Sharing Information, Saving Lives: a Noble Calling
By Gift Kaputolo, Program Associate, HIV Programming, HP+ Malawi
Nkhotakota District, home to about 300,000 people, is on the shore of Lake Malawi in the country’s central region. I went there this past July to meet with the district health office and the Evangelical Association of Malawi—one of six religious mother bodies implementing the Faith and Community Initiative with Health Policy Plus Malawi.
The goal of the activity is to increase the uptake of HIV services amongst men and boys—focusing on that group because surveys show that, in Malawi, men living with HIV are less likely to be aware of their HIV status, less likely to be on treatment, and less virally suppressed than women. Among HIV-positive adults 15–64 years of age, around twice as many men (12.7%) as women (6.4%) reported never having been tested for HIV or never receiving their test results. Only 63 percent of men older than 15 years and living with HIV are on antiretroviral therapy (ART), in contrast to 81 percent of women. Men are also more likely to die of AIDS-related causes than women.
Health centers and religious leaders in the eight districts where the Faith and Community Initiative is being implemented in Malawi work together to increase the uptake of HIV services, encouraging community members to get tested, get on treatment if found positive, and then adhere to ART. The success of this work hinges on the effective interaction among religious leaders, “expert client” volunteers, and healthcare workers. How the interaction works was part of my conversation with Austin Mattius, the ART coordinator at Kasitu Health Centre.
Since religious leaders started working with the health center, Mattius has seen a significant change for the better in regard to people sticking with ART. For example, in Kasitu, in the last quarter of 2020, 108 people had stopped ART, but in the first quarter of 2021, only 38 people had dropped out. Mattius says this is due to the relentless efforts of the expert clients recruited from churches and mosques.
Who are Expert Clients?
Mattius’s praise for expert clients is similar to what we hear across the other districts implementing the initiative. An expert client is someone who is open about their HIV-positive status and has been trained to provide support to others living with HIV. Their most important role is to inspire others—especially from their own church or mosque—to seek testing and treatment. As living proof that HIV treatment works, expert clients also provide essential peer-based support to men and boys who are reluctant to be tested, who have just begun treatment, or who are experiencing difficulties staying on treatment or with other aspects of living with HIV.
These expert clients belong to HIV support groups based in churches and mosques—a new approach to fight HIV in Malawi. Health Policy Plus, where I work, has engaged pastors and imams to use Messages of Hope to talk to their congregants about HIV testing, care, and treatment.
The Messages of Hope, first developed by PEPFAR for adaptation in countries implementing this initiative, were tailored for Malawi in collaboration with religious leaders, validated by the government, and then incorporated into an easy-to-use guide. The messages contain references to scripture from different texts including the Bible and the Qur’an. They help members of faith communities see that their beliefs and HIV treatment are compatible and help them understand that they can live long, healthy lives regardless of their HIV status.
How are Expert Clients Working under the Faith and Community Initiative?
Religious leaders and expert clients have built trust with health center staff. They bring new patients to health centers for testing and health centers inform them when patients have discontinued treatment or missed appointments. The expert clients visit these people at home or invite them to support groups. They share their own stories and urge clients to be tested or resume ART, highlighting the benefits of treatment and viral suppression.
In just over a year, by August 2021, religious leaders along with 632 volunteers have brought nearly 4,000 people back to HIV care—a crucial step toward Malawi reaching epidemic control. This has been achieved with concentrated efforts from all stakeholders: religious leaders disseminate the messages of hope in churches, mosques, and community gatherings and health facilities work closely with expert clients to reach people who have missed appointments.
Expert clients must travel long distances on foot—sometimes as much as 15 kilometers—to follow up with people who have discontinued treatment. Distance, coupled with the bad terrain, makes it sometimes a daunting task that would deflate most spirits. However, for most of the expert clients, this is a calling. They are committed to help others and to reduce the HIV burden in their communities. As Mattius stated, and I would agree, saving lives has not been much nobler.