Voices from the Field: Extending HIV Counseling And Testing To Rural Areas Of Zambia

"Each and every one should be proud of his or her [HIV] status, so that everyone is able to say, ‘Me, I’m so-so-so; me, I’m so-so-so’—even those who are positive,” says Henry Nkazi, an HIV lay counselor in the Republic of Zambia. “They can live a positive life and can live longer than one who is HIV-negative.”

Through community volunteers like Nkazi, IntraHealth International is working to increase Zambians’ access to confidential HIV counseling and testing and to refer more HIV-positive people to antiretroviral therapy treatment and prevention of mother-to-child transmission of HIV services. The project is funded by the US Centers for Disease Control and Prevention.

With a population of 11.5 million, Zambia has an HIV prevalence of 17% among the 15-to-49 age group. With only 13% of the population aware of their HIV status, those who do not know their status pose two risks: if they are HIV-positive, they could be spreading HIV unknowingly, and if they are HIV-negative, their sexual partners could be putting them at risk of getting HIV. The current life expectancy in Zambia is 38 years.

“The idea is to let more and more people know what their status is—and hopefully the status of their partner—so that they can take the appropriate actions to keep themselves safe,” says Jim McMahan, IntraHealth senior program manager with the Zambia project.

The IntraHealth-led initiative is training lay health workers to provide voluntary counseling and testing (VCT) services in rural areas of two districts: Namwala and Luangwa. VCT centers are located along the main roads and in the population centers, but, as McMahan explains, “even if somebody is a few miles away, that’s a long way away in a country where transportation is difficult like it is in Zambia. The roads are really bad in the rural areas, and it’s hard to get around, so we provided the lay counselors with bicycles so they can be mobile and go to further-reaching places to see people.”

Non-formally trained health workers are allowed to provide counseling and testing services in Zambia as long as they are prepared by an approved training organization—of which there are three—and certified after a practicum as competent in counseling and testing by one of the training organizations or their designate. Until they are certified, they have to work under the supervision of clinical staff.

The project trained six people to be trainers of the 40 volunteer lay counselors who were each selected by the local village leaders of Namwala and Luangwa. “A lot of people are suffering from HIV, and the counselors want to help,” McMahan emphasizes.

The counselors receive a small stipend to cover minor expenses incurred while providing VCT services three half-days a week. “We anchor them at health centers and then they work out of those and go out into the community but then have some clinical backup if they need it,” says McMahan. As the trainees completed certification, they began to provide mobile HIV counseling and testing services on their own.

Within the first seven months, they counseled and tested 5,539 people in the two districts.

One early goal of the project was to have two clinical facilities in each district providing VCT services. “In Luangwa we have eight, and in Namwala we have 12, so we have far exceeded that target,” notes McMahan.

This year, the project will extend VCT services into two new districts: Gwembe and Siavonga.

The project also aims to decrease the discrimination that comes with an HIV-positive status by providing outreach sensitization meetings about HIV testing in communities, schools, churches, and during traditional ceremonies. In addition, the project holds drama performances and sketches concerning HIV testing and has trained some village leaders as lay counselors so they can spearhead counseling and testing activities in their areas.

The messages are having an impact, as counselors like Dickson Ndona advocate for HIV testing in their communities. “[For] some, you see, HIV gives a stigma to people. It levels people in the sight of others to be unwanted, so many clients . . . are fearful,” says Ndona, but, he adds, “they are coming in . . . for now everybody’s quite open.”