Antonio Junior Xiranza is 12 years old. He lives with his Aunt Talita Agosto Mujovo, 39, and her three children in Maputo, Mozambique, after his parents both died from HIV-related illnesses. Antonio is HIV positive, something that Talita was able to reveal to him over the course of nine counselling sessions through IPPF Member Association AMODEFA’s Ntyiso programme. When Antonio was sent to Talita in 2015 he had no understanding of his illness. He was severely underweight and wouldn’t take his medication. “I didn’t think he was going to make it,” says Talita. But following AMODEFA’s intervention last year Antonio’s health has improved rapidly and is gaining weight. This is in large part because Antonio, though still young, has chosen to take on the responsibility for managing his illness himself.  “He takes his medication without being told”, says Talita. “If he’s injured he knows the other children can’t touch his wound.” Antonio is still small for his age but says he feels stronger. He is well enough now to attend school regularly and is already thinking about the future; when he grows up he wants to be a fireman.“I am happy about life here,” he says, shyly. Talita says she is “relieved” to see these changes in Antonio. “At first I was not going to say anything. I would have waited until he was 18 to tell him,” Talita says, which would have continued to put pressure on the entire family. “But with the help of the counselling I had through Ntyiso I was able to tell him now.” While Ntyiso was intended to help parents speak more openly about HIV with their children, it has given Talita the confidence to discuss the illness more widely. “I was able to tell my father, who was sick and had a wound, that he should get tested for HIV,” she says. Her father was diagnosed positive and is now in treatment. “Before I wouldn’t have advised people to take the test, I would have just kept quiet,” she says. Read more about AMODEFA's tireless work in Mozambique

Albertina Machaieie has been working with HIV patients for Amodefa for 38 years and is their longest serving nurse. “I’m going to work forever,” she says. “I like helping people, that’s why I do this job.” Albertina heads up Amodefa’s home care programme which provides medical, nutritional and emotional support to HIV positive patients living in the poorest suburbs of Maputo, the capital of Mozambique. She has seen a dramatic change in attitudes to HIV in the 19 years she has been running the service. In the past she had to hide her car and would visit her patients anonymously. “People feared HIV so they feared me coming to them,” she says.Now people welcome her into the community as a friend and will direct new patients to her. “They call us ‘Muhanyisse’”, which means saviour in the local language Shangaan, she says. Albertina and another nurse work with a large team of volunteers, or ‘activistas’, most of whom are also HIV positive. As well as delivering medication and food to patients and performing health examinations, an important part of Amodefa’s work is continuing to change attitudes towards HIV. “The homecare project encompasses everything,” she says. “It’s not just treatment for illness, we also work with the mind – people need to change their mindset.” She and the activistas give lectures in the community to raise awareness of HIV, and also offer counselling to patients, many of whom find it difficult to accept their HIV positive status. “Husbands and wives stop understanding each other when one is living in denial of HIV,” says Albertina. “They blame the illness on witchcraft.” In other cases, those carrying the virus are scared to tell their families for fear of being rejected. “There are many stories of family members, particularly of wives, who have found they are HIV positive and partners have threatened to leave,” she says. “But when Amodefa has stepped in and advocated, the husband has stayed.” This holistic approach to its homecare has been so effective that medical and psychology students have come from Brazil, the US and Mexico to Mozambique to study the programme and to learn from Albertina’s experience. “I am the library for Amodefa,” she jokes. Over the course of her career Albertina has worked with many challenging cases – particularly men. “Women are more open to treatment because they want to get better so they can care for their children,” she says, “but men often won’t seek help until their health has severely deteriorated.” She recalls one case where a woman tested positive for HIV while she was pregnant. She told her husband to get tested but he refused, and he also prevented his wife from taking any treatment. As a result her baby was born HIV positive - as were her second and third born. “With her last child she started taking the treatment without her husband’s knowledge and the baby was born without HIV,” says Albertina. “This man now says, ‘People, you need to be open – I have three positive children and it is my fault because I would not accept the truth.’” “Children who are HIV positive and don’t know often abandon their medication because they are tired of taking the drugs,” says Albertina. “Ntyiso teaches the importance of taking the medicine. When they are aware of their status, they start taking the medicine normally.” Albertina worked with ten families during the pilot phase of the programme. “Already I have seen great changes in the children, it shows why this project of revelation is so important.” The Ntiyso is a pilot project implemented in Maputo City and it has its focus on disclosure of the HIV + status to adolescents. It targets mothers, parents and caregivers of adolescents. The main activities are: Education and training of Mothers, Parents and caregivers of adolescents to reveal HIV+ status to their adolescents. Due to the Global Gag Rule this project lost its funding and was forced to close.

