Health counselors: A key element in the fight against HIV

"The health counselor is the key member of the team. They are the true pillar. It is with the health counselor that patients have their first contact, on which everything else depends."

~Mauro Timana – Chefe Médico at Mocubela

Under the intense sun in the district of Mocubela, in Zambézia Province, Ilda Pedro receives Bethe Gabriel into her home. They kiss each other’s cheeks and smile at each other. Ilda is an HIV positive patient, and Bethe is her health counselor. Over time, their relationship has grown substantially, moving from one between provider and patient to a deep and enduring friendship. At the time of the visit, Ilda was at home with her youngest son, still an infant. Two other children were at school, and her third was at her grandmother’s house.

Ilda Pedro and Bethe Gabriel, health counselor, at a home visit.

Ilda sorted and cleaned the beans she would prepare for dinner. "I grew these beans myself. We are great farmers." said Ilda, proud of her work. She confessed that her husband was battling for his survival in a remote village. When it was time to talk about her children, Ilda became more hopeful. "My sons are healthy. It was the first one who went through a lot of complications. But he's fine now. I don't know yet what they want to be (when they grow up), but I would like for them all to study so that one day they can take care of me," said the mother of four children. This climate of health and hope has not always been present in this family. "My eldest son was always sick. I would take him to the traditional healers, but he would always have relapses. When I got pregnant with my third daughter back in 2014, I was advised to take an HIV test. My result came back positive. It was at that time I was advised to have my eldest son tested for HIV. His result was also positive," Ilda told us. From that day onwards she started to look out for the family’s health. Today they all know their HIV status. Only Ilda, her husband, and her eldest son have HIV. They are all on combination antiretroviral treatment. The youngest has already had his first child-at-risk (CCR) clinic consultation and his HIV test result was negative. According to Beto Omar, the FGH clinician at Mocubela, “HIV treatment markedly reduces the probability that pregnant mom’s will transmit HIV to their newborn children.” Ilda is grateful for the "miracle" performed by the local health unit supported by FGH. "I did not think my son would be alive today. Even his hair color had changed; it used to be brownish. Today he plays and goes to school. He's the one that asks for his medication when the time comes to take it." According to Bethe, Ilda’s health counselor, Ilda was reluctant to initiate antiretroviral treatment early on. She tells us "Just like the majority of people, she (Ilda) did not accept the (HIV test) results. She had to go through a couple of counseling sessions before she could accept the reality. To be successful, we the counselors need to show that we are interested in seeing the patient get healthy." Mauro Timana, Chefe Médico at Mocubela, emphasizes the role of health counselors in the fight against HIV. "The health counselor is the key member of the team. They are the true pillar. It is with the health counselor that patients have their first contact, on which everything else depends." He adds that "If the health counselor’s work is not done well, all the rest is jeopardized." Timana says Ilda and her family are monitored by their health counselor and thanks to this follow-up, the entire family is healthy and is thriving. Ilda finishes our conversation by expressing her angst for those women that are reluctant to be treated (for HIV). "I feel (sad) for them. Before ARVs, a lot of people would lose their children. Even adults would lose their life. But this treatment is very good." Health counselors are stationed in key sectors within the health facilities: antenatal care, child-at-risk clinics, HIV counseling and testing, healthy child services, provider-initiated counseling and testing areas, and psychosocial support services unit, in order to receive and welcome patients and to facilitate the health facility's workflow.

Ilda Pedro and Bethe Gabriel, health counselor, at a counseling session.

During the antenatal consultation, aside from HIV counseling and testing, the health counselors screen for STIs, TB, hypertension and diabetes. There, they also invite male partners to benefit from the same health counseling, and to receive key positive prevention messages covering sexual behavior, correct and consistent use of condoms, treatment for STIs, prevention of mother-to-child-transmission (PMTCT) of HIV, family planning, disclosing HIV+ status to a partner, adherence to treatment, risk reduction counseling (focused on the dangers of alcohol and drug use), as well as referrals to community support groups. Ilda is one of many mothers that has benefited significantly from the services provided by the health counselors in the 14 FGH-supported districts within the Zambézia Province as of September 2016. The health counselors support is part of the U.S. government’s President's Emergency Plan for AIDS Relief (PEPFAR) funded Avante Zambézia project through the Centers for Disease Control and Prevention (CDC). FGH is affiliated with Vanderbilt University Medical Center and provides support to Zambézia's Provincial Health Directorate for the implementation of HIV health related services. This partnership has made it possible for FGH to have trained health counselors working in all 14 FGH-supported districts; an essential cadre of health professionals in the fight against HIV.