It is a cloudy Saturday in Mulanje. About 200 men and adolescent boys in Mpholiwa have braved biting weather to get tested for HIV and other chronic diseases at a mobile health clinic organised by Global Aids Interfaith Alliance (Gaia).
“This is an ideal day for me,” says Samson Muhosa from the area in Traditional Authority Njema. “It is not easy to go for testing within the week, for I have to work and fend for my family.”
In Malawi, men are considered breadwinners. Some shun HIV testing services in preference for income generating activities. Others feel out of place as health facilities are dominated by women who often care for the sick and get tested when they are pregnant. Yet others rue long walks to clinics.
“There are many things that dissuade men from knowing their status, but I have never gone for testing because I live an exemplary life,” says group village head Ndala of the area. “My wife and I are faithful to each other. The last time she was pregnant, she was tested and was found negative. I know I am not positive.”
The traditional leader’s reasoning mirrors a widespread excuse which is reducing women to test kits.
“This is why most men seek treatment when they are crawling and almost dying”, says a woman who was diagnosed with HIV four years ago.
“When I knew my status, I requested my husband to go for testing. He refused, saying there is no way he could have tested positive when I was negative. He didn’t know I was diagnosed with the virus,” she explains.
The use of women as proxies not only reflects men’s resistance to HIV testing services.
It negates the existence of discordant couples like Moonda villager Tanazio Masenze who tested HIV positive last year even though his wife was found HIV-free after taking three tests.
The sad thing is that a husband will delay to know his status if the wife is negative, says Gaia programmes manager Nelson Khozomba.
“If she is positive, they will end up sharing her dosage. This will exert pressure on the dosage, meaning drugs for a month will be exhausted in just two weeks,” says Khozomba.
Data shows that fewer men access HIV testing than do women. As a result, men living with HIV often enter care with more advanced diseases, are less likely to receive life-saving ART, miss opportunities to prevent ongoing transmission and have higher Aids-related mortality than their female counterparts.
This slows down strides towards achieving the 90-90-90 goals as the country has embarked on a test-and-treat initiative in which those diagnosed with HIV start taking the drugs immediately.
The 90-90-90 target, backed by UNAids, reflects global hope that by 2020, 90 percent of all people living with HIV will know their HIV status; 90 percent of all HIV-positive will be on regular antiretroviral treatment; and 90 percent of those on treatment have an undetectable viral load.
The mobile health clinic programme and door-to-door tests, which Gaia is implementing with assistance from Elizabeth Taylor Foundation, are strategically tackling the first 90.
The change agents have deployed five ambulance teams in Mulanje and two in Phalombe, the southern district where HIV prevalence is double the national average of one in 10 people.
Each team comprises six health workers who see about 15 clients each.
“When we begun the mobile clinics in 2008, fewer men were coming for HIV tests. Out of five clients, only one was a man. So, we asked ourselves: what can we do to encourage more men to get tested?
“By taking the services closer to where men and adolescents are, we are reaching out to more and some are becoming community-based champions,” says Khozomba.
Elizabeth Taylor managing director Joel Goldman, who has been championing the rights and well-being of people living with HIV since he was diagnosed with the virus 26 years ago, is excited by the increase.
He explains: “Ensuring every man knows his status will reduce new infections among women and children. Besides, it will help those diagnosed with HIV to start treatment on time, have a healthy life and live long,” he says.
He shared his experience: “When the counsellor told me my results, I went numb. But I am still healthy and strong because I take drugs consistently and my viral load is suppressed.” n