By Taufiq Chipinga
“Life is meant to be lived; after all, it is way too short,” Jalison Njewa, 42, told me, quickly adding that this is the motto of most men and women around Mitundu Trading Center in Lilongwe.
Njewa has been living with HIV, which causes Aids, for about 16 years, and is optimistic about a bright future for his four children and 28-year-old wife, who is HIV-negative.
Recounting how, as a young farmer, he used to spend days working hard in the maize field and nights out to reward himself for all the hard work put in cultivating and fending for his family, Njewa seems not to remember who infected him with the virus, but clearly knows how.
“I had a couple of girlfriends I used to meet at night for a bit of quality time to kill the stress from a long day of hard work, it was a mistake,” he explained.
With a population of slightly over 500,000 people, Mitundu sits on the outskirts of the Lilongwe Central Business District, at a distance of approximately 30 Kilometres (km) to the West.
The trading centre is a busy place flooded with farmers and traders from all walks of life but it is unusually quiet.
Eric Thuthuwa, clinician at Mitundu Community Hospital, warned that the silence of the beer halls, video show rooms and night clubs could be fooling.
He disclosed that there is a silent rising tide of sexual activity among men and women, both young and old, with HIV spreading like wild fire to the surrounding farming steads and beyond.
“There is a growing burden of diseases, including HIV and Aids, here. The HIV prevalence rate is, by estimation, around 3.3 to 4 percent,” says Thuthuwa, who is the hospital’s focal person for Anti-Retroviral Treatment (ART).
Since its inception in 2006, the ART clinic at Mitundu has registered 7,857 clients as at June 30 2022, out of which 2,747 are still alive.
According to Thuthuwa, some of the clients abruptly stop reporting to the clinic and default on treatment and are, at times, untraceable, leaving their statistics for HIV patients Lost to Follow-Up (LTFU) at about 33 percent.
“LTFU is a serious challenge we are trying to tackle. We are working very hard. As of 2021, the figures were standing at around 1,115 but we now have 844 patients that we can’t trace, but we are working very hard to reverse the trend,” he said.
Asked about reasons why clients default on treatment and stop reporting to the clinic, Thuthuwa says long distances to the hospital, self and public stigma and lack of HIV status disclosure are some of the reasons.
Attesting to Thuthuwa’s sentiments, Njewa says, during our conversation, that he cycles for a distance of about five Kilometres from his Kasumbu Village, in the area of Traditional authority Masula, every time he has a hospital appointment.
It takes him an average of one hour and a half for one way, he said.
“Since my diagnosis in 2006, I was in denial. In 2008, my CD4 count was so low that I was put on Anti-Retroviral (ARV) drugs, and the distance just made it worse such that I stopped taking the drugs and stopped coming to the hospital in 2008 up to around 2010,” he explained.
Thirty-five-year-old Halima Hamiton says, after losing her husband to tuberculosis in 2012, she experienced ill health, forcing her to go for Voluntary Counselling and Testing (VCT) for HIV.
The test came out positive and she was immediately put on ART in an effort to boost her immunity and CD4 count.
Two years later, she says, there was so much improvement in her health and quality of life that she started missing hospital appointments more often.
“I drew closer to God and I was sure that I was well and that my body got rid of the virus. I was no longer complying with treatment needs,” Hamilton said.
One Monday morning in November 2015, Hamiton had a rude awakening after waking up to breathing difficulties, a headache and some kind of panic attacks.
“It was pneumonia; I paid the price for non-compliance to ART and medical advice. Thank God, I was re-introduced to ARVs and I am now fine,” she said.
Today, Hamiton is a happy mother of four, with the youngest born in 2021 and is HIV-negative, thanks to the expatriate care and advice of health personnel at Mitundu Community Hospital.
She is now part of Chedza Support Group, where members living with HIV give each other emotional support and are able to access safety nets to cushion them in times of hardship.
Njewa and Hamiton present a good picture of challenges patients on ART face, not just in Mitundu but in most parts of the country.
Anthony Chafunya is Director for Mitundu Community Hospital and said, in an interview recently, that, with a catchment area of 550,000, the facility serves people from Dedza District on the eastern side and Mozambiqe on the south-western side.
