ANDA COM JEITO!Text by Alberto D’Argenzio
Everyone. Those who prescribe medicines and those who prepare or take them. Those who book the medical examinations and those who run or take them. Everyone is HIV+ at Manga Chingusura Medical Center, in the western suburbs of Beira, Mozambique's second largest city. Eight thousand people dealing with the virus.
"I came here in 2004 to take the treatment. I started working in 2006 as an activist to speak with men, to tell them that they need to cure themselves, that Aids is not a matter of women" says Matias Simbe, 42 years old, a HIV+ wife, 4 children, and since 2010 the Director of the Center. Manga Chingusura is a succession of houses and shacks placed at the very beginning of the Corredor de Beira, the strip of asphalt that bears goods, humans and Aids from this Indian Ocean port up inside Mozambique and then to Zimbabwe, Zambia or Malawi. And vice versa. In the Corredor de Beira HIV infection rates exceed 40%, with peaks of 80% in Inchope, the road junction that cut Mozambique from North to South and from East to West. The record is not random: Inchope is a crossroad, a town of truck drivers, prostitutes and brothels open 24 hours a day.
In recent years the country's development performance has continued to be highly skewed and in 2011 Mozambique, where life expectancy at birth is 50.2 years, ranked 184th out of 187 countries in the United Nation's Human Development Index. Against this background, the epidemic has been accelerating with increasing intensity and today there are an estimated 1.5 million people living with HIV or AIDS, constituting a prevalence rate of more than 13%, among the worst on earth.
Given the high average prevalence levels coupled with structural factors such as poverty, gender inequality, cultural conditions and high levels of labor mobility – all conducive to a rapid and continuing increase in HIV infection within the country – Mozambique has always faced a major HIV epidemic. According to UNAIDS, Mozambique is the second last country in the world in the fight against Aids. The Corredor de Beira is the incarnation of this tragic failure, which is governmental in a country that is rich in resources – but that doesn’t invest in its health system and depends on international partners for the 97% of the funding of HIV/AIDS related programs – and cultural in a society that still stigmatizes women as the vehicle of contagion.
Mozambique ranks third out of the 25 low-and-middle-income countries with the highest estimated numbers of pregnant women living with HIV in need of ARV therapy. In fact, some 57% of the adults living with HIV/AIDS are women, who generally are infected at much earlier ages than men. This gendered pattern of HIV infection is related to the low educational level and exceedingly high illiteracy rates among women, as well as to women’s subordinate economic, social and political position. Women are the weak point in the chain of transmission of the virus, but they are the strong link in the response to the disease.
Afua Assani, who is 27 years old and has two sons, now knows that Aids is not a matter of women but she had to struggle a lot to understand it. She found out to be HIV+ in 2006 when expecting her first child, the news bringing along despair and the desertion of her husband who refused to take the test. "Men just don’t do it, they are truly convinced that only women are those who carry the virus. But women are not the open doors that let the virus in, they are those who pay for all, to the extent that more and more often they don’t disclose their status fearing to be left completely alone when facing the disease and the stigma that comes with it".
Afua didn’t lose her heart though; she didn't want to pay for everyone. She got in touch with activists of the collective Kuplumussana, literally "let’s save ourselves one with the other", and understood that with a "better diet and adhering with discipline to the ARV therapy life does not end, for you or for your children”. Then she started pounding the villages and health centers looking for women to speak to, women like her who had fallen into the net of the virus and were left alone with their children and the disease. Now she is studying preventive medicine and, along with the other 39 members of the association, provides food, healthcare and support to anyone who is in her same situation.
Kuplumussana’s activists push women to go to health centers, to adhere to the therapy, make plays and give lectures on how and what to feed their mostly HIV+ children with. In some way they become the living symbol that the virus can be held down and controlled. 37 mamà, 3 papa and their red shirts with the logo on the heart. This is Kuplumussana. "Three men are not many but they are a sign that the battle isn’t lost", insists Afua during one of their weekly meetings, interspersed with songs and dances. Meanwhile the three men remain a bit aloof, somehow intimidated, a silent avant-garde in a world where women wear the cross. And bring hope.
