HIV Testimonies

Tuesday, May 20, 2008

Africa: Putting Human Faces on HIV/Aids

By, Cindy Shiner,, May 19, 2008

The widely acclaimed book, 28: Stories of Aids in Africa, has been highly praised for humanizing the story of HIV and Aids in Africa for readers around the world. The book tells the stories of 28 people affected by the virus – one for every million of those believed to be living with HIV in sub-Saharan Africa. Stephanie Nolen, author of the book and Africa bureau chief for the Toronto Globe and Mail, told AllAfrica's Cindy Shiner that her goal was to help readers get past the statistics and to put a human face on those 28 million people.

What did you hope to achieve by writing 28?

It's easier to care about this issue when you start to see those affected as individual people and to understand that it is every bit as disturbing to hear the news that you have HIV in a little counselor's office in Malawi as it is in New York or London or Toronto or Sydney.

I was writing for a northern, or developed world audience, trying to get them past the lack of engagement with this issue, which I think sometimes comes either from being paralyzed from the statistics or from thinking, "Well, sure Aids in Africa is bad but it's just one more bad thing in a place full of bad things so it's really not any different." [I wanted] to say actually that all of those [living with HIV] are people with families, people who had dreams and ambitions, people who would be as terrified by this news as you would be.

Have you succeeded in doing this? And if so, how do you measure it?

I have no idea, I think because it's almost impossible to measure. The ultimate goal was a broad change in Western public opinion and I don't know how one would assess that.

The response to the book has been quite gratifying. It's been published in 13 or 14 countries in a number of different languages and I've received lots and lots of mail from readers and really good attendance in places where I've spoken about it, either by myself or with people who were featured in it. So that's heartening because your gut feel when you set out to write a book about HIV in Africa is that no one will read it.

When I started writing the book, and certainly when I started reporting on this issue in Africa full time, there was a complete lack of interested engagement in the North. Over the time… I was covering this issue I saw a lot of things change. By the time I was finished, the GAP had a clothing line for the issue (HIV/Aids). So obviously it was on the radar in the West in a way that it just didn't used to be at all.

I don't really know how I would separate out the impact of 28 from things like the involvement of Bono or the efforts of Bill and Melinda Gates. I think a lot of things happened at once and 28 was a part of that.

Once you began reporting on the pandemic in Africa, did you come to realize that you had misperceptions about HIV/Aids and if so how were they turned around?

I wouldn't say that I had misperceptions that changed particularly. I think maybe I [developed] a deeper understanding of how these issues are incredibly complicated.

To give you an example, I was writing about migrant labor and the role that that's played in transmission of the virus. I was talking to some epidemiologists who had been tracking communities of miners who come from either rural South Africa or the surrounding countries to work in the mines around Johannesburg. The miners are here for a couple of years and then they go back home. And I was writing about how that quite often those men will have sexual partners in the cities where they live – which is not difficult to understand if they're away from home for a couple of years – and then they take the virus back home with them and infect their wives. That's the standard route of transmission that's discussed.

But in talking with these epidemiologists, they said, "Well, actually, when we survey miners we find that half of them are in couples where one partner is infected and the other isn't and half the time it was the women who were infected and not the men." What that says, of course, is that when these men went away, their female partners, their wives, were also choosing to have other partners, again perfectly understandable, [for] people looking for companionship, intimacy, sex, possibly financial support, while their partner was gone for years at a time.

The discussion around how the virus is transmitted is always about men and quite often there's a very loaded discussion of African men and their sexuality – which to some degree has its origins in behavior that has been extremely damaging… Nobody was talking about the fact that there were a lot of women choosing to have partners when their husbands were away and what that meant for the transmission of the virus. And, of course, until you're honest about that and really looking at all the ways the virus is moving you're not going to be able to come up with good strategies to respond.

That's a very long way of saying that I learned that there's a standard way that the African pandemic is discussed and below that is a very, very deep layer of nuance that much more often is glossed over.

What did you think was missing in the literature that prompted you to focus on the pandemic?

You never heard the human stories. If you got any news outside Africa about the Aids pandemic, it was this flat, one-dimensional picture of poor suffering Africans. You never heard about the fact that virtually everything that had been done to respond to the pandemic had been done by Africans, usually by Africans living with HIV. And you didn't hear the stories of incredible courage or resilience that I was hearing all the time.

