1. Strategies for empowering people living with HIV, to be part of the solution in resource restricted settings
AMREF Health Africa International Conference, November 24-26th, 2014, Nairobi
Keith McAdam
Emeritus Professor of Clinical Tropical Medicine,
London School of Hygiene and Tropical Medicine
Associate International Director,
Royal College of Physicians, London

2. People Living With HIV (PLWH)
68% PLWH worldwide
±30 million in Africa
ARVs bring life BUT
Challenged socially (stigma) economically (school fees)
Need to be part of the Solution for HIV prevention
Train ‘Change Agents’

3. NAMWEZA Elspeth McAdam, Kicki Oljemark, Alice Welbourn, Charles Steinberg, Keith McAdam
Life skills training
Learning-by-doing, participatory, future focused appreciative inquiry
10 sessions, designed as a public health intervention
Appreciate skills in others
Ask questions that induce reflection on how their behaviour affects others
Assertiveness: ‘I’ statements
Dreaming the future
Relaxation skills: mindfulness

4. Background
NAMWEZA 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.

5. Randomised 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 partners
Stepped wedge design
Evaluate effect on Change Agents
and on their Social Networks
Using Swahili and ACASI
Qualitative results compelling
Quantitative results: highly significant differences before and after training (p<0.0001)
for increased self esteem, self efficacy, self efficacy for safe sex, social support and
for reduced depressive symptoms and physical abuse victimisation (p=0.0003)

6. HIV PREVENTION Male Circumcision Microbicides for women Treatment of
Auvert B, PloS Med 2005, Gray R, Lancet 2007, Bailey R, Lancet 2007
Microbicides
for women
Abdool Karim Q, Science 2010
Treatment of
STIs
Grosskurth H, Lancet 2000
Female Condoms
Oral pre-exposure
Prophylaxis
Grant R, NEJM 2010 (MSM)
Baeten J , 2011 (Couples)
Paxton L, 2011 (Heterosexuals)
Male Condoms
HIV Counselling
and Testing
Coates T, Lancet 2000
Post Exposure
prophylaxis (PEP)
Scheckter M, 2002
Behavioural Intervention
- Abstinence
- Be Faithful
Treatment for
prevention
Donnell D, Lancet 2010
Cohen M, NEJM 2011
NAMWEZA

7. How to rollout NAMWEZA in Africa?
Would like to work with implementing organisations
Incorporate NAMWEZA in strategic planning for Prevention of HIV Transmission
Please contact me to help make this happen!
In India & UK : Street children and in Schools
Role of the Radio, TV and Social Media?