How integrated health checks can reduce HIV stigma

Dar es Salaam. This month kicked off with the commemoration of World Aids Day. For Erick Sembu, it was an opportune moment to campaign against stigmatization of People Living with HIV (PLWH) and call for devising new ways of curbing the vice.

Mr Sembu, the Managing Director at SGA Group, a security company in Dar es Salaam, believes that people at various workplaces and elsewhere across the country can overcome stigma and break the vicious cycle of HIV transmission if they are encouraged to do so through innovative ways.

“If HIV testing becomes part of the routine health checkups, just as we do for diabetes and high blood pressure, people won’t feel ashamed of lining up for testing,’’ said Mr Sembu, and added, “In order to stop new HIV infections, we have to deal with the mindset first.”

“How we name our screening progremmes matters a lot. Imagine how many people would turn up for screening if a camp in labeled—Tunapima Ukimwi—meaning, ‘We are testing for HIV’. Then, how many would also turn up to another camp labeled—Tunapima Afya—meaning we are checking your health,’’ he queries.

Mr Sembu spoke to more than a hundred SGA employees who convened at a World Aids Day event organized by the Association of Tanzania Employers (ATE) in Dar es Salaam. Soon after the event, he ushered all the attendees to a screening camp.

His choice of words, as he led people to the screening camp, suggested how determined he was, in his spirited campaign against the stigma leveled against people living with HIV and his endeavors to address the fears attached to HIV testing.

“It’s just about checkups,’’ he emphasized as he called on people to join queue for screening. “I actually mean, you need to check your health status—not necessarily HIV,’’ he insisted and advised, “It would be useful if you also get to know your HIV status today.”

Mr Sembu’s suggestions are part of a study project being carried out in Mbeya Region; whose preliminary findings say that combining diabetes and hypertension screening with HIV testing encourages more people to know their HIV status.

Since 1994, researchers from the Medical University of South Carolina, in collaboration with Tanzanian scientists have been studying ways of increasing HIV screening among the people and HIV/Aids care in the country.

In their recent media report titled, “An integrated approach to HIV prevention” released late last month, the scientists argue that the public generally “fear” to engage with programmes that solely deal with HIV due to stigma from other members of the society.

Professor Jessie Mbwambo, a Tanzanian mental health specialist who collaborated with American researchers in the recent study, believes that the growing trend of Non-Communicable Diseases (NCDs) has an impact on HIV patients.

This, she says, can be utilized in coming up with creative ways of encouraging people to embrace HIV testing as a routine service.

Professor Mbwambo says, “We believe that by integrating diabetes and hypertension care with HIV care, we can likely improve health in all these domains much more effectively and at a lower cost.”

“We cannot however, neglect other growing health needs such as diabetes and hypertension,’’ adds the psychiatrist from the Muhimbili University of Health and Allied Sciences (Muhas).

According to a behavioral scientist from the Medical University of South Carolina, Professor Michael Sweat, the integrated or rather more inclusive testing approach can improve access to HIV/Aids services across the globe.

“Global health is everyone’s health,” said Professor Sweat. “The greatest burdens of disease in the world—HIV, diabetes, and hypertension, among others—know no borders,’’ he added.

An earlier pilot study led by Prof Sweat indicated that this approach is likely to increase HIV testing, a finding that is relevant throughout the world, including rural, and impoverished areas of the US.

According to the World Health Organisation (WHO), nearly half of all people around the globe do not know they are HIV infected.

The UN health agency shows in this year’s report released on this year’s World Aids Day that 40 per cent of people with the virus that causes AIDS, or more than 14 million people worldwide, are unaware of their status, according to 2015 estimates.

The WHO progress report says that lack of an HIV diagnosis is a major obstacle to implementing the Organization’s recommendation that everyone with HIV should be offered antiretroviral therapy (ART).

Dr Margaret Chan, the WHO Director-General says, “Millions of people with HIV are still missing out on life-saving treatment, which can also prevent HIV transmission to others.”

Dr Chan encourages self-testing as one of the key steps towards realizing the gaol. She says, “HIV self-testing should open the door for many more people to know their HIV status and find out how to get treatment and access prevention services.” In Tanzania, where 1.4 million people are estimated to be infected, the national HIV/Aids Commission (Tacaids) is targeting to test and treat over 2.5million people through a recently unveiled “test and treat all” project; where everyone found HIV-positive will be immediately put on ARVs.

However, the attitude of people towards HIV testing, as told in real life stories in Tanzania and highlighted in some studies done in Southern and East Africa are hampering the efforts to attain the goal.

Whenever Alex Karumuna comes across an advert sensitizing him and other people to go for general health checkups, he usually takes a cautious step, making sure the screening doesn’t involve HIV testing.

“I have never tested for HIV. I fear the shock that could come with receiving the results. It’s easier for me to screen for other diseases, such as diabetes or high blood pressure but not HIV,’’ says Karumuna but he admits, “I know it’s healthier when one is diagnosed early for HIV.”

The 27 year old resident of Kimara suburb in Dar es Salaam, says, “There is a time when we (him and colleagues) were being persuaded to test for HIV but I declined,’’ he recalls.

The HIV/Aids Care and Treatment Centre (CTC) Manager at the Dar-based Amana Regional Hospital, Dr Shanny Mwaluko, says that cultural and social barriers, especially when individuals have their personal biases and attitudes towards HIV treatment must be ironed out in order to get more people in treatment.

“When a person is found HIV-positive, they are supposed to be put on ARVs within 14 days. But, many people usually ask to be given more time to think about it, citing preparedness,’’ said Dr Mwaluko in a recent interview with Your Health.

In this year’s study: “Opportunities and challenges for ‘test-and-treat’: Insights from eastern and southern Africa,’’ researchers from Europe and Africa—including Tanzania, noted that country programmes implementing the ‘test-and-treat’ must also consider shaping people’s readiness and motivation to test for HIV and accepting treatment. Findings published in the Alpha Network, a site for analyzing Longitudinal Population-based HIV/Aids data on Africa, warned of potential new challenges emerging from the success of the testing and treating all people with HIV.

As the fight against HIV/Aids continues to attract the attention of major donors, researchers and political leaders, the need to curb new infections remains a thorny issue, with scientists devising new approaches that can help tame the scourge.