You didn't see these people as people and you certainly didn't hear about all the ways they were taking on governments and pharmaceutical companies and even their own communities, their churches, their families to respond to this.

What was the reaction of your editors when you told them that you wanted to focus on HIV/Aids in Africa?

Initially it was extremely dubious. They were not enthusiastic at all. They couldn't believe that this would be anything but a continuation of that one-dimensional, extremely grim story.

We recently spoke with Stephen Lewis [formerly special envoy for HIV/Aids in Africa for United Nations Secretary-General Kofi Annan] and one thing he feels strongly about is the U.S. administration's Aids plan, Pepfar. He contends that Pepfar does not go nearly far enough to address HIV/Aids and that people should demand more rather than cheering what the administration is currently doing. What is your perception of Pepfar?

Well, I think about Pepfar like any other Western donor government response to the pandemic: I would say they don't do enough. But to my great surprise I have been extremely impressed with Pepfar.

Everywhere I go in Africa it is the most effective, most efficient response to the pandemic that I've seen. They spend money quickly and intelligently and they have a huge impact. If you look at the numbers they have on treatment, the number of mother-to-child transmissions they've prevented, the number of tests they've provided, it's been incredibly successful. Obviously it had some extremely large problems at the beginning that were the result of catering to American political constituencies [rather than] out of any real concern for the people of Africa… But most of those have been dealt with.

Sure, it would obviously be great if Pepfar were bigger and had more money and worked in more places and that's probably Stephen's point. But I think that frankly the Bush administration deserves a lot more credit for this than they've received. I would say that it's their great American foreign policy triumph and virtually nobody in America seems to know about it.

Are you planning a follow-up to 28 and to what extent to you keep in touch with the people profiled in the book?

I'm not planning a follow-up. For every subsequent edition I update the epilogue with the latest news of the people who are in it. I am in pretty close touch with all of them… It's really nice to see the way the book has had a really positive impact on a lot of their lives.

Is there anything else that you would like to say?

I have seen so many individual acts of great courage and heroism in so many different countries. People who are… fighting these fights are working with no resources, often when they are ill in isolated areas, up against huge forces and nobody writes this down.

There's been almost no recorded history of 25 years of response to the pandemic in Africa and almost all of these individual acts of heroism have been lost. There are a couple of people like Zackie Achmat, whose stories are quite well known internationally, and he's a huge inspiration for other Africans.

When the International Aids Conference was held in Toronto in 2006 I was almost finished writing the book and 13 people profiled were at that conference representing their organizations. My publisher hosted a dinner, and sitting listening to them talk to each other, listening to the Nigerian talk to the Zambian about what they were doing about prevention of mother-to-child transmission, and the South African talk to the Ethiopian about what was happening in the armed forces for HIV prevention, was possibly one of the most wonderful moments of the whole process for me.

I thought, this is not an opportunity that these individual Africans get. They don't realize that what they're doing is actually being repeated all over the continent, that other people have exactly the same challenges.

It's important that just a little bit of this get written down because by the very nature of HIV you lose so many of the people who've been important in these struggles... I did not have that as a goal when I started but certainly when I finished I thought that I hope the book does a small, small part of that.


Tuesday, January 08, 2008

Biggest hope: To live longer

By, Swatee Kher,, January 8, 2008

The new year is bringing new hope for me, of living and being able to raise my seven-year-old daughter. I want to live long enough to see my daughter grow up. I want to live for her. I hope we start getting the new medicines soon.”

For the frail and shriveled Sulabha Naik, an HIV-positive mother, the big new hope comes from the second line of drugs all set to roll out from the Anti Retroviral Therapy (ART) centres. They will help her body contain the deadly virus and perhaps stop her from moving to the AIDS-level. Though this single parent’s CD4 count — used to assess immune status, susceptibility to opportunistic infections, need for ART and for defining AIDS (if CD4 count is less than 200) — is over 600, she has suffered severe weight loss for a year now and she is suffering from side effects caused by two drugs she was consuming.

“I cannot afford to take the medicines from a private setup. I hope the government can provide us with the medicines through the ART centre. Sassoon Hospital had made a list of people who have developed side effects for the drugs and I am on that list,” says Sulabha, who works as a peer educator in Pune. Mumbai’s JJ Hospital will be the first in the region to offer the second line drugs.

A resident of Pune, she became aware of her HIV positive status in 2000 and joined the ART regime in 2004 at Sassoon Hospital. Her husband, also HIV positive, died a couple of years back, while her daughter is negative. During the initial phase of her disease, she even attempted suicide as family and friends suddenly turned them into outcastes.

