Happy New Year! It has been almost 4 months since I last emailed with an update and my last email was about my time at the World Cup in South Africa. I am now into my 6th month back in Zambia and it has been a very interesting 6 months, mostly because my work with Grassroot Soccer has been very different than last year’s work. If you remember, last year I spent much of my time working in two refugee camps, Meheba and Mayukwayukwa, through a project funded by UNHCR (United Nations High Commissioner for Refugees). When I left the project was continued by Lazarous (my coworker if you remember) and taken over by one of the other interns. We were very fortunate to receive continued funding from UNHCR for another year. While I was away at home and the World Cup the project continued and when I came back in mid-July I was actually asked to go on the next trip to Meheba to help with a VCT Tournament (soccer tournament with free HIV testing for participants and spectators). It was very exciting to be back in the settlement and see some familiar faces from the previous year.
However, I was just making a guest appearance in the project. My new role with GRS is under our newest project funded by the Elton John AIDS Foundation. It is a project that is very different from a typical GRS project. The title of the project is Bridging the Gap: Effective HIV Prevention, Testing, and Treatment Through the Power of Soccer. As an organization, GRS focuses on HIV prevention education (teaching kids how to prevent themselves from getting HIV and teaching them healthy life skills through a fun curriculum delivered by peer educators/coaches). If you notice in the name of the project it mentions prevention but also includes testing and treatment which is something that falls outside of the normal GRS model and goals. In the HIV research world, some studies are now finding that prevention education alone is not reducing HIV rates which basically means that even though people might know the correct information they are not changing their behavior and still acquiring and spreading HIV.
The idea of this project is to “bridge the gap” between prevention, testing, and treatment and reduce loss-to-follow up. So what do I mean by this? When I say loss-to-follow up it means that often when a person tests HIV positive there is a disconnect between that test and getting them to a clinic for care and treatment. This is because often tests are done outside of a clinic setting and they get lost in the system because no one is checking up on them or they are in an overcrowded government clinic. Under the Elton John project, we have partnered with a small private clinic called Tiny Tim and Friends (TTF) who solely focuses on treatment of HIV positive youth under 20 years and HIV positive pregnant mother (with the goal of preventing mother-to-child transmission of the virus). Without care and treatment the chance of pass HIV to a child during pregnancy, birth, or breastfeeding is about 40% but with proper care and treatment it can be less than 2%.
There are two kinds of activities that are involved in this project. There are the interventions and there are the community events. The interventions are normal GRS program that we’ve always done (peer educators/coaches facilitating the curriculum with kids) but now there are a few additions to the program. As the intervention begins the peer educators go on home visits to meet with all the parents/guardians of the kids in their group (~30 kids per group). During the home visit they explain about who they are and what GRS does and they also invite the parent/guardian to the graduation planned for the end of the intervention. They bring consent forms with them and ask the parents/guardians to think about if they would be willing to have their child go for an HIV test during the graduation. HIV tests are voluntary but the Zambian law says that those under 16 years old need consent from a parent/guardian. During the home visits the coaches (peer educators) are partnered with a woman from one of the TTF women’s groups. TTF is affiliated with ten women’s groups around Lusaka that are made up of HIV positive women who are community health workers as well as do other activities with their communities. Because they are older the parents/guardians may take the pair (coach and woman) a bit more seriously and since the women are HIV positive they have personal experience and can answer a lot of questions. Then, during the graduation, with the help of TTF we offer free voluntary counseling and testing (VCT). We encourage parents to attend the event and also test but it is often difficult to get parents there because of work, other family commitments, and stigma. There is a lot of stigma attached to testing which is often why people are scared or refuse to test.
The other kinds of activities we do are community events/outreaches. These include VCT Challenges and VCT Tournaments. They are the same type of event except that one includes a soccer tournament and one doesn’t. These events consist of setting up tents in a community (usually at a school or field) and providing an opportunity for community members to go for VCT. The events are either full day or half day and are mostly just a fun environment with music blasting (occasionally graced with performances from Zambian musician and TV celebrities) and free VCT as well as family planning services. We work with TTF as well as a few other organizations that focus on these issues. The coaches and women spend the week leading up to the event going throughout the community to homes to tell people about the upcoming event and encouraging them to come. Since the project started in June we have held 37 events (big and small), tested 8212 people, and found 287 people to be HIV positive.
We also had 30 of our 60(ish) coaches trained in Child Counseling by the Ministry of Health. This allows them to disclose test results to families and counsel them properly. This is actually an essential part of the process in order to ensure success in the program because many of the kids come to an event with a signed consent form but no parent/guardian present. Even though our partners can test the child they cannot disclose results without the parent/guardian. This means that after the event ends the GRS Coach/Counselor will go to the home of the child and disclose the results to the family. It is up to the family if/when they would like to disclose to the child. Sometimes when a child is very young and HIV positive the family may put them on medication but not tell them what it is for because they may feel like they are too young to understand. That is why it is important for those who are HIV positive to go regularly to the clinic for medication as well as counseling.
My main role in this project is to advise in the project and act as the liaison between GRS and TTF. At the beginning of the project there were a lot of issues with communication and understanding between the two organizations so I’m there to help in that regard. I usually spend a few days at week at the GRS office and a few days at TTF. I’ve really enjoyed working at TTF and getting to work closely with their staff. I’ve learned a lot because they are a clinic and focusing in a field I know nothing about.
We have found many challenges since we started 6 months ago but are all looking forward to kicking off 2011 because we have learned so much and have a lot of activities planned this year.
So yeah, that’s what I’ve been doing the past half-year. On the more social side we went back to Malawi for the Lake of Stars music festival like the previous year, had a lot of fun, slept very little, and listened to a lot of great live music. I just came back from a holiday/new years vacation to Tanzania and Zanzibar. We took the train from Zambia to Dar es Salaam which took 47 hours and had beautiful scenery along the way. We spent most of the time in Zanzibar at the beach which was absolutely beautiful but one of my highlights of the trip was going on a spice tour. Zanzibar is known as the Spice Island because it grows so many spices and it was really cool to go on a tour of a spice farm and see how spices are grown. (Little fact…at one point Zanzibar was producing 80% of the world’s nutmeg.)
On a last note, I will be coming home for a brief visit in February. Exact dates have not been finalized but the plan is sometime in mid-February for about two weeks. Looking forward to seeing some of you guys while I’m home and seeing my family!
Stay in touch! Miss you all
Lena