Stories

Five years ago, when Arnilda Simango was 13, she started dating a boy from her community, outside Xai-Xai City, in Gaza Province in southern Mozambique. A year later she got pregnant, at his insistence, and he left her shortly after the baby was born. AMODEFA’s youth services offered her counselling and advice throughout her pregnancy and became the network through which she made new friends.  Today, at the age of 18, she is raising her son, with help from her mother and plans to return to school. “When I started dating, I thought I wanted a partner who could take care of me and that could maybe fill the void I felt for not having a father. When I started the relationship with my boyfriend, he insisted that he needed a son because all his friends already had one. I had little space to say no because he threatened to date someone else and I was convinced he was the right person for me. When I got pregnant in 2016, he started behaving strangely. He stopped being affectionate and gave indications that he did not want to be with me anymore. That's when a friend of mine told me that there was a youth center where I could get advice on how to proceed in this situation". The Adolescent and Youth Friendly Services (SAAJ) center, based at the Patrice Lumumba Urban Health Center, on the outskirts of Xai-Xai, is run by AMODEFA and provides HIV testing and treatment, prenatal and postpartum consultations, and other information and services around sexual health and rights. The center is supported by the Women’s Integrated Sexual Health (WISH2ACTION) programme, led by IPPF.   "One day I walked there and received a lot of advice. As I was already 4 to 5 months pregnant, I was advised to open a prenatal form. They did all the follow-up until I gave birth to my son.” "Believe me, being a single mother at 14 was a suffocating experience and it could have been worse if I had not been accompanied by [the SAAJ]. I do not know how to thank them. I practically felt alone without knowing what to do, but I had a lot of advice here and made friends with other girls". Planning for the future  Arnilda dropped out of 7th grade once she became pregnant and helped her mother selling basic goods from a stall in her home. It is from this small business that her mother supports her two children who are still living at home, as well as five grandchildren. Arnilda plans to return to school next year to continue her studies now her son is old enough to stay with his grandmother. Her dream is to be a professional model. Until then she does not want to have another child, so she goes to the SAAJ for family planning purposes. Arnilda says she walks 50 minutes to the center every three months for the contraceptive injection.  "I wanted the implant, but it doesn't settle well with me, so I renew the injection every three months.  I do this because I need to continue studying to have a decent job that allows me to support my son. Next year I will go back to school. "A second child is not in the plans. I still consider myself a minor. Even the first child I only had because at the time I had no one to give me advice and show me the best way. I believed in my ex-boyfriend and today I have this lesson. Today I can say that I have come to my senses, not only from the experience of being a mother, but from everything I learn here [at the SAAJ]. There is no friend of mine who does not know SAAJ. I always advise them to approach here because I know they will have all kinds of counselling and accompaniment.”

In November 2017,  Planned Parenthood Association of Zambia (PPAZ) received the news that they must cease all USAID funded programmes. The stop order was a result of the 'Global Gag Rule' (GGR), also referred to as the Mexico City Policy. The reinstatement of the policy has resulted in Planned Parenthood Association of Zambia losing 46% of its funding. You can learn more about the Global Gag Rule here. “When I lost my job as service delivery manager [at PPAZ USAID's Open Doors project], I felt like a part of me had died, I’m very passionate about this. I look forward to seeing a day where everybody will be free to access health services without stigma and discrimination, especially public health facilities. That’s what I’d like to see, [I] want to see integrated services, being provided to key populations, without stigma and discrimination, and fear of being arrested." The Global Gag Rule The reinstatement of the ‘Global Gag Rule’ resulted in the termination of Planned Parenthood Association of Zambia grant for the USAID Open Doors being terminated.  Chipili says “We didn’t expect its implementation to come with the termination of the grants suddenly. We thought that we were going to be given time, a year, one year to work and complete the project and hand over to the partner that was going to take over the responsibilities that Planned Parenthood Association of Zambia handled.” The termination of the project means progress that has been made, especially the work done to help reduce the number of HIV and STIs cases among the key populations will be undone. Progress, that is desperately needed to meet Zambia’s targets on HIV reduction. “We are losing precious time. We have got targets to meet as a nation, we need to ensure that by 2020 we reach the 90/90 goals, set by UNAIDS, and also the country has a broader vision of eliminating the threat of HIV, HIV as a public threat by 2030. So if we have such stumbling blocks, then the targets might not be met.  And then these key populations are also linked with the general population, we have men who sex with men, they also have partners, some of them are married, and if we don’t get into their networks, HIV and STIs will end up in the general population, therefore putting everybody at risk." Other impacts have been the increased vulnerability and the lost investment of peer promoters from the key populations and loss of safety and security that was provided by the organization.  Loss of safety and security “For safety and security, key populations cannot freely go to facilities they don’t know very well. The clinic setup was the most ideal set up for them. No one would question them, because this is open to everybody. But now what the project is doing, they are renting houses, the USAID is renting houses where they are providing services, so a house is very different from a clinic, that also affects the element of sustainability. The element of sustainability has also been lost because PPAZ has been here for a long time, since 1972, so we were hoping that the project was going to build the capacity for PPAZ to continue providing services to key populations that are free from stigma and discrimination. That has been lost. To me it’s a lost opportunity.” The Zambia National AIDS/HIV Strategic Framework for 2017 to 2021, bears a strong emphasis on leaving no one behind when it comes to stopping the HIV/AIDS epidemic. “No one should be left behind, if we are to reduce HIV infections to zero, if this is not done, the dream, the vision will not be achieved, we cannot afford to start pointing fingers, we have to use the public health approach and eliminate the risk of HIV infection amidst our people”.

