IMPROVED ACCESS TO HIV/AIDS SERVICES THROUGH COMPREHENSIVE CARE AND

TREATMENT CENTRES

B. EtemesiDermato-Venerologist, Nakuru Provincial

Hospital

Introduction • Nakuru Provincial Hospital comprehensive

care and treatment centre opened in January 2004

• Services offered are intended to provide holistic family focused care to those infected and affected by HIV. Efforts are made to reach out to the family when an ‘index client’ presents to the Comprehensive Care Centre (CCC)

• Currently over 9000 adults and children are under care and treatment with an average of 100 patients per day seen at the CCC

Introduction• Services are provided to different groups

catering for their specific needs: pregnant women, children, youth and adults.

• Apart from Voluntary Testing and Counselling (VCT), Early Infant Diagnosis (EID), Diagnostic Testing and Counselling (DTC) are carried out for one to know whether they require CCC services

• Among the services provided at the CCC is a pharmacy specifically for the provision of ARV and opportunistic infection drugs. Adherence counselling is also provided to clients and/or care-givers

Stigma• In general stigma is severe social

disapproval of personal behaviour, characteristics or beliefs that are against what is considered “normal”. It results in social rejection arising from fear, and/or lack of understanding or knowledge.

• AIDS related stigma refers to the negative social response against people perceived to have HIV or AIDS and those who are closely associated with them.

• Stigma can fuel responses of discrimination, prejudice, fear, denial and anxiety.

Commonly encountered actions that can stigmatize

• Judgemental attitude why people of certain age brackets (especially the youth and elderly) or profession can acquire HIV

• The avoidance or extra care taken by health care workers when handling people infected with HIV

• Guardians reluctance to bring HIV infected children to the CCC for care and treatment

• Labelling of certain conditions especially skin disease and tuberculosis

• Whether by coincidence or choice HIV patients being found in one section of the ward.

Reactions to stigma• Guardians neglect of children (AIDS

orphans) under their care for fear of community stigma.

• Removal of labels on ARV bottles, or simply switching the incriminating bottles for fear of being identified to be taking ARV leading to the.

• Self-blame and denial of having the disease, often leading to refusal to disclose HIV status to partner/spouse, children or relatives.

• Reluctance to collect drugs from the CCC pharmacy since it will be know that they are on ARVs

Reactions to stigma• Health workers on ART pretend to be

picking ARV for a patient or relative for fear of being identified as the user.

• Where a drug for an OI is unavailable from the CCC pharmacy the patient will demand a different prescription that is not CCC branded so that it can not be identified when they purchase the drugs elsewhere.

• Youth who require comprehensive care avoid coming to the CCC because they don’t want to mix with the adults and if they come they will usually come with an adult so that it looks like it is the adult requiring the services.

Reducing the stigma• As the main causes are unfounded fears

and ignorance or lack of adequate knowledge about the disease, the best interventions involve tackling these causes

• Initial interventions need to target the stigmatizers: health care provider both medical and non-medical, the general community, faith leaders with factual and up to date information. This is done through making available literature with the information (e.g. leaflets and brochures), morning health talks, videos and seminars, targeting various groups, etc.

Reducing the stigma

• People affected as well as those living with HIV or AIDS also need be to be targeted. Counselling is the cornerstone to reduction of stigma of PLWHA, their partners, family and care givers. It is used to provide needed information at every point where treatment and care is provided and is critical in helping those affected as well as those infected to cope with fears and emotions related to HIV & AIDS, thus improving understanding and acceptance of HIV status

Reducing stigma• Support groups provide psycho-social and

material support by sharing of experiences, empowering themselves with skills, information and opportunities. Support groups provide a supportive environment with an ambiance of care and understanding.

• Ensuring all health care workers are kept up to date with information on HIV and AIDS

• Introduction of stigma as a topic in the ART trainings

Support group paediatric

Adult support group

Take home message• The person infected with HIV or living

with AIDS and those associated with them should not treated differently from any other person.

• We should remember that AIDS is a disease like any other. We need to be well informed about the disease so that we can free ourselves from irrational responses or reactions to HIV and AIDS.

Acknowledgement

Stella Etemesi, Dr Marion Ong’ayo, Lydia Njuki, Matron Mary Mware, Matron Sarah Mosop, Mary Mose,

Beatrice Mwangi