The Power of One: Expanding Home-Based Care in Tanzania

Develini, a home-based care provider, is proud of her 125 clients. She knows what a difference treatment and support can make because she, too, is living with HIV.

Develini uses her personal experience and the training she received from Pathfinder to help Mohamedi and Doto. Here, she delivers integrated services—HIV care and family planning—in their home.

The couple’s health has improved since beginning anti-retroviral therapy. They are feeling better and, thanks to testing through the project, they know that their children are “free from HIV.”

Still, poverty weighs on them, and Doto does not want to have any more children. So, in addition to providing HIV and AIDS services, Develini counsels the couple on family planning.

As Develini says, “For all who have lost hope, they should know they can work, and be active as normal people. I am happy and ready to assist anyone like me, to encourage them that an HIV-positive diagnosis is not the end. There is more life.”

Develini might be the most powerful woman in Ukonga. Twelve years ago, she was so ill she could not walk. Now she treks across her community, on the outskirts of Dar es Saalam, Tanzania, bending beneath crumbling doorframes to reach her neighbors.

They call her “the village doctor,” a title that speaks to her importance, though it is not entirely correct. Develini is a volunteer. Pathfinder trained her to visit her neighbors in their homes, educating them about importance of HIV testing and prevention, including how to protect their children from the virus. At the same time, she counsels women on family planning and distributes contraceptives. Develini knows how important it is to receive these services in one location. She understands her clients need privacy and want support because she, too, is a survivor.

For the past 20 years, Pathfinder has been at the forefront of the response to HIV and AIDS because our projects across the globe all stem from a simple idea: that the people you know best are the ones who can encourage you to change your life.

With one hand, Develini removes her glasses. With the other, she wipes her tears quickly before anyone can see them. “In 2000, the clinic told me I was HIV positive,” Develini said. At that time, anti-retroviral therapy (ART) was not subsidized for the public in Tanzania, so there was no treatment available to her. “They told me ‘you could die at any time’ and ‘to sell everything I own.” Develini was shocked. Despite her weight loss and failing health, she thought she was safe. She trusted her husband when he said he did not have HIV.

But the truth is Develini’s husband knew he was HIV positive even before they got married. “He knew his status and was taking medicine every day, but I didn’t know what they were,” she said. “When I asked him about the pills, he lied.” He invented an ailment. Perhaps most painful—“I even took the initiative to remind him to take the medicine,” Develini admits, “without knowing they were ART.”

When Develini finally learned the truth—that she is HIV positive—her husband left. She has not seen him since. She had to rely on her parents and doctors to save her life. And with treatment, her health dramatically improved. It is a debt she repays every day as a home-based care provider.

“For all who have lost hope, they should know they can work, and be active as normal people. I am happy and ready to assist anyone like me, to encourage them that an HIV-positive diagnosis is not the end. There is more life.”

Develini shares this message with her 125 clients, including Mohamedi and Doto.

TO BE FREE: One Family’s Story

In 2009, no longer afraid of the repercussions, Mohamedi decided to disclose his HIV-positive status to his wife. “I had to tell Doto,” he said. “Otherwise, she would have lost her life. It is important.”

Mohamedi had begun anti-retroviral therapy, and his health was improving. So whatever the fallout, however angry she might become, he believed that at least he could make her healthy by getting her treatment. What he did not expect was that, after hearing his news, Doto would not even get tested.

“She kept saying, ‘tomorrow, tomorrow, tomorrow,” Mohamedi said. He glances at his wife, for her assurance to go on. “Doto was afraid of seeing people at the clinic, of their eyes.”

Mohamedi sought help from the one person who had openly discussed their HIV status, who was known to everyone—Develini. Develini arranged for Doto to get tested in her home. When she arrived, she was greeted by 10 other family members, all wanting to find out their status, too. 

That day, Doto privately learned she was infected with HIV, as did four other relatives. Perhaps most critically, Doto and Mohamedi confirmed that their three children “are free from HIV.”

The couple wants to keep it that way; they want to get healthy and avoid pregnancy. So, along with anti-retroviral therapy, Doto uses contraception. She receives pills from Develini, who provides family planning in the privacy and convenience of her client’s homes and is never far away. Even now, as her clients bravely tell their story, Develini sits beside them, beaming from behind her glasses, giving them strength.
 
“I am not the type to share a lot of things. Having Develini is so important. I need her,” Doto says, looking at her friend. “After all, she is just like me.”

THINK OF DEVELINI’S IMPACT. NOW MULTIPLY IT BY 1,250

Develini is just one of 1,250 home-based care providers for the Tutunzane project (meaning "Let's take care of one another" in Kiswahili). Led by Pathfinder, the project relies on the talent of local individuals to stop the AIDS epidemic where it starts, one person at a time. And they are succeeding.

In 2011 alone, the project supported 44,000 clients by reaching people in their homes. This means that the person-to-person approach has been so effective that it has grown to support communities across five regions of Tanzania. It is what sets Pathfinder apart.

For the past 20 years, Pathfinder has been at the forefront of the response to HIV and AIDS because our projects across the globe all stem from a simple idea: that the people you know best are the ones who can encourage you to change your life.

Country: Tanzania
Focus Area: HIV & AIDS

Alden Nouga

Alden Nouga is Pathfinder International's Senior Advisor for HIV and AIDS.

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