cutters, who are mainly coming from other provinces of Zambia. The peer educators talk to them on one on one basis about HIV/AIDS information and mobilize them to get tested for HIV.
The partnership with Zambia Sugar Company is very good because it allows the peer educators and Field Officers to work freely. All the Field Officers working within the Sugar Estate are accommodated in the estate. Condom outlets have been opened in all the areas and are accessible by all the people. TCE appreciates the partnership with Zambia Sugar, because we can see that the cooperation is preventing further spread of HIV.
The Zambia Sugar Company funds the TCE activities covering the Sugar Estate and factory and the population around.
An example from HOPE Ndola, in partnership with PSI reaching out to People at risk with mobile HIV testing
HOPE Humana Ndola HIV testing centre is funded by Population Services International. The Testing Centre also does mobile/satellite counselling and testing services.
HOPE Humana Ndola year’s Theme for World AIDS Day is “Access to Prevention, Treatment, Care and Support is my right” has taken a further stance enhancing the activities that we have been doing all the years. We have taken the issue of HIV/AIDS in a more radical way. The idea is to secure that we reach out to all (MARPs) Most-At-Risk Populations – the miners, fish mongers, prisoners, sex workers, and farm blocks, which includes couples.
The new evidence out of the six main drivers of the HIV infection in Zambia is the higher infection rates among couples. We therefore saw the need to intensify prevention, care and support for couples. In order to achieve this HOPE Ndola has realized that the villages are the most important areas also where we can reach couples. We have started having sensitization meetings with the headmen and chiefs; the idea is to mobilize so that they become HOPE Advocates. This way will help more people to come out where HIV issues are concerned because their community leaders are in the forefront.
Couple Counselling Campaign – The project will be providing Voluntary Counselling and Testing services to couples in the following 5 villages; Kampelembe, Chanda Maunga, Kasununu, Mupata Hills, Miputu and Chikone in Luanshya rural. The testing will be done at schools and community halls which are central places. Our objective is to enable couples to have access to Counselling and Testing and increase information on issues concerning HIV/AIDS prevention.
VCT in prisons – During our satellite activities will be providing VCT in all the 4 prisons in our operation area. The project has seen the need of providing the services because they do not have access to these services. Our objective is to enable inmates to have access to CT and increase information on issues concerning HIV/AIDS prevention.
Countdown Number 7
Reaching out to the people in high risk groups
People who are regarded to be at high risk of contracting HIV include commercial sex workers, uniformed forces, men who have sex with men, intravenous drug users, young girls, truck drivers, etc. These are some of the high risk groups as they are vulnerable because of what they engage themselves into. In many cases they are exposed to HIV infection because of their trade; therefore they need to be well equipped with knowledge of how they can prevent themselves from infection.
TCE engages these high risk groups in many different ways. Here are some examples:
Mobilization of Truck Drivers in Katanga (DRC)
The Katanga Province in the Democratic Republic of Congo is part of the country which is connected to the SADC region. It is also from Zambia and South Africa that the Katanga Province receives some food supplies and other goods looking at the fact that there is no real road network connecting the province to the other parts of the country. A tarred road of 1,616 kilometers connects Lubumbashi (the Capital city of the Katanga Province) to Johannesburg.
It is also important to mention that the Katanga Province is a mining area where a lot of trucks are transporting mineral raw materials around.
The mobility of truck drivers means that the drivers are far from their families and this makes them very vulnerable and exposed to Sexually Transmitted Infections and HIV. That is the reason why the TCE program in the Katanga Province has decided to carry out a mobilization for truck drivers every Thursday at their parking areas in Kipushi and Kenya.
Every Thursday, all the 100 Field Officers are spread in the various truck parking areas to give lessons on STI, HIV and demonstrate proper use of condoms before giving them out. Our records show that these truck drivers are from four nationalities: Congolese, Zambian, South African and Tanzanian. So far we have sensitized 213 truck drivers among which 43% are Congolese, 26% are Zambian, 21% South African and 10% Tanzanian. The drivers have realized and accepted the importance of the information they get from the field Officers. Some of them even come to the Field Officers to get condoms.
