When Cabo Delgado, northern region of the country, started to be attacked by armed men, Elsa Manuel, 29-year-old, was already working as a health activist in that province.

During her time as activist, Elsa had seen a bit of everything: people abandoning the treatment and other people simply neglecting their health condition. Nevertheless, she had never faced traumatized people challenging malnutrition associated with abandonment of HIV/AIDS treatment.

“The trauma caused by war creates great stress for people living with HIV. In the resettlement centers, we discovered several people in these conditions”, states the activist, adding that her unique goal is “to tell HIV/AIDS positive people that there is still hope.”

The conflict in Cabo Delgado began in 2017, and has already created approximately one million displaced people and around thousand have lost their lives.

when the conflicts began, Elsa, together with her colleagues, was deeply terrified, but she still knew that the most important thing is to work to “bring at least the hope to the people who were hiding themselves in elsewhere in Cabo Delgado province.”

While she was working with colleges, one of the biggest problems had to do with communication.

“The people did not speak the same language, so we faced a huge difficulty to communicate with them. We tried, at all costs, to do this work of testing and advising people not to give up on HIV treatment”, she says.

At that time, the greatest fear was linked to the fact that people, who were still in the bushes, possibly living with HIV, would have to spend days without medication.

Usually, people used to take refuge in tense moments, without enough time to pack the bags. So, a lot of things, goods and medicines, were left behind.

“There’s no way people can think about medicines when they’re running away from attacks. Some people would flee in the middle of the attack, with only the clothes they were wearing,” he says.

They would leave everything behind, including their medications and the control ticket. So they had to start the whole process all over again.

“There’s no way people can think about medicine when they’re running away from attacks. Some people were fleeing in the middle of the attack, with only the clothes they were wearing”, she says.

So Elsa and her fellow activists went to meet the displaced people.

“I remember that once we were, for 15 consecutive days, doing the tests and opening new control tickets for the displaced people. It was a very long time for us.” 

According to Elsa, in this process of testing and opening new control tickets, there were people who were surprised by their health condition and immediately started the treatment process.

Many of these people are still living in refugee camps, with only a message of hope from Elsa: “there is still hope. It’s not the end of life.”

“There is still stigma and discrimination”

In her journey as an activist, outside of refugee camps, Elsa has seen people drop out of treatment and, because of this, falling weakened. Their bodies became thin. They lost strength.

“It was sad”, the activist remarks, explaining that “many of these people, in Pemba, abandoned treatment out of shame and stigma.”

For Elsa, people are afraid of being seen in the queue, waiting for antiretroviral pills. Because of this, she would always leave two messages: “don’t be ashamed. Save yourselves.”

But not everyone heard that message, and when it was like that, Elsa had only one solution “pick up the medication for the patients. That was the only solution. They would regress and to recover again would take a long time.”

Men abandon treatment

In 2021, Cabo Delgado authorities announced that about 160,000 people are living with HIV in that province and that dropout levels were dominated by male patients.

According to 2015 data, in the Survey of Indicators of Immunization, Malaria and HIV/AIDS in Mozambique (IMASIDA), Cabo Delgado Province has an HIV seroprevalence rate of around 13.8 percent, one of the highest in Mozambique.

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