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Launch of Non-Judgmental Wellness Centre for Key Populations

On the 3rd September, TB/HIV Care launched a fixed site wellness centre with a different focus. This wellness centre in Observatory, Cape Town, will concentrate on providing health care services to ‘key populations’; people who are ‘key’ to the response to the HIV and TB epidemics. This includes sex workers, people who inject drugs, men who have sex with men, and transgendered people.

Key populations often face high levels of discrimination, even at health centres, and therefore may have challenges accessing care. Catherine Williams, a professional nurse counsellor at TB/HIV Care Association explains why mainstream health facilities may not be the first choice for key populations, “Most people are not comfortable because they either get judged by health workers as immoral or, in the case of injecting drug users, there’s often a great deal of fear that health workers will report their illegal drug use to law enforcement and get them into trouble.”

The new wellness centre in Observatory will provide HIV counselling and testing, screening for TB and sexually transmitted infections (STIs), syndromic management of STIs, viral check-ups, and pap smears, among other services. It is believed key populations are more likely to access services at the wellness centre because it is a ‘judgement-free space’. TB/HIV Care’s outreach teams are also actively building connections within key population communities to help establish trust within these ‘hidden’ communities.

Providing an alternative point of health care is not the only or a complete solution to improving access to health care for key populations however. TB/HIV Care’s key populations programme also runs sensitization workshops with mainstream health facilities to improve the way vulnerable people are treated by health workers. It is hoped that ultimately improved service at mainstream health facilities will increase their use by key populations.

The wellness centre will be open from 10h00-15h00 on Wednesdays and by appointment Mon-Fri at 021 447 0565.

Why are community care workers important?

“By doing my job I am taking the clinic to the community”
-Philippi-based Community Care Worker

The July strikes and subsequent arrest of community health workers in the Free State have focused attention on the role of community-based workers in South Africa’s health system. This type of health worker is critical to the success of TB and HIV programmes.

In his recent budget vote speech, Health Minister Aaron Motsoaledi said that as of January next year antiretrovirals (ARVs) are to be rolled out earlier– at a CD4 count of 500 (as opposed to 350). This means more people will be on treatment. Yet success in fighting HIV as well as TB does not stop at access to and availability of treatment. Additionally, people who start treatment must continue to take TB medication for at least six months, or in the case of ARVs, for the rest of their lives. With clinics overwhelmed by the need to diagnose and start patients on medication, the difficult task of keeping patients in care and walking the journey of treatment with them falls to a different cadre of health workers – community care workers.

Community care workers (CCWs) are tasked with supporting members of their community who are living with HIV and/or TB. They do so weekly and focus on giving adherence support (monitoring whether clients are taking their medication through counting pills), making referrals for social services, and screening other households members. Their function is especially important when there is insufficient social support in the home and a lack of knowledge about TB and HIV. With busy clinic health workers who may not speak the language of the patient, community care workers can become the main source of health information for a patient and a critical link to the health facility.

TB/HIV Care Association employs a total of 243 community care workers in the Western Cape, the majority of whom are women. Being a community care worker is not an easy job. Because these women must walk around the community visiting their patients, they are at risk. Many experience varying degrees of gender-based violence while doing their work. Like other health workers, CCWs are also at increased risk of contracting TB.

As an indispensable part of South Africa’s current and future health system, it is TB/HIV Care’s position that community-based workers should be acknowledged, properly supported and trained, and adequately compensated for their work.

HIV Counselling & Testing – Revitalized!

In July, the National Department of Health announced a ‘revitalization’ of the national HIV counselling and testing (HCT) campaign that was held in 2010/11. The campaign, like the first, intends to make knowing your HIV status top of mind for the public, but this campaign has also refined its focus.

The initial, 2010/11 national HCT campaign aimed to test 15 million adult South Africans within the course of a year. About 13 million people were reached. TB/HIV Care has been running an HCT programme since 2007 and supported the campaign within clinics and hospitals through ‘facility-based’ lay counsellors, and in communities through mobile teams consisting of a professional nurse counsellor and 3 lay counsellors. Over the course of the 2010/11 campaign year, TB/HIV Care tested 282 339 people. Last year, this rose to 417 501.

The new, ‘revitalized’ campaign is different. The targets set for this year are focused on specific groups of people or populations. The campaign will aim to reach sexually active people, those who have not tested before or within a year, on young people in high schools and tertiary institutions, and on people living in densely-populated areas where HIV prevalence is high. The idea is to target efforts to achieve the greatest impact.

Another aspect of the new national HCT campaign is that it has expanded beyond HIV into a full wellness package that includes screening for TB, sexually-transmitted infections and non-communicable diseases like diabetes and hypertension, as well as promoting medical male circumcision and other methods of HIV prevention.

TB/HIV Care is well-placed to roll out this expanded package of care, and to reach the target populations. Each mobile team is equipped to test for HIV, to screen for TB, STIs, diabetes, hypertension and to measure body-mass-index. With mobile teams, TB/HIV Care is also well-suited to seek out the populations being targeted as these groups might not regularly visit health facilities.

TB/HIV Care Association will support the revitalized HCT campaign in all 10 districts in which the organization operates.