MALEALEA DEVELOPMENT HIV PROGRAMS

HIV/AIDS SUPPORT PROGRAMME – Mennonite University Students,
visited Malealea in May, 2004 – Harlan de Brun

On behalf of the Malealea Development Trust and community of Malealea, I would like to put forward the following proposal to work with the students of your University. The proposal concerns a joint work project between yourselves, the local clinic staff, and the village health workers to address the issue of HIV/AIDS in the Malealea area. HIV is one of the most serious threats to people’s livelihoods and development in the area more generally. To date, it is estimated that between 25 and 30% of people in Malealea are HIV+ (a statistic representative of the national figures).

We would like propose that we develop a support programme for HIV+ people . This programme will have several components. These are outlined below with the anticipated expenses:

(1) A food garden will be developed at the clinic in which we grow highly nutritious foods to support the nutritional requirements of HIV+ people in the community. Vegetables such as garlic, beetroot, ginger, lemons are especially good, but other vegetables also help to boost nutrition and are therefore also valuable.

We have already begun work on this garden in preparation for your visit, but we envision a joint gardening project during your visit. This will entail a team of village health workers working side by side with your students to prepare the soil and plant the crops that are seasonal at the time of your visit. We

Expenses : Garlic bulbs for planting (R400); Other seeds (R500), 2 spades, 2 forks, I rake (+- R60 each = R300) [At a later stage if funds allow we would like to be able to fence the garden to protect it from livestock.]

(2) A food supplement programme

Not all the foods that are required by HIV+ people are able to be grown locally. For instance, doctors are recommending the following mixture:

• Extra Virgin Olive Oil
• Pronutro (original)
• Ginger
• Garlic
• Lemon

It is not possible to grow the first three ingredients listed here. We would therefore like to be able to buy these ingredients and mix them into a paste that can be easily swallowed. We would also require a blender to be able to mix these ingredients together.

Expenses : Pronutro, ginger and Extra virgin olive oil required for one person for one month amounts to +-R90. We realise that this becomes expensive (R90 x 10 people x 6 months = R5400) and would therefore like to propose that a lump sum of R1000 be set apart for purchasing the Pronutro and olive oil in bulk, which at least will give us a head start in preparing the food supplement mixture. The cost of a blender is R160.

(3) Treatment

To date, treatment regimes (Anti-retoviral drugs or ARV’s) are not available in Lesotho through the public health system. The means that only those wealthy enough to consult private doctors are able to secure the drugs. This is the main reason we are going the food supplement route. However, the government of Lesotho has just acquired a CD4 count machine which is in Queen II Government Hospital. Members of the public are able to test there for a fee of R50. Knowing one’s CD4 count helps patients to monitor there health and progress. We would therefore like to include CD4 tests as the third part of the proposed programme, and ask that some money be put aside for this purpose. Receipts will of course be issues for the CD4 tests.

Should ARV’s become available in the future, we would of course like to include them in the programme. Nutrition will however remain primary, since even if a patient is on ARV’s, s/he needs to have good nutrition in order for th ARV’s to work effectively.

Expenses : R50 per CD4 test (x 20 people) plus transport to Maseru (2 trips @ R80 per trip) to take in the blood samples = R1160. [At a later stage if funds allow we can assist people to get ARV’s.]

Total expenses listed:

The money you have raised is $480 =R3120. The proposal thus exceeds the amount raised, but adjustments can be made where necessary. We feel this is a modest but considered budget to boost a much needed initiative in Malealea.

Your visit

As mentioned above, we plan to engage in some community gardening with you during your visit. We hope that this will be a time when the students may get to know the village health workers as well as some of the HIV+ people themselves. One person who is HIV+ has expressed a willingness to disclose her status to the students and talk to them a little bit about what it means to be living with HIV in Malealea. (She has however not disclosed to the community so this issue would need to be treated sensitively.)

We hope therefore that the time spent together on this project will be educational (in that the students get to know more about HIV/AIDS in Africa) as well as a time of positive cultural interchange. We also hope of course that this project might have the potential to grow and develop beyond the parameters presented here.

Gillian Attwood and Makhahliso Manyeo

(Malealea Development Trust)

HIV/AIDS IN MALEALEA - TAKING THE BULL BY THE HORNS

Document prepared by Gillian Attwood

Chairperson of the Malealea Development Trust

Malealea, like most other areas in Lesotho, is characterized by poverty and a migrant economy, two factors that make its population extremely vulnerable to HIV/AIDS. The official estimated HIV/AIDS infection rate in Lesotho is 31% (Central Bank of Lesotho, 2004), although it is likely that this figure is even higher if the number of people who die of AIDS related illnesses are factored in. It has become imperative that HIV/AIDS becomes a central focus of all efforts to develop the country.

