UNICEF supports HIV services for persons living with mental health in Malawi
Fiona was a curious case for staff and community health workers at Chambe Health Centre in. She was an antiretroviral therapy (ART) client who had transferred from another health centre at Kambenje in the same district.
From time to time, she would visit the healthcare centre to collect her supply of medications for the upcoming three months. However, it seemed like almost every month, she had to return to refill her ARVs. Upon further investigation by the healthcare professionals, they discovered that she was mistakenly taking the drugs three times daily instead of the prescribed once.
“We approached her mother and asked her to assist us in looking after her, by ensuring she takes the medicine in the right quantities at the right time,” explains Zione Mphepo, a mentor mother for the area under Mother2Mother, which tracks and links adolescent girls and young mothers living with HIV to treatment and care services with UNICEF support. Mother2Mother uses a peer-to-peer support model to track and support adolescent girls and young people living with HIV.
For a while, it seemed disaster had been averted and the problem had been solved. By and by, however, they realised she still reported to the clinic before her appointed time, and there was genuine fear she had relapsed.
“When we investigated the matter, we realised she was sharing her drugs with her husband, who hasn’t tested and doesn’t know his status. We have tried to persuade him to get tested and be prescribed proper medicine, if need be, but he has refused,” she explains.
Holding a meaningful conversation with Fiona, who is struggling with mental illness, can feel like an uphill battle. She would only respond to leading questions with a halting ‘yes’ or ‘no’. It is an experience Zione Mphepo is all too familiar with.
As she explains, no one knows when Fiona was diagnosed with HIV, but the widely held assumption is that was when she became pregnant with her youngest child, who is barely a year old. Fiona has two other children, aged 12 and four, with her husband.
She never misses a hospital appointment, even for her child’s under-five clinic. Whenever her drugs run out, which is frequent because of her husband’s actions, she almost always comes to the hospital.
Her mother and elder sister play a vital role in her support system, ensuring the children's needs are met and that she remains consistent in taking her medication.
According to Josephine Njowe, the Site Coordinator for Mother2Mother at Chambe Health Centre in Mulanje, Fiona is one of four individuals with mental illnesses, and two of them have babies.
From April to September 2023, Mother2Mother implemented an emergency response project with support from UNICEF. Under the project, Mother2Mother identified vulnerable populations and people living with HIV, and referred them for testing and services, supported client initiation on ART, and provided adherence counselling for retention in care. It also supported access to critical maternal and child health, development and social services as well as created demand for and facilitated access to sexual and reproductive health (SRH) services, including services to address reports of violence and neglect for adolescent girls and young women.
Mother2Mother is dedicated to preventing the transmission of HIV from mothers to their children, and individuals like Fiona face a higher risk of passing on the virus to their little ones, Njowe explains.
“We go above and beyond to provide special treatment to such people when they come to receive their medicine. We offer counselling on the importance of taking their medication diligently and provide valuable advice on caring for their children. Our mentor mothers continue to support them, ensuring they adhere to their medication schedules and come for refills as required,” Njowe says.
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