Prevention of Mother to Child Transmission (PMTCT) Option B+ is one of Malawi’s greatest success stories. Through this program, pregnant women living with HIV are given antiretroviral treatment to prevent their infants from acquiring HIV. After the child is born, both the mother and infant are placed on treatment to avoid possible transmission of the infection through breastfeeding.
Thanks to PMTCT Option B+ services, about 97% of pregnant women in the country are tested for HIV during their antenatal care visits and, if they test positive, 91% of them are linked to treatment and care (Source: Ministry of Health Intergrated HIV Program Report April - June 2017). Although these services have positively contributed to the decline of new infections among children born to HIV- positive mothers, retention of mothers on treatment particularly following delivery is still a challenge. One of the reasons for this problem is the personal acceptance of the mother’s HIV status.
This was the case for 40- year-old Agnes Simenti who tested positive in 2012 when she was pregnant with her last-born child Mphatso.
“I had just lost my husband, so the news of an HIV- positive status was not something I was prepared to handle; life was already difficult for us. Besides that, I felt healthy,” shares Agnes.
“Being young and HIV positive?” 16-year-old Rose Felera pauses “I did not think this was my fate. Especially not when I was only 13 years old.”
The events that Rose experienced at the age of 13 are ones that changed her life forever. Up to that point, she had a seemingly great life. Her loving father’s business was thriving. She was in standard (grade) 6 and had gotten further in school than most girls in her village. She also had a boyfriend whom she had hopes of one day marrying.
In the heart of Mangochi lies Matekwe village, which is where Elina Eliasi and her family bask in the recently found rays of hope they realized through One Community interventions. Elina is a 28-year-old mother to four children—Emily (13), Harold (9), Nathan (4), and Aubrey (1). She is also a stepmother to her husband’s child, 16-year-old son Samson, and an orphaned 15-year-old relative, Yamikani.
From the onset of her marriage, Elina has struggled to fend for her family while her husband, Mr. Burton, spent most of his earnings buying alcohol. In early 2017, Elina stumbled upon some One Community volunteers mobilizing community members for an HIV risk reduction and gender norm training session.
One Community offers HIV testing services using different modalities and strategies. The aim is to reach high-risk populations with convenient, and confidential HIV testing services. Methods that have been most effective include index testing (where the sex partners and biological children of an HIV positive person are tested) and mobile testing (where testing is brought to people in the community). Mobile testing activities include community testing and moonlight testing, which is testing done in the evenings/night, outside of normal operating hours. The moonlight testing sessions have been effective in reaching busy priority populations such as businessmen, vendors and fisher folks. These activities are conducted in and around markets, fishing communities, estates and around hot spots like bars and brothels.
On 22 December 2017, One Community conducted a moonlight testing session at Jali Market in Traditional Authority Mwambo, Zomba a district in southern Malawi. On this day Eneless and her husband Billy Mandota decided to go for an HIV test. The decision to get tested was not due to any risk indicators, the couple simply wanted to know their HIV status. Upon arrival, the couple received counseling and they consented to receive the test.
Disclosure of HIV status is a delicate issue that must be handled with care. For children in particular, it is important that the official process of disclosure is followed. Unfortunately for 12 year old Sada Kasimu of Traditional Authority Liwonde-Machinga, the issue of disclosure was not handled well, and Sada was abruptly informed of his HIV postive results by the HSA doing the testing in March 2017, when he was 11 years old.
According to the World Health Organisation, “Disclosure of an HIV status is an important part of the process of living with HIV, and is crucial to the continum of HIV Care”( Guideline on HIV disclosure counselling for children up to 12 years of age, 2011). This is true for anyone living with HIV, but especially for children, given the complexities that must be taken in to account related to the child’s emotions, ability to understand the situation, ability to cope with stigma and discrimination as well as concerns about social support.
Community Engagement Facilitator (CEF) Joseph Phiri beams with pride as he shares the success of his Village Savings and Loans (VSL) group, Tingathe, which translates to “we can.” Tingathe VSL group is from Msaka, a small village in Mangochi located on the shores of Lake Malawi. The group, which comprises 25 people living with HIV, outshined most One Community VSL groups in December 2017 when group members saved MK 2,132,330 ($2,901.12), an amount they never thought they could amass.
Meet Lufani Ali, a 23-year-old single mother of two currently living with her mother in Kammata village in Chileka. With a forlorn look, she reminisces about how sick her daughter was last year: “My child was dying and no one knew what to do.”
Without any real source of income, Lufani and her children lived a vulnerable life relying on menial jobs to feed the family.
In December 2016, her youngest daughter Trisha, who was 15 months old at the time, suddenly fell ill. She struggled with abdominal pains and lack of appetite. She was diagnosed with malaria when she visited the nearby hospital.
Ndadziwa Go Girls! Club in Matiya, Zomba has been a sanctuary for 25 out of school girls ages 10-14 since December 2016. The Club’s sessions are facilitated by mentor mothers Emily Mvukula and Ida Nandolo.
The hilly district of Blantyre is one of the most highly industrialized areas of Malawi and has an estimated 18.2% HIV prevalence rate (Source: MPHIA Report, 2016). The disease has affected the daily livelihood of many of its inhabitants leaving multiple households vulnerable. This is a situation 45-year-old Andrew Joseph can relate to.