Now, with the news of the second line of drugs to roll out at JJ Hospital and at Tambaram Hospital in Tamil Nadu, she doesn’t mind making a monthly trip to Mumbai.

Earlier this year, the National AIDS Control Organisation (NACO) announced the commencement of the second line of drugs after patients reported resistance to the first line of drugs being given since 2004 through ART centres across the country. According to NACO guidelines, there will be two sets of beneficiaries, one where first line therapy has failed to work and the other where there is a planned discontinuation due to side effects of one or more drugs from the first line regimen.

Sulabha, like hundreds of others in the country, is waiting for the NACO programme to roll out this month in Mumbai and Tamil Nadu.

In Chennai, S Manjula is waiting for the second line of drugs for her husband.

“You know, all the efforts in providing the first line of drugs for patients like us will be wasted if we do not shift to the second line. Even though I want to, I cannot afford to shift to a private setup for the medicines,” she says.

The criteria to select patients for the second line drugs have also been drawn up. A patient whose CD4 count falls below the base line after a high or persistently remains less than 100 is eligible, as also those who develop opportunistic infections and whose viral load count is 1,000 copies/ml.

“We are to start the second line of drugs in January. The pre-screening of the candidates is going on. We have not made the entire list yet,” said Dr Alaka Deshpande, who heads the ART Centre at JJ Hospital.

“This comes as a blessing. Patients are in need of the second line of drugs. We are waiting to understand how the plan for the second line of drugs will be rolled out in the state,” said an AVERT society official. “If patients get it through the government ART, it makes a difference in terms of finance. If they can save on the expenditure on medicines, they can spend on nutrition.”

“The second line of drugs are now needed as doctors tell us that there are more than ten per cent patients who are resistant to the first line here,” said P Kousalya, president of the Positive Women’s Network from Chennai. She, however, added that some centres started by the Tamil Nadu State AIDS Control Society were already offering the second line of drugs.

“There are perhaps two-three reasons which spell the need for the second line of drugs. One could be adherence problems among the patients for the drugs, which are combination pills. Second is resistance to the regime that is being given. And the third would be toxicity (side effects) of the drug in the patient,” said Dr Dilip Mathai of the Christian Medical College, Chennai, one of the members of the team that recommended the medicines to be included in the second line of drugs.

“I know that I have to change the medicines, but I don’t know what to change. After knowing the resistance test results I will know which class and domain to select from,” says Sulabha.

With the ray of hope on the horizon for her, Sulabha now wants the sun. She wants the medicine to cure HIV, so that “we can also hope to be rid of the disease and not just look forward to living as long as we take medicines.”


Friday, August 31, 2007

Neither living nor dying, I’m an HIV AIDS patient

By, Jamila Achakzai, Daily Times (Pakistan), August 31, 2007

Islamabad: Jamal Khan is one of many who repent their extra marital sexual relations, which have made them to lead life with HIV-AIDS.

Now aged 31 and admitted in the Pakistan Institute of Medical Sciences (PIMS), this father of four says he has lost good health, honour, money, relations, peace of mind, and in a word, everything to the deadly disease and has no charm in life.

Lying on a bed in a general ward, Jamal, whose name was changed on his request, has his sunken eyes and cheeks. Excessive loss of hair has rendered most of his head bald and his skin has turned black. He looks like a skeleton.

Belonging to a poor family of the conservative Malakand agency, Jamal was employed in a private construction firm in Saudi Arabia as a labourer and used to return home on vacations every year. As usual, he came back a few months ago to see his small family. Here, he had high fever for many weeks despite medication. Upset by his condition, he consulted doctors who recommended him for certain medical tests. To his horror and distress, the tests declared Jamal HIV positive two months ago and thus, landed him in a PIMS ward. He has been under treatment there ever since.

Jamal had contracted the deadly virus from a sex worker in Saudi Arabia. He insists he might have committed suicide if he knew he was an HIV-AIDS patient to avoid social stigma attached to a sex-related disease. Except for his brothers, his entire family is oblivious of his medical condition, as he has kept it in dark for the fear of abandonment. He knows he has not a long life ahead of him and wants to share all this with them at the earliest possible. Jamal says he is not a man of bad character and had committed just a mistake. “I wish my family and society forgives me because I regret having sex outside marriage. I feel ashamed to think about the time when my wife and children would learn about my disease and the immoral and un-Islamic act that caused it. They will abandon me which I cannot afford,” he told Daily Times.

