South Africa: Bringing HIV testing where it's needed

In the ten months since the Tutu Tester's mobile clinic began touring Cape Town neighbourhoods offering quick, confidential tests for a number of chronic diseases including HIV/AIDS, more than 7,000 people have climbed into its colourful camper-van for testing and counselling. Of these, 45 percent were people testing for the first time, indicating the clinic is making a valuable contribution to awareness of the disease in the poor neighbourhoods of Cape Town that are most severely affected by the pandemic. "Many of our patients have told us that they prefer not to go to public clinics for an HIV test because they are afraid of being seen by people they know," said Liz Thebus, one of the Tutu Tester's health workers. "Because we test for other diseases too, like diabetes and high blood pressure, the outside world does not know for what reason patients are waiting at our doors." Every Wednesday afternoon, the rainbow-coloured mobile clinic pulls up at the entrance of Imizamo Yethu - a small township on the steep hill above Hout Bay, a coastal village near Cape Town. Twenty-four year old Babalwa is one of those waiting for waiting for its arrival. She wants a test for HIV and high blood pressure. "I don't like to go to the clinic, because there is always someone you know," she told IPS. "I don't want that. My health is no one's business. Here, people don't know whether I am tested for high blood pressure or HIV. The workers here do not take my name either, which makes me more relaxed. It means that if I lose my results, no one will know the results are mine." Babalwa added that time is also an important reason why she rather goes to the Tutu Tester. According to her at Imizamo Yethu's clinic it takers sometimes half a day before patients are seen. "Sometimes you are even asked to come back the next day," she said. "I am working and cannot afford to stay away for that long. Here it takes thirty minutes." The crew of the Tutu Tester screens an average of 40 to 60 people per day. "Since we hit the road in May 2008, we tested roughly 7,000 people," said Nienke van Schaaik, the Tester's project manager. "About 40 percent of them were first-time testers." Wedges, as he calls himself, has never had an HIV test in his life. "It is my first time. I just want to know if I am healthy," the twenty-year old said. "But I do not want to go to the clinic. What if I run into people I know and they get suspicious? I am not worried or afraid about finding out what my status is. I know that I am healthy, but I want to know for sure." Thebus emphasised that the Tutu Tester does not provide treatment. "However, if applicable, we refer our patients to the clinic nearest to them for their medication. We follow up with the patient within a week after the consultation, to see how he or she is." The crew of the Tutu Tester does however offer professional counselling to those who need it. "It is important to help people cope with bad news," said Nokwayiyo Racaza, one of the three Tutu Tester counsellors. "We want the patient to leave the mobile clinic being relaxed. We do not want the outside world to read the news from our patients' faces." Racaza added that counselling is not only offered straight after the testing. "Sometimes the shock comes afterwards and therefore patients can come talk to us the following week, or whenever they are ready." Currently, the Tutu Tester is working to add a test for tuberculosis (TB) to its services. The disease is rampant in South Africa, especially in communities with a high HIV prevalence. It is believed that 54 percent of South Africans who are HIV positive are also infected with TB, which mostly affects the lungs and is transmitted through coughing, sneezing and spitting. People who are HIV positive have weaker immune systems, and are therefore at greater risk to contract TB. The Tutu Tester is not the only initiative operating beside the public health care system to test for HIV testing. New Start, which has mobile testing teams nation-wide, was established in 2004. In contrast to the Tutu Tester, New Start only screens for HIV. "According to our experience, people do not seem to have a big problem getting tested for HIV or being seen at our testing sites," Miriam Mhazo, senior project manager at New Start, told IPS. "We barely are able to meet the demand and the number of patients we see on a monthly basis is increasing. Wherever we pitch, people line up. In February 2008, we screened 17,000 individuals for HIV and 18,000 in the following month." Mhazo interprets this as a sign that the stigma attached to the disease is reducing. "We have not done research on the matter, but from a personal point of view the increase in the number of tests we have done shows that the stigma is not as strong as it used to be." Raphael Mukhunga from Malawi moved to South Africa four years ago. While his wife lives in his home country, he has a girlfriend and a child in South Africa. To protect all of them, he goes for an HIV test every half a year, he said. Mukhunga prefers the Tutu Tester to the local clinic, and not because of the stigma. "I do not care what other people think about me," he explained. "I come here simply because of time constraints, as at the Tutu Tester you know your status immediately. I think the fact that everything takes so long at the public clinic is an important reason why people only get tested when it is too late, when they are already ill. I have seen it myself."