Discovering the Kuplumussane

Laughter. Songs. Women dancing. Music at full volume. A blazing sun. A small door opens, and we step into a colorful courtyard on the outskirts of Beira, Mozambique. “It’s a happy home that welcomes guests,” says Francisca Joao Mavura, the president of the Kuplumussana association, a community of HIV-positive women who have been abandoned by their partners, many of whom have been victims of violence. Almost all of them have given birth to HIV-positive children. “We - says Father Dante Carraro, director of Doctors with Africa CUAMM - are supporting these women because they have been abandoned, are ill, and(or undergoing therapy. But we have experienced for many years now that if you give them an opportunity, they can find work and regain their dignity”. They encourage each other: here, resilience is not just a word. The heart of the community is this modest, colorful, and dignified little house, which CUAMM helped to arrange and serves as a base for these women who often have nothing. Some of them have found work in the clinics supported by CUAMM or in the hospital.

The association has been around for 20 years: the women elect a president and help and motivate each other: Kuplumussana, in the Sena language, means “women who help other women”. Instead, to be more precise, it is women who save other women.

It is a beautiful grassroots initiative that is trying to give dignity to these women, while contemporaneously help strengthen HIV control activities in the area. There is a great need for it: according to the latest data published by the Ministry of Health, the HIV prevalence rate among people over 15 years old is around 13.2% in the province of Sofala alone, where the city of Beira is located.

“For several years now - continues Father Dante - we at CUAMM have been working in the network of youth clinics where we aim to raise awareness among young people about sexual and reproductive health issues, and where individuals on antiretroviral treatment are accompanied and supported by healthcare personnel, including a psychologist”. There are nine clinics in the Beira district where CUAMM is present and where they work with groups of activists composed of young people as well as HIV-positive women, many of whom come from the Kuplumussana association.

“In 2022, within these clinics, it was possible to provide over 66,958 HIV tests and identify 597 HIV-positive patients”, Father Dante says with a hopeful smile.

In the courtyard, there are tables set up, but first, everyone dances together at a frenetic pace to thank life. The women of the community travel throughout the Beira district, organizing theatrical sessions, meetings, and activities on sexual and reproductive health topics. Isabel Domingos Aleixo, one of the veterans of the association, recounts, “At the beginning, there were a few mothers who gathered under a canopy every Friday to talk, to vent, and to overcome their fear. They checked on each other, monitoring those who stopped treatment. The most important task was to convince them to resume medication, and then they were integrated into the community group. Even now, it’s the same”.

They are all women. Another woman, Maria Laura Mastrogiacomo, a doctor sent by CUAMM to Mozambique, has helped them try to expand their scope to reach out to as many HIV-positive women as possible.

Here are some numbers to help understand how Mozambique is still a fragile but young Country: the average age of the population here is 17 years, but life expectancy is 56, and the average number of children per woman is 4.7. It is unfortunate that in this country, maternal mortality is 289 children per hundred thousand births, and due to malnutrition, the mortality rate of children under 5 years old is 70 per thousand. Truly too many.

Francisca Joao Mavura is 41 years old and has four children: “I was 22 when I found out I was HIV positive. I was expecting a baby and my world collapsed, I was afraid of dying: when I told my husband, he stood by me for the first few months, but then he left me and never agreed to be tested. At the Beira hospital, I discovered that this association existed and I started attending it: now I have my own house and my children have been able to study. Some women who have left here have become police officers or nurses and have built a future for themselves”. She tells me this with a pride that is contagious.

While I talk with Francisca, the other women organize tableaux vivants to tell their stories: twenty years ago, if a woman had HIV, she was thrown out of the house by her husband, to become an outcast, without any protection.

Now awareness has changed so much that the association has also opened up to men: there are dads who agree to speak man to man to other men to convince them to get tested and seek treatment.

The life of Isabel Mendes, 41 years old with a 24-year-old daughter, has been and continues to be a continuous exercise in resilience: she discovered she was HIV positive just when she became pregnant, and her partner disappeared one evening, leaving her with the newborn baby. She never saw him again, and Isabel also had tuberculosis, which complicated everything. But her eyes light up when she tells that “my daughter, thanks also to the help of the association and CUAMM, has just graduated as a nurse, and now we live in a house where there are three generations of strong women: my mother, me, and my daughter. For this reason, I must give back the help I received to other women: my dream is to continue to act as a godmother to other girls who need support and protection”.

