By VIOLET MENGO
28/09/2011
EMELIA Phiri, 33, a married woman with four children, a resident of George township in Lusaka, found herself pregnant again. She is scared because she has had three miscarriages which she has been suspecting her mother-in-law of being responsible for, through witchcraft.
She went to her local health centre for antenatal services at 24 weeks. She is one of the 16,000 newly pregnant women seeking antenatal services in the clinics of Lusaka in a month.
Because she did not want anything to happen with her pregnancy, she decided to take an HIV test and to her surprise she was found HIV-positive. When her husband learnt her results, she convinced him to be tested as well, partly because he had become ill several months earlier and was worried. He too was found HIV-positive.
The couple found great help and comfort in the supportive follow-up and counselling for HIV and AIDS and infant feeding that they received at the clinic. Ms Phiri delivered a healthy baby boy weeks later.
After assessing the infant feeding options presented by the counsellor, the couple decided to breastfeed exclusively for six months. The child is currently growing well.
Mary Chakulunta, a 24-year-old married woman with two children, early this year decided to attend Matero Clinic to seek family planning services.
After participating in health education on HIV and AIDS, Prevention of Mother to Child Transmission (PMTCT) and the benefits of voluntary counselling and testing, she decided to take an HIV test.
She realised that she could be at risk because her spouse has had extra marital affairs which had strained their marriage considerably.
Ms Chakulunta learnt that her tests were negative, later she tried to convince her husband who also tested and his results were negative. The couple was very happy and is now able to discuss their relationship more openly.
Miriam Daka and Osward Bwalya, a young couple who live together, have big plans to get married and grow old together and so they have much to smile about.
With such big plans, they say, it only made sense to start their journey together by getting tested for HIV as a couple.
“By getting tested together, we will know the truth together from the start,” said Mr Bwalya, a carpenter at Garden market. “It’s a way of showing commitment to one another.”
Against such circumstances, Zambia Emory HIV Research Projects (ZEHRP), a pioneer in couple voluntary counselling and testing has been encouraging couples and partners living together to know their HIV status.
ZEHRP director William Kilembe said couples’ voluntary counselling and testing has been low in Zambia despite the organisation’s continued sensitisation.
Couples are defined by ZEHRP as two people who are married, cohabiting, pre-marital partners contemplating marriage, sex partners, or pre-sexual partners.
Dr Kilembe said couples often won’t test together because of conflicting work schedules or because so many married couples in Zambia live great distances from each other due to work.
He said testing together as a couple actually eases the burden of disclosing results to partners. “It can be a difficult thing to tell your partner your HIV status. But if they are counselled and tested at the same time, and they are together when the results come, that added pressure is taken away,” he said.
Making a presentation at a recent Couple HIV Voluntary Counselling and Testing (CHVCT) at the Hotel Intercontinental, he said couples need to consider VCT as an important component of their life in terms of planning.
Dr Kilembe said the research conducted by the organisation in Lusaka and Southern provinces revealed that there is still a lot needed to be done to encourage couples to test together.
The study showed that from 1994 to 2002, a total of 10,000 couples tested, while in from 2002 to 2007, 15,000 couples tested.
Dr Kilembe said from 2008 to first half of 2011, a total of 14,297 couples tested while during the same period in Southern Province 15, 290 couples tested.
He said as the HIV and AIDS epidemic escalates, it is increasingly vital that services including VCT are provided along with information and education about HIV and AIDS.
“VCT is an important tool for preventing the spread of HIV especially in communities with generalised epidemics. Testing allows couples to know their own status and to evaluate their behaviour,” he said.
Dr Kilembe said a negative test result offers a key opportunity to reinforce the importance of safe and risk reducing behaviours, while the positive test should allow a couple to receive referrals for counselling, care and support.
Dr Kilembe said the low VCT turnout by couples has forced the organisation to enhance its services.
From 2007, ZEHRP has been conducting VCT stand-alone services with influential network agents and leaders such as faith-based organisations, health non-governmental organisations (NGOs) and the private sector.
Dr Kilembe said: “From 2008 onwards, integrated services into government clinics are done on weekends; nurses have been trained in Couple Voluntary Counselling and Testing (CVCT). The response has been overwhelming.”
He said integrating CVCT with antenatal programmes is key to identifying many pregnant women who in turn can come with their spouses for VCT.
Dr Kilembe said there is need for a comprehensive, structured and consistent referral system between Couples Voluntary Counselling and Testing and Prevention of Mother to Child Transmission.
Professor of Medicine and Public Health at the Emory University and Founder of ZEHRP Suzan Allen said with Government support in enhancing the lives of the people of Zambia, the CVCT is likely to be a success.
Dr Allen, who gave a presentation of how couples CVCT worked out in Kigali, said Rwanda’s Ministry of Health endorsed testing of male partners in antenatal while weekend programmes were set to accommodate both partners together.
“All parents want the best for their babies,” Dr Allen said. She said knowing one’s status allows couples to better decide their future and to have healthy babies.
She said: “The Kigali process to having a national CVCT programme a success took a lot of commitment from all stakeholders and government.”
It is said that one can really know the partner when you know each other’s HIV status. Testing is an act of love for each other.
She said from the lessons learnt, it is evident that successive implementation depends on support from government, funding agencies and leaders in influential positions in communities and faith-based organisations.
She said there is enthusiasm for CVCT, but tools, resources and political will are lacking . Advocacy and active promotion of couples testing together is critical to creating demand, as most Africans do not know that one partner can be HIV-positive while the other one negative.
Dr Allen said many approaches to HIV prevention and care require people to know their status. The importance of VCT has brought about wider promotion and VCT services.
However, since the majority of countries where HIV has a major impact are the poorest, the lack of resources has meant that VCT is still not widely available in the highest prevalence countries.
For VCT to be prioritised and for resources to be provided, demonstrating the effectiveness of VCT is essential.
ZEHRP has supported the training of health workers and HIV counsellors from public, private and civil society in CVCT.
As a result of the training, a good number of public clinics now target couples testing as part of the Prevention of Mother to Child Transmission (PMTCT) programme.
Zambia Prevention Care and Treatment (ZPCT) senior advisor Andrew Kumwenda said the organisation has been conducting capacity building among community leaders to enhance couple counselling and testing.
Dr Kumwenda said community sensitisation and mobilisation through the involvement of traditional leaders and other influential community members are vital.
“We have operated in Luapula and we have seen that the involvement of traditional leaders and other community leaders significantly improve couple counselling and testing,” he said.
Society for Family Health (SFH) has been running Partner for Social Marketing (PRISM) which focuses more on couple counselling and testing.
Since 2009 to date, a total of 134,656 couples have been tested in seven districts of Zambia.
The National VCT day this year placed emphasis on getting tested now and together.
The government, civil society and the private sector have been working to enhance and ensure that couples get tested together as this will build confidence and enhance the love for each other.
As they continue in their quest to encourage more couples to come out and test, issues of polygamous marriages need to be addressed because most data collecting tools only require two people.
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