In Mozambique, familiar faces—of children and teenagers as well as adult men and women—are helping to change widespread and longstanding perceptions of HIV/AIDS. Rather than a debilitating and often fatal disease, it is a chronic condition that can be managed with medicine, testing and confidence.
This new, client-centered public awareness campaign aims to align Mozambique with the 90–90–90 global goal established by UNAIDS, the third of which calls for 90 percent of people receiving antiretroviral therapy (ART) to achieve viral suppression by 2020. The Ministry of Health launched the campaign in June with support from Jhpiego, the US President’s Emergency Plan for AIDS Relief and the US Centers for Disease Control and Prevention.
The faces of the national HIV literacy campaign belong to real people living with HIV (PLHIV). They share an uplifting and empowering message with other PLHIV who may be hopeless about their diagnosis or unaware of viral load status: Start and stay on ART to achieve sustained viral load at an undetectable level in the blood. By knowing their status, PLHIV can be assured that the treatment is working and they are not transmitting the virus, while they live long, healthy lives.
In Mozambique, where an estimated 13.2 percent of adults are living with HIV, one in three on ART are lost to follow up within 12 months of starting treatment, according to the Ministry of Health. Because stigma and discrimination continue to negatively influence people directly affected by HIV as well as their health care providers, this viral load patient literacy campaign has ambitious goals:
- Help PLHIV to fully understand the impact of treatment and undetectable viral load. Materials such as educational flyers, posters and brochures will be distributed in health facilities nationwide to improve adherence, reinforce ART use and emphasize the importance of undetectable viral load.
- Share a positive image of PLHIV to combat stereotypes by showcasing individuals who lead healthy lives by achieving viral suppression and thus reduce transmission of the virus, bringing down the number of new HIV infections.
For too long, the voices of PLHIV were missing from educational materials and public messages that emphasized their vulnerability as opposed to presenting HIV infection as a chronic illness that can be managed and controlled.
“This people-centered literacy campaign will help PLHIV to maintain control of their virus levels by allowing them to know whether (treatment) is being successful or not,” said a female resident of Licuare, a rural area in Zambezia province, during a group discussion about the materials.
The overarching message from PLHIV who participated in creating the campaign is encouraging—and likely surprising to some: “We are healthy, we are capable, we are strong. That’s how we see each other and how we want to be seen.”
In a radical departure from the traditional, top-down approach to behavior change, the campaign emphasizes dialogue. PLHIV are talking to each other, not being lectured to. As a result, the strategy fosters respect and belonging while building self-esteem, confidence and power.
“We took a people-centered approach—as opposed to disease-centered—in the development of this material, recognizing those who actually live with the disease,” said Ruben Frescas, project manager for Jhpiego in Mozambique. “We wanted the voices of people, coupled with the current evidence, to deliver an empowering message that is informative and personable. The image of strong, healthy and happy people taking control of and overcoming HIV—this is the new face of people living with HIV on antiretrovirals in Mozambique.”
The campaign—guided by the motto “Nothing about us without us”—confronts conventional perceptions about people with chronic diseases—particularly those living with HIV. They are not passive patients whose fragile existence depends solely on a pill; rather, they are active participants driving their own good health.
The new messaging more accurately reflects the fact that consistent daily dosing of antiretroviral drugs (ARVs) and sustained viral suppression—along with quality psychosocial support and nutrition—are crucial to the well-being of PLHIV. By coupling knowledge of the importance of sustained viral suppression with continuous and regular ARV treatment, the campaign seeks to convince all PLHIV that they can reach a healthy status, maintain active and productive lives and avoid transmitting the virus to others.
“When people see us beautiful and happy, they will learn not to discriminate against people living with HIV,” said one focus group member, a young man living in Natite, a semirural area in Cabo Delgado province, after reviewing the campaign materials. “We also feel motivated to adopt behaviors that help us to control viral load.”
Benilde Matsinhe is a communications officer in Jhpiego’s Mozambique office.