Community Groups Bridging the Gap in HIV Care in Mutoko

Nathan Guma  

LONG distances between health facilities and residential areas are hindering access to information on HIV/AIDS, with findings showing that people in Mutoko, Mashonaland East Province are walking over 15 kilometres to clinics for treatment.

This is likely to derail efforts to end new infections.  

Zimbabwe has been making strides to end new HIV infections, with statistics from the Ministry of Health showing that of the 1.3 million people living with HIV in Zimbabwe, 1.2 million are on HIV treatment and 97% of these have achieved viral suppression. 

In 2023, Zimbabwe reached the Joint United Nations Programme on HIV/AIDS (UNAIDS) target dubbed 95-95-95, whereby 95% of people living with HIV should be diagnosed while 95% of those living with HIV should be on ART medication and another 95% should achieve viral suppression.

However, these gains are at risk. An investigation supported by the Voluntary Media Council of Zimbabwe (VMCZ) and ActionAid Zimbabwe found that people in rural areas like Mutoko are still walking between 15 and 20 kilometers to access HIV treatment.

This contradicts the World Health Organization’s (WHO) recommended distance of five kilometers to the nearest health facility.

An investigation using geolocation open source tools and site visits found that some health facilities, such as Chindenge Clinic, are located over 15 kilometers from residential areas like Chirindi in Mutoko.

In some cases, people travel more than 20 kilometers from Chirindi in Mutoko, while others have been crossing into Uzumba Maramba Pfungwe District for medical attention and antiretroviral treatment (ART).

Community-based organizations say this is likely to slow progress in ending HIV.

More people have been traveling over 15 kilometers from Chikukwa, a village in Mutoko, to Makosa Clinic.

The clinic is located in the mining area of Makosa, which has been identified as an HIV hotspot due to its activities and a rise in sexually transmitted infections (STIs).

Although there are other notable clinics in the district, some people have been forced to travel long distances due to a lack of quality HIV treatment kits and medication.

A baseline survey by the Disaster and Environmental Trust (DEMT) found that some people in Mutoko have been walking about 10 kilometers to access sexual reproductive health commodities and equipment.

They have also been paying up to US$120 to obtain medicines from hospitals that are far away, such as All Souls Mission.

Other respondents in the survey reported paying between US$1.00 and US$6.00 to access sexual reproductive health services at health institutions.

This cost is beyond the reach of many.

Several people expressed uncertainty or a lack of knowledge about the availability and quality of pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP) at their local health centers.

PrEP, taken before possible HIV exposure, and PEP, taken after exposure to HIV, help people stay HIV negative, even if their partners may have HIV.

“This indicates limited access to sexual reproductive health services. It also highlights the vulnerability of young women and girls who travel long distances to access specialized sexual reproductive health services at health centers. Therefore, it confirms how a significant number of young people obtain these services at home, from parents, friends, and relatives,” the survey says.

“In patriarchal societies like Mutoko, young women and girls are responsible for household chores such as cooking, washing, cleaning, fetching water, and providing household energy. As a result, young women and girls have limited time to seek sexual reproductive health services from distant health centers.”

Health Minister Dr. Douglas Mombeshora told The NewsHawks that the government is building more clinics to reach people who live far from health centers.

“We are planning to build at least 6,000 clinics to reduce the distance factor nationwide. It is a long process that cannot be done in a day, but it will be done. We are going to reach the target,” said Dr. Mombeshora.

CBOs covering the gap

In the meantime, community-based organizations in the area have come up with innovative ways to bridge the gap and help HIV patients access medication and HIV/AIDS-related information.

Mhuriimwe Aids Challenging Trust (MACT), a CBO operating in Mutoko, has been training volunteer caregivers to follow up with HIV/AIDS treatment defaulters and disseminate HIV education.

“We are exploring how communities can contribute to ending HIV/AIDS by 2030. We have realized that the major challenge is that communities are walking very long distances to get to hospitals and clinics for medication and services. After identifying that gap, we came up with the My First Choice Model, where we bring health workers to the people,” said Tichatonga Nyangu, MACT coordinator.

