HIV RESILIENCE HEROES
In Zambia, volunteer HIV educators hit the streets to end an epidemic
It’s a warm, humid Wednesday morning. Musongole Mutambo waits until 10, when the streets begin filling with people. He packs his backpack with condoms and referral forms and sets out.
He’s with two friends today, Melvin Malambo and Kennedy Zulu. They are all in their 20s, they all grew up here, and they all are volunteer peer educators with the Zambia Community HIV Prevention Project, or Z-CHPP. They make their way to Chitemmwiko Road, a bustling stretch of broken pavement lined by vendors selling produce, phone cards and still-squawking chickens. Bob Marley is blaring from nearby speakers.
“We know that there are lots of non-injectable drug users here,” Musongole says. “They’re one of the groups we target because they’re at higher risk.”
He spots a group of six men about the same age as he is. “Can I talk to you about HIV?” he asks. “Do any of you have sex without a condom?”
A few of the men shrug. They look less shocked by Musongole’s questions than one might expect. They answer yes to both.
Musongole, who is 29 and a mechanic, has been volunteering as a peer educator with Z-CHPP for three years. For several hours three days a week, he pounds the pavement. He says it’s something he felt compelled to do after losing five aunts and uncles to HIV and AIDS.
“I only have one uncle remaining,” he says. “I saw others in my family following that same trend, my cousins and brothers involved in risky things.”
He talked with his mother about what might be done to stop HIV’s devastation. It starts with you, she told him. Do something.
Back on Chitemmwiko Road, Musongole explains the basics of HIV, how it is spread, how it can be prevented and how people who contract the virus can live full, productive lives if they learn their status and take antiretrovirals properly. He pulls a penile model and a large box of condoms out of his backpack. He demonstrates how to check the condom’s expiration date, how to open its gold wrapper, how to put it on, how to take it off and how to properly dispose of it. All of the men are listening intently now, and a few more have joined the group.
When Musongole asks who wants condoms, they all reach for some. When he asks if they have questions, they bring up myths that Musongole dispels often: I’ve heard that condoms give you HIV. Is it true that antiretrovirals are bad for you? Is it true that we are all born with HIV already inside of us?
No, no and no, Musongole says. He shares more facts to make sure the men understand, then asks if anyone is interested in HIV testing. Three men say yes. As Melvin and Kennedy chat with other groups nearby, Musongole fills out referral slips to the nearest clinic, then fist-bumps the men and waves goodbye.
“They’ve taken a really important step in deciding to get tested,” he says.
“There is so much wrong information going around. Giving people the correct information is very powerful.”
Like all Z-CHPP peer educators, Musongole received thorough training to prepare him for this work. Also critical to his success, he says, is that he is from Mandevu. “This wouldn’t work if I wasn’t.”
He sees himself as a soldier in the fight against HIV: “The job of a soldier is to protect the community. We are protecting the community from HIV.”
He says his ultimate goal is to take back control from HIV.
A little ways up the road, Kennedy steps into a small wooden cigarette stand and makes his pitch. A group of seven men agrees to listen. “Do you know how someone gets HIV?” he begins. When he does a condom demonstration, it’s clear that at least some of the men have never used one.
Across the street, a couple has approached Melvin and Musongole. They share that one of them is HIV-positive and the other is not – what is known as a discordant couple, another group that Z-CHPP targets. They have questions about whether they can have sex safely and what they should expect if they decide to share the HIV-positive partner’s status with their families. Melvin carefully explains the importance of condom use and good adherence to HIV treatment.
“Did you know that it’s possible for HIV-positive parents to have HIV-negative children?” he asks them.
Besides non-injectable drug users and discordant couples, Z-CHPP targets adolescent girls and young women, people living with HIV and mobile men – those whose jobs keep them on the move, such as truck drivers and miners. Melvin, Kennedy and Musongole are adept at reaching all of these groups, at putting people at ease, and at making the uncomfortable comfortable. Every time they hit the streets, people decide to get tested who probably otherwise wouldn’t have. Usually the educators are accompanied by volunteer HIV counselors who can test on the spot.
“There is so much wrong information going around,” Melvin says. “Giving people the correct information is very powerful.”
The educators’ last stop is a place called Malasha, a charcoal market where they know they will find lots of mobile men – seasonal charcoal farmers who bring hulking bags of the handmade cooking fuel from far away. Everything here is covered in black dust – the ground, the walls of buildings, the trunks of trees.
“When they are here, they are away from home, away from their wives,” Musongole says of the charcoal farmers, “and they mingle with the community. This means a higher risk of spreading HIV.”
He and Kennedy and Melvin split up to cover more ground. Musongole approaches a large group of men and women selling charcoal and drinks under a tree. They’re skeptical, but they agree to hear him out.
Musongole wipes sweat from his forehead and then dives in, covering condom use, HIV testing, STI screening, the benefits of medical male circumcision and more. They’re his toughest audience yet, but his confident, spirited presentation draws them in. After he answers several questions, he has a few one-on-one conversations, including with a woman with a persistent cough. He fills out a few referral slips.
Musongole is pleased with the outcome: Several people in the group now want to be tested for HIV, although most said they’d prefer to do it here rather than at a clinic.
“We have HIV counselors who can do that,” Musongole says.
“We’ll be back tomorrow.”
A five-year project funded by USAID and implemented by Pact, Z-CHPP is reducing new HIV infections in Zambia with a range of prevention activities across five provinces chosen for their high HIV burden. Z-CHPP focuses on high-risk groups, using outreach and education to boost HIV awareness, change risky behavior and increase the use of HIV services. The project works closely with local Zambian organizations, building their capacity to plan, implement and monitor their own quality programs to stop the spread of HIV.
All photos: Brian Clark/Pact