In November 2017,  Planned Parenthood Association of Zambia (PPAZ) received the news that they must cease all USAID funded programmes. The stop order was a result of the 'Global Gag Rule' (GGR), also referred to as the Mexico City Policy. The reinstatement of the policy has resulted in Planned Parenthood Association of Zambia losing 46% of its funding. You can learn more about the Global Gag Rule here. "My name is Thomas, I’m 34 years old. At PPAZ I worked as a peer educator and counsellor, I used to work on the outreach programmes in the community to offer access to health services like voluntary counselling and testing, we also used to sensitize women on the importance of family planning. We also used to refer women we would find had different problems, to the facilities so they can access health services. We also used to help by giving information on things like HIV prevention and signs and symptoms to look out for.  At other times, since the places were very far, we would take the services from the facilities to where the people were, so PPAZ used to help us do that.  I was at the clinic when they came to tell us that PPAZ would no longer be involved in the project because the funding had been stopped. It was a challenge for us because the services that people had become accustomed to in the communities, HIV counselling and testing services levels reduced because we couldn’t manage to go and take these services to them in the places where they live.  When we worked with PPAZ we used to put condoms in these places for them, in the bars and taverns, and even pool tables. Now that PPAZ is gone, the government cannot meet the supply of condoms needed in these places, even the services can’t be offered on the same scale. Unable to meet needs in rural areas Like you can see here, I look after my grandmother and other family members and that money [peer educators' allowance] used to go a long way in helping us look after our children and buy food, and other things. At the moment it is very difficult. Nyangwena is a very big place, it also includes 14 villages, so there are many people in this area. With the money that we were given through PPAZ, my friend and I would manage to get tyres for a bicycle and go to these places, we’d cycle distances as far as 14Km away. It was very helpful; the community really appreciated the services we were offering because we used to take them to the people. We would be very happy if PPAZ were to start them again because we would really help our communities a great deal with these services. Even school children would go and access them, at the youth-friendly corner twice a week. Information is really needed amongst these school children."

In November 2017,  Planned Parenthood Association of Zambia (PPAZ) received the news that they must cease all USAID funded programmes. The stop order was a result of the 'Global Gag Rule' (GGR), also referred to as the Mexico City Policy. The reinstatement of the policy has resulted in Planned Parenthood Association of Zambia losing 46% of its funding. You can learn more about the Global Gag Rule here. “My name is Joyce. I live in Sopoloyi with my grandmother. I tested positive for HIV, around November, but was doubtful about starting treatment. I stayed away for three months and came back in January, to retest, when they asked if I wanted to start treatment right away, I refused, because I wasn’t ready.  I told my sister what happened and explained that I had tested positive for HIV, so she advised me to go back and start treatment as soon as possible, because the longer I waited the more I was wasting away.   I returned to the clinic and I was given medication for two weeks. I was changed and put on another course for a month. I would go back every two weeks to get medication, then gradually I was given a course for two months. From the time I commenced treatment till now, there’s a clear difference, my body is slowly coming back to normal. I felt very safe, I was happy that they protected me, if I hadn’t come at that time to get help I would have been seriously ill, the medication wouldn’t have helped me at all, but now I have been on medication I feel much better and my body is also getting better. They are still giving me medication. They need to continue giving us the medicines and the information, because at least they tell us that once we start we are not supposed to skip any dose, even when you feel fit, you can’t stop because the virus multiplies everyday by a thousand, so the more you take your medication it keeps the virus levels low, so I would say they need to continue. All I am asking is that they don’t stop giving us this treatment because a lot of people will suffer or even die without these medicines.”

Marinho, 30, works as an activista for Amodefa’s Challenge TB programme, bringing treatment to remote villages in the Ribaué district of Nampula. Since August last year he has identified 84 cases of TB in the eight communities in which we works; “75 patients are in treatment at the moment, the rest are recovered,” he says. Before Amodefa started work in Nampula, Marinho says, “people were dying because they couldn’t reach the hospital, but with this programme it is becoming easier because we bring the medication to the patients.” However, lack of transport means it is a challenge for him to keep on top of all his cases. “The distances are far and the few bikes we have are breaking,” Marinho says. Yesterday he travelled 40 km to visit his patients. Some of the communities he visits are up to 50 km away. In the first quarter of this year 1,318 people were tested for TB in the eight districts where Amodefa operates; 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 have TB. The surge in the number of people going for tests is in a large part due to Amodefa’s ‘Day of the Cough’.  On the 27th of each month teams of activistas and volunteers go into communities, schools and jails to educate people about TB.   Before volunteers had to go from house to house to identify patients, “but now, with the lectures, it’s easy to find people who are TB positive because they are identifying themselves,” says Marinho. Children are particularly receptive to Amodefa’s message, Marinho says. He remembers one woman who had been sick for a long time and her daughter, knowing he was an activist, sought him out. The patient’s initial test for TB came back negative, so she was given alternative medication.  “She took the tablets but she was still sick - she was unable to walk or to eat,” Marinho says.  “We brought her here to the clinic, examined her and she immediately started TB treatment. Now she has started her recovery and is able to sit.” Lessons taught during the ‘Day of the Cough’ means communities are also now taking greater precautions against the disease, he says. Steps such as opening windows, cleaning the house, not eating from one communal bowl, and practising ‘coughing etiquette’ have all helped limit the spread of TB.  “People understand now and are taking serious measures to prevent it,” Marinho says. However, the US decision to withdraw funding from Amodefa following the introduction of the Global Gag Rule , could halt the Challenge TB programme just as it is gaining momentum. “If the programme stops the people will suffer,” says Marinho. “For people who live too far from the hospital to receive treatment, this programme saves their lives. Knowing Amodefa has come to eliminate TB, it can’t stop. If they stop now the TB will get resistant, so we’ve got to keep going, we’ve got to get stronger.”   SUPPORT OUR WORK WITH A DONATION

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.

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