A walk in my shoes: A social worker in South Africa makes a difference for children vulnerable to HIV

By Matshediso Mohoje

This story was originally published on USAID's website. See the original article here.

I first heard about the girl from a nurse at a clinic that I support in Bojanala, South Africa. A social worker with USAID’s Government Capacity Building Support program, or GCBS, I followed up with a visit to the girl’s home. I knew the case might be critical, but the situation was even more dire than I’d expected.

We found a 13-year-old girl alone and locked up inside an unkempt house, unattended to and malnourished. She was pale and had lost a considerable amount of weight, and she had not been attending school for about four months.

The girl had been born with HIV, but her mother had never explained this to her because she remained in denial about her own HIV-positive status. I knew from my training that the girl needed urgent medical attention. With permission from the girl’s mother, I got her to a clinic. It was a turning point for the family. I provided the girl’s mother with counselling to help her accept her HIV status and disclose to her daughter why she’d been so ill. I also helped to ensure that the girl stayed on antiretroviral medication, that she got enough nutritious food, and that she rebuilt her relationship with her mother and returned to school. Today, both mother and daughter are thriving.

This family’s story highlights how strong social services – provided through dedicated case management by well-trained social workers – are a critical part of the fight against HIV and AIDS. For children and families affected by the epidemic, HIV is not only a medical experience; it is also a social and emotional one that profoundly affects their lives and their futures. It is often social workers who provide important links between families and health workers and help children overcome the many social challenges associated with HIV. Social workers contribute to the achievement of 95-95-95 targets by reducing risks associated with HIV infection, promoting HIV testing, and providing medication adherence support for HIV-positive children and adults in household and community settings that are beyond the reach of clinics.

We all need somebody to listen to us and to have a little faith in us despite our scars and imperfections. HIV and AIDS is everyone’s business. We are all impacted by it, it is all around us. We therefore need to approach it in an impartial and non-judgemental manner.

I have been a social worker with Pact for about five years. I work under the GCBS program, a partnership between Pact, USAID/PEPFAR and South Africa’s Department of Social Development. Since 2013, GCBS has worked to build South Africa’s capacity to better support orphans and vulnerable children in an effort to reduce new pediatric HIV infections. One of the program’s main achievements has been building up the capacity of social workers like me.

For as long as I can remember, I have wanted to help people. I have always wanted to make a difference, to be the difference, to see the difference. Social work has provided me an opportunity to do just that. It is a career that has instilled in me a great drive and ethic. 

The crux of my job is to effectively implement the South African Children’s Act 38 of 2005, by providing social services to children and adolescents who are orphaned or vulnerable because of HIV and its impacts. The case management process is critical to this. It guides me as a case manager to systematically screen, assess needs, plan and monitor a client’s progress. In the context of HIV/AIDS, case management enables referral and linkages among local partners and stakeholders.

A big part of my role is helping families to understand and accept their HIV status, including disclosing their children’s status to them, and helping children to stay on antiretroviral medication. But in doing so, I also assess and address many other needs, often through referrals to other qualified professionals. This includes HIV testing and services to meet socio-economic needs, such the provision of social grants and food parcels. Case management is an indispensable technique that advocates for children and their families to receive a comprehensive package of services.

Another key part of my job is providing education and fighting social stigma and nonchalance about HIV – a need that is especially great in rural parts of North West, the South African province where I work. Misinformation is one of the biggest barriers that my clients and I face. Teaching girls and boys about basic concepts such as safe sexual practices and sexual reproductive health is quite pertinent, particularly in low-resource communities where myths and untruths prevail.

The Covid-19 pandemic has meant additional challenges, but GCBS and its social workers have adapted, introducing telephonic counselling during South Africa’s nationwide lockdown to ensure that families have the resources they needed to stay healthy. I have been able to offer my clients the support and guidance they needed during the sombre and uncertain times of the pandemic, including guidance on how to prevent the spread of Covid and how to continue accessing medication and other vital HIV-related services.

Yet for as much as I do for the children and families I serve, they serve me, too. Social work is the one career where you walk into an office or a home thinking that you are going to help somebody, only to walk out being reformed by that person’s circumstances.