ACSM and TB/HIV Stigma

1. ACSM and TB/HIV Stigma By Cephas Kojwang’ Kenya

2. Stigma within the family • Halima decis ded to go back to her parents home • The support group members received food support and brought her some • Family members destroyed the food believing it would infect them with TB/HIV • Halima left NE for Nairobi to live with friends

3. ACSM and TB/HIV stigma • Halima told her story to me. She had pain all over her face. • I comforted her and enrolled her in the ACSM workshop for TB/HIV Ambassadors of Hope • She is currently one of the most effective AoH. • Her house is constantly full of neighbours seeking advise on all manner of health problems.

4. Faces of TB/HIV Stigma • Halima lived in a closed community in Kenya’s pastoralist North Eastern Kenya. • North Easterners are predominantly muslim • Halima had a cough that turned out to be TB • After a few months on TB treatment she tested HIV+

5. Faces of TB/HIV stigma cont.. • Her land lord locked her house and posted a notice telling her to vacate her house despite having paid her rent. • The notice stated that she should take her deadly diseases far from the landlord’s tenants. • She pleaded for time to look for another house, three days later her the landlord removed her clothes from the drying line and made a bon fire out of them

6. Faces of TB/HIV stigma cont. • In tears she took her remaining earthly belongings and secured another house half a kilometre away. • Her former landlord followed her and disclosed her status to her new landlord • For a second time she was shamelessly evicted • In the meantime she had joined a support group with regular meetings

7. How ACSM has worked for us • We selected 17 high TB burden districts in Kenya the prevalence curve for TB is very similar to that of HIV. • We identified 50 CBOs each of about 30 members from the 17 districts • We thereafter trained 50 representatives of these CBOs in TB/HIV ACSM • Thereafter we trained 100 TB/HIV AoH

8. What the AoH are doing • They have formed a useful link between communities and the health facility • They carry out community mobilization using he knowledge from ACSM training • They refer TB/HIV suspect to the health facility • They provide psychosocial support to many TB/HIV suspects in the villages

9. What AoHs do cont… • They are a big relief to the country’s health system • They work with DTLCs to trace treatment defaulters • They bring defaulters back on treatment • They contribute to increased treatment uptake • They demystify TB and HIV

10. What AoHs do cont… • They use public meetings and every available opportunity to amplify health messages to communities. • They use reporting tools developed by DLTLD and modified by NEPHAK to capture challenges in the field • They have identification letters and work with the full knowledge of the MoH in charge in their various localities.

11. What needs to be improved • More AoH are needed to help trace and bring defaulters back to treatment • More funding partners are needed to support the work of AoH in at least 40 districts out of Kenya’s 80 • Diagnostic services need to be available at the health centre level to ease the work of AoH, increase treatment uptake and watch out for XDR-TB

12. Conclusion • Since approx.53% of PLHIV also have TB it is important to strengthen TB/HIV collaboration thro’ strengthening capacities of PLHIV groups to implement ACSM activities. • My national network of PLHA in Kenya (NEPHAK) has membership in 72 out of the 80 districts. • NEPHAK has excellent working relations with PATH, NACC, DLTLD, public and missionary health facilities in Kenya

13. Finally • We support the strengthening of TB/HIV collaboration and ACSM since we see them as the surest strategy of dealing with TB/HIV co-infection, early detection of cases, and prevention of new HIV infections. With a little support we will make a difference • THANK YOU..ASANTE SANA!!!