Home-based HIV testing offers families the opportunity to understand and face the virus together. This is a new phenomenon in South Africa, having first been introduced in certain districts of the Mpumalanga and Free State provinces.
Before home-based HIV testing came to the mining community of eMalahleni, in Mpumalanga, David Mncwarhane was always concerned about the wellness of his family. It was his desire that everyone in his family may test for HIV infection.
“If you don’t know your status, you will have problems. You may already be having HIV and refusing to go get tested while you’re still strong. By so doing, you weaken your system and you will get sick not knowing what’s eating you up. When you eventually seek help, it might be too late as the infection would have taken hold. So, it’s important to know your status while you’re still healthy. Don’t waste time”, says Mncwarhane.
He saw an opportunity when New Start, an HIV prevention programme, introduced home-based HIV testing in his area of Hlalanikahle Extension 1, in the mining town of eMalahleni. Trained counsellors go to people’s homes to counsel and offer them free HIV testing. After an initial visit by New Start counsellors, Mncwarhane sat down with his wife and children who range from the age of 39 to 13 and urged them to take the HIV test together as a family. He also requested everyone to disclose their HIV status to other members of the family. Five out of the seven members of the family proceeded to take the HIV test. Only the youngest child, who is 13 years-old, and another who was away on a trip did not take the test.
“As the head of this family, I don’t want uncertainty. I always advise my family to get tested. I want to know your status. I also want you to know my status because I don’t want to be a burden. If I’m positive, I want to know that early. We must know one another’s status as a family. According to me, if my wife tests positive and I test negative, there’s nothing I can do about it. I just have to accept it and move forward. Fighting will not solve anything”, Mncwarhane says.
His request got the understanding and support of his wife, Martha, who believes that “if you keep your status secret, it might harm you emotionally, which might result in illness. So, it’s better to discuss our statuses as a family and know what to do thereafter. The ones that don’t have HIV must do everything to ensure that they don’t get HIV”.
The children also understood.
“It’s important to disclose your status. I can test with the family and not tell them my true status. If I’m positive, they’ll see me showing symptoms of HIV after a while – maybe, coughing, and other conditions and not getting better. Much later on when I’ve badly deteriorated, they’ll find out my status. So, it’s the right thing to do to disclose one’s status”, says 39-year old Esther, the eldest of the five Mncwarhane siblings.
But testing wasn’t easy for Esther who had never had an HIV test her entire life. She says upon testing, she promised herself that “no matter what results I would get, I will accept them. If I find myself to be having HIV, I will take medication and go on with life”.
Her result came back negative. Only one of the siblings tested positive for HIV. New Start’s home-based HIV testing programme has tested over 100 families in the small township of Hlalanikahle since it started one month ago. While the community has welcomed the programme, it’s not every family that appreciates the service. Edith Nqakuvane is the manager of the programme in the area.
“There were families that said to us: ‘Why do you say we’ve got HIV? We know where to go and test! Why are you coming into our homes?’,” says Edith Nqakuvane, the manager of the programme in the area.
“But, it was about two families”, she adds.
According to Nkanyiso Ndlovu, manager of the HIV Counselling and Testing programme at the Society for Family Health, which manages New Start, people should consider home-based HIV testing for the following reasons:
“It saves time for the people that we test because we actually come to them. They don’t have to go anywhere. It saves them money. They don’t have to pay to get on a taxi. They are all in their home… everybody is there, so they encourage each other. Those that need support, find support within their immediate family. So, it’s much easier and much more beneficial to test in your house because you’ve got all your family members with you. And if you need to disclose, you don’t have to stress a lot about who you’re going to disclose to because everybody in the home is already informed about what’s happening. So, it’s easier to disclose and get support”.
He adds: “We do encourage it (disclosure), but it’s not something that we force people to do”.
Home-based HIV testing is already practiced in countries such as Zimbabwe and Uganda.