When you read about the rate of infection of HIV in South Africa, the numbers are hard to comprehend. It is the country with the most people in the world living with HIV and AIDS: nearly 5.5 million of the country’s total population of 48 million. In some parts of the country one in five is infected.

South Africa’s North West province is one of the places with a high rate of HIV infection. The area I visited was not far from Pretoria and Johannesburg, on the border with Botswana. We visited a local community organization called Pholo Modi Wa Sechaba that provides essential services for infected and affected people. You can read my story about this visit here.

There was another facet of this story that I wanted to describe: the way Pholo Modi Wa Sechaba and its home-based care givers work closely with the clinic in an area called Sandfontein. “They play a liaison role between us and the community,” said Lulu Sitsila, the head nurse, pictured above with Gerard Payne of the AIDS Consortium. She added that the care givers are essential for the survival of many of the 1,500 patients they see each month. With only 12 nurses on staff, they need the help the care givers provide in the homes. “We can only concentrate on clinical work here,” she said.

The Sandfontein clinic serves 65,000 people in four villages. There is supposed to be a doctor working at the clinic one day a month, but Nurse Sitsila said they have not seen a doctor there for six months. She said most are not interested in working in rural clinics like this one.

The clinic struggles to meet the needs of all the people in the area, especially those who only seek medical treatment for the first time in the later stages of the disease. Some families turn to traditional healers first, and this puts them in even more danger. “People who get traditional medicines from families advance quickly,” said Nurse Sitsila. “By the time they come to the clinic they are very sick.”

Itumeleng Modimola, the 34-year-old manager if Pholo Modi Wa Sechaba, said their outreach work in the community has taught many people that sick family members, especially women, must go for immediate health care at clinics and or a hospital for HIV/AIDS. “Women are no longer oppressed by this culture,” she said, raising some skepticism from the visitors at the clinic that day. “Maybe [only] 10 percent now.” She credited a concerted effort in the community and at the clinic to counsel people living with HIV and AIDS to get proper treatment. “People living with HIV and AIDS encourage others, particularly mothers, to stop saying it is witchcraft, and now things have changed.”

The clinic counts on Pholo Modi Wa Sechaba to help counsel patients, and encourage those who need medication to come to the clinic and get on antiretroviral treatment. Helping people understand their treatment options is essential, and it is a function with which the government health system struggles.

“We can never function without them,” Nurse Sitsila said. “We don’t have extra hands and ears in the community, but since we now have these home-based care workers, we are functioning much better.”