STORIES
KUPLUMUSSANA helping one another
In Mozambique, AIDS is a doenca (illness) that has already spread in every house, in every family, but nobody even dare to name it because it’s a symbol of shame and death. People suffering from AIDS are often left behind by their families, with higher chances if they’re women. Especially in Beira, the second biggest city of the country, where the incidence rate of HIV is among the highest in the entire African continent.
Kuplumussana – a Sena dialect word that literally means “helping one another” – is a peer-to-peer support group of HIV+ mothers for HIV+ mothers. It was formed in 2005 – with the help and strong commitment of Dr. Maria Laura Mastrogiacomo, a pediatrician working for Doctors for Africa CUAMM – as a self-sustaining autonomously organized association. In 2009 Kuplumussana was included in CUAMM’s projects supported by UNICEF in the Sofala Province.
The 37 women of Kuplumussana, along with the 3 men who recently joined the group, cooperate with the health centers and sanitary units of Munhava, Macurungo, Nhaconjo, Ponta Gea, Chamba e Manga Loforte. They search in rural areas for children and mothers who abandoned consultations and treatment, grant psychological and social support through lectures and individual counseling, help fight stigma and discrimination and provide, whenever possible, economic support to HIV+ mothers who were abandoned by their partners.
Kuplumussana’s mothers have now become essential in both connecting HIV+ women with the PMTCT (Preventing Mother To Child Transmission) programs and integrating maternal and child health services with those of HIV control. In 2010, for example, to track down the most at risk children who had left the medical supervision for over three months, the mothers of Kuplumussana began an intensive program of home visits that brought them to identify a total of 1767 children. 414 of them had left medical follow-ups either because they moved to a different health facility, were confirmed HIV negative or died. Out of the remaining 1354 children, some 732 (54%) were reinstated and actively completed the follow-up programs.
Kuplumussana’s mothers represent an extraordinary experience of emancipation and promotion of gender equality within the society in the history of African women.
INFOGRAPHICS Mozambique - Treatment
The infographics are presented for informational purposes only. Every attempt has been made to ensure that the information contained herein is accurate. Figures and percentages are based on latest available data as collected by the World Health Organization (WHO) and the Joint United Nations Programme on HIV/AIDS (UNAIDS) and published on their respective websites.
THUMBNAILS AND CAPTIONS
Going north on the road between Maputo and Beira, the second
largest city in the country. Beira is the hardest hit city by the epidemic and - with more
than 30% of its population living with the virus - has the highest HIV prevalence rate in
the country. Since the first case of AIDS detected in Mozambique back in 1986, the
number of new infections has grown exponentially, causing a devastating socioeconomic
impact on the society.
In 2011, in Mozambique there were 205,000 HIV+ children, with about
116,000 eligible for ART. The percentage of HIV+ children born from HIV+ mothers
increased significantly in the last five years and the ART coverage rate among children
continue to stagnate at around 19%. Preventing effectively mother-to-child transmission
and enrolling eligible HIV+ women in appropriate care and treatment have been main
targets of the public response. The rate of mother to child transmission of HIV has been
steadily reduced, even though it remains at a considerably high level (20.2%).
Pregnant women are waiting to be taken care of at Macarongo’s
Centro de Saude, near Beira. Among the seven thousands people taken care of at the
Centro de Saude, some seventeen hundreds are HIV positive. Only recently Mozambique
was finally reported among the five States providing HIV testing and counseling to over
75% of pregnant women. The rate of mother to child transmission of HIV has been
steadily reduced, even though it remains at a considerably high level (20.2%).