High Risk Groups in HOPE Bindura
Commercial sex workers, gold panners, mobile informal market traders, flea market traders and farm workers are some of the groups that are listed as high risk groups in HOPE Bindura. There are a lot of gold panners and farm workers in the HOPE catchment area of Bindura and Shamva. Bindura area is surrounded by farms where many people are working and most of them do not have enough information about the risks of contracting HIV. Many people also survive on selling clothes and shoes in the flea markets.
HOPE provides different activities to these groups. They give information on basic facts about HIV/AIDS and provide counseling and testing services. They go out into the areas where these groups are found, put up tents and provide counseling and testing services. They promote the use of condoms through condom demonstrations and they distribute condoms to those who need them.
HOPE promotes PMTCT programs to pregnant women. They address pregnant women together with their spouses especially in farms where many young girls get pregnant. They also provide counseling and testing for the pregnant women and refer them to the clinics and hospitals for PMTCT programs when tested HIV positive.
Commercial Sex workers are encouraged to go for early treatment of sexually transmitted diseases and opportunistic infections. They are also provided with pass on loans to earn a living. They are trained as Peer Educators so that they can educate their own peers as well. They get information about child care and protection as they have to realize that their children need good life and don’t follow commercial sex work.
The people in high risk groups are encouraged to form support groups if tested HIV positive. They are also informed about adherence to treatment. Many of these groups visit the HOPE centre for repeated HIV testing as they have understood the importance of staying negative if they test HIV negative as well as keeping fit if tested HIV positive.
Countdown Number 8
PMTCT – saving lives
World AIDS Day is a good opportunity to campaign for an accelerated PMTCT program to save more lives.
In all the TCE areas and in our HOPE program we are increasing the mobilization on uptake to ANC and Prevention of Mother to Child Transmission (PMTCT).
An example from TCE in KwaZulu Natal and Eastern Cape Province in South Africa
Humana People to People (TCE) in South Africa is taking part in the new accelerated PMTCT Program in the country. The TCE program in ILembe district in Kwazulu Natal Province and Amathole district in Eastern Cape Province covers 500.000 people with 350 Field Officers. We have started a pilot program for PMTCT in these areas. The pregnant mothers are being followed up by the TCE Field Officers until they have testing for HIV, joined PMTCT if needed and given ARV. From there we follow up to see that the baby has been breastfeed exclusively, gone through Viral Load scan to see if they are viral free and healthy. In case not, we need to see that the infant is given Cotrimixazole. We follow the child all the way in the process to 18 month after birth.
This program is to ensure primary prevention of HIV especially women of the child bearing age and to prevent the new born babies from being infected with HIV.
In these two districts TCE is working with the department of health. 150 Field Officers in ILembe were trained on PMTCT information and in Amathole district 100 Field Officers got refresher courses. Through this training, the Field Officers got more skills on how they should support the pregnant mothers and how they should identify early pregnancies and refer them to the clinics.
The Field Officers are involving the partners and the families to be part of the support to the pregnant mothers. In order to achieve this, 342 Passionates (community volunteers) have received training on how they can support the Field Officers in the follow up of HIV pregnant mothers from one stage to another.
Field Officers are working very closely with the clinic staff to follow up on defaulters and referring the women back to the clinic. We have a referral system for the pregnant women mobilized by TCE.
Field Officers are giving health talks in the clinics to the pregnant mothers once every week. TCE Field Officers and Passionates are doing follow up to the mothers until they give birth and from there until the child is 18 months old. TCE submit monthly reports to the District Officer for Health about the results achieved on the mobilization and we compare with the results from the Ministry of Health to see how efficient we have been in the mobilization.
