iTEACH: Taking on TB and HIV in South Africa

Zinhle Thabethe, Outreach Director of iTEACH, talks with frog about the impact of technology on the treatment of HIV/AIDS and TB.

Zinhle Thabethe is Outreach Director of iTEACH, a privately funded program based in KwaZulu-Natal (KZN), South Africa (SA), whose multiple activities aim to improve delivery of care and treatment for persons affected by HIV/AIDS and tuberculosis. The program seeks to educate and empower communities, medical professionals, and patients alike.

iTEACH stands for Integration of TB in Education and Care for HIV/AIDS. Why the emphasis on TB specifically and how is this incorporated within a broader response to HIV?

TB is the number one killer of HIV-positive people, and many people who test positive for TB are also affected by HIV. Yet in the current health system, TB and HIV programs work parallel to each other, while often serving the same person – missing a critical opportunity to help the patient who is affected by both. [Lack of] proper training and education for TB is resulting in high numbers of multi-drug resistant strains of TB and high default rates on TB care and treatment. At iTEACH, we have seen that education and empowerment can yield wonderful results in HIV care. We believe that if the two systems can be fully integrated, patient care will be much more beneficial.

I know you’re partnering with Pop!Tech and frog design to identify ways that technology can be better utilized in the struggle for awareness and drug adherence across Africa. What role do you see technology playing here?

Technology has been widely used to address many of the world’s challenges, but we at iTEACH believe that it has not yet been fully utilized to address health challenges, such as HIV. We are living at a time when technology is changing people’s lives around the globe. Cell phone technology reaches 80% of people in South Africa; in rural areas and in urban areas, mobile technology is there. So we have to use available resources, rather then trying to re-invent the wheel.

The South African government began providing limited ARV treatment in 2004 and drug availability has risen throughout the country – yet still only 10% of those in need of ARVs are currently receiving them. What are the distribution challenges unique to this region?

I would not say that this issue of distribution is unique to our province, but there are a number of contributing factors. One is the late response to the HIV pandemic; the large number of infected people now outweighs the HR capacity of the existing medical system. Centralized ARV programs based around hospitals, rather than community clinics, can make it hard for those who need the programs to reach them. And social stigma also prevents people from seeking HIV related intervention and care.

How do you work to overcome the social stigma, malnutrition, and other secondary challenges faced by those living with HIV in your region?

When iTEACH first came to work in public sector, we realized that there were many resources available for patients – but that they were not well coordinated, well publicized, or easy to reach. Communities were simply not aware of the help available to them, and even the NGOs had no idea what other organizations were functioning within their same communities. So we developed a booklet called uZwathi net, a comprehensive database of all psychosocial services needed by patients. This database also helps inform healthcare workers, including traditional healers, community health care workers, and professional health care workers, of what services are available to their patients for further support, including in the areas of nutrition, stigma, domestic violence, etc. With good referral systems, coordination of available resources, and training – and by empowering patients to seek aid in the right places – there is help available for those who need it.

Do you encounter resistance in asking communities to acknowledge and treat HIV?

There will always be resistance when there is no good education and information. Our education and empowerment approach seems to work for the communities we operate within. Knowledge is power and power is life.

The South African National HIV Survey, 2005 reports that 16.2% of those between 15 and 49 years old are HIV positive. Of these, 80% still see traditional healers for medical care. How have you approached traditional healers to incorporate emerging treatments?

It is important to us to recognize, acknowledge, and respect the culture of people we work with. At iTEACH, we work exclusively with the Zulu communities, and the culture there [supports] use of traditional and herbal remedies before Western treatments. This is the way it will always be.

At the same time, traditional healers are open to learning new ways of treatment. They are also aware of what they can and cannot treat. They are aware of the fact that they cannot diagnose and treat HIV, so they are willing to refer people to the Western health facilities. The challenge lies with Western doctors, who have not yet shown confidence in the old ways of traditional treatment and care. We are currently working with a group of traditional healers in our communities to help build this relationship between traditional healers and doctors.

How has this been received?

This is a long, slow process – but efforts are now being made at the national, provincial, and district levels to integrate the two systems of treatments.

It seems there is such a great opportunity to break the dichotomy of traditional versus modern medicine by incorporating the two. Yet President Thabo Mbeki’s government has repeatedly questioned the validity of HIV treatment plans – most recently with last July’s reinstatement of health minister Tshabalala-Msimang, who has long supported nutritional changes, rather than drug therapy, as a cure. How does this political struggle play out on the ground?

It is, indeed, a controversial issue, confusing to people on the ground. But as you know, people have their own ways of reading a situation – and so do those in government. In this case, also, education and empowerment play a critical role in helping people make the best decisions for themselves.

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