A HIV+ child in his crib at the Missionaries of Charity's Orphanage in
Maputo. Out of the estimated 400 daily new infections, around 85 are children infected
through mother-to child transmission. Preventing effectively mother-to-child transmission
and enrolling eligible HIV+ women in appropriate care and treatment have been main
targets of the public response. The rate of mother to child transmission of HIV has been
steadily reduced, even though it remains at a considerably high level (20.2%).
Doctors’ coats are hung outside the immunology lab of Maputo's
Central Hospital. Doctors at the lab are working on the TaMoVac I program, a
randomized, controlled, double blinded study enrolling healthy, HIV negative, low risk
volunteers. The trial is the first of its genre to be run in Mozambique and after the
laboratory tests in vitro and having proved to be safe and effective in animals, has now
proceeded to the first phase of evaluation in humans, aiming to assess eventual tolerance
and possible adverse effects on men and women.
A young doctor is giving antenatal care to a pregnant woman at the
Manga Chingusura Centro de Saude, near Beira. Mozambique is one of 16 countries in
the world that contribute with 60% to the global number of pregnant women living with
HIV, following South Africa, Nigeria and Kenya in terms of the number of yearly infected
pregnant women. The rate of mother to child transmission of HIV has been steadily
reduced, even though it remains at a considerably high level (20.2%).
Ivadencia, 18, (L) is seen with her newborn baby in the maternity ward
of the Centro de Saude Matola II, near Maputo. Ivadencia and her baby are HIV negative,
however in Mozambique there are some 116,000 children living with HIV in need of ART
but only less than 20% of them currently have access to treatment. In the whole country,
while there is good progress in reaching more women with MTCT prevention services, too
many babies are still getting lost along the continuum of care.
A woman is breastfeeding her two babies. Among the seven
thousands people taken care of in Macarongo's Centro de Saude, some seventeen
hundreds are HIV positive. Only recently Mozambique was finally reported among the five
States providing HIV testing and counseling to over 75% of pregnant women. The rate of
mother to child transmission of HIV has been steadily reduced, even though it remains at
a considerably high level (20.2%).
The estimated number of new HIV infections among children have
dropped from 21,000 in 2001 to 14.000 in 2012. In 2011, 40.9% of infants born to HIV+
mothers received a virological test for HIV within 2 months of birth. In general, in
Mozambique children lag behind adults in terms of access to services and in the last five
years only 19% of children younger than 15 living with HIV were receiving ARV therapy.
Pregnant women are seen while waiting to be taken care of by
doctors at the maternity ward of the Centro de Saude Matola II, near Maputo. Antenatal
care is the main entry point to identify HIV positive women through the Mother and Child
Healthcare services. According to the latest survey (2008), 89% of pregnant women
attended antenatal care at least once. However, skilled attendants assisted only 55% of
births and the rate of mother to child transmission of HIV remains at a considerably high
level (20.2%).
Women are seen while waiting to receive their ARV treatment at the
Centro de Saude of Manga Chingusura, the first in Mozambique in terms of HIV+ people
taken care of: out of seven thousands there are an estimated 4.200 children. In
Mozambique, only less than 20% of the 116,000 children living with HIV in need of ART
currently have access to treatment.
A condom’s advertising panel in central Beira, the second largest city
of the country. Only 18.5% of the adults aged 15 to 49 years who had more than one
sexual partner in the past 12 months reported the use of a condom during their last
sexual intercourse.
A Population Services International’s volunteer is counseling a young
woman in the outskirts of Maputo. Only 35.7% of young women aged 15 to 24 both
correctly identify ways of preventing the sexual transmission of HIV and reject major
misconceptions about HIV transmission. Still, an estimated 57% of the adults living with
HIV/AIDS are women who are generally infected at much earlier ages than men, This
gendered pattern of HIV infection is related to women’s subordinate economic, social and
political position.
A nun is taking care of a HIV+ child in the kitchen of the Missionaries
of Charity's Orphanage in Maputo. Out of the estimated 400 daily new infections, around
85 are children infected through mother-to child transmission. Preventing effectively
mother-to-child transmission and enrolling eligible HIV+ women in appropriate care and
treatment have been main targets of the public response. The rate of mother to child
transmission of HIV has been steadily reduced, even though it remains at a considerably
high level (20.2%).
