A Day with an HIV + AIDS Counselor

During the month of March, I had the opportunity to observe my friend Thandi* in her work as an HIV + AIDS counselor at a rural health clinic. Both my discussions with Thandi and observations of the environment and her clients opened my eyes to the complexity of confronting HIV + AIDS.
Thandi gave me information about HIV + AIDS at her clinic. The following information is based on statements from the booklet called, “HIV and AIDS and Treatment,” sponsored by the government. The virus HIV causes AIDS. HIV is a disease that attacks the immune system. The disease lives in sperm, blood and vaginal juices. HIV spreads between people in three ways: one, having unprotected sex with an HIV positive person; two, becoming in contact with infected blood; and three, passing from an infected mother to her unborn or newborn baby. HIV usually becomes AIDS with time, which is a different amount of time for every person. An HIV positive person has AIDS when their immune system is extremely weak. One way to measure the strength of a person’s immune system is to take a CD4 blood test. The CD4 number helps to determine when a person with HIV or AIDS may start taking ARVs (anti-retrovirals). ARVs cannot cure AIDS, but they do help make the immune system stronger.
Add about PMB’s HIV + AIDS status
As an HIV + AIDS counselor, Thandi runs three main programs: VCT (Voluntary Counseling and Testing), PMTCT (Prevention of Mother to Child Transmition), and HAST (HIV + AIDS Sexually Transmitted Disease and TB). She provides counseling and testing for people, including ongoing counseling, adherence counseling, and literacy classes. The programs and counseling sessions are free to the public due to governmental sponsorship.
People see Thandi on their own terms or they will be referred to Thandi by other clinic staff if they are diagnosed with an opportunistic infection. An opportunistic infection is common for a person to have when the person has HIV. HIV is an autoimmune disorder, so it challenges the body’s cells that fight off illness. Opportunistic infections take advantage of the body’s immunity deficient status to enter the body. Opportunistic infections include TB, diarrhea, thrash (of the tongue), weight loss, meningitis, pneumonia, and sexually transmitted infections (STIs). Thandi always reconfirms that patients are taking HIV tests on their own free will and they sign a statement saying so.
Thandi tests clients for HIV with two rapid tests. The rapid tests receive their name from the fact that they should be read five to twenty minutes after a blood sample, taken by a pinprick to a finger, is placed in the small, plastic tests. The first test is a screening test called “S D Bioline” and the second test is a confirmatory test called “Sensa”. The tests must show the same result, obtained by reading line(s) that appear on the tests, to confirm whether a person is HIV positive or HIV negative as of three months prior. The control line should always appear to demonstrate that the test is working properly. If the tests do not read the same results, samples will be sent to a hospital for further testing. When testing for HIV, there is a window period of three months after becoming HIV positive when a person may not test positive, so if a person tests negative, a person is always recommended to come back in three months to retest.
On the day I observed, Thandi tested four people. Two people tested positive and two people tested negative. On a good day, Thandi stated that six out of ten will be HIV negative. On a bad day, seven of ten will be HIV positive. She also counseled four people for ongoing treatment. Additionally, Thandi encourages people to use condoms.
One of the clients Thandi tested was a farm worker on a local farm. He makes 580 rand per month, which is about 80 US dollars per month. Based on responses from clients, Thandi said that farm workers make about 500 to 1,500 Rand per month. With his wages, this man not only supports himself, but his wife and six children, ages seven to seventeen. He sends money to his family, who live in Lesotho. How do eight people survive on 80 dollars per month? While we waited for results, he stated that he was not cheating on his wife and he had no girlfriend. Prior to Thandi telling the man his results, I reached for some information and saw two lines on each of his tests, meaning he was HIV positive. Until Thandi told him the results, I felt numb in shock. After Thandi told the man the results, she asked if I had seen the results, and I leaned over to confirm that the two lines truly appeared on the tests. Thandi ushered the man to another room for further testing. I stood in the doorway, observing this thin man in an oversized blue worker outfit. The other clinic workers told me to come into the room; I stepped far enough into the room to close the door behind me. The results changed this man’s life, and in these moments of human suffering, I felt that I should disappear, disappear from being the white girl observing this man’s pain. My heart goes out to the man.