Achievements in the 5 TCE areas covering 500.000 people are so far:
3.257 have been identified for early booking at the ANC
2.775 pregnant mothers have been followed up and supported
320 women are on HAART
18 infants are on HAART
We encountered a good number of challenges in the process. Some pregnant mothers do not want to disclose their pregnancy at an early stage. Some pregnant mothers are not open to their family members. We see a lot of progress where the pregnant women overcome their fear and open up to the Field Officer about their HIV status. We acknowledge that the PMTCT program means quite some work but we can now see that more women go for the ANC, HIV testing and the PMTCT programme, as we fight stigma and discrimination in the community. 2 years into the TCE campaign we can see that the atmosphere and attitudes are changing to a more open one, where the women feel freer to go to the clinic and use the Health services to save their babies from HIV.
Example from Guruve and Zvimba districts in Zimbabwe
TCE Zimbabwe has created a good network system with the Ministry of health for the PMTCT program. Pregnant mothers are mobilized for Antenatal Clinic (ANC). TCE gives information on PMTCT- Prevention from Mother to Child Transmission to the pregnant mothers, who come for ANC. Pregnant mothers are mobilized to take an HIV test to know their HIV status.
In Guruve, TCE made an agreement with the Ministry of Health to collect statistics from the district hospital on a monthly basis for the number of pregnant mothers, who attended the ANC clinic and enrolled in the Prevention of Mother to Child Transmission. It helped us to see if we were having results in the mobilization of the pregnant women. TCE Field Officers was able to follow up on the pregnant women and help those in need of ARV and mobilize them to join TRIO system (adherence support).
The table below shows the results during the period TCE operated in Guruve. In 2008, the number of ANC increased. TCE did much on mobilization and this helped to increase the number of women attending ANC.
PMTCT PROGRAMME PERFORMANCE
JAN- AUG 2008
ANC FIRST VISIT
ANC WOMEN PRE-TEST COUNSELLED
ANC WOMEN HIV TESTED
ANC WOMEN HIV POSITIVE
ANC HIV POSITIVE WOMEN-
ANC HIV NEGATIVE WOMEN-
DELIVERIES BY -
KNOWN HIV POSITIVE WOMEN
HIV EXPOSED INFANTS-
WHO SWALLOWED NEVIRAPINE
When TCE was completed in the Guruve district in Mashonaland Central Province we moved to Zvimba district in the Mashonaland West Province where we have continued to mobilize pregnant women for PMTCT.
During the World AIDS Day in Zvimba we will work on mobilizing all the pregnant women participating in the event for an HIV test. We have organized to have counsellors to be present on the World AIDS Day to counsel and test the pregnant women.
Countdown Number 9
Mobilizing TRIO support for ARV adherence together with the people
World AIDS DAY is a day where people have the chance to learn more about HIV. Wherever TCE is celebrating World AIDS Day people will become familiar with the system of TRIO support for ARV adherence. You have the chance here now with this article.
What is a TRIO - and what is the importance of TRIO support for ARV adherence ?
A positive development that has taken place in many countries over the last years is that more and people have got access to ARV, when tested positive.
In most countries, where Humana People to People’s TCE and HOPE programs are working this is a reality, though there are not sufficient ARV drugs available to cover the needs in e.g. Mozambique, Zimbabwe, Zambia, Malawi as well in South Africa. In DRC most people still do not have access.
It is our experience from the field over the years that people on ARV need support to get into the practice of taking the medicine timely with high discipline and not to drop out of treatment because of side effects, neglect or simply because of lack of knowledge. People also drop treatment when they start to feel good. It is here the TRIO comes in.
A TRIO is a support group of 3 people – the client and 2 Passionates (volunteers) – typically a family member, a friend or a Passionate neighbour.
The Field Officers mobilizes the people, who are HIV positive and on ARVs to select two other people, the three; the person on ARVs and the two supporters are what we call a TRIO. The TRIO is then trained in different issues related to HIV like counseling, nutrition, early treatment of opportunistic infections, pregnancy when HIV positive and so on.
