Health-e (Cape Town)

18 September 2012

South Africa: Taking HIV Testing to Homes - Living With Aids

Photo: Allan Gichigi/IRIN
More than 20 million South Africans have come forth to be screened and tested for various diseases, including HIV, since President Jacob Zuma launched the HIV, Counselling and Testing campaign in 2009.

opinion

Home-based HIV testing, which enables you and your family to have an HIV test in the privacy of your own home without having to go to a health facility, is one of the newest efforts to be introduced to get people to know their HIV status.

The Mncwarhane family in Hlalanikahle Extension 1 township in eMalahleni, in Mpumalanga, is one of the first house-holds to test for HIV together in a home-based HIV testing programme.

"Almost all of us tested. Only one child wasn't around when we got tested. But all of us got tested, except for the under-age child", says sixty-something year-old David Mcnwarhane, the patriarch of the family of seven.

Home-based HIV testing gave David's oldest off-spring, 39-year-old Esther, her first ever opportunity to test for HIV.

"I probably wouldn't have tested if there was no home-based HIV testing. Even though I always wanted to go the clinic to test, I was fearful", Esther admits.

Five members of the Mncwarhane family all tested together in a new home-based testing programme initiated by New Start, a non-profit organisation that promotes HIV prevention. The programme involves visiting house-holds to educate people about HIV prevention and treatment and the need for people to know their status. It also offers HIV testing in people's homes. But how did the programme come about?

"Basically, we've been doing HIV counselling and testing at shopping malls, at taxi ranks and prisons. We've been going to people where they work or where they play. But we have been missing people who are stay at home people - that are sort of at home most of the time. So, the idea is to capture people everywhere they are. To get them we have to go where they are - in their homes. Definitely, it was an observation that we are missing out on a lot of people who are stay at home and, also, there are programmes like this in other countries where they've been doing this programme and it's been running successfully. So, it's a combination of observation and learning from others", explains Nkanyiso Ndlovu, the manager of the HIV Counselling and Testing programme at the Society for Family Health, which manages New Start.

Home-based HIV testing is already practiced in countries such as Uganda and Zimbabwe. Since the start of the programme in Hlalanikahle township in Mpumalanga, about 110 families have tested. Ndlovu explains that the programme has advantages.

"It saves time for the people that we test because we actually come to them. They don't have to go anywhere. It saves them money. They don't have to pay to get on a taxi. They are all in their home everybody is there, so they encourage each other. Those that need support, find support within their immediate family. So, it's much easier and much more beneficial to test in your house because you've got all your family members with you.

And if you need to disclose, you don't have to stress a lot about who you're going to disclose to because everybody in the home is already informed about what's happening. So, it's easier to disclose and get support. We do encourage it, but it's not something that we force people to do", he says.

The matriarch of the Mncwarhane family, Martha, says if families test together it's important to disclose their results to one another.

"We deemed it important to share our results so that we can support one another. If you're HIV-positive and you don't disclose your status, it might affect you emotionally and that secret might result in illness. So, it was important to know who has HIV and who doesn't so that we know what to do", says Martha.

Four out of the five family members tested HIV-negative. One of the children was found to be positive.

"We don't discriminate against him. We tell him to be open and to look after himself the right way and to go on with life", says the father, David.

New Start's home-based testing programme goes beyond offering just the HIV test.

"In addition, we do tests for their CD4 count right in their homes. We also do TB screening and collect sputum for TB. We then refer to clinics that are close by or the clinics that people prefer to be sent to. We already have established relationships with those clinics. So, by the time the client goes there they are being expected by the clinic and it saves them on waiting time as well because if you go on your own straight from nowhere, it might take you a whole day to get served. But if you have been at New Start already, they already know So, they'll take you through the service quickly", says David Ndlovu.

The manager of the programme in Hlalanikahle, Edith Nqakuvane, said home-based HIV testing is able to take testing services to members of the population who wouldn't otherwise have the opportunity to go for HIV testing, such as the elderly.

"The elders have a privilege of being tested. Because they've got arthritis, they can't walk for distances. So, when we come into their homes they are so happy. They say: 'I wanted to test, my child. But I can't walk to the clinic'," Nqakuvane says.

The programme offers testing to people from the age of two, with the consent of their parents or guardians. New Start currently offers home-based HIV testing in the Nkangala district of Mpumalanga and the Motheo and Lejweleputswa districts of the Free State.

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