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Jun 18
Breaking the chain of HIV transmission

​Thandeka Simelane (24) feels as if HIV was a bullet she couldn't dodge.

She did her best, went to school, stayed faithful and found a job as a domestic worker to support her family.  She met her partner and they became engaged in 2013.

"He paid half my lobola and we had a child in 2016," she says. "I thought everything in my life was going well. Then last December my boyfriend went home and while he was away he cheated on me with someone who is HIV-positive. My cousin died of AIDS some time ago, and I still remember it. I don't want to die like that."

Thandeka uThukela.jpg

Shortly afterwards, community health workers were doing door-to-door HIV testing and she agreed to be tested, with the thought of her fiancé's infidelity on her mind.

"I'm so glad Mfundo (the community health worker) came here because I am pregnant again and too busy working and coming home late, so I would not have been able to go to the clinic for testing. My fiancé wasn't home so I asked him to come back on the Sunday. Mfundo counselled us both together and then tested us."

For Simelane, her initial horror at getting a positive HIV diagnosis has given way to calm acceptance after counselling. "I learned that I can give birth to an HIV-negative baby and I am already enrolled in PMTCT (prevention of mother to child transmission) so I am not worried. I know that if I take my medication I will be fine."

While she is clear that this is not what she wanted for her life, she feels it was almost inevitable. Her goals were a good education and a better life for her children.

"If it wasn't for my fiancé I would still be HIV-negative. But now I am staying with him because we are both HIV-positive. Even if I leave this man and find another one, they will want to have unprotected sex. So it's better we don't keep spreading this thing."

Simelane says that the outreach by community health workers like Mfundo* is invaluable. "I can't disclose to my family because they talk too much and will tell the whole world. I'm afraid of going to the clinic because the sisters shout at you and say 'why are you having sex so young?' It's better to have people like Mfundo who come to our house."

Simelane says that one of the unexpected advantages of being tested and treated as a couple is that she and her fiancé are now communicating much better with each other.

"Can you believe it?' she asks, seized by peals of sudden laughter.  "Since we were diagnosed we have been using condoms – and he says it feels just the same!"​

The goal of index testing is to break the chain of HIV transmission by offering HIV testing and if necessary, linking clients to HIV treatment or prevention services.
If any patient who is enrolled for HIV services reports that someone in their household has not been tested, community health workers will then offer them a test.
If the index client agrees, each listed sexual partner and child is contacted, informed tha​t they have been exposed to HIV, and offered voluntary HIV testing services.​

Sugar daddies and testing by proxy: men and HIV​

Mfundo uThukela.jpg
"I don't want to lie to you: the truth is men are cowards. They don't want to test for HIV because they think it's a death sentence. Instead they do what we call 'testing by proxy' where they wait for their wife or girlfriend to be tested and if she's HIV-negative then he assumes he is​.

Mfundo Dlungwana is just 34, but he has seen it all in his young life. He has been a Lay Counsellor for six years and works for AFSA (AIDS Foundation South Africa). AFSA uses strategies such as door-to-door testing to ensure that they reach as many clients as possible.

"Men don't want to be tested, but as a man I know how to explain to them the importance of testing. I explain to them that HIV is treatable and is just like any other chronic condition such as diabetes. Men say 'we came from a vagina and that is how we will die'. I remind them that it is mostly men who infect women so they need to take responsibility."

Dlungwana says that poverty is a key driver of HIV in uThukela District. "Most of the 'sugar daddies' in this district work in government; they have cars and lots of money. Even if they know their status, they won't use condoms. So you will see a man who is about 45 with a young woman of 16. It's very common."​​


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