‘In our hands’—HIV self testing in Malawi

I watched an excellent documentary “In our hands” about HIV self-testing in Neno. It is a touching, educational, inspiring look at the lives of people in Neno who have either been touched by HIV, have sought to use self testing or support people to access and appropriately use the test kits. It uses a participatory film approach so the voices and narratives of the people in Chipunga and Jonathan villages tell the story.

Half way through watching, I thought about community-based distribution agents (CBDA) in my home village in Nchenachena, Rumphi. CBDAs are responsible for going around the different villages educating people on HIV and showing them how to use the test kits and are also the contact point for referrals for further testing or treatment.

This programme is part of the HIV Self-Testing Africa (Star) initiative which is a five-year project to catalyse the market for HIV self-testing. In the first phase (2015-2017) they generated information about how to distribute self-test products effectively, ethically and efficiently, with adequate post-test support services, and answered key questions about the feasibility, acceptability and impact of this intervention. With funding support from Unitaid, 4.8 million HIV self-test kits will be distributed across Malawi, Zambia, Zimbabwe, South Africa, Lesotho and Swaziland by 2020.

Twenty eight percent of people in Malawi do not know they are infected with HIV.  The film highlights barriers to people getting tested at hospitals– long distances, fear of stigma, lack of confidentiality and loss of work opportunities. The recurring themes is people fear of knowing and the perception of lack of confidentiality at clinics. One female client commented “I shouldn’t be ignorant in today’s world”…”that I have my children to take care of…”

The Ora-quick self-test kits use saliva (and not blood). They are simple to use and the CBDA provides advice on how to conduct the test and interpret the results. You do the test yourself—in your own time, your own place and alone. You don’t have to reveal the results to anyone however clients are advised if they have positive test to go to a clinic for confirmatory tests and treatment.

The film features young and old people, male and females—people who are positive and negative. A husband talks about losing four children when they didn’t know their status—now on treatment, they have two healthy children. One of them who was getting measured for school uniform.

My hope is that self-testing kits with the support of CBDAs and free condoms are made widely available across the whole of Malawi.