Being a Mae godmother is essential, as Nicha Alberto, 30 years old with three teenage children, explains. She was adopted by a Kuplumussana when she began experiencing HIV symptoms: “She supervised me, was there for me when I was unwell, and convinced me to take the test, while at that time I was denying to myself what was happening... She accompanied me, and when I tested positive, she began to encourage me, especially because I had recently lost my husband to the same illness. He had never accepted his positive result. He believed it was ‘um fetisso’ (like a curse); he sought answers in alternative medicine, left home seeking healers and other witch doctors. When he finally accepted treatment, he was already very ill, and the medicines could not save him. When he died, I did not take the test; I convinced myself that the result was incorrect. Nevertheless, after a year, I began feeling unwell, tired, with pains all over, and it was precisely at this moment that I met the Mae Kuplumussana. She knew just by looking at me, but could not tell me directly because she was afraid of my reaction. She convinced me slowly.”

If you ask Amelia Afonso, 49 years old and one of the founders of the association, what it means to be HIV positive today, she lowers her eyes and whispers, “When I went to the hospital for prenatal check-ups for the first time and tested positive, people avoided me because everyone knew that hospital treated those with HIV. Now my three children are negative, the oldest is 20 years old: until a few years ago, children were born and died without knowing the real reason. Today, information is clear, there are lessons on television, on the radio, in health centers. In the past, there was a lot of discrimination”. Her husband also left her.

“When I found out I was HIV positive, we went to the beach and he cried, terrified of being positive too. I convinced him to get tested: he was negative. However, from that moment on, he lost trust in me, left me, and found another wife. I went through a hard time, I didn’t have a home of my own, I had to pay rent, I started doing odd jobs on the street, I had to feed my children. But the other kuplumussane mothers told me ‘there are people who lose their husbands but survive by supporting each other’ and so today I am without a husband, alone with my children, but I have my own home. After a while, he came back to me, found me strong, and when he saw me, he said ‘aren’t you already dead?’ He asked to get back together, but I told him he had already left me once and he could do it again”.

Albertina Francisco was 29 years old when she stumbled upon the Kuplumussane, and she had likely contracted HIV as a child, orphaned by both father and mother, abandoned. “At 20, I was already very sick, small, frail, malnourished, I didn’t even have my period; my sister of a similar age was already married with children while I looked like a child. With my first relationships, I became pregnant, and during the prenatal check-up, I met the kuplumussane. A girl was born, and she tested negative, she is 20 years old now. After this first child, I felt well and decided to stop taking the medication. Then I got pregnant again, and this time, the baby tested positive. The Kuplumussane came back to me to remind me how important adherence to therapy and medical check-ups was. They convinced me that I was not alone, that we were responsible for our children. From there, I started working with the association, giving lessons myself”.

“I worked on a project in Buzi (south of Beira) where in the ‘casa de espera’ (waiting house) for pregnant women, we held ‘mae para mae’ meetings for HIV-positive women”, Albertina continues. “I bonded with a mother who died when her baby was born. I had become very attached to her family - four children with the youngest just born - I helped them; as time went on, they called me mom. Until then, many men would leave me when I told them I was HIV-positive, so I would decide to stop treatment, so they would not find out. I had my first three children with three different men. However, with this family, it was different, the father proposed we should live together. I told him I was HIV-positive. He replied that if I continued treatment, he was ready to live with me. Then, he too tested positive, but is doing well with treatment, and now we have three children together. Everyone calls me mom, no matter who the biological mother is. We have created a happy home (‘lar feliz’). The Kuplumussane helped me realize this dream, with what I earn, I provide food for everyone. My husband does not work, he is a farmer. Now one of my daughters, the eldest, is studying, and that is a blessing for me. I am illiterate. All in all, the Kuplumussane project cannot end here”.

TEXT AND PHOTOS BY DIAMANTE D’ALESSIO
With the collaboration of Irene Avagnina (CUAMM pediatrician)