ACSM and TB/HIV Stigma By Cephas Kojwang’ Kenya

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

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.

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+

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

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

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

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

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

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.

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

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

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!!!