Resilient and grateful is how Shole, a mother of two in the Arusha region of Tanzania, describes herself. She is also HIV-positive.

“I discovered I was positive in 2012 while pregnant with my third child,” she explained. “I was devastated to receive my results. I shared the news with my husband who didn’t take it very well. He decided to leave me and my children without any support. However, I delivered the [third] child safely. Sadly, after six months, my baby died.”

Shole's life took a turn for the worse as she went into depression. She says that as her health deteriorated, she turned to alcohol as her refuge.

“I was living a very hard life,” Shole said. “I had no help since the father of my children had abandoned us. My income couldn’t sustain us. I couldn’t pay rent or afford basic needs.”

Shole thought she had reached the end of the road, but her life took a turn for the better when a local community case worker visited her.

The case worker explained to Shole that being HIV positive does not mean her life is over. “She told me about herself and her story was very inspiring. She offered me support and promised to walk with me through this journey. She told me that I was too young to give up on life.  She advised and educated me. I didn’t have any love in my heart, but she made me feel loved.”

The case worker continued to visit Shole on a regular basis and convinced her to take her ARV medication regularly. Shole said her case worker became like a second mother—someone in whom she could confide and get the support she needed.

Shole is one of the one million people in Tanzania who have been tested for HIV through USAID’s Community Health and Social Welfare Systems Strengthening Program (CHSSP). Ninety percent of those who tested positive have started treatment. CHSSP has contributed to these impressive results by training more than 15,000 community case workers, like the one who visited Shole, to identify, track, and manage HIV cases in communities around the country. All of these efforts by the case workers ultimately contribute to the global UNAIDS 90-90-90 goals, which are: 90% of all people living with HIV are tested, 90% of all people tested are diagnosed and provided with treatment, and 90% of all people receiving treatment achieve a suppressed HIV viral load, which makes them less likely to become ill or transmit HIV to others.

Training case workers is just one part of CHSSP’s approach to strengthening Tanzania’s community-level health and social welfare systems. CHSSP has also trained other community groups to ensure that vulnerable citizens can access social services. The program has built the capacity of these groups to better execute their roles and responsibilities within the country’s community-level HIV response. To date, CHSSP has strengthened or established more than 600 AIDS committees at the district and ward levels, more than 50 local groups for people living with HIV, and more than 50 protection committees for violence against women and children.

So far, the community case workers and other community-level groups have identified and linked approximately 800,000 orphans and vulnerable children and over 1,000,000 adults to critical health and social welfare services, including HIV testing.

Shole’s perspective on life has changed. “The implications of not taking ARVs are great. I have been a victim and have witnessed a lot of avoidable death. The medication strengthens and protects HIV positive people and also protects them from infecting others. I advise other PLHIV to keep taking their medication so they can live a normal life and carry out their responsibilities just like any other person.”

Shole now lives a healthy life, and her two sons are excelling in secondary school. Shole calls herself an ambassador for others in her community – providing them with the help and support they need, just as the community case worker helped her.


*Note: The name "Shole" is an alias of the benficiary. The real name has been removed for her protection.

Shole (left) shares her progress with her local community case worker (right) during a routine home follow-up visit.
Photo by Erick Gibson for JSI Research & Training Institute, Inc.