Addressing HIV in South African public health programmes is always both a priority and a challenge for interventionists. In a society characterised by some of the highest HIV rates in the world, programmes to challenge misconceptions, increase awareness, and improve testing and ARV adherence rates are many. Saturated with long-running HIV campaigns, intervening in communities now requires innovative, novel, and comprehensive efforts which engages individuals in their multiple roles: as mothers and fathers, as workers and colleagues, and as key role players in the fight against HIV.
HIV affects the development of young children directly and indirectly. ECCD interventions can address risks such as HIV and can improve the lives of children in the short term but also positively influence the trajectory of health and development into adulthood. ECCD interventions, thus, provide an ideal opportunity to address HIV related intervention, especially with focus on child health and well-being.
Our current flagship in this regard is The Mphatlalatsane: Early Morning Star project. The Mphatlalatsane: Early Morning Star project integrates ECCD, HIV testing and treatment services, and nutrition education, for caregivers with children aged 1-5 in informal preschool settings in rural communities near Mokhotlong, Lesotho.
The Mphatlalatsane project focuses on HIV in two ways, through group-based parenting activities and community health days. The parenting groups are led by an intervention facilitator who focuses implementing an early booksharing intervention, and a community based mentor (CBM) who leads the health and growth components of the intervention. Each group session lasts for two to three hours, and are held weekly for eight consecutive weeks. HIV is gradually introduced to the health sessions after an initial focus on overall child and family wellness. By week 3, the CBMs start to introduce specific information about HIV prevention and modes of HIV infection. Specifically, they show a short film, focusing on the importance of early identification of HIV, which is followed by a group discussion.
The groups are participatory, make use of songs and contain several local metaphors in their content. The community based mentors emphasize a non-judgmental and caring approach to HIV and encourage caregivers to look for solutions to their problems with seeking testing and care.
As one participant, a local chief, related, “I loved the way you approached the HIV issue and gave education about it. Most people in the rural areas are now tired of this HIV – it has become a boring and monotonous issue to talk about. So the way you did by putting it towards the end of your sessions is very good for if you start with it, they will not come back. You had built a relation with us before you asked about HIV that made us free to talk about it.” This epitomises, to us, something which The Mphatlalatsane project strives to achieve: an non-invasive, comprehensive, and dialogical way of addressing HIV.
The CBMs are also actively involved in advertising upcoming community health days that are part of the project and encourage the caregivers to attend them.
These events are run in several locations after the intervention is complete. Local organizations, in partnerships with Baylor College of Medicine, Children’s Foundation Lesotho, the Child and Gender Protection Unit, the Ministry of Health’s District, Health Management Team, the Food and Nutrition Coordinating Office, the Ministry of Agriculture and Food Security, the National Identity Civil Registry and a local NGO called Touching Tiny Lives, are mobilized to co-ordinate accessible community health events that aim to increase HIV testing among families through promoting an overall focus on child health.
The community health outreach days provide a wide range of services which including HIV testing and counselling, nutrition assessments, vaccinations, general health consultations, birth document registration, and delivery of information on child protection and community gardening.
Ultimately, we are interested in programme impact, which will be measured through HIV testing rate, HIV treatment uptake and treatment adherences. Currently, data on these outcomes is collected through interviews with caregivers, at the community health outreach days and through a data sharing agreement with Baylor College of Medicine.
Although these outcomes will provide reliable, quantitative evidence of the effect of the intervention, the voices of our participants is providing meaningful, and optimistic fuel for our continued efforts. As one mother related, “I shared with my husband what we are doing at book sharing and also told him the story we were told about HIV, my husband seemed to now understand HIV better, and he said he thinks he would like to go test and know his status, but said he is very scared on needles. But I explained to him that we were told that things used for pricking fingers are not that painful. He said he is till scared but he will go.”
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