Botswana, 25 November 2013: Lay counsellors support Botswana’s health workers - and the country’s fight against HIV/AIDS
By Suzanne Beukes
On 29 November, UNICEF releases Children and AIDS: Sixth Stocktaking Report, the first report of its kind since 2010.
An AIDS-free generation once seemed like a far-off dream. But, now, the world has what it takes to make this dream a reality. Advancements in preventing mother-to-child transmission of HIV have greatly decelerated the rate of new infections in babies in low- and middle-income countries. However, the same progress has not been seen in treatment for children living with HIV, and the trajectory of AIDS deaths among adolescents living with HIV remains alarming.
A bold approach employing non-medical staff as counsellors has helped Botswana achieve a major reduction in mother-to-child transmission of HIV.
GABARONE, Botswana, 25 November 2013 – In a small office in a busy health clinic, Esther Tebatso spends much of her day dealing with what is sometimes the most traumatic moment in a person’s life: giving a 15-minute rapid HIV test for pregnant mothers.
“This job is difficult,” she says. “If a woman finds out she is positive, we sit down, we give her counselling so that she can cope with the situation, and we also do follow-ups on how she is doing and check that she is taking her medication if she is on antiretroviral treatment.”
Esther is a lay counsellor, a health-care professional introduced as part of Botswana’s efforts to address the country’s high HIV prevalence and to help ensure that babies born to HIV-positive mothers are born HIV-negative.
Testing and counseling HIV-positive mothers is a far cry from Esther’s former career in a bank, but after seeing the impact HIV was having on her community, she felt she had to do something to help.
“I decided to become a lay counsellor because there was a lot I saw in the community. People were dying, people were sick from HIV.”
In 1999, Botswana had one of the highest rates of people living with HIV, with an estimated prevalence above 35 per cent in adults. As a measure to prevent the transmission of HIV from pregnant mothers to children, the country piloted a massive programme to provide free testing, counselling and antiretroviral drugs to expectant mothers who were HIV-positive.
The programme was rolled out nationwide a year later. Dr Refeletswe Lebelonyane, Director of the Department of HIV and AIDS at the Ministry of Health, describes the political push behind the programme: “We knew we had to fight with what little resources that we had in the fight of this HIV, because saving the children was to save the nation.”
This quick turnaround in the government’s HIV policy, however, meant that health staff found themselves overwhelmed.
“The workload was quite high, because we were doing our normal things and then we were asked to take the HIV patients into the programme,” says Dirang Sibanda, a midwife at the Kgatelopele Clinic and a nurse for 37 years. “We had to do the screening, take the blood test, and then start giving the treatment to the mothers.”
To alleviate the workload put on nursing staff, the Government came up with an innovative and effective plan: encourage citizens with a basic education to learn how to test and counsel HIV-positive pregnant mothers. In 2003, the ‘lay counsellors’, as they were known, started working in clinics and hospitals.
The introduction of these new foot soldiers in the fight against HIV, combined with routine HIV testing for all pregnant mothers in antenatal programmes, proved to be a turning point.
“When the lay counsellors were introduced, it was quite a relief,” says Ms. Sibanda. “Because sometimes we would take quite a lot of time doing counseling, and the queues would just grow outside.”
As a result of the Government’s bold policies and their rapid implementation, the number of HIV-positive pregnant mothers receiving antiretroviral treatment increased from 37 per cent in 2003 to 95 per cent in 2012.
Today, an estimated 99 per cent of pregnant women are tested for HIV, and the HIV transmission rate from mother to child has dropped to less than three per cent.
The question now is how will the country reach zero new infections?
With support from UNICEF and other partners, Botswana has developed the Strategic Plan towards the Elimination of Mother to Child Transmission of HIV and Keeping their Mothers Alive 2012–2015. Its purpose is to help guide efforts to meet the national target of less than one per cent mother-to-child transmission by 2015.
“We want to go below the one percent, so this is the fight that we want to continue,” says Dr Lebelonyane. “It is important to us because while we don’t want our children to be infected with HIV, we also don’t want them dying of other diseases. And we want to put the mother on early treatment, so that she is healthy and can take care of her children.”
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