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.
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