Transcript 9 - Susie Mclean

www.aidsalliance.org
Supporting community action on AIDS in developing countries
The role of communities in scaling up
HIV/AIDS programmes
Susie McLean
Senior Policy Advisor
International HIV/AIDS Alliance
Title of presentation
Supporting community action on AIDS in developing countries
What roles do communities play in the
delivery of ARV treatment?
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Where is health experienced?
Where is HIV/AIDS experienced?
Where do people take treatment?
20 minutes in the clinic vs rest of life in
community
Title of presentation
Supporting community action on AIDS in developing countries
Why communities?
• “HIV/AIDS is seen in the clinics, but it lives in
our communities”
• Treatment also ‘lives’ in communities
• Fear, stigma & lack of understanding stop
people from accessing testing & treatment
• Increased knowledge & understanding of HIV
& ART across a community can increase
support for people on treatment, reduce
stigma and support protective behaviours
Title of presentation
Supporting community action on AIDS in developing countries
Different roles
• Advocacy and policy
• Planning
• Programme implementation – treatment,
education, community mobilisation
• Evaluation, critique, quality
Title of presentation
Supporting community action on AIDS in developing countries
Tools for community
engagement
in treatment
• The Treatment Journey
- a simple tool for individuals
and planners to describe need
and the different places where
needs are met
• Formal, informal systems,
pharmacies, friends, where
people come to know about
AIDS
Title of presentation
Supporting community action on AIDS in developing countries
ARV treatment in Burkina Faso 1
• Centre Oasis – a community initiative started by a
group of friends concerned about AIDS, AAS
• Started with HIV prevention – education, condoms &
clean razors for barbers
• Progressed to small scale treatment based on drug
donations
• Alliance support enabled set-up of Projet Orange –
nurses, doctors, pharmacist etc.
• Scaled up to delivery of ARV treatment for 300, target
was for 500 by end of 2005
• Good clinical results
Title of presentation
Supporting community action on AIDS in developing countries
ARV treatment in Burkina Faso 2
• Holistic, comprehensive support for
treatment, adherence, prevention and income
generation
• People with HIV engaged in all aspects
• Community education through internet café &
14 roadside coffee shops – snacks & info.
• Micro-finance & micro-health insurance –
poor households & those caring for orphans
Title of presentation
Supporting community action on AIDS in developing countries
ARV treatment in Burkina Faso 3
• Sharing lessons & supporting other civil
society organisations re treatment.
• Challenges of scale, treating children;
prevention; intensive capacity building &
investment; funding; working with govt,
drug procurement
• Proof of concept – AAS important
advocacy role with national govt
Title of presentation
Supporting community action on AIDS in developing countries
“At the time when many of us were dying, we were told
that the community cannot do it. We wanted to show that
the community can do it.”
Title of presentation
Supporting community action on AIDS in developing countries
ARV treatment in Ukraine 1
• Global Fund-funded project – Alliance is
Principal Recipient of funds for national
ART programme
• Public health system programme providing ARV treatment, training, M&E
• Works with national and regional AIDS
Centres to provide treatment for 4000
people with HIV (currently ~ 2800)
Title of presentation
Supporting community action on AIDS in developing countries
ARV treatment in Ukraine 2
• HIV mainly among drug users & sex workers
• High levels of human rights abuses towards
drug users
• Lack of substitution therapy for injecting drug
users – buprenorphine/methadone
• Community myths – ‘experimentation by
western drug companies’, ‘money will run out’
• People need food, vitamins, counselling to
add to prevention & care programmes
Title of presentation
Supporting community action on AIDS in developing countries
ARV treatment in Ukraine 3
• Interaction of social, medical, political
and economic factors
• People need stability, adequate
nutrition, removal of social isolation to
support ARV treatment & prevention
• Education of wider community and
improved services are essential to
improve the situation
Title of presentation
Supporting community action on AIDS in developing countries
ARV treatment in Ukraine 4
• Local NGO role in treatment programmes –
NGO social workers in ART clinic teams,
comm based treatment info programmes,
comm based adherence support, advocacy,
prevention
• National PLHA organisation - advocacy
• Community preparedness remains a
challenge
• Slow uptake, defaults from treatment and
deaths due to late start of ART
Title of presentation
Supporting community action on AIDS in developing countries
“It is good to see those younger ones start recovering and
getting better. It is very important to have each other.”
Title of presentation
Supporting community action on AIDS in developing countries
ARV treatment in Zambia 1
ARV treatment Community Education & Referral
(ACER) Project
• Supports Government ARV programme
• Supports treatment of nearly 300 people
• Involves traditional healers, NGOs, pos. people’s
network, church groups, local health workers
• People with HIV employed as treatment supporters
• Builds on existing community structures
Title of presentation
Supporting community action on AIDS in developing countries
ARV Treatment in Zambia 2
• Experienced Zambian manager
• Treatment support workers – 2 in each of 2
ARV clinics: referral point for people from
communities, information providers,
psychosocial support
• Treatment mobilisers – coordinate activities
and advocacy in community settings
• NGO partners – range of activities –
education, home care
Title of presentation
Supporting community action on AIDS in developing countries
ARV treatment in Zambia 3
Community activities:
• Treatment literacy, adherence counselling, food
support & micro-credit
• Treatment support groups
• Community education through traditional meetings,
churches, markets, schools, street theatre, drop-in
centres
• Education & mobilisation of traditional healers & birth
attendants
• Youth drop-in centres – education on treatment &
prevention
• Two-way referral system,to and from health system &
other sources of help for people on treatment
Title of presentation
Supporting community action on AIDS in developing countries
Youth group performing for audience of traditional healers
- Ndola, Zambia
Title of presentation
Supporting community action on AIDS in developing countries
Lessons learned:
• Preparing communities takes time, effort & respect
for local context & protocol
• Must build on & mobilise existing resources and
relationships
• Must be actively part of formal health system
• Vital to combat stigma & improve uptake of HIV
testing & PMTCT as gateways to ARV treatment
• Vital to good adherence?
• “Gatekeepers” must be committed and supportive Government & local leaders
• Programme reach beyond HIV – addressing other
health needs
Title of presentation
Supporting community action on AIDS in developing countries
Further information
• Toolkits, policy papers, fact sheets,
resource manuals available on website:
www.aidsalliance.org
• [email protected]