Thyolo, Malawi — As a mother living with HIV, Jane Edward recognized that her family might be at risk for the virus. She knew her husband and children needed to be counseled and tested for HIV, and that they should also start on treatment if they tested HIV positive. But despite her encouragement, getting her husband Harry to voluntarily test was a challenge. Like many other men in the couple’s community of Bvumbwe, Harry didn’t see the urgency to test.
But then, Jhpiego Gateway project volunteer Mervis Chapotoka entered the family’s life.
Chapotoka is a volunteer expert client—she is living with HIV herself. Chapotoka shares her experience of being diagnosed with HIV and going on treatment with others who test positive for HIV. She encourages them to start and stay on treatment and to talk with their partners and family members about HIV and to get tested. Chapotoka is based at the health facility where Jane receives antiretroviral therapy (ART), and also works in the community visiting clients and their families at home.
A ‘Turning Point’
When Chapotoka spoke with Jane about getting Harry and other family members tested, Jane was initially discouraged, informing her that, although her husband had been feeling ill, he still refused to get tested. But through her discussion with Chapotoka, Jane gained hope. Later, she said, “I was very sure this was the turning point of my husband’s life, and that of my entire family.” Chapotoka gave Jane a Ministry of Health Family Referral Slip, an official invitation for her husband to visit the health facility for HIV testing. Jane handed the slip to Harry that night.
Influenced by the official referral slip for testing, Harry visited the clinic, where he received counseling and testing for HIV. He admits he was in denial about being tested because he feared being HIV positive and the stigma associated with this result. He noted the importance of the official referral slip, stating, “I have high respect for health workers and I believed they had called me for a serious matter.… Through the counseling, I was convinced my life would be better [if I knew] my HIV status.” He tested positive for HIV as did two of the couple’s four children.
Encouraged by his wife’s experience on ART, Harry and the two children immediately started on treatment.
“She was my living testimony that I will be just fine once I start the treatment since she has been in good health throughout the time she was diagnosed,” Harry said of his wife, Jane. “I had the proof of the benefits of knowing one’s HIV status and how effective the medication is…. And here I am today, living a healthy life.”
Men Less Likely to Know HIV Status
In many communities in Malawi, men and young people are the least likely to know their HIV status and be on treatment. Unlike adult women, who have the opportunity to test during pregnancy, men don’t routinely access health care services. The 2015-16 Malawi Population-Based HIV Impact Assessment (MPHIA) final report estimates that 76.8% of people living with HIV (ages 15-64) in Malawi know their HIV status, 80.2% of HIV-positive females and 71.7% of HIV-positive males.
Jhpiego’s Gateway project works with a local organization, Malawi AIDS Counseling and Resource Organization, to support the Ministry of Health’s scale up of comprehensive HIV testing, treatment and prevention services for high-risk and hard-to-reach populations in priority districts in Malawi. With funding from the President’s Emergency Plan for AIDS Relief, through the Centers for Disease Control and Prevention, the Gateway project uses the index testing strategy, which works with people living with HIV to reach their partners and family members so that they can also learn their HIV status and access treatment and prevention services. Chapotoka and other project expert clients support others on ART to adhere to treatment and maintain healthy lives; they also do community outreach to encourage HIV testing for their clients’ sexual partners and children to ensure no one is left behind.
A Healthy Life
By engaging with ART clinics and peer support groups, the expert clients identify people living with HIV and engage them to bring their family members for HIV testing. “We provide counseling about the importance of testing partners and biological children of HIV-positive people, and offer a family referral slip to give the family members,” explained Chapotoka. They also provide psychosocial support and counseling for those who have been recently diagnosed, and proactively support disclosure for clients who choose to notify their partners themselves.
Expert clients link partners and children with health facilities for testing, or with Gateway’s community-based HIV testing providers who can test them at home or at another community spot of their choice. The index testing approach has proved to be a key intervention in diagnosing people living with HIV and enrolling them in treatment and care.
Jane’s family is one of hundreds in Thyolo who have learned their HIV status through the Gateway project’s index testing strategy. In Thyolo district, of the 5,468 people tested for HIV between April and September 2018, 1,030 people were tested through index testing and of these, 419 tested positive.
“Index testing has helped us not only to reach out to many people, especially men, but also to do well in testing high-risk clients. In the past, we reached many women through antenatal care visits, yet we could not reach men . . . but with index testing, we are also able to have men tested for HIV,” Chapotoka reported.
For Harry, knowing his status has empowered him. “My fears of stigma are all gone,” he said, “and I now encourage my friends to go for HIV testing. But above all, since I have the energy . . . I am working on my dream of becoming a [taxi] driver. Each time I take my medication, I think about my dream and the reasons why I want to live a long and healthy life.”
Sarah Sakanda is a Communication and Knowledge Management Specialist in Jhpiego’s Malawi office. Titus Chiwindo, a Quality Assurance Advisor, and Kristina Grabbe, Senior Technical Advisor, HIV/AIDS and Infectious Disease, also contributed to this article.