With tears rolling down his cheeks, Jamal said he was neither living nor dying and was just like a living dead body. He regretted being looked down upon as an AIDS patient and disliked being avoided as if he was an untouchable.

“My message for people is that they should prevent themselves from establishing extra-martial relations to prevent HIV-AIDS by waging jihad against desire,” he said.

According to figures of National AIDS Control Programme (NACP), Pakistan has so far 3,198 HIV/AIDS registered patients. Independent estimates, however, put the number at 70,000 to 80,000, which means the country’s 0.1 percent population is suffering from the disease.


Thursday, August 02, 2007

Margaret Zania, "Taking care of my HIV+ grandchild has changed my life"

By, IRIN PlusNews, August 1, 2007

Margaret Zania, 60, a petty trader in Bukavu, capital of South Kivu Province in the eastern Democratic Republic of Congo (DRC), is all that seven-year-old Mwajuma Rajabu has in the world since her parents died of an AIDS-related illness in 2005. Zania's life has been taken over by caring for her grandchild, who is often ill. She told IRIN/PlusNews how her life had changed.

"As a single mother, I was already living with one of my sons when my daughter started getting sick. She and her husband tried to deny the fact that they were suffering from AIDS but it was there for all to see. My daughter was a lay preacher and her husband was a football player. They had two other children before they had this little girl, Mwajuma. I thank God that the other two children do not have the virus.

"My daughter's condition worsened in 2005, and she died in September, with her husband following her soon thereafter.

"Before taking in Mwajuma, I used to sell soap and second-hand clothes at the market, and this could sustain me. But since there was no one else to take care of Mwajuma, I had to stop the small business in order to be there for her. She was always sick: her stomach would swell so much, then she would have diarrhoea and many other ailments that I don't know their names. It was very stressful for me and my son's family.

"I took Mwajuma for testing soon after the deaths of her parents and she tested positive. I was devastated: What do I do now? Will she grow up like other children?

"That is when I sought help from Foundation Femme Plus [a Congolese non-governmental organisation supporting people infected and affected by HIV/AIDS]. Now Mwajuma is on ARVs [antiretrovirals] and her bouts of sickness have decreased. She is now healthy, she plays like other children and I am even looking forward to seeing her go to school.

"Looking back, I know that HIV/AIDS has changed my life: I have learnt to accept the people living with the virus, and I know that with proper care and medication my grandchild will grow up to be healthy and go to school. Who knows, maybe she will be an important person in our community one day.

"Now that Mwajuma is no longer as sickly as she used to be, I wish I could get financial help to enable me resume my petty trade. Look at me - I am 60, and can still try to fend for myself. When she goes to school, I would like to have my life back, the life I had before 2005."


Friday, July 27, 2007

YEMEN: "It's tough living with HIV"

By, IRIN PlusNews, July 26, 2007

For Alawi Bahumaid, 41, who recently lost his job with a Norwegian oil company in Yemen, the bitter struggle of rebuilding his life and looking for a new job starts again. "This is the second time I have lost my job because of my HIV status," he said in the capital, Sanaa. "I had such hopes this time around."

Those hopes were dashed, however, when two months after Bahumaid started the job, his previous employer was contacted for a reference, and his current employer discovered that their newest staff member was HIV positive. Fearing a revolt by the other workers if he was returned to the production line, his employer summarily dismissed him.

"It's tough living with HIV," said Bahumaid, who has done so since the 1990s. "People in Yemen don't know what HIV is, and are afraid to shake my hand or even talk to me."

He described discrimination against those living with HIV in Yemen as "rampant", and has become a reluctant advocate of sorts. "This time I'm going to speak out," he said.

But in Yemen, a staunchly conservative tribal society of some 20 million people, where over 40 percent of the population live below the poverty line, it is going to take more than speaking out to change things: it will need action, particularly by the government.

Rampant stigma

The government's National Strategic Framework for the Control and Prevention of HIV/AIDS acknowledges that Yemenis living with HIV are heavily stigmatised: they often flee or are even expelled from hospitals where they have sought treatment, and face harassment by the police.

Like other countries in the region, Yemen requires HIV sero-negative status for foreigners seeking residence or employment. HIV-infected foreigners are deported, with many policymakers considering this a necessary and fully justifiable measure, which reinforces the longstanding denial and stigma regarding HIV and AIDS.