The fight here is to mobilize people to become open about their HIV status to family, friends and the TCE Passionates to they can get the needed support and then from a TRIO. We are making progress and constantly raising our own goals forming TRIOs, as we gain more experiences every day. As we can see the TRIO’s systems works, we want to see that all the people who are HIV positive and on ARV should have a TRIO. We see it as an appropriate demand to us to form TRIOs for all as it will tremendously reduce the death rate, because drug adherence is still a big issue. The TRIO system also remove stigma as people become open to other people in their family.
TRIO support for ARV adherence – reducing the defaulter rate
Here is an example of how far with have reached with ARV adherence with TCE Zambia.
The Total Control of the Epidemic (TCE) project in Mazabuka district, Zambia has provided counselling and testing services to many people within the district. The TCE Field Officers have done about 130.000 HIV tests through the house to house testing progam this has increased the need for ARV and health services.
On average over the last 3 years 17% of the people tested by the Field Officers had positive results therefore more ARV services were needed. This also includes helping those who are already on treatment to adhere to the treatment.
Before the TCE programme started in Mazabuka district there were many cases of people defaulting from treatment due to different reasons, and the Field Officers started to work closely with the heath centre staff to identify the defaulters. We could see that the people needed daily care to adhere to the drugs and TCE introduced the TRIO support system, where 2 people come to support someone on treatment. The person on treatment will be at the centre then a family member and a community volunteer, TCE Passionate, comes together to make sure the client takes the drugs on time, as instructed by the clinician and to support the person to overcome the side effects.
We have seen a big change in the Mazabuka district because of this. People of course need to become open to their family and friends and in return they can get the care and support they need. Currently we have established 1.692 TRIO support units around the People on ARV and we can see they now cope much better. The community express clearly that they have seen the change and more people become open, more people are ready to get tested and receive treatment when tested positive as they can now see from others that the treatment works.
The TCE Field Officers have also trained 170 Adherence Supporters, who help establish TRIOs and make sure all the people in the catchment area do not default. We still continue to work closely with the clinics and it seems to be of mutual benefit and importance, as the clinic cannot reach out to the people but this TCE can and the clinic delivers the health services people need.
This has really helped the district not to have many people defaulting ARV treatment. This has been extended to TB treatment where TRIOs are also formed to help the people taking TB treatment. We have established more than 130 TRIOs for people on TB treatment and people adhere well
People in TRIO’s have been giving public testimony on many occasions to mobilize other people to get assistance from TCE to get a TRIO. There will be more testimonies on World AIDS Day from people who are adhering to ARV treatment because of TRIO support.
Countdown Number 10
Organizing access to condoms for all - together with the people
Prevention is the main thrust in the fight against HIV and AIDS. During the World AIDS Day many organizations and governments will carry out campaigns to promote the use of condoms to stop the spread of AIDS, Total Control of the Epidemic as well.
TCE Field Officers are during the TCE Campaign mobilizing people to make sure that all in the sexual active age group learn to use condoms for Prevention of HIV and other STI’s and mobilize people to use them consistently. For easy access to condoms, the TCE Field Officers organize communal condom outlet in the townships and rural areas also in the rural areas. The outlets are manned by Passionates (community volunteers), who have been well trained in demonstrating the use of condom to those, who come to collect them. They also organize that there is adequate condom supply, which is normally a challenge in the TCE Areas. Each Area has a target of 30,000 condoms per week in a population of 100,000 people.
Securing adequate supply is and ongoing fight in most TCE areas. Our experience in the distribution of such a number of condoms is quite possible once people are mobilized and trained in condoms use. People are changing and actually using them to protect themselves from infection and re-infection of HIV. There is currently an ongoing action to establish 10 condom outlets per field of 2.000 people or more if the population is spread widely. This means an outlet for every 35 households.
TCE Field Officers have a tradition for joining up with the Passionates to campaign on World AIDS Day with the people all over where we work. Every place has got its own programme and we are planning together with local people and government institutions and civil society. Common for all of them will be an intensified condom campaign. The TCE Passionates will join up with the Field Officers to give demonstrations on the use of condoms to all the people, who have come to take part in World AIDS Day. We aim for that people will go home with a new or further understanding of the importance of using condoms for HIV prevention – not only in general, but also for them personally.