The Malealea Development Trust has been established to advance the educational, economic and social quality of life of the Malealea community through undertaking a range of education and development projects. The Trust, supported by generous donations from tourists visiting the valley, has developed a response to HIV/AIDS. This response includes three main foci:

• Education
• Voluntary counseling and testing (VCT)
• Support for HIV positive people

Education

Apart from HIV/AIDS education taking place at the school level, the Malealea Development Trust has supported the establishment and implementation of adult learning and development groups . These ‘learning communities’, currently established in 14 villages scattered throughout the valley, have between 10 and 30 participants, with a total of about 300 people directly involved. Twenty (20) local people have been trained to facilitate the learning groups which meet twice a week. The educational approach adopted combines adult learning with a social change approach to development. During meetings, participants come together to identify, discuss and analyse the problems in their lives. Based on their analysis, the group plans some form of action to address the problem concerned. This process is empowering in that it gives participants a chance to develop literacy and communication skills, as well as wider life skills such as planning and management skills.

The learning groups are addressing HIV/AIDS from three directions:

• The first direction is that of education . In the first meeting of the week, groups work through structured learning materials, that support them to become informed about all aspects of the disease - how it is contracted, how it can be prevented, factors that influence vulnerability, care of infected people, stigmatization, etc.
• The second direction is that of encouraging people to know their status through testing . Both facilitators and participants are encouraged to make use of the established channels (see below) for testing, as we strongly believed that education alone is not sufficient to address this disease. People need to know their status in order to effect significant change to address the disease and its implications. We also believe that the more people who know their status, the greater the chance of de-stigmatising the disease.
• The third direction is that of development action . Based on the information acquired, groups identify the different ways in which they are affected by HIV/AIDS and the various associated problems, and then make plans that will contribute towards alleviating these difficulties. For example, 6 of the groups have established communal vegetable gardens and orchards so as to improve nutrition for both the infected and affected. Other groups have started small income generation projects that help families with income needed to cope with the costs associated with care and treatment of illnesses, and in many cases decreased income through losing a breadwinner.

Voluntary counseling and testing (VCT)

Research has shown that while efforts to educate the individual about behaviour change are necessary, they have not been sufficient. Until people know their status, it is unlikely that change will be more than superficial. By knowing their status, the disease becomes more real, and the chances or taking effective action to effect change are increased.

We are currently using the existing channels available through the Mafeteng Hospital and the New Start Programme to get people tested and treated. However, within the next few months we are planning to train the local nursing sister, village health workers and other interested people in VCT (about 15 in total) so that people do not need to travel in order to test. This will significantly reduce the expenses associated with testing, while simultaneously increasing the confidentiality - people can be tested and receive their results within the privacy of their homes. We anticipate that this will significantly increase the number of people willing to test.

Support for HIV positive people

When people do test positive, it is important that support mechanisms are in place to assist them to cope.

• The first support mechanism will be that of counseling . With 15 local people trained to provide counseling, psychological support will be in place to assist infected and affected people.
• Secondly, HIV positive people will be able to join an existing support group which meets at the clinic on a weekly basis.
• Thirdly, HIV+ people have access to immune boosting nutritional and medical products (such as ‘E-pap’). (Donations from tourists help to sponsor the costs of buying these products.)
• Fourthly, HIV + people will have subsidized access * to CD4 and viral load tests to monitor the progression of the disease and ascertain whether a person should be on Anti-Retroviral drugs (ARV’s)
• And finally, if needed, subsidized access * to ARV treatment will be provided.

Conclusion

The experience of the Malealea Development Trust has shown that tourists are sincerely interested in supporting constructive development processes. It is because of their response and generosity that the Trust has been able to put together the strategy outlined above to help address the devastating impact of HIV/AIDS. It is our belief that through harnessing the efforts of local people and the generosity of tourists visiting the valley, it is possible to reduce the HIV infection rate and alleviate the suffering of those already affected. Ultimately this will mean that the valley remains an inviting and inspiring place for tourists to visit, and that the community can continue to benefit from the industry.

This approach is known as REFLECT, an acronym for ‘Regenerated Freirean Literacy Through Empowering Community Techniques’. Developed by ACTIONAID, a reputable British organization, REFLECT integrates literacy and development by fusing Freirean literacy theory with the methodologies of Participatory Rural Appraisal (PRA).

Campbell, C. (2003) ‘Letting Them Die’ – Why HIV/AIDS Intervention Programmes Fail. Oxford: The International African Institute in association with James Curry, Indiana University Press and Juta Publishers.

* ‘Subsidized access’ means that those people unable to afford the costs of transport and the basic fee for testing and treatment will be ‘sponsored’. Funds will be generated from tourist donations and channeled through the Malealea Development Trust.