Kuplumussana is a peer-to-peer support group of HIV+ mothers for
HIV+ mothers. The women of Kuplumussana, through their search for children and
mothers who abandoned consultations and treatment, over the years have become
essential in both connecting HIV+ women in rural areas with the PMTCT programs and
integrating maternal and child health services with those of HIV control.
A Population Services International’s volunteer is testing a young guy
in the outskirts of Maputo. In 2011, only 8.9% of the men aged 15 to 49 years received an
HIV test in the past 12 months and know their results. PSI's house to house voluntary
testing and counseling program aims to reach people in peripheral suburbs of
Mozambique's biggest cities, where it is much more difficult to find facilities providing
such services to the population.
In Mozambique, there are an estimated 1.5 million people living with
HIV or AIDS, constituting a prevalence rate of more than 13%, among the worst on earth.
An estimated 57% of the adults living with HIV/AIDS are women. This gendered pattern of
HIV infection is clearly related to women’s still subordinate economic, social and political
position.
A nurse of Matola II Hospital is talking to the father of a HIV+ kid
about the importance of adhering to treatment. In Mozambique children in general lag
behind adults in terms of access to services and in the last five years only 19% of
children younger than 15 living with HIV in need of ART were accessing it.
In Mozambique, an estimated 57% of the adults living with HIV/AIDS
are women. Preventing effectively mother-to-child transmission and enrolling eligible
women living with HIV in appropriate care and treatment have been among the main
targets of the public response to the epidemic, even though the rate of mother to child
transmission has remained at a considerably high level (20.2%).
Nurses are waiting for Ivadencia, a HIV- 18 years old girl, to give birth
to her first son in the maternity ward of the Centro de Saude Matola II, near Maputo. In
Mozambique there are some 116,000 children living with HIV in need of ART but only less
than 20% of them currently have access to treatment. In the whole country, while there is
good progress in reaching more women with MTCT prevention services, too many babies
are still getting lost along the continuum of care.
Students are attending a gynecology class at the Catholic University
of Mozambique, in Beira. Antenatal care is the main entry point to identify HIV positive
women through the Mother and Child Healthcare services. According to the latest survey
(2008), 89% of pregnant women attended antenatal care at least once but skilled
attendants assisted only 55% of births. The rate of mother to child transmission of HIV
has been steadily reduced, even though it remains at a considerably high level (20.2%).
The pharmacy of the Centro de Saude of Manga Chingusura, the first
in Mozambique in terms of HIV positive people taken care of: out of seven thousands
there are an estimated 4.200 children. Thanks to DREAM, a project run by the Community
of Sant'Egidio, the majority of mothers and children are now being offered a holistic
package of crucial prevention of MTCT services free of charge.
Kuplumussana is a peer-to-peer support group of HIV+ mothers for
HIV+ mothers. The women of Kuplumussana, through their search in rural areas for
children and mothers who abandoned consultations and treatment, over the years have
become essential in both connecting HIV+ women with the MTCT prevention programs
and integrating maternal and child health services with those of HIV control.
A woman is lying in her bed at Matola II Hospital. In Mozambique, an
estimated 57% of the adults living with HIV/AIDS are women. This gendered pattern of
HIV infection is clearly related to women’s still subordinate economic, social and political
position. Mozambique ranks third out of the twenty five low-and-middle-income countries
with the highest estimated numbers of pregnant women living with HIV in need of
antiretrovirals therapy.
Beira, the second largest city of Mozambique, is the hardest hit city
by the epidemic and - with more than 30% of its population living with the virus - has the
highest HIV prevalence rate in the country. Since the first case of AIDS detected in
Mozambique back in 1986, the number of new infections has grown exponentially,
causing a devastating socio-economic impact on the society.