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| Ambassador Brennan During a site visit |
Making a New Start
“Knowing ones status is not a death sentence but a life sentence.”
United States Ambassador Martin Brennan at the opening of the second New
Start Center in Kitwe, July 2004.
In a country where 16% of the population between the age of 15 and 49
years is HIV positive, many Zambians have yet to seek HIV testing. The
2003 Zambia Sexual Behavior Survey indicated that only 9% of women and
9% of men have ever been tested for HIV. The expressed unmet need for
HIV testing is 69% for females and 64% for males. To address this need
for VCT, the Emergency Plan, through Population Services International
(PSI) and its local partner in Zambia, Society for Family Health (SFH),
funded the opening of a new Voluntary Counseling and Testing Centers in
Kitwe (Copperbelt Province) in July 2004 to provide high-quality, confidential
testing services. This facility is modelled and named after the original
New Start Center opened in 2002 in Lusaka.
The old adage says, “knowledge is power”. Such knowledge-based power is becoming a reality in Zambia. Many Zambians now have access to information and are able to learn their HIV status. Voluntary Counseling and Testing Centers (VCTs) are giving Zambians the power to take control and act on their HIV status. The opening of VCT Centers in various parts of the country has enabled thousands of Zambians to know their HIV status.
VCT has been shown in many countries to be an effective intervention that promotes positive and protective behavior changes amongst those counseled and tested for HIV. Quality VCT services act as the link connecting Prevention, Care and Treatment programs as clients learn their status and look for a plan for their future.
With support from USAID, SFH and 13 other agencies have implemented the “Zambia VCT Partnership”. Over the last three years, this partnership has improved the quality of VCT services, including pre- and post-test counseling, the test services themselves, and post-test referrals. Under this partnership, SFH has been implementing generic promotion campaigns to generate demand for counseling and testing.
New Start’s design is based on the findings of mystery client survey of existing VCT sites, and includes: full-time, dedicated VCT counselors; posters, VCT signs and IEC material that are consistently available, visible and in the appropriate local language; an area dedicated to VCT that has its own reception and comfortable waiting area and is easy to find, but discreetly located; sufficient rooms available, dedicated to counseling only; and guaranteed privacy, including audio and visual privacy as well as freedom from interruptions.
Using a variety of outreach techniques, including community education and awareness campaigns and mass media communications, New Start encourages Zambians nationwide to seek VCT services and know their HIV status. The New Start project generates messages that target sexually-active young people aged 16 – 25, young couples planning to marry or enter into a “serious” relationship, young couples planning to have a child, and men and women who frequently travel away from home. Since the inception of the program, New Start has counselled and tested over 21,000 clients, well over double the anticipated client load and averaging more clients tested per month than any other VCT site in Zambia.
The centers strive to increase access to quality VCT services in Zambia and uses brand positioning to de-stigmatize VCT. They also aim at reducing stigma against those living with HIV/AIDS. HIV testing serves as a critical link between prevention, care and treatment. The New Start Centers offer pre and post-test HIV/AIDS counseling, rapid HIV testing, follow up psycho-social or HIV educational counseling, and referral for care and support services.
Client satisfaction surveys conducted at New Start in 2003 noted that the clients at New Start rated the services highly. about 96% of the clients were satisfied with pre-and post-test counseling services. Also, all the clients were satisfied with the privacy and confidentiality offered at New Start and indicated they would want to recommend the service to others.
The profile of New Start clients indicates that one third are youth aged 20-24, more than half (58.6%) are male and single (63.1%), and about one third have senior level secondary education (33%). New Start attracts clients from different socio-economic groups, as the price charged is very affordable. Almost 40% of the clients are either students or unemployed. The test results show that more female than male in all age groups test positive.
The expansion of New Start brings renewed hope for Zambians to help them know their status and act to protect themselves and those around them. Increased knowledge of one’s HIV status provides power to employ new strategies to live a long and full live. As Dr. Peter Mijere, Copperbelt Province Director of Health stated recently at the opening of the New Start Center in Kitwe, “The majority of Zambians are in fact HIV negative and VCT can help relieve the worry and fear.”
The Emergency Plan has allowed SFH and the people of Zambia to make a
new start together!
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Christopher |
Home Based Care Program – Christopher Nkweto
Christopher, 35 years old, is a Home Based Care (HBC) client in Chinsali site of Mpika Diocese in the Northern Province of Zambia and has been enrolled in the HBC since 2003. His first wife divorced him and his second wife died after a year of marriage. He is alone but lives a few meters away from his mother. He narrated (in his language, Chibemba) how he found himself in Home Based Care:
“After the death of my second wife, I was depressed. I suspected that she could have died from (AIDS) because she complained of many ailments for some months before her death. The people at the clinic had even suggested Counseling and Testing to her. She did not go for it.
about three months after her death, I had malaria. I was given medicine at the hospital… it worked for a short while and the fever came back again.
