Should a couple of aliens happen to land in the Bethal/Kriel/Ermelo district, chances are they will meet a group of women, neatly dressed in uniform – bright red t-shirts, starched socks and black canvas takkies.

They may even think these Mpumalanga women are preparing to go to war as they form circles ‘€“ singing and dancing as they shuffle around in formation.

They won’€™t be too far off the mark. In fact these women are preparing for a war, but their enemy is almost “invisible” – killing people, destroying families, alienating others, impoverishing many and leaving children orphaned.

But these women know their enemy well. Backed by knowledge and ongoing training about the HIV/AIDS epidemic, the women visit bars and shebeens every day to arm their community against the epidemic, dishing out half-a-million condoms within the space of 12 months.

For the past four years, Mpumalanga has been at the forefront of piloting and implementing innovative projects, designed to distribute condoms, treat sexually transmitted infections and care for those infected and affected by the HI-virus ‘€“ in a “highly focused and highly targeted” manner.

“The World Bank has said that if we wanted to make an impact, our interventions needed to be highly focused and high targeted,” said Dr Kelvin Billinghurst, head of Mpumalanga’€™s HIV/AIDS and STD programme.

The leading project in Kriel was established in late 1996 as a partnership between three private sector companies (Ingwe, Amcoal and Eskom), the Department of Health, the local authority and representatives from the community to address the sexually transmitted infection problem within the workforce and community.

Support training was provided to health department employee Fikile Mthimunye by the Project Support Group in Zimbabwe with peer education projects prioritised as a key focus area for expansion.

At the beginning of 1998, 12 effective peer education projects were functioning in different areas of the province and a support structure was required.

Thus, the non-profit body, the Mpumalanga Support Association (MPSA) was formed to provide an efficient, economical, central funding and reporting mechanism.

The MPSA receives funds and provides a funding mechanism. It administers funds using explicit, already agreed protocols and seeks to minimise administrative costs.

The MPSA is involved with two projects currently, both of which run on a similar front. These are peer education and a home based/orphan care project.

Today, the MPSA supports 50 community-based peer education projects (960 peer educators), 28 community home-based and orphan care projects as well as three youth out-of-school peer education projects.

The projects generally have the following components:

A key area is identified where the projects could be implemented (areas that are traditionally disadvantaged for health services) ; They are primarily led by a motivated person within the health department keen to see a project functioning in their area; Community-based committees are set up; The community is mapped and functional implementation zones are identified. These maps identify areas where HIV transmission is most likely to occur (such as shebeens and bottle stores) or where facilities exist that may support care for those in the home (clinics); Key individuals are recruited from these zones as volunteers.For the peer projects many of the volunteers are recruited from formal or informal drinking centres and for the home-based and orphan care projects, from church groups. These volunteers undergo training in the project area and begin implementation, with ongoing training on a weekly basis; Individuals who take part in community outreach activities are remunerated at R200 per month for working between two to four hours per day. They are supported by a community co-ordinator (who is supported at R1 000 per month for a 40-hour week). No remuneration is provided to government employees for any involvement with the projects; The different areas give regular reportbacks to the MPSA concerning activities; Successful projects then become training sites for further expansion within the province or within local areas.

“There is no doubt that these projects have led to massive savings for the province with thousands of sexually transmitted infections averted,” said Billinghurst.

Peer education projects involve the recruitment of mostly disadvantaged women, some of whom are involved with formal or informal sex work. These women are trained in basic health care, including the correct use of condoms, the identification of sexually transmitted infection, HIV management and care, and issues relating to the empowerment of women.

A typical community meeting would involve an attention-grabbing item such as an action song followed by a presentation using a number of interactive mediums such as one-minute role plays, longer plays and the use of flip charts to engage the audiences in open discussions on HIV-related issues.

The “community”, in many instances men in the shebeens, are then invited to participate in discussion around the issues highlighted by the play. Condoms are then distributed and in some cases questions are answered on a one-on-one situation.

“I am definitely in favour of this happening in my shebeen. People are having sex, we should try and make that safe sex and there is no doubt that many people are dying from this disease,” said a shebeen owner in Mzinoni, near Bethal.

Two years after it started, an assessment of the lead project in Kriel clearly demonstrated a marked improvement in AIDS awareness and a positive behavioural change among males and females in the target community.

The assessment estimated that 20% of the adult population in the province have regular contact with peer education projects while an estimated 30 000 to 50 000 sexually transmitted infections may be averted because of these positive behavioral changes.

The home based care/orphan projects were initiated following implementation of a lead project based in the Masoyi area in the White River Kabokweni district.

The Masoyi project uses a model developed in Mutare, Zimbabwe, where community recruits or care supporters strengthen the family carers through appropriate education and support.

Care supporters are trained in basic nursing care. Projects target the “sick” in communities, particularly those who are HIV infected or who are living with AIDS, and vulnerable families including orphan-headed households.

Referrals come directly to the project from the community, clinic or hospitals. Projects cost between R80 000 and R200 000 depending on their size and save the health services between R400 000 and R1-million in averted hospital costs.

The MPSA is also piloting the distribution of female condoms through peer education projects and is providing technical support to Swaziland for home-based care, the Eastern Cape and NorthWest for peer education and the Northern Province for both.

Anyone wanting more information on the projects can contact Project Manager Corrie Oosthuizen on 017-647-4011 or 017-647-6840.