Prevention with Positives; Using Multiple Strategies to Involve Persons Living with HIV in Prevention. TASO Uganda. Emmanuel Odeke,

PRESENTATION Introduction Brief Background The AIDS Support Organization (TASO) HIV prevention Strategies Prevention with Positives Interventions Achievements Conclusion

INTRODUCTION Efforts to prevent new HIV infections have expanded from a focus on HIV-negative individuals to include interventions targeting people living with HIV/AIDS. Adopting strategies to involve persons living with HIV in prevention is key to reducing new infections.

Background In 1982, the first AIDS case in Uganda was diagnosed, and the link between ‘slim disease’ and AIDS was clinically recognized. By this time the country was in the midst of a major epidemic, with prevalence rates of up to 29% in urban areas. During the period 1992 to 2000. the HIV prevalence fell dramatically, from a peak in 1991 of around 15% among all adults, and over 30% among pregnant women in the cities, to around 5% in 2001.

Background Cont The current HIV prevalence in Uganda is estimated at 6.4% among adults and 0.7% among children. Women are disproportionately affected, accounting for 57% of all adults living with HIV The number of new infections (an estimated 111,000 in 2008) exceeds the number of annual AIDS deaths (61,000 in 2008), and it is feared HIV prevalence in Uganda may be rising again.

What is TASO TASO stands for “The AIDS Support Organization”. It is a Non-governmental organization in Uganda, founded in 1987 by a group of 16 volunteers including People Living with HIV/AIDS (PLWHA). From a small group initiative, TASO has grown into one of the biggest organized national response to HIV/AIDS epidemic in Uganda. involved in HIV prevention, care and support both at facility and community.

TASO TASO has 11 service centers a cross the country Each center extends its services to neighbouring districts within a radius of 75km. TASO’s HIV/AIDS programs include; HIV prevention Counseling Medical Care Social Support Training and Capacity development Community mobilization, Partnership and HIV Education Advocacy and Networking Research

HIV prevention Strategies ABC HIV/AIDS Sensitization and community capacity building. Behavioral change counseling. Home based HIV counseling and Testing. Treatment of STIs. PEP PMTCT Prevention with Positives

Prevention with Positives Interventions in TASO Active involvement of PLWHA in the planning, delivering and monitoring of prevention, treatment and care services (Meaningful Involvement of PLWHA). PLWHA committees (Client council committees) at all centers Membership in Advisory boards of TASO Some Staff members are clients Involvement of HIV positive persons in HIV sensitization through Music, Dance and Drama (MDD).

HIV sensitization through Music, Dance and Drama

Interventions Cont Counseling HIV positive persons to prevent transmission of HIV and this involves discussion of behavioral intervention in medical and counseling visits. Promoting the use, and provision of condoms to sexually active HIV positive individuals accessing services from TASO.

Counseling session in progress

Discordant couple Being educated on Condom Use

Group session, a counselor educating on condom use

Interventions Cont Adherence counseling Strategies to increase adherence to PMTCT and therapeutic treatment regimens Adherence counseling Use of pill boxes and Pill counts Community peer support groups and medicine companions. Discussing with HIV-positive persons strategies for disclosing one’s HIV status to sex partners by self or counselor mediated during home visits or at the earliest opportunity.

Pill Count at clients Home

Interventions Cont Providing diagnosis and treatment of STIs as part of routine HIV care. Particular care paid to the syndromic management, diagnosis and treatment of genital herpes and other STIs in HIV-positive persons and their partners in Medical sessions.

Interventions Cont Incorporating prevention interventions with PLWHA in community-based settings by; Formation of peer support groups in the community. Home Based HIV counseling and Testing of family members of PLWHA in care. Community Volunteers to Monitor Adherence and referral

Achievements Most of the persons realize that they have a role to play in prevention of HIV. There is 8.5% increase in the uptake of condoms by sexually active HIV positive person between the year 2008 and 2009.

Achievements Adherence levels on antiretroviral drugs is at 92% of the clients on ART have adherence >95%.

Achievements There is a remarkable increase of >50% in disclosure of HIV status to partners by PLWHAs between the year 2008 and 2009.

Achievements There was a reduction in the prevalence of STI among clients attending the clinics.

Achievements Community awareness of HIV has increased in the areas served by the organization hence reduction in stigma and discrimination.

Conclusion HIV positive persons are important partners in HIV prevention therefore their involvement should be prioritized in all HIV prevention activities.

ACKNOWLEDGEMENT Co-authors Clients of TASO Development Partners TASO Management and Staff AIDS 2010 Conference organizers

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