ICAP News - May 2010
Peer Educators: The Power of People Living with HIV
Yenenesh Belay has come a long way in the last two years. At the end of 2007, tuberculosis, thrush, and toxoplasmosis had taken their toll on her health. Her husband had just died of AIDS, and she came to realize she also had HIV. Now, she was desperately ill.
Like many places, the social stigma of HIV in her native city of Dire Dawa, Ethiopia compounded her condition with feelings of shame, depression and a sense of isolation. These are often the natural reactions for many patients once confronted with the diagnosis of HIV. Fortunately for Yenenesh, when she visited nearby Dil Chora Hospital, she met a peer educator who helped her see beyond the initial shock.
“She made me see that I was not alone,” said Yenenesh. “There was treatment, and I could get better.”
Two years later, Yenenesh is strong and healthy. She’s gone on to become a peer educator herself, and plays a key role in the lives of many HIV-positive people in Dire Dawa.
Yenenesh is part of the ICAP-supported peer educator program. She shares her experiences with others, educates newly diagnosed patients on myths regarding HIV and its treatment, and works to help them overcome the prevailing stigma that accompanies HIV. A friendly face for patients waiting to see their clinician, Yenenesh talks to other people living with HIV about how to take their medicines, and the importance of coming back regularly for clinic visits. She is a role model for how to live a healthy life with HIV.
“Adherence to care and treatment is the key to living with HIV,” says Zenebe Melaku, ICAP country director in Ethiopia. “But sometimes the message has to come from someone else besides a doctor or nurse. When patients hear advice from a peer, from someone who is living with the same problem in the community, it can reach them at a deeper level. For some, this is what convinces them to stick to their follow-up and treatment.”
The success of peer educators in other areas of public health has been well documented. During the early days of the U.S. epidemic in the late 1980s, ICAP Director Wafaa El-Sadr was instrumental in establishing a peer-based program, Positive Links, at Harlem Hospital in New York. ICAP started supporting a similar approach in 2005. ICAP has since partnered with health ministries to support the launch of HIV peer educator programs in Côte d’Ivoire, Ethiopia, Kenya, Mozambique, Nigeria, Rwanda, South Africa, Swaziland, and Tanzania.
In Ethiopia, peer educators help prepare newly diagnosed patients for antiretroviral treatment. If a patient wishes to disclose their positive status to family members, peer educators are available to guide that process. They can help encourage family members to be tested. They provide counseling, link patients to support groups, inform about healthy living, and provide advice on how to prevent HIV and tuberculosis transmission.
At facilities where staff are overwhelmed, peer educators assist nurses and counselors in providing key services to patients as part of a “task shifting” strategy.
Peer educators also help fill a need in patient adherence by providing additional outreach outside the clinic. In Nigeria, peer educators sometimes travel to patients’ homes to help them work through adherence problems. This has been one of the major successes of the program, according to Mary Ashie, ICAP’s adherence advisor in Nigeria. “Poverty, difficulty of
transportation, bad roads all deter patients from making regular appointments,” she said.
In areas where peer educators work, Ashie has also seen marked improvements in the level of information that patients have about HIV, and notes that patient adherence in ICAP-supported
facilities has increased since the Nigeria peer educator program began in 2006.
Peter Twyman, regional program director at ICAP, noted that
ICAP strives to make peer educators full members of the care and treatment teams. “Weekly meetings where doctors, nurses, social workers, pharmacists, and peer educators get together to talk
about core services and how to support individual patients can
only serve to ensure the highest quality of care.”
One of the most important benefits of the program has been the positive changes it has brought to the lives of peer educators themselves. Yenenesh Belay credits the program with saving her life. It has also given her a strong sense of purpose. After Yenenesh’s husband died, she and her three year-old son were subjected to stigma and discrimination. Now her work bringing encouragement and hope to her community has won her widespread admiration.
“Two years ago I thought my life was over,” 'Yenenesh says. “Now my new life has just begun.”
To access ICAP's Peer Educator Training Curriculum and Implementation Manuals, click here.
Photo captions: ICAP’s peer educators gather together for a meeting to share their experiences; A peer educator interacts with patients while they wait at a clinic.
From the Field
- ICAP is beginning work in the Democratic Republic of the Congo (DRC). ICAP’s work will focus on supporting the integration of HIV and TB clinical services and building the capacity of local clinical laboratories. This effort will be supported by the U.S. Centers for Disease Control. ICAP will work in partnership with the DRC Ministry of Health’s Zonal Health System Management Team, Equipe Cadre de Zone de Santé, in support of integrated TB/HIV services and a local lab network in six zones in Kinshasa. In the first year, ICAP will support HIV services at four hospitals, and integrated HIV and TB services at 20 tuberculosis sites. In addition, the program will build capacity at six local labs. Laboratory staff will learn to provide HIV rapid testing, acid-fast bacillus (AFB) TB smears, CD4 tests, hematology, and chemistry tests. Once these clinical labs have gained capacity in HIV and TB diagnosis and monitoring, the national reference lab will be able to focus on quality assurance and other activities needed to strengthen lab networks in the DRC.
- ICAP-Ethiopia conducted training on malaria diagnosis and management. A total of 251 health workers have received training, including laboratory personnel and clinical staff from 57 health facilities in Ethiopia’s Oromia region. The training focuses on building capacity on malaria laboratory diagnosis, rapid HIV testing and quality assessment, and fever case management. ICAP-Ethiopia is the implementing partner of the Malaria Laboratory Diagnosis and Monitoring project, funded by USAID-Ethiopia through the President’s Malaria Initiative. ICAP-Ethiopia also recently conducted training on financial management for 9 organizations who receive sub-grants through ICAP. The training helped strengthen their financial management and reporting so that they can seek their own direct funding in the future.
- ICAP-Nigeria supports care for orphans and vulnerable children in Makurdi and Gwer West areas in Benue State. Through support of the Jireh Doo Foundation’s Youth Made Vulnerable program, ICAP has helped 179 children receive educational services and access to a food bank. Many children receive support in the form of school bags, school sandals, and other supplies. Microfinance loans and entrepreneurship training has empowered more than 250 caregivers to ensure the stability of these children. The success of the program has allowed it to expand to include at-risk children that are not orphans or HIV-positive. In addition to support by ICAP, the Foundation is currently funded by the national TB/Leprosy project and USAID.
- U.S. Centers for Disease Control and Prevention awarded Bugando Medical Centre (BMC) Laboratory, a facility supported by ICAP, with its highest honor, a Certificate of Excellence. The lab was recognized for excellence in its PCR DNA testing, required for early diagnosis of HIV in infants.
Photo caption: Health workers in Ethiopia participate in an ICAP training session.
Inside ICAP
ICAP Director Wafaa El-Sadr spoke at a U.S. Congressional briefing on the value of U.S. investments in HIV/AIDS. Discussions centered on the gains that have been made since HIV first emerged. The April 30 briefing entitled “AIDS Research at NIH: New Opportunities to Change the Course of the Epidemic,” was sponsored by the HIV Medicine Association, part of the Infectious Diseases Society of America’s Center for Global Health Policy and the American Foundation for AIDS Research (amFAR). For the full article and a video of Dr. El-Sadr's talk, click here.
Wafaa El-Sadr received an honorary doctoral degree and delivered Boston University’s Baccalaureate address during the 2010 commencement ceremonies. For the video of her address, click here.