I started experiencing chest pains, a cough and night sweats. They asked for my sputum and they found me with Tuberculosis (TB) after tests were done. I was put on treatment. I completed the treatment. I then noticed that my health had deteriorated despite recovering from TB. The backache persisted and I started experiencing bouts of diarrhea. I was no longer as energetic as I used to be. I was gripped with fear that I may be suffering from AIDS, a thing that scared me from going to the hospital again lest they diagnosed me so.
I used to trouble my mother a lot while on TB treatment over food. I used to feel very hungry and needed to eat after short intervals. She struggled to feed me and very often the food was not enough.
One day Mr. Chanda (a community volunteer caregiver) visited and…told me about Home Based Care and the Chinsali Parish clinic. I was comfortable because it sounded private, unlike the hospital I had been going to.
When I visited the Parish clinic, I was well received and got some painkillers and the nurse talked about Voluntary Counseling and Testing. I gathered courage and took the test; the result came out HIV positive. After getting the result, I registered with HBC.”
Christopher at his house in Reuben Nsunge village
When Christopher took the HIV test he could manage only very light work and weighed 35 kg. After enrolling with HBC he said:
“These people (caregivers) have changed my life. They bring drugs to my home when I am unable to go to the clinic. I am particularly thankful for the HEPS and cooking oil. These foodstuffs reduced pressure from my mother afar as looking for food is concerned. I was able to have HEPS porridge between breakfast and lunch and between lunch and supper. My health has improved tremendously. I now weigh 45kg and am able to do more activities than I could before they came. For example, I have managed to grow some sweet potatoes”.
Business Response for Access to Treatment (BRAT) administered by Comprehensive
HIV/AIDS Management Program (CHAMP)
“The death of one employee in a company from HIV/AIDS can have a devastating affect on the lives of as many as 30 - 40 people who may have been supported by the employee directly or indirectly. Companies … are negatively impacted by loss of productivity, funeral benefits, and increased health care expenditure as well as the loss of valuable professional experienced staff.” CHAMP BRAT Project Final Report, 30th September 2004
The BRAT project is a public/private partnership between USAID/Zambia, Konkola Copper Mines plc, Dunavant Limited Zambia, Comprehensive HIV/AIDS Management Program (CHAMP), and the PEPFAR funded POLICY Project. The project supported private sector companies to establish or strengthen their HIV/AIDS workplace program and extend it through outreach to communities.
The project addressed HIV and AIDS in two communities near the companies’ operational areas. The projects sought to accomplish the following objectives:
· Increase awareness on the benefits of HIV prevention, access
to care and support programs, and HIV-related treatment care and support
services
· Increase the number of employees and outreach community members
accessing VCT as an entry point to HIV treatment programs
· Strengthen STI awareness, prevention, and management programs
to lead to increased number of STI cases treated amongst KCM and Dunavant
employees and the outreach community.
· Increase the knowledge and skills of identified healthcare providers
to provide comprehensive HIV services to KCM and Dunavant employees, and
the outreach community.
· Strengthen care and support for KCM and Dunavant employees and
community members at community level.
· Strengthen KCM’s ability to provide a sustainable program
and funding mechanism for antiretroviral therapy for employees and other
interventions by the end of the project.
Results
Between mid-April and 30th September 2004 the BRAT project:
· Trained 8,272 people in peer education, community education,
community-care giving, and voluntary counseling and testing.
· Sensitized 5,219 KCM and Dunavant employees.
· Sensitized 182,845 community members.
· VCT services offered to a combination of 309 Dunavant employees/community
members and 1,034 KCM employees/community members.
During the project there was a country-wide shortage of HIV test kits, however, CHAMP was able to source 1,600 kits for use in the project sites. The response to VCT availability was very good. The majority of people tested were HIV negative but 24.3% were positive.
The reasons given for coming forward for HIV testing were:
No. %
Sick 190 14.1
Partner is HIV positive 11 0.8
Just to make sure 717 53.4
Partner tested and advised 11 0.8
Worried about partner’s behavior 63 4.7
Planning to get married 59 4.4
Planning to have a baby 13 1.0
Other 130 9.7
BRAT VCT drive 652 48.5
The BRAT experience demonstrated that employees and communities are ready to access HIV prevention, care and treatment services when they have sufficient information about why it is important and where services can be accessed, and they are assured that follow-up support is readily available if it is needed and desired.
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