Condom Access for all – doing what it takes
A HOPE Project Leader tells about how they take action to prevent the spread of HIV by educating and mobilizing people to use condoms:
30% of the people living with HIV/AIDS in the world are less than 25 years. The situation is the same in Angola, Cabinda Province where the Hope Humana People to People project is working. Because of many years of war, which is now over, people of mature age are going back to school. Students here can be up to 35 years of age.
In partnership with the ministry of education HOPE Cabinda has established youth friendly corners in schools with trained activist distributing condoms to the people. People from the HOPE project gives weekly condom demonstration lessons around schools with videos showing how to use condoms both male and females to capture this generation with prevention of HIV and other STDs. Teachers in public schools are also being mobilized and trained as activist – to mobilize the youth for HIV prevention.
Police and armed forces are among the groups of the population with the most incidence of HIV. Hope Cabinda has made a calendar of distributing condoms weekly in the police units-points and armed forces in the municipalities that the project is covering. Hope has distributed 700 pamphlets on the basic information on how to use a condom so far this year.
Angola had a HIV prevalence rate was 2.1 % in 2008, and although there are no statistics now, it is clear that Cabinda has a growing HIV infection rate because of the interaction over the borders Cabinda share with the 2 Congo’s. The migration of people has contributed, with about nearly 200 sex workers at the boarder of Massabi, who are coming from Congo. The Hope project in partnership with the Global Fund in Angola has implemented a prevention program since 2009. 120 sex workers have been mobilized and trained by our HOPE Outreach Officers to be Activists (volunteers) in distributing condoms at this boarder post to the Democratic Republic of Congo. The Hope project is transporting condoms twice a week to the trained sex worker activists who will distribute in the bars and restaurants at this border post. Access to condoms for all is very important to stop the spread of AIDS. We can see some important changes as the sex worker are now telling the partners about condom use and mobilize them to use them.
The Hope Project is also carrying out action campaigns with the sex workers, who have been trained as HOPE Activists distributing condoms in the villages starting by mobilizing the local village leaders to be on the forefront. 14.832 condoms have been distributed in such campaigns. We are distributing condoms all year round, but during World AIDS Day we will have an intensified campaign for condom use with our Outreach Officers and Activists and we are looking very much forward to the day.
HIV testing for all – an important part of HIV prevention
It was clear from the start of TCE (Total Control of the Epidemic) in year 2000 that to move the question of the people taking control of HIV, knowing ones HIV status is the starting point for the individual to take action on stopping the spread of HIV to other people if tested positive and as well to remain HIV negative if tested negative.
It has over the years been one of the priorities of the TCE and HOPE program to ensure that as many people as possible get tested. Constantly during the years we have raised the goals for mobilizing people for testing. Testing is also the entry point for HIV positive pregnant women to control the passing of HIV to the unborn child.
We have been advocating for the most radical way of testing, which is Home Based Testing, because it is the most effective way of reaching out to many people.
Today TCE is doing home based testing in Zambia and Mozambique and recently also in Malawi.
In Zambia, Malawi and Mozambique the Field officers have been trained in Counseling and prick testing following government regulations and here TCE Field Officers are going door to door to do Home Based testing for people who opt for testing.
Because of Home Based Testing many more people especially in rural areas are now getting access to HIV testing and are getting to know their HIV status and we can see the demand for treatment and other health services are growing. This has meant that we had to engage the Government and donors in assuring that people who test HIV positive get treatment and all the other services they deserve. This is a good development.
An example from Zambia
Development Aid from people to people Zambia (DAPP) introduced the Total control of the Epidemic (TCE) program in 2006. The project is funded by the Centres for Disease Control and Prevention (CDC Zambia). The project is based in Mazabuka District in the Southern province of Zambia covering the whole District with a population of 280.000.
