© P. Vermeulen / Handicap International © W. Daniels pour Handicap International © B. Franck / Handicap International Project / Subject:Author:Last updated: Diffusion:Version:Validation/status: ROLE OF PSYCHOSOCIAL SUPPORT IN STIGMA REDUCTION AND PROMOTION OF OPTIMUM ADHERENCE TO ANTIRETROVIRAL THERAPY IN LOW RESOURCE SETTING AMONG NOMADIC PASTORAL COMMUNITITES, KENYA HANDICAP INTERNATIONAL Presented by Dr Nicole Curti ICASA CONFERENCE - 4 th December, 2011 Addis Ababa, ETHIOPIA

Background Information 1.In Kenya, PLHIV on antiretroviral therapy (ART) increased from 250,576 (230,059 adults and 20,517 children) in 2007 to 337,050 in 2009 (308,680 adults and 28,370 children) 2.According to 2009 census Garissa County has a total population of 623,060 (334,939 males and 288,121 females). The main inhabitants are Somali nomadic pastoral communities 3.HIV prevalence is 1.0% (KAIS 2007) 4.The main ART Comprehensive Care Center is at Garissa Provincial General Hospital, Garissa town 2 Title of document

Cont’ Estimates 2009/2010 HIV prevalence rate1.0% HIV+ Children147 Need for ART (Adults)371 Need for ART (Children)93 Need for PMTCT63 Orphans8,337 HIV+ Adults1,074 Population Counseled and Tested for HIV: (VCT, PITC, DTC, HBCT) 29,238 Adults and children with advanced HIV infection started on Anti Retroviral Therapy 446 Number of condoms distributed86,560 National AIDS Control Council (2009) Source: Garissa District Annual Operation 6 (2010). 3

Overall objective and Result 1.Objective: To reduce the spread of HIV infection among youth in Trans Nzoia and Garissa districts through improved access to HIV prevention, treatment, care and support services. 2.Result 3: Provision of care and treatment for youth infected with HIV is enhanced through improved links between VCT, medical care, and community-based services and through adherence support for youth on antiretroviral therapy in Trans Nzoia and Garissa Districts. 4 Title of document

Issues addressed by the project 1.High social stigma and discrimination 2.Weak strategies on psychosocial support 3.Low utilization of HIV Counseling and Testing services 4.Low enrolment to care 5.Poor adherence to antiretroviral therapy 6.Low treatment literacy among PLHIV on treatment and care 5 Title of document

Strategies 1.Construction of Comprehensive Care Center and Community Pharmacy 2.Capacity development of health workers on HIV management 3.Health facility based group therapy sessions 4.Involvement of veteran clients in mentorship, health education, peer counseling and positive speakers during outreach 5.Formation of community-based psychosocial support groups 6.Training PLHIV as home-based caregivers 7.Referral networking with HIV service providers and community-based PLHIV groups 6 Title of document

Outputs 1.One Comprehensive Care Center and Community Pharmacy established 2.Monthly group therapy meetings at the Comprehensive Care Center conducted 3.Formation of four satellite groups (community-based) comprising of 123 members, meeting on routine basis 4.20 PLHIV trained as home-based caregivers, 5.20 PLHIV participating in stigma reduction outreach activities as positive speakers 6.PLHIV from the support groups participating as volunteers at the Comprehensive Care Center 7 Title of document

Outcomes 1.Improved treatment literacy, 2.Self-acceptance and disclosure of status, 3.Strengthened two-way referrals (community-based structures and health facility), 4.Better defaulter tracing mechanisms, 5.Peer counseling through treatment buddies, 6.Less incidences of hospitalization resulting from opportunistic infections among group members, 8 Title of document

Lessons learnt 1.Importance of psychosocial support groups: empower members to fight against self and society stigmatisation; provide good entry points for defaulter tracing, paediatric ART, prevention of parent-to-child transmission; and strengthen continuum of care. 2.Experience sharing: is a powerful tool in mentorship and increases treatment literacy resulting in optimum adherence and positive living. 3.PLHIV trained as home-based caregivers: are accepted more readily by clients and this also promotes self-care. 9 Title of document

Conclusion 1.The project outcome clearly indicates that psychosocial support significantly contributes to antiretroviral therapy treatment outcomes. However, knowledge gap still exists on their contribution to: reduction in defaulters’ rate, stigma reduction and improving quality of life for PLHIV 2.PLHIV empowered as Home-Based Care Givers gain more acceptance among clients than non-PLHIV care givers. 3.Stigma and discrimination is still a major challenge. 4.Lack of involvement of PLHIV in service delivery perpetuates social stigma and discrimination. 10 Title of document

Recommendations 1.Psychosocial support services should be strengthened in HIV care and treatment to complement HIV treatment. 2.More research is needed to understand the role of PLHIV support groups in preventing parent-to-child transmission of HIV, reduction in defaulters’ rate, stigma reduction and improving quality of life for PLHIV 3.HIV programming should endeavour for greater and meaningful involvement of PLHIV at all levels of decision making and HIV and AIDS service provision 4.PLHIV need more in-depth knowledge on HIV & AIDS and treatment so as to increase their treatment literacy and promote self care 5.Need to change strategies in terms of not only looking at PLHIV as service users, but also as service providers 11