Interactive game raises awareness on managing HIV

They teeter on a narrow, unstable bridge with the hope of making it to the other side – a sunbaked island where life is good. But the journey will be treacherous. If they fall off the bridge, there is a menacing shark, crocodiles ready to snap and hippos about to charge.

It’s game day at the Eersterust Community Health Centre in Pretoria and Portia Mazo, an HIV counsellor, explains the lay of the land.

The photo of the island represents the hopes and dreams of a bright future, she tells the participants. The ropes are the support systems that will help get them there – things like abstinence, mutual faithfulness and condom use. The sharks, crocodiles and hippos – fellow participants wearing masks – represent HIV, sexually transmitted infections (STIs) and unintended pregnancies.

Today’s game is helping Mazo teach her patients about STIs. She uses the same approach to show people who have HIV why sticking closely to their treatment will allow them to live a healthy life and get to the island with a beautiful future. 

According to a study published in the Southern African Journal of HIV Medicine, it’s an approach that works.

Adherence to antiretroviral treatment (ART) – properly taking medicines that help people with HIV reach viral levels so low that they can’t infect someone else – is a big barrier to ending Aids.

“Adherence is the be-all and end-all of successful HIV treatment, especially as side effects are so limited and far less common,” says Francois Venter, the executive director of the Ezintsha research centre at the University of the Witwatersrand.

“The struggle is to swallow the tablet every day, and that is a real issue for almost all of us taking medication.”

It’s also a big part of the United Nations' 95-95-95 plan to end Aids around the world. By 2025, the goal is for 95% of people in those states to know if they have HIV. Of those who tested positive, 95% should be on ART and, of that group 95% should have viral levels low enough that they can’t infect someone else.

Although SA has come a long way, reaching the middle 95 could be a problem. The country’s latest figures  – from the Thembisa model, which the government uses to report on its UNAids targets, show that 95% already know whether they have HIV. But of those – in other words, the group for the middle target – only 78% are on treatment.  

Workshopping the game

Mazo learned about using a game as a teaching tool at the South Africa Aids Conference in Durban in 2023. 

Peter Labouchere, the social and behaviour change specialist who came up with the game, held an interactive workshop to show how it works. 

The game helps participants understand how the body responds to infection and treatment. But more than that, it also shows why it’s important for someone to take their pill at the same time every day, how to deal with the stigma of being HIV positive, how to ask for the support of family and friends, and the importance of people telling others about their status. 

Why people don’t take their medicine

There are many reasons why people don’t stick to ART – from fear of being discriminated against and the stigma of having HIV to high transport costs to get to a clinic for refiling a script, side effects and not having support from family or friends. Issues such as long queues at a clinic or negative attitudes of health workers towards people with HIV can also be a problem. 

Venter puts it down to the “chaos of everyday life”. 

Patricia* had been living with HIV for many years. But it wasn’t until she came to some of Mazo’s groups that she finally understood the importance of adherence. After telling her three children and her mother that she was HIV positive, taking her medicine regularly became a lot easier.

However, she still struggles with telling others about her status – like her new partner, who she’s not yet had that conversation with. 

That’s a problem, says Mazo.

Back at the health centre, Mazo turns to the participants and the sunbaked island of life ahead.

“Tell me about your future. Where do you see yourself in five years’ time?” she asks.

One young woman says she sees herself in a house with her husband and children, running her own business, happy and content. A woman in a floral dress says she’ll also be working and self-employed. A girl in a pink shirt sees herself living abroad. 

“We do not have to abort our goals,” Mazo tells the women.

“Even with HIV.” 

BHEKISISA.