The project has employed locals as Field Officers to provide house to house counselling and testing services to people in all the households. The project has partnered with the government to increase the uptake for counselling and testing services in the district. TCE Zambia has provided this service for the past four years in the district. Since we started doing house to house testing Field Officers have done 126.696 tests in the district of Mazabuka. 44.549 are people tested more than once which means that 82.147 are people having been tested first time. The people are tested as individuals as well as couples and all get the results there and then as the testing is performed with rapid test kits. It is a very high rate of people tested for a district where close to 60% of the sexually active population now knows their HIV status.
In the beginning more women were tested, but due to the analysis of our results done every week during the weekly Field Officers meeting the picture have changed completely as we decided to put more emphasis to also reach out to the me, and now more men are coming for the services and they are also volunteering to mobilize others to know their HIV status. The government has been providing technical assistance to make sure quality work is being done and they have also been providing most of the test kits and other supplies required.
After testing a lot of people in hard to reach areas through the home based testing, questions were raised on what will then be done after testing. This contributed to the introduction of us carrying out Mobile ART services and strengthening the referral system to care, treatment and support services. People are well counselled on behaviour and they have started to change behaviours which put them at risk of contracting the virus. The advantage of the Field Officers providing both counselling and testing is that it is the same person who does carry out the entire process in people's homes where they are more free and confident.
Many people are now accessing ARVs, because of the Mobile ART team and they are able to support their families through the income generating activities they start.
Fighting HIV & AIDS together with all the peopleThe world is soon to celebrate the World AIDS Day and this takes place at many places national as well local, rural as urban and Humana People to People join in this event. Preparations for the day are underway all over the world and we want to use this opportunity to raise the awareness be that more needs to done and look at the achievements so far. A lot has been done and the efforts of Governments, NGOs, Businesses, donors and the people have brought results. Countries have experienced the HIV prevalence dropping but of course we have not won before there are no more infections and all the people in need of treatment are getting HIV & AIDS.We are using this chance to write an article every day on our website on the programs that Humana People to People are carrying out. These are the TCE and HOPE programs.About TCE a 3 year HIV prevention campaignThe Total Control of the Epidemic program is now in its 10th year of implementation. TCE is a 3 year campaign which started with 1 area in year 2000 and since then been implemented in 113 Areas of each 100.000 people.
More than 10 million people have been reached direct or indirect by a TCE Field Officer in 11 countries. These are Angola, Botswana, DRC, Malawi, Mozambique, Namibia, South Africa, Zambia, Zimbabwe, India and China.
How to reach and mobilise many people The Field Officers are from the local area and they are usually organised as 50 in a TCE area. More than 5.000 Field Officers have been or are now carrying out the TCE prevention campaign. The TCE Field Officers are the key to reach every single person in the population systematically going house to house, person to person in each their field of 2.000 people. All the people are mobilised to take part in the fight against HIV, starting with changing their own life, their families, neighbourhood and even the community at large. In all more than 556.000 people have joined the Passion for People Movement in the countries and areas, where TCE works. The TCE Passionates are actively engaged in many different activities to help the people to prevent HIV and to cope with the Epidemic. Some examples of measureable achievements from 2000 to 2010:TCE Field Officers have during the 10 years had one-to-one interaction about HIV prevention with 7.7 million people above 10 years of age and mobilized them personally to take control of their life in the face of HIV & AIDS. Concretely the Field Officers assist them in making a personal HIV risk reduction plan and support them in the process of change. 6.5 million of the 7.7 million people have taken action to get in control of HIV/AIDS, by own determination and with each other's help changed their lifestyle to prevent HIV infection and prevent the spread of HIV as well.
The Field Officers and TCE Passionates (community volunteers) have distributed 174 million condoms over the 10 years, which has had its impact on prevention of new HIV infections and re-infections. As part of the prevention people have been mobilized to know their HIV status and 1.6 million people have been referred for HIV tests at VCT sites and health centers or through mobile and home based testing. This has meant that they have been able to take action according to their HIV status.
The Field Officers have reached about 489.000 pregnant women and talked to them about PMTCT and mobilized them to go for ANC clinic and join the Prevention of Mother to Child Transmission program to save their babies from HIV.