Every day, Joseph Ramokoatsi - an ‘HIV/TB lay counsellor’ working at St Rodrique health centre, an MSF-supported clinic in the mountains of Lesotho - sees more than 50 patients who have HIV, TB, or both infections at the same time. Joseph counsels patients about the importance of knowing their HIV status, the difficulties they may encounter in the course of their HIV or TB treatment, and the importance of adhering to treatment.
These are all well-known challenges for Joseph. He himself is fighting HIV and has had TB several times. “I found out I was HIV positive in April last year. I decided to get tested because I had TB, and after finishing the treatment I was still very sick. So I wanted to know my status.” He has been on ARVs for more than one year and although his immune system is becoming much stronger, he once again has symptoms of active TB.
Lay counsellors like Joseph have helped expand HIV testing and counselling in the area and improve uptake and delivery of HIV services. As nurses take on more clinical responsibilities under the decentralisation of HIV care, lay counsellors have absorbed numerous tasks - not only educating and counselling but also weighing patients, completing patient paperwork, and in some cases performing triage for stable patients - thereby reducing the nurses' workload.
The fight against HIV and TB does not diminish Joseph's strength and optimism. He wakes up every morning long before the sun rises to work in his family's fields. At six, he sets off to the clinic, a four-hour walk away. “I don't feel ill. I only feel I have a problem when I don't do anything that day.”
Joseph is the face of a "Positive Voices" poster campaign that encourages people to get tested and to access treatment in facilities supported by MSF. “What I like most about my job is that I give hope to the people. When people see the posters, they don't believe it is me, that I am alive. So when they see me, they are happy and it gives me something to be happy about.”
Alessandra Vilas Boas