She says she wanted to die
When Nosiphiwo Sitshetshe (33) was diagnosed with HIV in February 2012, she was devastated. She had contracted TB from her partner, and as a result was tested for the virus. She was immediately started on antiretroviral (ARV) therapy, but things at home were unbearable. Her family made life extremely difficult so she fled to her partner’s home, seeking refuge, but she found none. That was when the beatings started.
This emerges as the NSP Review team visits a number of families in the Peddie South area served by community health workers from the Keiskamma Trust. The exchange between Nosiphiwo and her partner, Thanduxolo Makhabana, becomes intense as their story unfolds. They sit next to each other on the couch in their living room but do not look at each other.
The couple met when Nosiphiwo was 22 years old. She says that he was very good looking then. Now, 10 years later, he is gaunt and frail. He openly admits that he likes to drink.
“It’s when he’s drunk that he starts abusing me”, she says. Thanduxolo was diagnosed with HIV in 1996 when he was just 25 years old, 10 years before he met Nosiphiwo. The 44-year-old has fathered all three of Nosiphiwo’s children, the oldest of whom is nine. Fortunately, none of the children has tested positive for HIV. Nosiphiwo had visited the clinic consistently during each of her pregnancies and adhered to her drug regimen, until a violent beating from Thanduxolo pushed her over the edge. She stopped taking her medication. She says she wanted to die.
Nosiphiwo is not the only woman who has felt this way. In a paper published in AIDS, the official journal of the International Aids Society, Abigail Hatcher, a senior researcher at the Wits University Reproductive Health and HIV Institute, found that women reporting partner violence are half as likely to adhere to treatment. These women also have 36 percent lower odds of achieving viral suppression, which indicates whether or not the infection is under control. Together, these findings suggest that women who live with partner violence have poorer health and could be more likely to transmit HIV than others.
“In some ways, the findings were not surprising,” says Hatcher in an article on the subject.
“We have known for the past few years that partner violence leads to higher rates of HIV infection. But this is the first time anyone has shown that violence consistently impacts the health of women already living with HIV.”
Nosiphiwo’s health deteriorated dramatically in a matter of weeks. She developed sores all over her body and her feet swelled to such a degree that she could not walk. Community health worker (CHW) Nokwezi Mati, realising she had not seen or heard from Nosiphiwo, paid her a visit at her home. This was the lifeline the mother of three needed to bring her back from the brink of suicide.
Nokwezi visited her regularly and ensured that she resumed her retreatment. Nosiphiwo’s family is just one of the many that Nokwezi visits in the Peddie South area. She is one of 51 community health workers in Hamburg who are employed by the Keiskamma Trust. They work in teams serving 47 villages that surround the Hamburg Clinic. The trust has been active in the area since 2005. The health programme was established to provide ARVs and palliative care to AIDS patients in their own homes. Today, community health workers continue to visit patients, help them take their medication, do pill counts, report side-effects and assist them to access clinics and treatment. In her experience, Noluthando Luceka, a community health worker and AIDS activist, says people in rural areas are not open about their status.
“The stigma here is still strong. That’s what makes our work even more difficult but we do what we can,” she says. She says that since the ARVs were made available, things have been easier; when her sister died of AIDS in 2008, Noluthando vowed that the same would not happen to her. She was diagnosed with HIV in 2003, but because she was a member of the Treatment Action Campaign she felt sufficiently equipped to manage her health and even asked to be placed on HAART in 2012 when the doctor found her CD4 count had dropped significantly. She compliments the state’s ARV programme, but says that it is insufficient.
“Our patients do take their treatment, but because they are poor, they don’t survive because they don’t have access to good food. They need more support from the government. Some of them need psychological help,” she says. It is clear that women like Nosiphiwo require more than just ARV treatment; the CHW programme in Hamburg is a lifeline.