(Left) Kim Gerstman is associate director of development for the Population Council. She visited USAID-funded Council projects in South Africa including the Caregiver Project, which raises awareness of the need for early HIV diagnosis and treatment for children; (right) "Grannies" in the Caregiver Project.
I was visiting the Population Council's South Africa office and had just flown to East London, a small city in Eastern Cape Province. Thandi Mini, a program officer with the Council, was my guide. Thandi drove us to a very poor township on the outskirts of East London. The hills were covered with tin shacks. Each shack contained an entire family: four to seven people.
In this community, health workers have identified high rates of child sexual abuse. Some of these children tested HIV-positive. According to 2007 estimates, in South Africa nearly one in five people is living with HIV and AIDS, including an estimated 280,000 children under age 14.
We drove to a government grants disbursement site surrounded by armed guards and barbed wire. This is where people went to enroll for government grants. When we arrived, we were surrounded by a group of 15 or so older women (called "gogos," meaning "grannies") wearing Council caps and t-shirts.
Each granny came over to me, introduced herself, and gave me a big hug! I was immediately taken by their warmth and enthusiasm. These grannies, who participate in the Caregiver Project, are responsible for approaching older women who are enrolling for grants to help care for their grandchildren.
Many of the grandchildren had parents who had died from AIDS or were no longer present in the children's lives. These elderly caregivers face incredible hardships trying to take care of their grandchildren. Some have been afraid to get these children tested for HIV. The grannies educate the women about HIV in children and encourage them to have their grandchildren tested.
The caregivers who do go for HIV testing are extremely glad they did—whether the children are HIV-positive or not. Many of them report back to the grannies about the test results and their future plans. It was clear that the grannies love their work. I could see that they felt empowered in being able to help others in their community.
I visited two health clinics and the public hospital. The waiting rooms were packed with people, and the people were standing along the hallways. Residents travel long distances to get health services, and the facilities are overextended.
Many children were being treated for HIV and AIDS only when they showed up with serious symptoms and were quite sick. Children—who have such a strong chance of positive health outcomes when treated early for HIV—were not getting medical care soon enough. Most children living with HIV reside in households where another family member is also HIV-positive.
I met data collectors who were approaching patients seeking HIV treatment and asking them for more information about their families. Using this family-centered approach, the data collectors would encourage patients to have their children tested for HIV. They give patients referral cards that can be used to access services.
In South Africa, effective interventions are needed to reach out to children who are not accessing HIV treatment services. Because HIV is clustered in families, innovative methods that target the entire family link may help people get the care they need. Just as grannies reach out to others, the Council is committed to finding new ways to reach some of the most vulnerable populations in South Africa.