Decentralised distribution of ARVs restores villagers’ dignity

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Alvine Kapitako

Onandjamba-Benhard Uugwanga is Gwaanaka Support Group’s last man standing. Diagnosed with HIV 13 years ago, Uugwanga gets moral support on how to live positively with the virus from a group of spirited women, who also happen to be HIV-positive.

They often gather under a tree close to the main road at Onanjamba village in Onyaanya Constituency. The frail-looking Uugwanga previously attended the support group meetings with two other men, who have since died.
“Men are not comfortable to reveal their HIV status to the community; that is why they are not here,” he says. When the group meets, it is easy to identify the members as HIV positive, because word has spread throughout the village and other nearby villages that they meet to encourage one another to live positively with the virus that causes AIDS.

In fact, the group’s services advanced as of June 1, when the members started receiving their HIV medications under a tree. Gwaanaka Support Group is the first group in Oshikoto Region to start community-based refill antiretroviral therapy distribution at support group level.

They meet at 07h00 in the mornings and group leader Elli Ndhikwa then takes their health passports. Ndhikwa travels to the Onyaanya Health Centre, where she collects the medicine on behalf of the group members.

She has the privilege of not queuing up at the Onyaanya Health Centre though. Instead, she gets the medicines on behalf of the group, straight from the pharmacist. She then signs for all the medicines received.

Each group member who receives their medicine from Ndhikwa also signs in a yellow book that they received the medicine when it was dispensed to them. One of many advantages is that the group members are now seen by a medical doctor twice a year for blood examinations.

I was shocked to death
Coming to terms with being HIV positive was not easy, says Uugwanga, who sat quietly with 16 women of his support group, as journalists interviewed them individually on Wednesday.
“It was hard. I really felt bad,” Uugwanga said softly in response to a question about how he dealt on receiving the news that he is HIV positive. “I was shocked to death,” he adds with an strained smile, that seemed slightly forced.

Although being HIV-positive is not a big deal nowadays, it was then because at the time, stigma and discrimination were much more pronounced than it is now, Uugwanga noted. This made it even more difficult for men to come out and reveal their status, he adds.

“I like it here. I get to spend time with people who are like me… people who understand what I go through without judging me,” adds Uugwanga, who barely maintained eye contact throughout our interview.

His eyes do not reveal too much. He responds to questions directly, yet softly and somehow with a sense of hope, relief or perhaps an indomitable sadness at the hard blows life had dealt him over the years.

Nonetheless, he chose to remain positive in his outlook and was happy that the group members no longer have to undertake long distances to get their antiretroviral drugs. “Waiting in the long queues for our medicines is now something of the past,” Uugwanga said, adding that their dignity has been restored.

“We don’t have to ask for transport money to go to the clinic [anymore],” the father of five further stated.
Community-based ARV therapy

The community-based antiretroviral therapy (CBART) is a model for stable patients on HIV treatment. It is one of the features of decentralisation of treatment.

CBART is designed to take the delivery of ARVs closer to the community and provide appropriate support to encourage long-term retention of patients. Previously, some people walked as far as 70 kilometres to get to the nearest health facility.

The government of the United States of America, through the US President’s Emergency Plan for AIDS Relief (PEPFAR), has teamed up with the Namibian government to address HIV and AIDS in country.

In May, US Ambassador to Namibia Thomas Daughton visited the Gwaanaka Support Group here at Onandjamba to acknowledge the 750 people living with HIV and receiving ARV medication through refill groups.

“As a result of the incredible work that we have done together, we have been able to celebrate the progress made in reducing new HIV infections and in improving the lives of patients living with HIV,” Daughton said at the time.
CBART is an answer to one of the basic challenges in Namibia, where patients are spread across large expanses of territory, said Daughton, who was present to observe the milestone celebration of the Gwaanaka Support Group as a refill group.

“CBART allows HIV-positive patients who are otherwise healthy to get their HIV medicines right in their own communities without having to travel to a clinic every one or two or three months. And making it easier for the patients to get their medicines means they can take their medicines on a regular basis and not miss any doses – and stay healthy,” Daughton stated.

The load has been lifted
Ndhikwa, who has been living with HIV since 1994, said some HIV-positive patients defaulted on their medication because they are discouraged by having to spend many hours in long queues to access the medicine.
“Some people waited for many hours at health facilities to receive their medication without having anything to eat,” said Ndhikwa.

The nurse in charge at Onyaanya Health Centre, Loide Nakumbwata, says nursing staff is reaping the benefits of community refill groups, saying a huge burden has been lifted since decentralising the ARV services to the Gwaanaka Support Group.

“The overcrowding of patients has been decongested,” Nakumbwata noted. Many patients have since expressed keen interest in joining the support group, she added. But, there are requirements for patients to receive their medicines at community level.

“People who can join the groups are those who adhere to treatment, they should not consume alcohol or use drugs, and they must be in difficult to reach areas,” said Nakumbwata.

For now, the only problem members of the Gwaanaka Support Group encounter is that they meet in an open place without any protection from the sometimes harsh weather conditions.

“We are thankful for the assistance so far, but we are calling on supporters to assist our group by building a shade to protect us against the sun and rain. We also hope that Good Samaritans will assist us with food while we wait for our leader to get our medicines from the clinic, because some of us come and wait here on an empty stomach,” said Uugwanga, with Ndhikwa sharing similar sentiments.

The group ended their meeting with songs and dance in appreciation of the Namibian and US governments’ support.
Statistics from the US Embassy in Namibia show that HIV/AIDS remains the number one killer in Namibia, with up to 3,900 deaths a year. Thus, much more remains to be done to attain the 90-90-90 target of the United Nations, which aims to help end the AIDS epidemic by 2020.

This means that by 2020, 90 percent of all people living with HIV in Namibia should be identified and know their status. It also means by that same year, 90 percent of those identified should be on antiretroviral treatment and 90 percent of those on antiretroviral treatment should have their viral load suppressed.

In Namibia about 85 percent of people living with HIV know their status, while 86 percent of those who are HIV-positive are on antiretroviral treatment; and 84 percent of those on antiretroviral treatment have their viral load suppressed.

“We‘re close. The last mile is usually not the easiest,” Dr Simon Agolory, the country director of the U.S. Centre for Disease Control and Prevention told journalists in May.

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