The continuation of many vital health services Amodefa offers in Mozambique are under threat following the reintroduction of the Global Gag Rule by the US Administration. The Global Gag Rule, or Mexico City Policy as it is formally known, stops US aid to all health programmes run by organisations who perform or counsel on abortion. The decision, which will deprive Amodefa of $2 million, 60% of its budget, will have devastating consequences for the fight against HIV in Mozambique, where an estimated 12% of the country’s nearly 30 million population are living with the virus. Photography © IPPF/Grant Lee Neuenburg

Palmira Enoque Tembe, 54, is HIV positive She lives with two sons, who are also HIV positive, and four grandchildren in a small house in Bairro Feiroviaro on the outskirts of Maputo. Three times a week she is visited by Amodefa volunteers and once a week by a nurse who provide medication, food and therapy to the family. “Amodefa counsels me through the difficulties in life,” Palmira says. Palmira found out she had HIV when her youngest child was nine months old. He was diagnosed as HIV positive. Palmira asked her husband to get tested too,“He refused” says Palmira. “He said I was possessed by evil spirits and was trying to kill him and my son". Her husband abandoned the family and Palmira was left to battle the illness and raise the children on her own. “I was terrified. I lost hope. I didn’t want to do anything, just sit in my room and cry,” she says. Now, however, the nutritious food, medication and regular medical check-ups she receives as part of the homecare programme have given her a new lease on life. “I’m fine and I am making plans for the future. I know now to get ill is not to die,” says Palmira, who has started to subsistence farm again. At first she was wary of the service. “It seemed like an advertisement for having HIV and I didn’t want my neighbours to isolate me,” she says. “But now I depend on it.” It was through Amodefa’s new pilot counselling project, ‘Ntyiso’ - which translates as ‘The Truth’ in the local language, Shangaan - Palmira was finally able to open up to her son that he had HIV too. While he had always suspected he was carrying the virus, he needed to hear it from his mother for it to become real.“It has changed by life,” she says. “It has improved our relationship because I no longer feel ashamed.” The Ntiyso is a pilot project implemented in Maputo City and it has its focus on disclosure of the HIV + status to adolescents. It targets mothers, parents and caregivers of adolescents. The main activities are: Education and training of Mothers, Parents and caregivers of adolescents to reveal HIV+ status to their adolescents. Due to the Global Gag Rule this project lost its funding and was forced to close. Read more about AMODEFA's tireless work in Mozambique

