By: Judith King (Copy and Content Editor: SA SURE)
Thabo Nkosi – HST Lay Counsellor for the MINA programme in uThukela.
HST Lay Counsellor Thabo Nkosi serves the MINA programme for men's health at Ekuvukeni Clinic in Ladysmith, uThukela District. He works hand in hand with Department of Health Professional Nurse Thuthukani Mthembu, who conducts clinical screening, while Thabo conducts counselling to bring men into care.
"We are committed to reaching as many men as possible through routes such as community mobilisation of the MINA Campaign, and index contact testing to identify male partners of women diagnosed as HIV-positive," Thabo explains. "This man-to-man connection makes it easier for men to open up about their health concerns, and enables us to support our clients in realising that the responsibility for their own and their loved ones' wellbeing lies within them. We fast-track them for testing and treatment, and usher them through the journey of care."
This is not a rapid process, nor an easy one. Thabo encounters many instances of intimate partner and gender-based violence among all age groups, and has supported individual men and women, as well as couples, to free themselves from the cycle of physical, sexual, emotional, and even financial harm and exploitation.
"Behind each person's predicament − even as a perpetrator − there is always some form of deprivation, neglect and/or abuse that they have suffered," he says. "Improving their health requires building a rapport with them, and helping them to deal with various social dynamics and circumstances."
As a skilled communicator with strong experience in community engagement, he brings his academic background in Psychology and a passion for helping people to his counselling work. "This service opens the door to a new path of support, purpose and holistic health for clients," he shares. "It begins with the first counselling session, where − before probing for details − I reassure them that I see how they are struggling, and that here, they are safe, respected, and not judged. It's important to engage with them kindly and confidently."
When two partners test positive for HIV, a first session of couples' counselling typically descends into the man blaming the woman for his infection. In one such case, Thabo found that even though both partners were already on treatment, they were both unemployed and unable to afford food, which made adherence to medication difficult. They were not using condoms, and the male client was beating his girlfriend every day.
"The boyfriend felt disempowered," he explains, "and was taking this out on her, physically and emotionally." After giving the couple clear facts about their health needs and guidance for better communication between them, Thabo referred them to a Department of Social Development (DSD) Social Worker, who ensured that they received ongoing assistance with food supplies and more in-depth counselling. Thabo regularly follows up on their welfare, and they keep in touch with him. "They've told me that they recognise how much they needed this support," he says, "and they're doing well together now. One could sense that despite everything, they have a bond of love."
Thabo maintains a list of clients to prioritise for extensive counselling. One of these was a young transgender client who presented at the clinic with a sexually transmitted infection, and was emotionally 'shut down'. Alone in the world, he made a living through odd jobs and transactional sex (often being abused in the process), and was bullied by community members for being gay. "He felt more worthless every day," says Thabo, "but has slowly made progress since attending the clinic. He is now registered for a learnership and wants to do social work so that he can use his experience to help others. You see – we are all born for something good."
In Ekuvukeni, substance abuse is rife among men and women in the 19−35-year age group, which leads to a wretched life aggravated by the risk of numerous viral infections from needle-sharing among injecting drug-users, and sexual assault through disinhibition. "These clients have HIV and other STIs, but no relationships – and so the cycle of despair and illness continues," says Thabo. "While our clinic staff cannot provide all the services that they need, we partner with organisations like Families South Africa (FAMSA) to help them with professional counselling and rehabilitation support."
Nonetheless, Thabo goes above and beyond to be of use. To entrench the personal attention that men need for psychosocial support, he gives male clients his private phone number so that they can contact him at any time. "Sometimes they're reluctant to share everything about particularly sensitive topics during the counselling session – once home, they feel more comfortable with going into detail and asking further questions during a follow-up call." He also conducts counselling for the clinic's Adolescent- and Youth-friendly Services (AYFS) programme on Saturdays, so that he can support school-going boys through integration with the MINA Campaign.
Thabo sees a need for other targeted interventions, such as support groups, and urging community members through mobilisation and education to come forward when they witness gender-based abuse. "Through our outreach efforts, we receive 'hearsay' referrals, but we could address more of these cases were there a groundswell of awareness about how people can be linked to services."