“I cannot say I was rich before my HIV positive results, but we had enough as a family. I was employed as a guard at a garage in the nearby town and was aspiring to one day become a mechanic,” shares Andrew.
“My husband died in 2016 from AIDS-related illnesses, and since then, I have struggled to raise our three children,” shares 36-year-old Ida Matiki of Gomeza Village, in the southern district of Blantyre in Malawi.
Kennedy is a 12-year-old, single orphaned boy who lives in Malembo village, Group Village Head Dalamponda, Traditional Authority Nsanama in Machinga district. His father died in 2014 leaving him to be looked after by his mother. Being a single parent and in dire poverty, the mother could not manage to provide for the family. Both Kennedy and his mother would go to sleep for some days without food. They had no land to cultivate and no assets or livestock to raise money from. This made Kennedy go hunting mice in order to get food for his mother and himself.
Village Savings and Loans (VSL) Groups play a crucial role in bringing financial services to rural areas where formal financial institutions, such as banks, are limited or cannot be afforded by the surrounding populations.
“As a facilitator of these groups, I have seen people transform into independent and financially stable individuals. Most of these people were poor and widowed, raising orphans and/or dealing with the burdens of HIV but now they are a source of inspiration for their community,” shares Community Engagement Facilitator Patricia Makumbi.
Life for 23-year-old Sherifa Demba (also known as Cecelia Chisema) has taken a hopeful turn and she has a timely community announcement to thank.
A year ago, Sherifa’s thoughts were plagued with “what ifs” as the derailed plan for her life left her depressed and filled with regret.
With sadness in her eyes Mary Kulima, Sherifa’s grandmother, explains, “Sherifa was a very intelligent girl. I believed she took after her mother who is an excellent primary school teacher. Unfortunately, Sherifa chose to ignore everything we taught her when she fell in love with Lasten.”
At the heart of One Community’s (One C) efforts is the Malawian child. Orphans, vulnerable children and their caregivers face tremendous health, social and economic challenges on a daily basis. This booklet, One Community-Saving Lives is a collection of 18 stories selected to show how One C’s work has helped adolescent girls, young women, and caregivers of children take back their lives, often from the precipice, and how communities are being empowered to question their living conditions and take action to change them for the better.
These stories showcase human resilience and how a little external support delivered in an efficient manner, and in collaboration with local communities can increase their agency, steer them away from the path of desolation and hopelessness towards hope for the future and belief in themselves. These stories were collected over a one-year period (October 2016 – September 2017). At One Community, we believe that these stories add meaning to the numbers and statistics that one would find in our annual report, and are a testimony that with the support of PEPFAR through USAID, One C is saving many lives.
The booklet will be shared with our donors, implementing partners, government stakeholders and the general public.
All stories were written with consent from concerned parties and they are aware of the purpose behind the narratives
“My oldest sister wanted me to die. My sickness brought too many extra problems for the family. I would spend nights sleeping outside or on the cold floor without a blanket and often times she would beat me up” Reminisced a sad Judie Lemucha of Tambala village, Mulanje.
Ten-year-old Judie is the fifth in a family of six. Until February 2017, her life story had been characterized by desolation, abuse and neglect. This all begun when she lost her mother and father to HIV at the age of two. Judie’s oldest sister, Odeta, who was 19 at the time of their parent’s death, assumed the role of household head. This was not an easy task for Odeta as she had two children of her own.
For twenty-three-year-old Community Engagement Facilitator, Bridget Namacha, her job is a realization of a personal journey which started when her closest Aunt nearly died due to an undiagnosed HIV infection in 2007.
“During that time, not much was known about HIV. My Aunt discovered very late what had been causing her recurrent illness. She would have died if she hadn’t eventually gotten tested for HIV and started her treatment.”
Her Aunt’s gift of life is a constant inspiration. Bridget has committed her time to bringing HIV testing services to her community and ensuring that those who test positive get on treatment immediately. Coincidentally, Bridget was hired by One Community - USAID’s flagship community based HIV prevention and impact mitigation project.
For months on end, sickness was a term 24 year old Edina Sitande was very familiar with. In the months of December 2016 her situation had gotten so bad that she could barely care for her children. Her husband’s disappearance from the village to remarry did not help with her situation.
A dedicated mother of 2, Edina comes from Machinga, a district in the southern region of Malawi where the burden of HIV has left 14.5% of the population vulnerable. Yet this statistic did not resonate with Edina.
“Even when I was at my weakest state, HIV was not what concerned me; I assumed I had malaria as the disease was rampant in the area.” Edina reminisced.
Like many girls in rural Malawi, Carolyn Mkhunga found herself in an abusive marriage at the early age of 16.
“He would go drinking and leave me alone at home for days. I would hear stories about where he had been and the women he was seeing.’’
Pregnant and alone Carolyn battled many fears, she worried about her unborn child and the environment he or she would grow up in. She worried about her husband’s infidelities and the chance that he might give her HIV. Most of all she was constantly troubled by the sad reality of her current life, with very few options.