Tsima: Treatment as Prevention Project

Tsima traditionally means working together to plow a field, and the project was given this name to signify working together for community good health. The Tsima Programme aims to mobilise communities to "Activate HIV Treatment as Prevention" by increasing community uptake of HIV testing and antiretroviral treatment (ART). Research shows that partners who are sero-discordant, that is, where one is HIV-positive and the other does not have HIV, can prevent HIV infection by taking and adhering to antiretroviral treatment - the medicines can suppress the HI-Virus to very low or undetectable levels, thus reducing or eliminating the risk of transmission.
The project is guided by a community mobilisation model that suggests that for community members to fulfil their right to health and to prevent the spread of HIV, action is needed at both personal and community levels. Tsima seeks change through six different community components or domains. "These include building (1) shared concerns around HIV and HIV-related care and treatment, (2) community consciousness about TasP [treatment as prevention], (3) leadership to support achieving the 90%-90%-90% goals [90% of people will know their HIV status, 90% of people living with HIV will be on treatment, and 90% of those individuals will be virally suppressed by the end of the intervention], (4) organisations and networks to help enhance community messages and resources, (5) collective action to make change, and (6) social cohesion to bring communities together to improve our health."
The programme implements the following activities to achieve its goals:
Community mobilisationCommunity Action Teams (CAT) are being trained to generate community action around these issues. Tsima project staff and partners work with the Action Teams to carry out workshops and other activities in the community, such as door to door campaigns, film screenings, theatre performances, etc. These activities are intended to bringing visibility to the personal and community prevention benefits of regular HIV testing and early HIV treatment and to the issues of HIV, gender, HIV-related stigma, and human rights to health and health care. These workshops are designed to "encourage community members to reflect on their own experiences, attitudes and values regarding gender, HIV/AIDS, democracy and human rights, so that they can take action to support people living with HIV and AIDS to get the support and care they need, reduce the spread HIV and the impact of AIDS, and promote gender equality. The activities are generally simple to use and do not require a lot of prior facilitation experience." Following the workshops it is expected that the participants will lead actions within their communities.
Community mobilisation booklets and handbookTo support work in the communities, a series of booklets and a handbook have been produced. Community mobilisers and Community Action Team members can use these resources to guide workshops. The booklets include a Community Mobiliser's Handbook [PDF], Community Mobilisation Workshop Manual [PDF], and Community Mobilisation Toolkit [PDF]. There is also a Tsima project handbook.
Public Service Announcements (PSAs)A series of Public Service Announcements (PSAs) were produced to promote the Tsima project. These PSAs use personal testimonies from health care workers, mobilisers, and people living with or affected by HIV to promote the project messages.

According to Sonke Gender Justice, "recent research shows that ART protects the health of someone living with HIV and greatly reduces the chance that that person will transmit HIV to an uninfected partner. When taken correctly and consistently, ART reduces the amount of virus (or the “viral load”) in a person’s body so much that it becomes undetectable (i.e. very small numbers of the virus) – so there is little virus that can be passed on to an uninfected partner. If a large enough proportion of people get tested, start treatment as soon as they are eligible, and stay on treatment for HIV in our communities, very few people will become infected."
"As of 2014, an estimated 22% of adults ages 15-49 are HIV-positive in Mpumalanga province. Only about 50% of these individuals are currently taking ART, with fewer men choosing to get tested and treated than women. If only half of people infected with HIV take their ART, transmission of the virus will continue. This is far less than the proportion needed to produce a substantial prevention effect from treatment at the community level. In line with national and international targets, our goal is to ensure that in each community, at least 90% of people will know their HIV status, 90% of people living with HIV will be on treatment, and 90% of those individuals will be virally suppressed by the end of the intervention. To achieve these goals over time, we will support each community to set its own yearly goals related to testing, treatment and viral suppression, and monitor community progress towards getting new transmission of HIV to zero."