1) They are all working with both HIV positive and HIV negative people
2) But there are some services that cater for only HIV positive people like the income generation programmes. HIV negative people can only participate if they are the sole care providers for HIV positive people (Zandile)
3) Encourage testing as well as looking at risk assessment profile with clients and see what behaviioural change work can be done with clients
4) Encourage to ask partners to test
5) Have services like food parcels to ensure that people are not forced to engage in risky that will put them at risk
6) Are seeing an increase in people regularly testing and retesting close to 10%
7) Increase in men testing and retesting voluntarily and this could be because of increased access to medication
8) Window period when it comes to testing to ensure people continue practicing safe sex

Issues raised
1) Window period and to ensure that if people test negative they remain that way (illustration of crossing full of crocodiles – that if someone has had an unsafe encounter and tested negative then they will feel that they are immune while they were actually in the window period)
2) Is there a need for HIV negative heros like there was a campaign for HIV positive people
3) Is enough being done to ensure that people remain negative?

The NSP and national budgeting on prevention. Had an example from Zimbabwe on how 50% of budget used for prevention work in relation to 11% in SA. Yet this is also an important area to focus on

4) To ensure that when working with HIV negative people not to antagonise HIV positive people
5) Being HIV negative is not always a choice that people can make for themselves especially when one looks at issues of rape particularly “corrective” rape on the LGBTI community. And the lack of resources thereafter. Thuthuzela clinics are in many regions not functional and run by volunteers.
6) Are we doing enough for HIV negative people like we are for HIV positive people
7) What happens after people test negative and when they come back to retest are positive?

Test could have been in window period time as well as getting new partners

8) When people test negative is it because they are engaging in safer sexual practices or that they were never at risk because partners are also negative.
9) Bongani spoke about the work that they do with youth in the schools. The programme works with both negative and positive learners as well as their educators. So the programmes run in conjunction with the school syllabus. So Life Orientation classes are used as well as incorporating it in other classes. Found that many educators are not well informed about HIV and hence can’t share or impart knowledge to learners.

Matters for clarity

1) Questioning of some data about retesting. It was not too clear from Modjadgi’s progamme how they get stats and how frequent people retested from the table presented?

Cecile – BelaBela
This organisation is being proactive with HIV negative people, and encourages people to remain negative. One of the services they offer are food parcels to HIV negative people. Have tested close to 1 500 people and of these about 10% are regular repeat testers.

There has been an increase in men testing in recent years and this could be because of the access to ARVs.

Modjaji
This is an organisation that works with both HIV positive and negative people. In the pretesting counseling clients are asked information to assess their risk but also their lives. The risk assessment program is to produce a risk reduction plan, and is done in the post test counseling. At this stage clients are encouraged to test regularly. In addition to testing, education is also key and seen as a tool to ensure that people have all the necessary information and knowledge on HIV/AIDS. Clients are also encouraged to go to any health facility get and test when they are exposed to sexually risky behavior.

Between January and September of 2009, 453 people were voluntarily tested and were negative. Of these 326 (166 males and 160 females) came back and retested and of these 191 tested negative after the repeat test. The organisation has of late reached more men and men are increasingly utilising health facilities.

For people who test negative from the pretest information if need be they are referred to social services, so that they can access food parcels. This is done to ensure that they remain negative by taking care of the some of their needs so that they are not forced to engage in risky behavior that might put them at risk.

The centre offers reproductive health services are also offered to all clients regardless of their status. So clients are able to access pap smears if they need, family planning, pep so that they can make informed choices.

Zandile
Presentation was on the work that her organisation does which works as a VCT site. They encourage all people to test. They do a risk assessment with all their clients and then they do the test. With those who are negative they encourage them to come back and retest after 3 a few months in case they are still in the window period when they test. Behavioural change work is done with clients and for those who are negative as a means to ensure that they remain negative, as well as encouraging people to know the status of their partners. In addition to the HIV tests, TB tests are also conducted as TB in the region is a big issue. They have support groups with both groups. When people test positive they are encouraged to attend support groups as well as income generation projects as a means to generate a livelihood and ensure good diet. HIV negative people can only participate in these projects if they are the sole caregivers of people who are positive.

Discussions

After presentations it was mentioned that it was good to hear that there are some programmes for HIV negative people.

So what happens when people test and then retest and are positive? Do we know why?

Cecile – people go and celebrate and as a result engage in risky behavior after testing negative. Also when people get new partners they will use condoms for a few months and then stop without getting their partners tested.

Is enough being done to ensure people remain negative?

The group felt that enough is not being done. There are many organisations and programmes that focus on HIV positive people, for incase support groups and income generation programmes. The NSP for instance spent only 11% of the total budget on prevention programmes and the rest for treatment and research. Not to say that this is not important but work needs to be done to ensure that people remain negative.

The window period of testing was another area that the group felt needed a lot of emphasis to ensure that HIV negative people remain negative. As some people negative and they go out and celebrate without realising that they are in the window period.

An example from Zimbabwe showed that the principle strategy that was used was on prevention where 50% of the national budget allocated for HIV/AIDS was used for this. This strategy looked at key infection factors such as multiple concurrent partners and tried to address the issue as a means to reduce risk of infection via behavioral change programmes. This worked until the recent instability when women were being forced into sex work as a means of survival.

When looking at how to remain negative need to involve men in PMTCT programmes. Cultural dynamics also need to be explored as they come into play. For instance the fact that women are normally taken into the village to give birth to the first child and that breastfeeding is seen as an integral aspect to mothering. So what if the mother is positive and on medication?

Looked at the positive heros campaign, by showing three posters (a priest, a young black woman and a man).

Not many in the room knew of the campaign. So questions were around whether the campaign is effective and what that means and also what it means.

Should there also be campaign for negative people?

Being negative was good, but not enough is being done to ensure that they remain negative. But is it that people remain negative or that they were never really at risk. That their partners are negative and so not that they are engaging in safe sex.

• And are the three people really heros?
• They are heros in their communities and programmes
• Yes they are as they are showing that anyone can be infected and still live a good life and make a success of their lives.
• As a means to encourage others to test and know that life does not end with a positive result.
•  

Bongani spoke about the work that they do with youth in the schools. The programme works with both negative and positive learners as well as their educators. So the programmes run in conjunction with the school syllabus. So Life Orientation classes are used as well as incorporating it in other classes.

Remaining negative is not always a choice. Some people are forced into being positive. So it is not a choice. For instance there is increasingly violence against especially lesbians and gay men who are raped as a means to either sure them or show them what it means to a woman. The acts are violent and also normally do not involve condoms.

In addition to this is also the fact that there are no services to ensure that people remain negative. For instance with rape, how many thuthuzela centres are operational and how many people after being raped are able to access pep? It is about time we put some focus into that and this must be done in conjunction with the prevention methods and also to ensure that people who are positive are able to access services.