Submitted by Eduarda Cipriano, Executive Director, NGUNI (Esperança’s indigenous partner in Mozambique)
The Social Determinants of Health Impacting HIV/AIDS in Mozambique
For most people in western countries, HIV and AIDS are a scary story of the past that were once rampant amongst gay, poor, and black people, mostly. For the continent of Africa, HIV and AIDS are a reality that has touched every family. According to UNAIDS, “the vast majority of people with HIV are in low- and middle-income countries. In 2020, there were 20.6 million people with HIV (55%) in eastern and southern Africa, 4.7 million (13%) in western and central Africa, 5.7 million (15%) in Asia and the Pacific, and 2.2 million (6%) in Western and Central Europe and North America.” In sub-Saharan Africa, where Mozambique is located, women and girls accounted for 63% of all new HIV infections in 2020.
Currently, Mozambique is among the top ten countries globally with the highest prevalence of HIV. In 2018, an estimated 2.2 million people were living with HIV, and a disproportionately high incidence has been reported in the Central and Southern Provinces of the country and among adult women aged 15–49 years; thus, HIV prevalence varies by region, sex, and age in Mozambique. See the map below:
Cultural practices among Mozambicans such as cleansing rituals for widows and widowers, which vary from region to region and are gender-dependent on the person subjected to the ritual, have been reported as key to the spread of HIV infections. Studies have also reported risk factors for HIV to include multiple sexual partners, extramarital sex, intimate partner violence, poverty or household wealth, and infrequent or lack of condom use.
Overall acceptance of people living with HIV/AIDS in Mozambique remains low with only 35% of women and 37% of men saying that they would not want to keep secret that a family member has HIV. Furthermore, only 18% of women and men express accepting attitudes on all four indicators:
- Are willing to care for a family member with HIV in the respondent’s home
- Would buy fresh vegetables from shopkeeper who has HIV
- Say that a female teacher with HIV who is not sick should be allowed to continue teaching
- Would not want to keep secret that a family member has HIV
Antiretroviral (ARV) drugs are free in Mozambique, and access to them is relatively easy, but for many HIV-positive Mozambicans the real challenge is a far more basic problem of finding enough food. ARVs are powerful drugs that need to be taken with nourishment. Regular and nutritious meals are also needed to help the body's own defenses fight the opportunistic infections associated with AIDS. People from the poorest families often decide to abandon their ARV treatment as their experience and suffer from constant nausea and weakness as a result of taking the medicine on an empty stomach.
A Look Inward: The Community of Maciene
Maciene, the community where Esperança serves, is not different from the rest of the province. Unfortunately, as per our anecdotal data, more than 70% of the adult women that our project serve, are people living with HIV and AIDS, although they do not disclose their serostatus. Therefore, our initiatives in food security and nutrition respond to their needs in nutrition so to help them continue with their treatment. Regular antiretroviral treatment can reduce HIV in the blood to undetectable levels. According to the Centers for Disease Control and Prevention, a person with undetectable levels of HIV in their blood can't transmit the virus to a partner during sex.
Maciene has lost its laboratory specialist given that the entity that was contributing to his salary lost that capacity. Now people need to travel 14 miles to Xai-Xai and back. To that one needs to add resources for food and other expenses for a one-day-travel, amounting to close to 250 MZM (around $4USD) that they do not possess. Due to that, Esperança provides support to the Community Adherence and Support Groups (GAAC in its Portuguese acronym) in Maciene by providing the needed resources to pay for transportation to Xai-Xai to get the monthly medicine for its members while the person whose turn is in that month, gets his/her medical checkup.
Young girls are the most likely to get infected by HIV; in fact, in Maciene they begin their sexual activity as young as 14, increasing their likelihood of becoming infected. Esperança has added to its activities, “Rodas de Conversa” or “Circles of Conversation” targeting youth (both boys and girls). During these rodas de conversa, not only do the activists, but also two nurses (one male and the other female) engage the 27 young people (19 girls and 8 boys) enrolled in conversation about sexual and reproductive health and rights. HIV and sexually transmitted infections and their impact on their future are part of topics addressed. One of the major challenges for young people is the lack of places and activities for them to occupy their free time in safe and healthy ways. At the Mabumwine center, Esperança has provided space for them to chat and rehearse dance after their talks. We have purchased a sound box and are looking to hire a seamstress to teach both boys and girls how to sew (purses – the boys; and dresses – the girls), as they have requested.
Older women, most often, the gatekeepers of values and traditions are also engaged in some of the rodas de conversa, bringing to light the cultural practices that help disseminate HIV in the community, such as the widow cleansing through sex. Over the years, some families have adopted the cleansing using “green medicine” in replacement of unprotected sex.
The Future of HIV/AIDS Prevention
Progress in the area of HIV/AIDS education and prevention is slow going, and in many ways it must be. Implementing lasting change that involves both learning and unlearning is a process that may take generations. But Esperança, in partnership with NGUNI, is committed to ensuring that this undertaking is both sustainable and culturally competent. Learn more about our work in Mozambique.