Presentation on theme: "Strategies for empowering people living with HIV, to be part of the solution in resource restricted settings AMREF Health Africa International Conference,"— Presentation transcript:
1Strategies for empowering people living with HIV, to be part of the solution in resource restricted settingsAMREF Health Africa International Conference, November 24-26th, 2014, NairobiKeith McAdamEmeritus Professor of Clinical Tropical Medicine,London School of Hygiene and Tropical MedicineAssociate International Director,Royal College of Physicians, London
2People Living With HIV (PLWH) 68% PLWH worldwide±30 million in AfricaARVs bring life BUTChallenged socially (stigma) economically (school fees)Need to be part of the Solution for HIV preventionTrain ‘Change Agents’
3NAMWEZA Elspeth McAdam, Kicki Oljemark, Alice Welbourn, Charles Steinberg, Keith McAdam Life skills trainingLearning-by-doing, participatory, future focused appreciative inquiry10 sessions, designed as a public health interventionAppreciate skills in othersAsk questions that induce reflection on how their behaviour affects othersAssertiveness: ‘I’ statementsDreaming the futureRelaxation skills: mindfulness
4BackgroundNAMWEZA is a ten sessions participatory program for training of Change Agents (CA) affected by HIV, using an appreciative approach, focusing on what people are good at. Through interviewing and listening to each other, the Change Agents become a network of supportive people who are recognizing and naming each other’s skills and abilities. Namweza importantly has a future focus, encouraging people, as they appreciate their competences, to dream/imagine their futures including future entrepreneurial activities.
5Randomised Clinical Trial in Tanzania to train Change Agents with Sylvia Kaaya and colleagues at Muhumbili and Mary Kay Fawzi et al at Harvard and with CDC, PEPfAR as funding partnersStepped wedge designEvaluate effect on Change Agentsand on their Social NetworksUsing Swahili and ACASIQualitative results compellingQuantitative results: highly significant differences before and after training (p<0.0001)for increased self esteem, self efficacy, self efficacy for safe sex, social support andfor reduced depressive symptoms and physical abuse victimisation (p=0.0003)
6HIV PREVENTION Male Circumcision Microbicides for women Treatment of Auvert B, PloS Med 2005, Gray R, Lancet 2007, Bailey R, Lancet 2007Microbicidesfor womenAbdool Karim Q, Science 2010Treatment ofSTIsGrosskurth H, Lancet 2000Female CondomsOral pre-exposureProphylaxisGrant R, NEJM 2010 (MSM)Baeten J , 2011 (Couples)Paxton L, 2011 (Heterosexuals)Male CondomsHIV Counsellingand TestingCoates T, Lancet 2000Post Exposureprophylaxis (PEP)Scheckter M, 2002Behavioural Intervention- Abstinence- Be FaithfulTreatment forpreventionDonnell D, Lancet 2010Cohen M, NEJM 2011NAMWEZA
7How to rollout NAMWEZA in Africa? Would like to work with implementing organisationsIncorporate NAMWEZA in strategic planning for Prevention of HIV TransmissionPlease contact me to help make this happen!In India & UK : Street children and in SchoolsRole of the Radio, TV and Social Media?