I had heard that South Africans were warm and friendly, but imagine being hugged by 15 grannies! This was one of the highlights of my recent trip to South Africa for the Population Council.
In South Africa, nearly one in five people is living with HIV and AIDS, including an estimated 280,000 children under 14. I was visiting the Population Council’s South Africa office for a week and had just flown to East London, a small city in the Eastern Cape Province. Thandi Mini, a program officer for the Population Council, was my guide for the day. In the car, she explained to me that I would be seeing some health clinics, the Cecilia Makiwane Hospital, and a government site where South Africans receive grants to assist in caring for their families.
Thandi drove us to a very poor township on the outskirts of East London. The hills were covered with tin shacks. Thandi explained that each shack contained an entire family – 5-7 people, which was hard for me to fathom. I really couldn’t count how many people were living in this community…certainly thousands. In this community there are high rates of child sexual abuse identified by health workers and some of these children tested as HIV positive. Near this settlement we drove to a government grants disbursement site surrounded by armed guards and barbed wire. This is where people went to enroll for government grants.
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When we arrived, we were surrounded by a group of 15 or so older women (called “gogos”, meaning “grannies”) wearing Population Council caps and t-shirts. Each one came over to me, introduced herself and gave me a big hug! I was immediately taken by their warmth and enthusiasm. These grannies, who are part of the Caregiver Project, funded by the President’s Emergency Plan for AIDS Relief and the American people through the U.S. Agency for International Development , are responsible for approaching older women who are coming to enroll for grants to help care for their grandchildren. Many of the grandchildren had parents who had died from AIDS or were no longer present in the children’s lives. The grannies educate the women about HIV in children and encourage them to have their grandchildren tested. We were unable to stay long because we had an appointment at the local hospital. We told the grannies that we would come back later to hear more about their work.
Next, Thandi took me to visit two health clinics and the public hospital. The facilities were packed with people who were there to get health services. The waiting rooms were filled, and people were standing along the hallways waiting for services. The surroundings were uncomfortable, and the patients were so patient! Residents are travelling long distances to get health services, and the facilities themselves are clearly overextended. We met with quite a few staff members, some involved with pediatric care and others involved in maternal care. The staff told me that many children were only being treated for HIV and AIDS when they showed up with serious symptoms and were quite sick. In this environment, children, who have such a strong chance of positive health outcomes when treated early for HIV, were not getting attention soon enough. Most children living with HIV reside in households where another family member is HIV-positive, so we need to find better ways to reach these families about getting their children tested and treated early.
At the East London facilities, I met data collectors who were approaching patients seeking HIV treatment and asking them for more information about their entire families. Using this family centered approach, also funded by the President’s Emergency Plan for AIDS Relief and the American people through the U.S. Agency for International Development, they would encourage these patients to have their children tested for HIV. I could see that with these masses of people the data collectors definitely had their work cut out for them. I spoke with one of the data collectors, and she said that her work was very satisfying because she has had success in advising mothers to have their children tested for HIV. After each interview, she gives them a referral card which can be used to access services. The hospital and clinics have seen many people show up with her referrals.
Thandi and I decided that it was time to go back and visit the grannies. The grannies were expecting us and were already seated in a circle when we arrived. One of the grannies had written down some remarks to share with me. She said that they have all had very intimate conversations with people and have gotten involved in the lives of the women they have met. These elderly caregivers face incredible hardships trying to take care of their grandchildren. Some have been afraid to get these children tested for HIV. However, the caregivers who do go for HIV testing are extremely glad they did this – whether the children are HIV positive or not. Many of them come and report back to the grannies about the test results and their future plans. It was clear that the grannies truly loved their work. I could see that they were feeling empowered in helping their community in this way.
In South Africa, strong interventions are needed to reach out to children who are not currently accessing HIV treatment services. Since HIV is clustered in families, innovative methods that target this family link may help people get the care they need. Just as grannies reach out to more grannies, we need to be committed to finding new ways to reach some of the most vulnerable populations in South Africa.