Catherine Alfonse, a community health worker living in Same, Tanzania, knows what it is like to be shunned. Now, through USAID’s Boresha Afya (“Improve Health”) activity, she works with other mothers living with HIV to make sure they have a friend they can count on and confront stigma.
After Catherine’s husband passed away from an undiagnosed illness in the late 1990s, Catherine lived with the rumors that he had died from AIDS. She was pregnant with her son Emmanuel at the time.
“When I had given birth to my child, none of my relatives came,” says Catherine. “My in-laws told the rest of the family, ‘Don’t go there because her husband died of HIV. If you wash her clothes, you will be infected.’ I left the hospital alone, carrying my child home. I said to myself, Even though I am still weak, and I have just given birth, if I fall, I don’t have any support.”
A young widow with an infant, Catherine had not yet been tested for HIV, but she was already experiencing HIV stigma. It was difficult to find work because many people were afraid that she might infect them. Catherine occasionally found herself begging her sister for food for herself and her child.
“I lived in a difficult situation,” says Catherine. “I was feeling bad in the beginning, but later, I told myself to be strong and tell God that I can go on, and my child shall grow.”
Seven years later, in 2005, Catherine finally learned her HIV status when she was tested during an antenatal care visit for her second child. She tested positive. The health workers assured Catherine that she could be healthy and deliver an HIV-free baby. Her new partner and father of her second child supported Catherine through her pregnancy and beyond. That granted Catherine some relief—she was not utterly alone. But she still had to face the misinformation about HIV in the community.
“When I went to fetch water, they would talk,” says Catherine. “They think I didn’t hear but I heard: ‘Let her fetch water; if she gets angry and bites you, you will be infected.’”
Fortunately, Catherine found support at Same District Hospital, where she receives HIV services from compassionate health workers, and she participates in a peer support group of other women living with HIV.
In 2006, a nurse asked Catherine if she would be willing to work at the hospital as a community health worker.
“After I gave birth to an HIV-free baby, I found out there is no need to hide myself,” says Catherine. “I thought, it’s better I do this job instead of staying at home to die because of anxiety. I was no longer worried that society would talk about me—they already knew my HIV status. I decided to volunteer and educate my fellows.”
Catherine explains that part of her strength is that she knows what it feels like to receive an HIV diagnosis. It can be a lonely and frightening moment.
“When a woman has received her HIV-positive test result, I reach to her, and I hug her,” says Catherine. “I quietly ask her to come, and we go for a talk. I won’t talk to her right there around the health workers. I tell her, don’t be afraid. I was in the same boat as you. I was afraid, and I even cried. But after the education I was given, I no longer expected to die soon.
“What you have got isn’t a problem. If you adhere to these drugs, your immunity will increase, and you will not get infectious diseases. And if you don’t get infectious diseases, you will be like normal people, and you will not be known to be living with HIV.
“I will ask her, ‘What is your worry?’ She may tell me that there are people who will see her coming to the clinic to collect antiretroviral drugs. I would say, ‘Don’t worry. That shouldn’t be the reason for you not to take the drugs.’”
Through counseling, Catherine finds out about mental and logistical impediments and helps her new client find solutions. Catherine helps her think of alternatives, such as picking up drugs at another clinic or even offering to bring the drugs herself to the home of the newly diagnosed client. “I will be coming to your home; I will look at your progress,” says Catherine. “If you become healthy, and things go on well, I will continue bringing drugs for you.
“So, for five or six months, I continue with positive messages until she can accept herself. I educate her that she is not alone.”
Catherine has noticed that stigma around HIV has decreased in her neighborhood, and she takes credit for some of that shift in thinking.
“I have become a teacher in the community. I have become an example,” she says. Today, more than 20 years after rumors were first spread about Catherine, she is alive and healthy with two grown, HIV-free children.
“My name is Catherine Alfonse. I believe that this work I am doing is a great achievement for me and for the community and for the whole of Tanzania—because I believe that there is 100% assurance of getting to an AIDS-free generation.”
USAID/Tanzania