Antiretrovirals slowly reach rural areas

At 10 in the morning the thermometer has already hit 35 degrees centigrade in the community of Chingondole in Mozambique's Zambezia Province, about 500 meters from the Malawi border. Most adults are in the fields planting maize to provide food for the next six months; the availability of food will be less certain for the other six months of the year.

Assisted by her brother, Maria Zeca Candrino, 29, seated herself in front of workers from the international nongovernmental organisation (NGO), Save the Children-UK (SCF-UK). "You have to go to the doctor. If you don't, you will die," Luisa Camurina, a nurse, told Candrino.

Four years ago Candrino lost her husband to AIDS-related illnesses, followed by her four-year-old daughter three months ago. Eight months ago she discovered she was HIV positive, but has still not seen a doctor. "The hospital is very far," she told IRIN/PlusNews.

The nearest hospitals to Chingondole are either 35km away in the Shire community of Malawi, or in Morrumbala in Mozambique, about 45km away. It costs Chingondole residents the equivalent of US$2 to take a 'chapa', the local word for a minibus-taxi, to the District Hospital in Morrumbala. The difficulty of making a return trip in one day also often means paying for overnight accommodation.

"These people are unlikely to go get AIDS treatment because they need to go in for frequent consultations and to get their antiretrovirals (ARVs)," said Camurina.

Most of Chingondole's 22,000 residents go on foot or by bicycle to the hospital in Malawi, but Candrino is lucky: this time the SCF-UK workers have offered her a lift to Morrumbala hospital. "The problem is how to get back. I don't have money to catch a chapa," she said.

Community response

The Morrumbala district has an HIV prevalence of 14 percent among its approximately 327,000 inhabitants. Although 111 of them are receiving ARV drugs, Candrino will be the first person from Chingondole to start treatment, and is one of 321 people receiving assistance from SCF-UK's home-based care project, which has been operating since 2003.

Photo: L. Bonanno/PlusNews

Henrique Candeeiro, a caregiver from Morrumbala district, shows a "Best Caregiver of 2006" trophy he was awarded by Save the Children-UK. Besides his nine children, he also looks after six nieces and nephews.

According to SCF-UK's provincial manager, Daphne de Souza Lima Sorensen, the goal of the project is "to have someone in the community, and from the community", who can tend to cases like Candrino's. With this in mind, SCF-UK has trained 77 caregivers from 16 villages and neighbourhoods in Morrumbala district.

The 12-day training course included lessons in first aid, hygiene, HIV transmission, treatment of basic sicknesses, how to teach family members to care for a sick person, and how to encourage people to get ARV treatment.

The caregivers were chosen by their communities and, just like the sick people they treat, receive a monthly basic food package.

"We want to sustain and support the home. When parents die it's like knocking out the foundation: the roof falls on the children," said Sorensen.

Soon, Candrino may not have to travel the 45km to Morrumbala for HIV treatment. A health unit at the Megaza administrative post, about half a kilometre from Chingondole, will start distributing antiretrovirals in the next few months, according to Dr Junior Antonio, Morrumbala's medical chief.

"We have just one health technician in Megaza, but he will be trained in antiretroviral treatment," said Antonio.

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