By: Lunga Memela (Communication Engagement Lead)
Clinic Operational Manager, Sr Samaria Simelane, performs a song and dance to de-stigmatise HIV before her address.
Cultural nuances and a level of shyness and discomfort about discussing the realities of sex usually derail communication on this topic between parents or guardians and their young and adolescent children. However, if we want to see local communities striving for healthier, more prosperous futures, it is time for honest and open intergenerational discussions about HIV transmission, treatment and care, and the often overlooked implications of poor family planning.
This reminder emanated from a recent Community Dialogue held with young and old residents of Pongola – a small town in northern KwaZulu-Natal Province, situated only 10 kilometres from the eSwatini border. Co-facilitated by staff from the Itshelejuba Gateway Clinic and Health Systems Trust (HST), this community education session took place at Inkosiyethu Crèche, near the Itshelejuba District Hospital, which is home to the clinic.
Through technical assistance (training, mentoring and coaching) and supplemental support, HST's SA SURE Plus project strengthens local capacity to provide sustainable HIV and tuberculosis (TB) care and treatment services in South Africa's public health system. Funded by the Centers for Disease Control and Prevention (CDC) through the U.S. President's Emergency Plan for AIDS Relief (PEPFAR), the project supports the provincial, district and facility Department of Health (DoH) staff and communities in four PEPFAR focus districts in KwaZulu-Natal (KZN) Province, namely eThekwini, uMgungundlovu, uThukela, and Zululand.
Itshelejuba Gateway Clinic treats a host of patients from within the province and near the eSwatini border, which is often a challenge for healthcare workers conducting HIV contact tracing and promoting treatment adherence. Sir Busangani Nhlabathi explained that the range of health services rendered at the two Itshelejuba facilities encompasses counselling, testing and treatment for HIV and sexually transmitted infections; promoting HIV pre-exposure prophylaxis (PrEP) and medical male circumcision; nutritional monitoring and care for minor ailments; women's health and family planning; maternity and postnatal care; adolescent and youth services; emergency services; and screening for and management of multidrug-resistant TB.
Despite these offerings, there is low throughput of patients in the facilities, which causes major concerns, not just about HIV care and treatment, but also the collection of and adherence to various treatment regimens. For example, women who have discovered that they are pregnant do not visit the clinic to receive the necessary services for maternal and child health, particularly to curb mother-to-child transmission of HIV.
To understand this problem, HST's Community Co-ordinator, Mzikazi Masuku, led a conversation to probe the perceptions and misconceptions that lead people to delay visiting the clinic or hospital, even when protection of their health requires medical attention. The facilitators raised issues such as HIV transmission and unplanned pregnancies in an entertaining, interactive manner, designed to engage the participants of all generations in open and constructive discussion.
It surfaced from these community members that there was low awareness of and misinformation about the services available at the health facilities – notably the Family Planning options and HIV programming available. They shared that family dynamics tend to cause fear, shame, judgement and embarrassment when it emerges that young family members are sexually active.
Most of those attending the dialogue were not aware that antiretroviral therapy (ART) is promoted and widely available to prevent sexual transmission of HIV. Young girls want to be on contraceptives but feel that they would be judged by the local nurses if they are seen to be sexually active. Most women are unable to negotiate condom use with their partners, and when individuals contract illnesses such as TB, the symptoms are often attributed to witchcraft instead of seeking expert medical opinions. The list of misconceptions is expansive.
Findings from the Community Dialogue were presented by a range of men and women in all age groups, to stimulate fair and open discussions on matters presented. Clinic Operational Manager, Sr Samaria Simelane, spoke frankly, taking note of all patient concerns. She encouraged the participants not to fear or perpetuate stigma around HIV and sexual activity – which all agreed was born of a lack of accurate information and support – and urged them to come to the clinic or hospital for expert advice.
A dialogue participant gives feedback after a group discussion on PreP and family planning.
The participants were encouraged to know their status (be it for pregnancy or HIV) and to receive help promptly. "Pregnant women must come to the clinic as soon as they are aware that they have conceived a baby," Simelane advised. "We can live long lives! We need to give girls and boys a chance to finish their schooling and pursue their desired careers. Eat healthily and take very good care of yourself."
Attendees were left fully aware of the importance of maternal and child health, the need to prevent HIV transmission by every means necessary, and to always adhere to medication. They were reminded that stigma about HIV is grounded in old and false understandings of untreatable illness that must be dispelled.
Further community engagement will continue through HST's partnership with the local Department of Health. With around 166 000 people in South Africa newly infected with HIV during 2020 (as estimated by the Thembisa Model), this clinic–community connection is urgently needed.
HEALTH SYSTEMS TRUST - CONTACT DETAILS
1 Maryvale Road, Westville, Durban, 3630
+27(0)31 266 9090