TB/HIV Care has joined a working group, headed by Sonke Gender Justice, aimed at lobbying the Ministry of Women to design, fund and implement a plan to combat gender-based violence, similar to the plan that has been devised to respond to the HIV and TB epidemics; the National Strategic Plan for HIV, STIs and TB.
The group is calling for co-ordinated, concrete actions to be taken against gender-based violence rather than the ‘lip-service’ paid to the issue during the 16 days of activism campaign.
But what does gender-based violence have to do with HIV? Gender-based violence has been identified as a driver of the HIV epidemic by South Africa’s National Strategic Plan for HIV, Sexually Transmitted Infections (STIs) and TB 2012-2016. Studies published by the Medical Research Council (MRC) suggest that women with violent or controlling partners are at greater risk of HIV infection. The MRC’s Rachel Jewkes has found that 12% of HIV cases among women were associated with more than one case of violence from an intimate partner. Another Tanzanian study found that HIV-positive women (18–29 years) were ten times more likely than HIV-negative women of a similar age to report partner violence.
TB/HIV Care supported a collective action by the working group on Wednesday, the 10th December. In Johannesburg a petition was handed to Minister of Women’s Affairs, Susan Shabangu, calling on her to take action. At the same time in Cape Town, groups gathered at bridges with banners and posters asking people to hoot their support and participate in a letter-writing campaign to the Minister expressing their ideas for the proposed national strategic plan.
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.
“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.