“We realized that men have not been taking testing as seriously as women. Some take it lightly and easily give up because of the distances between residential areas and clinics. From our surveys, most men take this lightly as they will be working most of the time, so they consider going to the hospital an afterthought.”

MACT has also been tracking patients, investigating reasons for defaulting, and referring most of them to health facilities for treatment.”

In Chikukwa, where we have been implementing this program, people travel between 15-20 kilometers to the hospital. So, we have talked to service providers, who then go and test them for HIV. If they are HIV positive, professional health workers take it from there, and care workers will only make follow-ups,” Nyangu said.

“We have seen that after implementing the model, Mutoko’s prevalence rate has dropped.”

“Incidence rates have fallen from 22% to 17%, which is an achievement. This is helping reduce new infections. While we do not have many resources, we have used what we have to make an impact. We have also been training caregivers.

“Training caregivers and mobilisersMACT has also been training caregivers, particularly women, on Sexual Reproductive Health, leadership, communication, and advocacy, so they can reach communities that are located far from health centers.

“We have also taught them to identify problems and find solutions. We are currently working in Wards 5 and 15 in Nyamakope and Makosa. We teach people about their bodies so they can seek treatment promptly when necessary,” said Anna Penduka, a trainer from Mutoko.

“We have realized that there are misconceptions about HIV. Some people believe sickness is due to witchcraft. We have trained caregivers to handle these situations with care. They open support groups with facilitators who identify and assist sick people. Lack of food can worsen illness, so facilitators provide support to encourage patients to continue treatment and seek hospital care.”

Limited resources

Caregivers like Greshen Mudzengerere, stationed at Makosa Clinic, travel 10 kilometers on foot to work daily before going to community wards where she teaches people the importance of HIV testing.

“If positive, we refer them to clinics to start treatment. We visit the villagers to ensure they are taking treatment. We travel on foot. I travel 10 kilometers from Chikukwa to Makosa daily to reach the clinic before going to the wards themselves,” she says.

“We meet every Thursday to update each other on reports. However, our work is challenging due to limited resources. There is only one care worker in each village, and we care for villagers in our wards.”

Despite the limited resources, the work of caregivers like Mudzengerere – disseminating HIV/AIDS information to villages sparsely located from clinics – has helped reduce serious Aids-related illnesses.

“Bed-ridden patients are now rare due to increased awareness. Our work is primarily counseling. A care worker can attend to at least two bed-ridden patients. Before HIV became widespread, we had several bed-ridden cases,” she told The NewsHawks.

“Before medication was available, we lost many people due to fear of testing or long distances. STIs and HIV cases are rising as young girls are increasingly interested in men in the mining sector. Makosa has become a hotspot.”

Another caregiver, Bertha Pasipamire, travels 14 kilometers from her base in Chirindi Primary School to Chindenge Clinic, before she can go to her respective Ward where she operates from.

“Getting medication is relatively easy. But from my residence to my workplace, I travel 14 kilometers, from Chirindi Primary School to Chindenge Clinic,” she says.

“In Chirindi, some people go to Katsukunya Clinic, which is even further. Others cross over to Uzumba Maramba Pfungwe or go to Katsukunya, paying at least US$2 for the 20km journey.”

The work by the caregivers has given some of their patients hope.

In Mutoko’s Mufakazi Village, Mudzengerere and her group, Takashinga, has been helping HIV patients like Lydia Jenge (pictured), one of the bed-ridden patients in the area, with food and house chores.

“I live with my daughter-in-law, but caregivers have been giving me assistance which has made me a happy person,” Jenge says.

Enock Karumbika of Kaunye Village in Ward 23, says he now has a sense of belonging in the society, after getting help from caregivers who helped him while he was sick.

“I was facing serious mental challenges. But when I began to mix with other people, I felt like I was belonging. I was segregated by everyone, but caregivers always came through to help me. Now I am helping other people that are going through the same predicament that I went through,” he said.

“I had to spend most of my time sleeping. But now I mix with other people, including social welfare and other crucial. I can also do some things that I could not formerly do, like gardening, which has helped me become a better person.”

This story is published under the Voluntary Media Council of Zimbabwe Investigative Journalism Fund with support from Action Aid Zimbabwe under the Partnership for Social Accountability Program.