“They call us ‘Muhanyisse’”, says Albertina Machaieie, a nurse working with Amodefa, the Mozambican Association for Family Development. It means saviour in the local language, Shangaan. For 19 years, Machaieie and her team of activists – volunteers who are HIV positive – have been visiting communities in the poorest suburbs of Maputo, bringing healthcare to those with HIV and raising awareness about the disease. This year they provided medical check-ups, treatment, food and counselling to more than a thousand families living with the virus. But the continuation of the home care programme and other vital health services Amodefa offers in Mozambique are under threat following the reintroduction of the Global Gag Rule. The Global Gag Rule, or Mexico City Policy as it is formally known, stops US aid to all health programmes run by organisations who perform or counsel on abortion. The decision, which will deprive Amodefa of $2 million, 60% of its budget, will have devastating consequences for the fight against HIV in Mozambique, where an estimated 12% of the country’s nearly 30 million population are living with the virus. “We estimate half million people across their HIV, tuberculosis, malaria and family planning projects will be affected,” says Santos Simione, the executive director of Amodefa.   Albertina’s team of 60 volunteers has already had to be halved. She says some of her volunteers will continue to visit families, but without funds to cover transport many patients will no longer receive the treatment or counselling they need. For women like Palmira Enoque Tembe, who lives with her two sons who are also HIV positive, and four grandchildren, stopping these visits would sever a vital lifeline. Tembe says she was terrified when she found out she had HIV: “I didn’t want to do anything, just sit in my room and cry.” But the anti-retroviral therapy and counselling Amodefa provides have given her a new lease on life. She is well enough to start subsistence farming again, “and I am making plans for the future. I know now to get ill is not to die,” she says. By the end of October, 14 of Amodefa’s 20 sexual and reproductive health clinics across three provinces in southern Mozambique will also have to close. Nurses at the clinics see around 300 patients a day, mostly girls seeking family planning advice, but also people looking for testing and counselling for HIV and other STDs. “Outside of these service centres young people have little to no access to this information,” says Nalia Chambal, the head of the Tua Cena programme, which is operated through these clinics. “[With the closures] we’ll see a rise in unwanted pregnancies, early child marriage, HIV and STD transmission,” she says – which will mean more girls will drop out of school, and there will be more unsafe abortions. Amodefa works closely with the Ministry of Health to ensure the family planning services it offers, as with its HIV, tuberculosis and malaria programmes, complement and support the government’s own health services. “When we stop, there will be a huge pressure on government facilities,” says Simione. “It will tough on all the country.” But it will be the poorest and most vulnerable that will be most affected, such as those living in rural Nampula, one of Mozambique’s largest and most impoverished provinces, where Amodefa’s ChallengeTB programme is under threat. The programme, which has been running just over a year, identifies and treats patients with tuberculosis, some living more than 80 km from the nearest health centres. As the team of volunteers and staff on bicycles and motorbikes bring awareness and testing to ever-more remote communities, the true scope of the disease is beginning to be understood. In the first quarter of this year, 1,318 people were tested for TB in the eight districts where Amodefa works; in the second quarter, 2,106 were tested; and in the third quarter, the number reached 3,154. More than half of these people were diagnosed to be carrying TB. “We’ve done a lot but there’s a lot more to do,” says Maria Teresa de Fátima, head of monitoring and evaluation for the project. She expects the number of cases will continue to rise over the next two years, before they start to drop off. Particularly at risk are the roughly 2,000 patients currently taking medication. TB treatment must be taken daily for six months, and those who stop because they can no longer access healthcare may develop a multi-resistant form of the virus which is much harder to treat. Mario Vilanque, a volunteer working with communities in Naha in Morrupula district, where 5 new people have just started treatment, said his patients, are “very confident” in Amodefa; “They have seen 10 people cured – now they have great faith.” It wasn’t always this way. When Machaieie started the HIV homecare programme in Maputo, she had to hide her car and go into communities anonymously. “People feared HIV so they feared me coming to them,” she says. It has taken 19 years to change attitudes and break taboos in Mozambique. Now, just as hope is overcoming this fear, global gag rule threatens to force the work of Amodefa and the lives of its patients back into the shadows.

This publication shares the experiences of people living with HIV. Men and women from Ethiopia, Mozambique and Swaziland talk about HIV-related stigma and describe their courage, inspirations, suffering, resilience and determination to trigger change. Their stories demonstrate how stigma and discrimination can hinder access to vital support and care and the prevention, testing and treatment of HIV. National and international organizations working on HIV-related issues have an immense responsibility towards people living with HIV, to change the unjust reality revealed by these personal stories into a better one. We must increase our efforts towards ensuring everyone enjoys a dignified, stigma-free life – one where every human being is valued and free of discrimination.