Njombe, Tanzania—Tumpe Chaula, the mother of a 9-year-old daughter, noticed the tents down the street from the bar where she works. A team of community health workers were offering free health services there, including HIV counseling and testing and family planning, as well as screening and referrals for sexually transmitted infections, gender-based violence and tuberculosis. Impressed with the scope of services available, she and a friend decided to take advantage of what the community health workers had to offer.
Tumpe is among the first Tanzanians to benefit from a new project funded by the United States President’s Emergency Plan for AIDS Relief (PEPFAR) through the United States Agency for International Development (USAID). In partnership with the Ministry of Health and Social Welfare, the Sauti project is working in Njombe and 10 other regions in Tanzania to bring community-based HIV and reproductive health services close to vulnerable populations such as out-of-school adolescents and young women, female sex workers and their partners, men who have sex with men, and other Tanzanians disproportionately affected by HIV.
Led by Jhpiego and in partnership with EngenderHealth, Pact and the National Institute for Medical Research – Mwanza, the Sauti project is providing a comprehensive, integrated package of community-based biomedical, behavioral and structural interventions that also include sexual risk reduction counseling and screening for alcohol and drug abuse. Individuals who are HIV-positive or recent survivors of gender-based violence receive peer-escorted referrals to treatment services. Community dialogue around stigma, discrimination and gender-inequitable social norms, treatment and adherence support groups, Alcoholics Anonymous groups, savings and loans groups, and parenting education (for new parents) round out the package of Sauti services.
Earlier this fall, Tumpe had been sick off and on with frequent fevers, headaches and general body weakness. Although she was worried she might have HIV, especially given her history of high-risk behavior and having been sexually abused, she was afraid to get tested. “I had a fear due to my lifestyle and even the issue of stigma discouraged me to go for testing,” Tumpe said.
Years ago, while working as a housemaid, Tumpe was repeatedly raped by the son of the woman she worked for, and, despite reporting the abuse to her employer, no action was taken. She quit the job and rented a room with friends. But without a job, she couldn’t keep up with her rent payments. Soon after, she learned she was pregnant, and with no other option for income, she became a barmaid.
After Tumpe gave birth to her daughter, circumstances became even tougher for the single mother. Unable to make ends meet, she gave in to advice from friends to engage in sex for money to supplement her income. Her job as a barmaid gave her cover and an opportunity to meet clients, most of whom refused to wear condoms.
During her visit to the Sauti mobile testing site, Tumpe learned that she was HIV-positive. Despite the compassionate counseling and advice provided by the counselor, Tumpe wouldn’t go to the health facility to start HIV medication. She left the tent with a stock of condoms and lubricants, but she wasn’t ready to confront her new reality.
However, the Sauti project’s team of community health promoters did not give up on Tumpe. They texted her and followed up with phone calls and then discreetly provided Tumpe with one-on-one counseling sessions at her home and at the bar. “I made visits to her home and workplace. She didn’t always want to talk to me, but eventually she agreed to meet and discuss further her future and the importance of using antiretrovirals,” community health promoter Mohamed Bawzi said.
By the third visit, Tumpe was ready to start antiretrovirals at Kibena Hospital’s care and treatment center. A buddy escort brought her directly to a health care provider who had been identified by the Sauti project as welcoming to vulnerable women like Tumpe.
With support from the Sauti project, Tumpe is now receiving pre-treatment for her HIV and services to help prevent malaria—people with HIV are at higher risk for malaria—and other opportunistic infections.
“If this program did not come to my bar, I wouldn’t have been tested [for HIV],” she said. “I cried a lot, but now I’m glad I know.”