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Zimbabwe: Countering stigma among young HIV patients in Epworth
Ann Sellberg is a doctor for Médecins Sans Frontières/Doctors without Borders (MSF) at an HIV clinic in Epworth, Zimbabwe.
All of her patients are under 20-years-old, many of whom are orphans and suffer from stigma due to their HIV positive status. These support groups are focused on regaining their dignity in spite of this stigma.
"The psychologist and I had prepared questions, a tape recorder, and engaged a peer counsellor for translation – who is also HIV positive. We were doing focus group discussions with the HIV positive teens, and the first interview with the children under 12, I would do on my own.
I was nervous and excited. This was my first chance to really talk to our patients.
We were recruiting the children from the HIV positive adolescent support group. I was with the little ones and after about an hour of play I asked the peer counsellor to check for their interest to participate in the focus group discussions.
To my disappointment, only one girl raised her hand. I asked the counsellor to insist, but she explained to me that the rest were quite happy and wanted to go out and play football.
The counsellor and I took the girl to one of our open-air shades and I brought out the tape recorder.
'Those were not happy eyes'
'Chiri sei?' - How are you?
'Chiri bvo.' - I’m fine.
'Makore mangani?' - How old are you?
'Ndine' - 11 years.
She was pretty, with a square face and a sweet smile, but what struck me was her gaze. It was clear and awake, and filled with knowing. Those were not happy eyes.
Support group provides relief from home
'How do you experience coming to the support group?' The girl answered in Shona, directing herself to the counsellor. 'She says it makes her happy,' the counsellor said. 'She always looks forward to coming here.'
'What do you like about it?' I was curious, as the girl answered at length. She had struck me as a shy girl, but her voice was clear, without hesitation.
'She likes being around the other kids, she doesn’t remember about the past, the bad memories don’t come up. She also forgets about her experiences at home.'
This answer made me concerned and I asked about her family situation. Not surprisingly, she lived with her mum, her step-dad and three step-siblings.
HIV status a secret for young patient
Her dad and two older siblings had died when she was very young. I wanted to go further into this, but we had prepared a long list of questions that I needed to get through.
'When did you find out that you had HIV?' I asked.
The counsellor translated for the girl, 'When she was 8 she came here to the clinic with her mother. She had sores all over her body. After that she got tested and her mother told her that she was HIV positive but that she must not tell anyone because it wouldn’t be good for her.'
'How did you feel about that?'
'She says it was painful, she was hurt. She asked her mum: ‘How did it come into me? How did this happen?’ But her mum wasn’t in the right space to answer, she couldn’t say anything.'
Treated differently within family
I enquired further, 'Is there anyone else who knows?'
'She’s saying that her aunt knows, but she’s not allowed to talk about it with her step-father or her siblings. The church and the community don’t know about it either,' The counsellor added.
'Are you ever treated differently than other children?'
'At her aunt’s place she is treated like any other kids, but at home, whenever the little ones gets gifts she never gets gifts.'
The girl must have understood some English, because when the counsellor translated her words she put a hand to her face and started crying. 'Oh come here,' I said, indicating the space next to me. She edged closer and I put an arm around her. She kept crying for a while, her face hidden in her hands.
'Are there any other ways that you feel that you are treated differently?'
'When her step-father comes home from work, she welcomes him, but he doesn’t give any sign of seeing her. But when her sister Julie says you’re welcome [to her father], there’s welcoming, there’s warm feeling and when the other siblings get money for school items, small amounts, this one doesn’t get anything.'
The counsellor was holding the girl’s hand and I could see how sympathetic she was to this girl.
'And how does that make you feel?' I asked again. 'She says she doesn’t do anything, but sometimes she asks her sister for money, just a few Rands, but she always refuses to give it to her.'
'Have you ever told anyone about this before?' She shook her head.
'How does it feel to talk about it?'
'She says it makes her feel better.'"