The longtime nurse is a community health agent and activist who has dedicated her career to combating misinformation about HIV/AIDS and improving the lives of HIV-positive people in her community.

Sub-Saharan Africa has been, and remains, the epicenter of the global HIV/AIDS epidemic —more than half of the 37.9 million men, women and children living with HIV call this part of the world home. While the virus is no longer the automatic death sentence it once was thanks to antiretroviral drugs, HIV/AIDS is still the leading cause of death in the region.

Mozambique, which lies along the coast of the Indian Ocean in southeastern Africa, has the eighth highest HIV rate in the world; 12.6 percent of adults aged 15-49 have the virus. The first case was diagnosed in 1986, amidst a grueling 15 year long civil war which devastated much of the country’s infrastructure, including its health care system. By the time the war ended in 1992—after one million lives lost and some 40 percent of the population displaced—the HIV/AIDS epidemic had seized the nation. Misinformation about the disease was fueled by deeply-held cultural misconceptions that HIV/AIDS are caused by witchcraft, as well as entrenched stigma and denial.

By 2001, 1.1 million Mozambicans were infected—more than half of whom were women and children. HIV infections loomed large in southern Mozambique, home to Maputo, the nation’s capital, in Maputo Province, as well as the neighboring provinces of Gaza and Ingamabane. There, the infection rates topped 20 percent.

There are many theories why HIV/AIDS continues to have such a stronghold in Mozambique:  the fallout of war, pervasive poverty, gender inequality, a vast migrant labor system, and an over-reliance on the vagaries of foreign (predominantly US) aid. Only when antiretroviral drugs were introduced, in 2004, did the rate of new HIV infections and AIDS-related death begin to change course

What has worked in Mozambique and elsewhere globally is a concerted effort to get people tested, so that they know their HIV status (in 2018 Mozambique, 72 percent of people with HIV knew their status, according to the UN). For those who test positive, the most effective efforts involve getting them the medicine they need and making sure they take it. HIV awareness campaigns that educate people about the disease, its spread, and how to protect themselves and their families, have also shown efficacy.

With just 10 doctors for every 100,000 people in Mozambique, the bulk of such life-saving work happens outside the hospital walls—by people like Albertina Machaieie. 

HIV/AIDS patient in Mozambique. Photo by Eskinder Debebe/UNAIDS.

Shortly after Mozambique gained independence from Portugal in 1975, Machaieie, then in her 20s, began work as a multipurpose community health agent (agente polivalente elementare, or APE) in the Gaza province where she was born. She first worked in the villages of the Chibuto District, but quickly achieved her childhood dream after the Gaza Provincial Health Administration sent her to study nursing. 

In Gaza’s Chokwé district, Machaieie saw firsthand the devastation wrought by HIV and the denial and stigma surrounding it. 

“I witnessed a couple leave eight orphan children because they never believed in the disease,” she said. “This led me to make a decision to dedicate my life to saving lives and reduce the number of children who are orphaned by both their parents in this country.”

As a nurse, Machaieie was stationed at various hospitals in and around the capital city of Maputo—first at José Macamo General Hospital and later at Maputo Central Hospital, where she worked directly with patients who were HIV-positive. She was sent there by the Mozambican Association for Family Development (AMODEFA), the leading sexual and reproductive health organization in Mozambique and a member association of the International Planned Parenthood Federation (IPPF)

“AMODEFA placed me in the Dia Hospital in the Maputo Central Hospital, which would only attend to people diagnosed with HIV,” said Machaieie. “I broke through the stigma in order to serve others because I felt compassion and love for my patients.”

Albertina Machaieie. Photo courtesy of IPPF.

After serving for 14 years in hospitals, Machaieie brought that compassion directly into people’s homes, running the home care program for AMODEFA in and around Maputo, starting in 1998. This was before antiretroviral drugs; education, condoms and compassion were the only HIV-prevention tools she could wield.

AMODEFA’s home care program provided vital medical, nutritional, and emotional support to HIV-positive patients, in particular those living in Maputo’s poorest suburbs. The program also helped ease stigma and fear, which so intense in the program’s early stages that Machaieie would hide her car when she went for home visits. “People feared HIV, so they feared me coming to them,” she said in an interview with IPPF

“Before, when someone was infected with HIV they would be shunned, isolated,” she explained, adding that families would not eat with their HIV-positive relatives. “They would serve their food in a dog’s dish and make them sleep in the kennel. Many times, they would even abandon them on the streets. ‘Just leave them there a few days until they die,’ their family would say.” 

In the face of such intense discrimination, and lack of information, Machaieie counseled people individually and as a family. “Still, their families would send us away, saying they were not an asylum. They would lock the patients up and say they were bewitched by their grandmother. They would tell us not to come back to their homes, that we were damaging their standing in the neighborhood.”

