In the town of Eshowe, South Africa, 1 in 4 people between the ages of 15 and 59 is HIV positive. Slindile is part of the MSF / Doctors Without Borders team trying to combat the disease and is based at a clinic at the local college, where students can get tested, receive counselling and start their HIV treatment, all without leaving campus...
HIV is a big problem here; this is a high transmission area so we find really high numbers of HIV-positive cases. The truth is that everyone is either infected or affected, so it is important to provide testing and treatment services. Eshowe College has an interesting set-up that enables and encourages HIV testing and treatment.
Everyone is either infected or affected
People arrive at our clinic with any illness or health-related question - it doesn't have to be related to HIV. They are seen in the room next-door to mine – the first room you see when you walk into the facility. The counsellor there will provide them with information and suggest HIV testing (at the same time, we also have mobilisers working in the college, encouraging people to get tested). Next, the counsellor tests anyone who wishes to be tested, before passing over any positive cases to me. I then manage these positive cases and provide anti-retroviral care. Anti-retrovirals are a class of drug that are highly effective at reducing levels of HIV, allowing people to lead healthy lives.
In fact, many people don’t arrive at the clinic for HIV testing, even though this is a big focus for us here. There is still some stigma and some misconceptions around HIV so it’s important that we make it easy for young people to access care.
Slindile at work. Photo: Hannah Whitcombe / MSF
We see roughly 20 patients a day, mostly for STI (sexually transmitted infection) screening, family planning, and HIV treatment, although students can come for any minor ailment. We thought if we only offered HIV testing, patients might not come, so this set-up really works for us. No one is forced to get tested. We provide information to everyone, and then people make a decision about whether they want to be tested or not.
I love working with young people. I’ve been working specifically with youth for six or seven years, so I know their tricks - the way they think, their attitude, they always think they know better than you. But nothing much surprises me anymore! I used to think the same way about my parents – no one thinks their parents have been through the same phase of life!
Nothing much surprises me anymore!
The patients we meet are kids, they are scared – they just need motivation and encouragement to take the test and learn about HIV. Males especially don’t seem to have time for the clinic, so they won’t come in unless they feel sick. That's why it's important that there are mobilisers in the college, who are a crucial part of the team. Mobilisers encourage the students to get tested, give them education about preventing HIV, and provide free condoms. Young people know where to get help because the mobilisers are telling them.
Working in a college presents its own challenges, though. We are specifically reaching students here, so after three or six months, they may leave as they finish their studies. If someone is leaving, we write a transfer letter so that they can continue treatment and collect their medication near their homes.
The patients we meet are kids, they are scared – they just need motivation and encouragement to take the test and learn about HIV
These young peoples’ adherence to treatment is generally very good. We work with lay counsellors who do adherence classes individually with each patient; it helps a lot. The students here are almost all viral load suppressed, which means that the drugs are working and the levels of virus are extremely low. I had one patient who came to me after they had stopped taking their HIV medication, because they found it difficult to take while living with others. But we welcomed them back and are working with them to stick to their treatment.
Slindile at work. Photo: Hannah Whitcombe / MSF
Most people understand what HIV is; these days there are very few people who are ignorant about it.
However, we do have to correct misconceptions and add more information so they understand it better – some people say they trust their partner because they've been together for a long time and so they have unprotected sex, but they know that their partner hasn't been tested, so it's blind trust. We have to continue to tell them that trust is not enough: you must imagine everyone to be positive until they test negative, otherwise you are at risk.
Trust is not enough: you must imagine everyone to be positive until they test negative, otherwise you are at risk
I am hopeful about the future, I think that things are getting better. Now there are children that are born HIV-free, even though they have HIV-positive parents – that brings hope.
With the treatment we are giving, as long as the viral load is surpressed, the next generation can be HIV free.