Next, Thandi counseled a girl in her school uniform who was raped in 2005 and subsequently tested HIV positive. Both her parents are dead and she lives with her brother. Her birthday was unknown, so Thandi and she made up her birthday: April 3rd, 1993. A local myth about HIV is that if a person rapes a virgin, the virgin will get the disease and the rapist will become HIV negative. The man who raped the girl is now in prison and she is still going through the trial. The girl talked about committing suicide. I asked her if she had any dreams. She smiled but said no. Then, she asked Thandi if she would be able to have children, even though she was HIV positive. Thandi initially did not want to respond, because she did not want to encourage sexual behavior, but the girl said she did not want children yet, she wished to know for the future. The girl will soon start classes on HIV + AIDS and join a support group.
After observing Thandi at the clinic, I asked her if she thought people felt uncomfortable with me in the room. She replied, “Because you’re from another culture, they don’t mind… Also, they know you can’t speak Zulu.” I tried to show each person dignity and respect.
Thandi discussed the many challenges of working as an HIV + AIDS counselor. Alone she provides lots of programs, due to a staff shortage, yet the government does not have the money to employ more people. The clinic is situated in a fairly isolated spot; there are no houses nearby and people walk long distances to reach the clinic, as no transport exists to the clinic. Due to the small size of the clinic, the clinic does not have ARVs. In the rural area, many people do not have identification books, and without this identification, they cannot receive social grants. Also, Thandi said many rural people do not know their rights, so the government ignores them. She elaborated: “Here in South Africa, you have to know your rights before the government will help.” Therefore, she concluded that the rich become richer and the poor become poorer.
The greatest challenge, according to Thandi, is that people do not take their ARVs properly. Sometimes people don’t have food, so they cannot take the necessary food with their ARVS. Sometimes people have given up on themselves, demonstrated when they drink alcohol. Sometimes, people end up “defaulting” and lie about taking the ARVs.
Thandi also gave examples of local perspectives on HIV + AIDS. For one, even if people know that they have HIV or AIDS, they will assume that others do too, so they do not worry about spreading the disease. Thandi alleged that people living on farms: “…just makeup their own stories about HIV + AIDS because they’re in denial.” Additionally, she stated, “Because in the farm, there is no entertainment for them. Their entertainment is sex, so they’re spreading it [HIV + AIDS].”
I asked Thandi about the greatest joy of her job and she said, “If people say thank you, it means I’ve done my job.” She described people will not say thank you at the time of testing, but they may come back and show her the tablets they are taking or they were sick and they come back to tell her thank you. She tries to refer people to the right channels, such as to social workers, for grants, or the police station, to receive an identification book.
When Thandi was new at the job, she told me that she used to cry and give people money because she was more sensitive. Now, she affirms, “Everyone on this planet must stand on their own feet… can’t spoon feed them… they will abuse you.” Now she empathizes, not sympathizes and tries to stay neutral but listen carefully. She wisely realizes that she can’t solve everyone’s problems.
Thandi sees lots of people with HIV or AIDS. For example, she sees children growing up HIV positive because their moms did not take nevirapine treatment when they was pregnant, which lowers women’s chances of passing HIV onto their children. Then, shortly after the child is born, the mom dies and the grannies take care of the AIDS orphans. Furthermore, moms are often too sick to see a social worker after their children’s birth, therefore not obtaining an identification document for the child.
Although Thandi constantly gives, she, too, is struggling to get by. She shares, “I do wish to have a house with a toilet inside and my own bedroom, because I’m older, but I don’t want to challenge God and say I’d like a car and a big fancy house.” In her home, curtains separate the family room from the kitchen and the only bedroom, which she shares with her daughter and sister. Her cousin and uncle live in one-room dwellings on the property. Thandi insisted that I sleep in the double bed and she, her sister, and her two-year-old daughter share the twin-sized mattress on the floor. For serving as an HIV + AIDS counselor, Thandi receives 5,000 rand per month in wages from the government, without benefits, which is about 685 US dollars per month. I believe we may all learn from Thandi. She elaborated, “We also have people who call themselves Christians, but they do not talk to their neighbors… They are only Christian in name… Because they have everything they don’t see the need to plant relationships with their neighbors.” May we all learn from Thandi’s loving service and wisdom.

* Thandi is a pseudonym, meaning love in isiZulu, for my friend in order to protect the identity of her and her clients.