Due to the geography of the area, he said, there are HIV patients who transfer to other clinics on their own accord, while very few seek reference from the hospital, making it difficult to track them.
Among some of the healthcare facilities close to Mitundu Community Hospital are Chiunjiza which is 31km away, Dickson Health Centre at 20km and Malingunde, which is situated 25km away, among others.
Chafunya observed that the huge transport costs that people have to incur to come to the hospital for ART are contributing to increased losses as far as caring for patients is concerned, additional to myths and misconceptions about HIV and Aids.
Other patients, he said, think the clinic lacks privacy and that they do not like the long waits they have to endure in order to be attended to.
He warned, however, that such patients’ immunity goes down and are prone to HIV-related sicknesses and that such defaulters increase the risk of transmission in their communities.
“Many are the times that we get patients wanting to restart treatment after a couple of missed appointments due several reasons; those are our concern too,” he said.
Despite a constrained resource basket of about K500,000 per quarter, Chafunya disclosed that they, as a hospital, have designed interventions aimed at improving treatment retention and, ultimately, patient outcomes.
From January to March 2022, he said, they embarked on a deliberate initiative of bringing back to care all patients that had been lost to care, through community visits and phone calls, which saw them reducing the LTFU rate from 40 percent to 33 percent.
Following that success, through the newly launched Bring Back to Care (BBC) initiative, Chafunya said they would like to address serious barriers to HIV treatment in Mitundu.
Apart from extending weekend ART clinic hours, the hospitals adopted a segmented approach for attending to clients so that they are able to deal with specific issues depending on age-groups separately.
“We want to, through BBC, bring down the LTFU rate from the current 33 percent to 15 percent by end of August 2022,” he explained.
Chafunya said they have, so far, been engaging community members through faith leaders and community-based organisations to sensitise people in their areas to issues such as the importance of taking ARVs and also ironing out myths and misconceptions surrounding the disease.
One of the expert clients, Etria Chimwala, who has lived with HIV for about 20 years, admits that religious and cultural beliefs are a hard nut to crack in their work since they involve the spiritual and psychosocial component of a human being.
But ART nurse at the hospital, Mark Chiipanthenga, is optimistic that, through BBC, they will be able to achieve their ambitious target of bringing down the LTFU rate to 15 percent by August 2020.
“Despite the problem of limited resources, we have a number of options we are working on, and the results are quite encouraging. To patients that are traveling longer distances, we provide supplies for not less than three months, apart from engaging other clinics when the need arises,” he says.
Asked on how the Ministry of Health intends to support the initiative that authorities at Mitundu Community Hospital have embarked on, spokesperson for the Ministry of Health Adrian Chikumbe referred us to Ministry of Local Government, saying the health financing system being used does not allow the ministry to engage with community and district hospitals directly.
“We do not want to rush to say it is a welcome move when we don’t know the nitty-gritty of whatever they are doing, need I say that] facilities like Mitundu are funded through the National Local Government Finance Committee,” he said.
But health Rights activist Maziko Matemba says the ministry’s stance defeats the whole cause in the fight against HIV and Aids in the wake of the new targets that Malawi has set for itself, having succeeded in achieving the 90:90:90 benchmarks that were set for the year 2020.
Recently, Health Minister Khumbize Kandodo Chiponda called Malawians to embrace the five-year T = T campaign, which aims at reducing the HIV and Aids occurrences in the country by 2030.
The T = T campaign, which stands for Tizilombo tochepa (ta HIV) = Thanzi (labwino), is an initiative that encourages people living with HIV and Aids to adhere to medication as one way of fighting the virus.
The Minister launched the campaign on June 19 this year.
“The Ministry of Health will continue to strengthen collaboration with civil society organisations, networks of people living with HIV, and other relevant organisations to raise awareness on the benefits of treatment adherence and viral load monitoring as well as the concept of Treatment as Prevention through this campaign.
“I would like to request all people living with HIV in our country as well as local and faith leaders, parents, guardians and health workers to collaborate with my ministry and embrace this campaign as we roll out campaign activities,” she said.
However, achieving overall success depends on small, but significant, efforts such as those being made in Mitundu.