A religious woman, Machaieie would go home and pray—then come back the next day. “I would read to them from the word of God,” she said. “I would ask them about their faith, and this was how I got through to them.”

But often, their beliefs faltered. 

Another aspect of Machaieie’s work with AMODEFA was to help HIV-positive patients become activistas—community volunteers who could help educate people about the disease using first-hand experience. 

“As their health improved, I would take them and instruct them on how to become an activista so they could overcome the HIV stigma,” Machaieie explained. But often, the activists would abandon their patients because they were still frightened of HIV/AIDS. It took years of tireless one-on-one counseling and lectures in the communities to stop the rumors that HIV was witchcraft. 

“The homecare project encompasses everything,” she told IPPF. “It’s not just treatment for illness, we also work with the mind—people need to change their mindset.”

Over time, she saw change. 

“There are many stories of family members, particularly of wives, who have found they are HIV positive and partners have threatened to leave,” she continued. “But when AMODEFA has stepped in and advocated, the husband has stayed.”

In one family, a woman who tested positive for HIV while pregnant gave birth to three children, also HIV-positive, before her husband truly understood the disease. “With her last child she started taking the treatment without her husband’s knowledge and the baby was born without HIV,” Machaieie said. “This man now says, ‘People, you need to be open—I have three positive children and it is my fault because I would not accept the truth.’”

AIDS awareness mural in the Machaze district of Manica Province.

Machaieie also spearheaded pilot program called Ntyiso (which means “the truth” in the local language, Shangaan) meant to help parents “come out” to their children as HIV-positive and help manage the astonishing rate of pediatric HIV infections in Mozambique. (Many children are unaware of their HIV status). These conversations helped children better adhere to their medication and make choices,  like using condoms, to help stem the spread of the disease.

“It has changed by life,” Palmira Enoque Tembe told IPPF of the Ntyiso program. HIV-positive Tembe wasn’t sure how to tell her son, who is also positive, about her status. “It has improved our relationship because I no longer feel ashamed.”

Fighting that shame has made all the difference. Program participants call Machaieie and her colleagues muhanyisse, or savior. 

Then, in 2017, everything changed.

One of the first acts of the newly elected American President Donald Trump was to reinstate the global gag rule, known officially as the Mexico City Policy.

AMODEFA would not yield to the law, which prevents NGOs from mentioning abortion as a part of reproductive health care (even though abortion is legal is Mozambique). In doing so, AMODEFA lost $2 million in funding—nearly two-thirds of its entire budget. 

That same year, AMODEFA closed half of its 20 youth clinics and cut one-third of its staff. In Gaza Province, where the HIV rate is double the national rate—24.4 percent—AMODEFA was forced to reduce its number of activistas from 600 to 64.

The true effect on infection rates, drug adherence and HIV/AIDS-related death because of Trump’s reinstatement of the global gag rule is not yet known. But one can extrapolate from the numbers: at one clinic in Xai-Xai, where one in four people have HIV, HIV testing and condom consultations dropped nearly 90 percent. Gynecological exams and cancer prevention services stopped entirely. Studies of previous eras of the gag rule have shown dismal results: abortion rates increase up to 40 percent and a wide array of health services—from family planning and contraception, to HIV testing and treatment, and tuberculosis care— suffer as a result.

When Machaieie was interviewed about the Ntyiso program in 2017, she said happily, “I’m going to work forever.” But at the end of 2017, it was time for herthe longest-serving nurse with AMODEFAto retire. She spent 2018 as a voluntary nurse, helping pass along her decades of wisdom to activistas whom, she lamented, do not have the health care knowledge of a trained nurse, or how to provide medical care to the HIV positive community. “You have to take into account that seeing patients at home is not an easy task,” she said.

Now, at 66, she tends her machambas (a small farm) and cares for the five grandchildren who live with her and her son. 

On World AIDS Day 2017, a month before Machaieie retired, Mozambique President Filipe Jacinto Nyusi reaffirmed the country’s commitment to ending AIDS as a public health threat by 2030, and to achieving ambitious goals set forth by UNAIDS:

    • By 2020, 90 percent of all people living with HIV will know their HIV status. 
    • By 2020, 90 percent of all people with diagnosed HIV infection will receive sustained antiretroviral therapy. 
    • By 2020, 90 percent of all people receiving antiretroviral therapy will have viral suppression.

And yet, the year 2020 is right around the corner. It’s hard to imagine reaching those numbers in Maputo City, or Beira, where one in six adults has HIV, without the help of the Albertina Machaieies of this world.

Laura Lambert is a writer and editor living in Los Angeles. You can read her work on Facebook.