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My name is Khawulani Dinangwe. I'm 32 years old and I am a Nurse Clinician at Health Systems Trust. I went to school in the deep rural areas, near Underberg and close to the Lesotho border. After school I moved to Pietermaritzburg to further my studies. I fell in love with nursing because of my background, coming from a community with a high prevalence of HIV and TB where I saw the terrible impact of these diseases.
I grew up wanting to be part of the forces helping to combat these diseases and help the community. I finished my Diploma in General Nursing in 2010, and then did community service in a hospital near my family home. In 2012 I did a Postgraduate Diploma in Primary Health Care, and completed a number of short courses such as Nurse-initiated Management of Antiretroviral Treatment (NIMART).
In 2017 I joined HST, which has given me the opportunity to reach my dream of working with communities to combat HIV and AIDS. Working for the SA SURE Plus Project has enabled me to work hands-on in our focus on reaching the UNAIDS 90-90-90 targets to help end the AIDS epidemic by 2020.
'90-90-90'; means that 90% of all people living with HIV will know their HIV status, 90% of all people with diagnosed HIV will receive antiretroviral therapy (ART), and 90% of those on ART will be virally suppressed.
Viral suppression means that the ART medication has reduced the number of copies of the virus in the person's blood. This does not mean the patient is cured; the HIV virus remains in the body, but in such small quantities that it is undetectable. If the person stops taking ART, their viral load will increase again and they can become very ill.
One of the challenges we face is the high rate of clients defaulting on their treatment, or clients not attending follow-up appointments at the clinic to collect medication. One of my clients, a 20-year-old woman, had been on ART for three months, but during the fourth month she missed her appointments, and came to the clinic two weeks later than scheduled. When I asked why she hadn't been to fetch her medicine on time, she said that she had "extras" at home.
When I asked why she still had medication left over, she replied that when she started ARVs, she was unable to take them at home because she was afraid that her parents would find out and she would be in trouble. We gave her ongoing counselling and she decided to start again, stick to the regime and keep appointments.
Clients like this woman need the help of support groups and ongoing counselling, especially when families respond negatively to disclosure of HIV or taking ARVs. It is really important that thorough counselling is given before ART initiation to make sure that clients can raise and discuss any concerns or obstacles they might face. Now we give her counselling every time she comes to collect her medication.
It's also very important to form adherence clubs in the community. This helps to reduce stigma, provides peer support, and guides clients in adhering to their medication so that they can be healthy and strong.