Although the government's commitment to controlling and preventing the pandemic is evident in its adoption of a national framework in 2002, it is clear that much more is needed in terms of treatment and assistance to people like Bahumaid, who have to live with the discrimination.

"People living with HIV suffer a lot," said Fouzia Abdullah Saeed Ghramah, director of the National AIDS Programme (NAP) run by the Ministry of Health. "[They] are denied their rights, particularly in the area of employment, which in turn leads to additional social and economic problems. We're working to address that."

But efforts to combat the prevailing stigma and discrimination are up against the negative perceptions held by even the country's most educated inhabitants.

The results of a survey published in the daily Yemen Observer newspaper on 10 July indicate that shame and fear of judgment are among the greatest obstacles preventing HIV-positive people from obtaining diagnosis and treatment.

The study, conducted by researchers at Sanaa University, compared the attitudes of medical students with non-medical students, and revealed that even educated people harbour a negative bias towards AIDS patients, and often misunderstand the disease.

Low prevalence

According to the NAP, 2,075 cases of HIV have been recorded since the first case was reported in 1987. However, health experts believe the real number to be over 20,000.

"Nobody can prove it; nobody can deny it," said Abdullah Abdulkarim al-Arashi, executive manager of Yemen's AIDS Project Unit, part of the government's National Population Council, which aims to improve awareness levels.

"People prefer to view it as a western problem and are afraid to even talk about it. And without awareness they will never talk about it, nor will people that are infected go to hospitals," he said.

Although life-prolonging antiretroviral drugs are available in Sanaa and the southern port city of Aden, the country's two largest population centres, al-Arashi noted that the lack of openness about HIV prevented many people from seeking treatment.

"Our society here in Yemen is so closed. To talk about HIV is shameful, as people associate it with sex," he said. Most people believe sexual contact is the only mode of transmission.

"People are afraid to disclose their HIV status; they are afraid of the government; they are afraid of the policemen, and even of their families."

One man in Aden was barred from entering his home by his wife and children after disclosing his HIV status. "You are infected with HIV. Get out," his wife reportedly screamed before calling the police.

"Regrettably, this is our mentality toward HIV," al-Arashi said. "This is what we are trying to change now."

Lack of legislation

Although there is no legislation to protect Bahumaid and others from discrimination, the establishment of Yemen's Ministry of Human Rights in 2003 offers some hope.

Referring to the lack of legislation for protecting people living with HIV and other chronic diseases, Nusaibah Ghushaim, the ministry's manager of information, told IRIN/PlusNews, "This is something that needs to change."

She was confident that appropriate laws would eventually be passed, but feared that implementing them in Yemen could take much longer.


Tuesday, July 24, 2007

AIDS women fight fear and stigma as well as disease

By, Jane Lee, Reuters, July 23, 2007

When Papua New Guinea's Maura Elaripe was diagnosed with HIV she thought it was a death sentence, but 10 years later she is still fighting the disease and the fear and stigma associated with it in her homeland.

The 31-year-old former nurse said many afflicted with the disease are left untreated to die in Papua New Guinea, a developing nation where black magic still rules many people's lives.

"I saw people dying in front of me -- deaths which could have been prevented," Elaripe told Reuters at the International AIDS Society conference on Monday.

"I saw a 16-year-old die just next to my bed. They said we don't want to waste our medicine on her. Another woman with HIV died and was put in a black garbage bag and they disposed of the body...that freaked me out. I was so scared," she said.

HIV-AIDS has found fertile ground in Papua New Guinea, a jungle-clad, mountainous nation, where polygamy is common and rape and sexual violence widespread.

Officially there are only about 12,000 people infected, but AIDS workers estimate that under-reporting and reluctance to be tested mean the real number ranges from 80,000 to 120,000.

The island's 5.4 million people, most of whom live a rural subsistence life, presently face an epidemic on a par with Cambodia, Myanmar and Thailand. An estimated 300,000 people are expected to die due to HIV-AIDS by 2025.

Papua New Guinea Health Minister Peter Barter told reporters at the world's largest AIDS conference that polygamy was a major obstacle in the fight against HIV-AIDS in his country.

"In many parts of Papua New Guinea a person can have up to 5 or 6 wives and 20 children. We have to change that behaviour, its a cultural matter and it will take some time to do it," he said.


The United Nations says close to 40 million people are infected with the HIV-AIDS virus -- almost half are women.

