Research psychologist Neil Orr and therapist David Patient are change agents. They have taken psychoneuroimmunology (behaviour change) and repackaged it as Empowerment/Group Synergy. Their Empowerment Concepts company has worked in 14 countries to guide organisations through transition and transformation.
In SA, clients include Tsogo Sun, Sun International, Reckitt Benckiser, Standard Chartered & Merchant Bank, top private schools and some government departments.
Three years ago they produced a small book for people living with HIV called Positive Health for Metropolitan Life. It's a holistic look at life, with plenty of information on what to eat and how to exercise to keep your immune system strong. About 3,5m copies have been distributed in SA. A government minister from Mozambique saw one and now 750 000 Portuguese copies are in circulation there.
In February Orr and Patient were signed by the Mozambican government in a trail-blazing contract to work with government to tackle HIV/Aids in that country.
Mozambique has a population of 22m, 12%-17% of whom are estimated to be HIV-positive. Its 812 379 km˛ are served by just 350 doctors, of whom perhaps 200 are in public practice.
Today, the duo's first 14-month Vida Positiva ("positive living") Train-a-Trainer programme is in full swing. All 21 government ministers have a delegate under training - most of them at department director level. Other delegates include 132 people from nongovernmental organisations (NGOs) and 56 from church organisations.
"Mozambique doesn't have the infrastructure or capacity to handle the pandemic," says Orr. "So government decided to increase the capacity of its senior staff, the NGOs and the rest to start dealing with the issues, all the way from prevention and home-based care to nutrition and how to stay healthy. It's a huge project.
"There are few industries in Mozambique, and those that are there have been hit hard by Aids. They're in our training courses as well. And the international donor community, which is supplying most of the funds, is supportive of government's efforts."
The first four months of Train-a- Trainer are the basics: HIV/Aids prevention; health motivation; and nutrition. "Then they are sent back to their communities and have to pass on this information," says Orr. "And it's monitored."
After three months, if they deliver the way they should, they return for the second four months' training: topics such as support groups; home-based care; and orphan care, which they take back to their communities. When they complete the programme next April, they will be certified by the education ministry as trainers.
The enforced delivery programme is difficult. There's no time for window-dressing or going through the motions. "They all sign a contract, stating they will identify three people from their organisation and another three people from their community, and teach them what they've learnt," says Orr. "We call it the replica process."
The 450 people under training now will indirectly produce 2 500 trainers.
"It's a rapid delivery process," says Orr. "We've linked up with national TV and radio stations, so when we're talking about the immune system, every radio station in the country is put in touch with the delegates in their region, who are invited to speak on the radio about the issue for 30-60 minutes twice a week."
This way communities - there are more than 17 different languages - discover immediately who has knowledge locally and they can access it immediately.
"In countries like Mozambique, where you have few resources and few skilled personnel, you do what you can," says Orr. "It's working well.
"We've done most of our Aids work in SA, so when we went to Mozambique we had a kind of scepticism of government. You know, things take so long, you never know what is going on and everything's affected by politics.
"In fact, the Mozambican government has been superb. It's amazing. Compared with my experience in SA, the Mozambican experience has surprised me in terms of what can be accomplished in a short space of time, when people are committed."
Co-trainer Patient is not only HIV-positive himself, he's one of the longest-surviving HIV-positive people in the world. He was diagnosed on March 13 1983, when living in Las Vegas where he worked as "a chef, flipping hamburgers". The doctors told him he had six months to live.
Patient was among the earliest to be tested with antiretrovirals when Duke University in North Carolina first tried them on humans in 1995. "There were 1 800 people in the programme. Two of us dropped out - and we're the only two who are still alive," he says.
"I dropped out after six months because the side effects of the AZT were so bad. I literally couldn't get out of bed. So I dropped out and took my chances."
Nine years on, Patient still hasn't taken antiretrovirals. "I decided to do my damndest to keep my body as healthy as I can," he says. "My immune system has improved threefold; my CD4 count is within a normal range and now I'm simply HIV-positive. I get a recurring lung infection because specific cells during infection were knocked out and my body has lost the blueprint. But apart from that I lead a normal, highly active life."
The Mozambican government does not supply antiretrovirals to the community. "Even if they got them for free, it wouldn't be feasible," says Patient. "There simply isn't the infrastructure.
"People think the medication is a magic bullet. It isn't. The drug regimen is so complex that unless you are middle class, can afford a minimum of six small meals a day and have access to medical care and the person taking care of you is familiar with the side effects of drugs, there's no benefit.
"The combination therapy involves taking one pill 20 minutes before a meal, one during the meal and another one after. You can't do it any other way. The problem is what do you do when people don't have food? When there is a famine? You simply accelerate the progression of Aids."
Patient describes himself as "a therapist: death and dying [D&D]". D&D, he explains, "means helping people come to terms with the fact that they've got a terminal illness; helping them through their illness and their dying process; and supporting the family afterwards.
"I don't want to come across as being jaded, but I've got to a point now where I go onto auto pilot," he says. "I've found it's easier for me not to get attached, because if I do I get emotionally wrecked. I burnt out three times before and I can't afford to burn out again."