Women are eight times more likely than men to contract HIV during unprotected sex, with most learning they are infected once they are pregnant. Of more than 600,000 new infections in children each year, 90 percent are mother-to-child transmissions.

"In some developing countries, HIV has significantly increased the burden of care for many women, particularly in the developing world with far-reaching social, health and economic consequences," said Francoise Barre-Sinoussi, from France's Institut Pasteur, told the conference.

When Elaripe was diagnosed while pregnant, there was no counselling available -- she lived with HIV for three years without treatment.

"Nobody took care of my emotional needs or my psychological needs. I went home and I said I'll wait for the day I die," she said. "I was so scared to go out. I lived in fear."

Elaripe said ignorance of the disease saw her sick baby turned away from hospital because her mother had HIV.

"The next day she died without any medical attention because they said that I was HIV positive...and because I was positive the baby was also positive," she said.

Medical authorities also forced Elaripe to be sterilised after her diagnosis. "I felt that my reproductive rights were also abused," she said.

Despite some improvements in treating HIV-AIDS in Papua New Guinea in the past 10 years, Elaripe said the challenge of living with the disease in her homeland does not get easier with time.

"I'm hoping there will be a cure soon. I'm tired of having to get up every day to take gets scary," she said.


Tuesday, June 05, 2007

Why Graça took an HIV test

By, The Times, Claire Keeton, April 15, 2007

Former First Lady sends message to her family and SA: It’s not a death sentence

GRAÇA Machel, the wife of former President Nelson Mandela, is championing the Each One Reach Five campaign.

Machel said she wanted to reach out to her own family as well as the nation through this initiative.

The former First Lady, who did not hesitate to test for HIV or find five others to agree to do so, said: “I also want to send a message to my own kids.

“I want my family to engage on this seriously, both the Mandelas and the Machels. We are a big family and many of the family are young. I don’t want to go out and do social work and not do it at home.”

In addition to her five nominees, Machel invited her daughter Josina, who turns 31 this week, to take the test.

“We have much in common. She is also socially inclined and works on HIV,” said Machel.

She said she had lost loved ones to Aids, including Mandela’s son Makgatho and her brother-in-law Boaventura Moisis Machel. Graça is the widow of former Mozambican President Samora Machel, who died in a mysterious plane crash in 1986.

She said: “Samora’s brother passed away in 1999. He was strong and well-built and enjoyed life. We saw him going slowly as he did not want to know [his status] and he didn’t want to accept it. At the end he decided to go to test but it was too late and we lost him.”

She said that, in contrast, Makgatho Mandela had found out his HIV status quite early and had taken care of himself, until an opportunistic infection claimed his life, at 54, in 2005.

“We know there are millions among us who do not know their status and that is why it is necessary to promote testing. It is not like 10 or 15 years ago when having HIV was a death sentence with no hope. We have very good reasons to know our status. Now it is possible to live a long, healthy and productive life and to live a long time even before [needing] treatment.”

She praised Judge Edwin Cameron and Sowetan columnist Lucky Mazibuko as role models for living positively and long-term with HIV.

Machel said: “If you do not know your status and don’t take a test you can shorten your life. If you don’t take precautions, you can shorten your life.”

As a social activist, Machel said, she had seen how HIV/ Aids had had an impact on people around her, “adults and children, women and men”.

She said: “One of the problems, particularly with young people, is that either they do not have enough information or, if they have the information, there are so many psychological barriers to overcome to test and know their status.

“Then there is the problem of disclosure to family and friends, a boyfriend or girlfriend.”

Machel said she hoped the campaign would erode the stigma around testing and HIV/Aids. She had her test at the Nelson Mandela Foundation offices in Johannesburg.

“It feels as normal as if I were doing a malaria test. I am from a malaria area in Mozambique where now and again you get feverish and then have a test. It is like that.”

She added: “HIV is here to stay for many decades at least and we must accept it as a normal chronic disease.”

Josina Machel, the co-ordinator for capacity building in the HIV unit at the Institute for Democracy in SA, said that having an HIV test always made her reflect on her life.

“I have tested before,” she said as she did the test. “But it always makes me stop and take stock of my life, where I am and where I have been. I tell people A, B, C, D and it makes me think: ‘Am I practising this?’ It makes me question my behaviour, which is good.”

A stands for Abstain, B is Be Faithful, C is Condomise and D is Do a Test.