There's no substitute for support when taking ARVs

"We [people living with HIV] must eat well, must keep off stress - it is not good for you ... if you can, please walk out on anything annoying and go and watch Vitimbi [a popular TV sitcom] or sing your favourite song ... be happy and positive."

This is part of a message Dorothy Kendi* gives her 'class' of HIV-positive people at Meru district hospital in eastern Kenya. Her students listen eagerly, interrupting her dialogue every now and then with questions about diet, adhering to an antiretroviral (ARV) drug regimen and other lifestyle issues.

Kendi has lived with the virus for the past 23 years, during which time she has gathered a wealth of knowledge. She has also become a valued asset of Zingatia Maisha (ZM) (Swahili for focus on life), a project started in 2006 and supported by pharmaceutical giant GlaxoSmithKline through the Elizabeth Glaser Paediatric AIDS Foundation (EGPAF), as well as the African Medical and Research Foundation and the Ministry of Health, among others.

The project empowers communities to participate in HIV care and treatment, with a focus on encouraging people living with HIV/AIDS to take a more active role in the fight against HIV.

"Zingatia Maisha came here to help those of us who are infected. Those on ARVs have been trained to stick to drug prescriptions to the letter, and we have been taught good nutrition habits and positive living," she told IRIN/PlusNews.

Rogers Simiyu, programme officer for EGPAF, said: "The number of people testing HIV-positive was overwhelming health facilities and health workers, so we decided to go into the community to get support for the programmes."

He added that the project was particularly useful on the issue of adherence, because while so much focus had gone on increasing the numbers of people on ARVs, there was not enough on keeping them on the drugs.

"HIV-positive people usually visit the clinic once a month, but they live in the community for the other 29 days. It's important for them to have support systems within their social networks."

Support groups a "safety net"

The ZM initiative fosters adult, paediatric and youth support groups. Group leaders assist with client referrals and ARV defaulter tracing, while HIV-positive youth and adult members pair up as 'treatment buddies' to check on one another's health and general welfare. Groups also engage in income-generating activities to improve the socio-economic welfare of members.

Kendi, a leader of Meru's Mwiteria support group, is among the many volunteers who train visitors to the hospital's comprehensive care centre. For example, every Monday morning, when infected children gather with parents or guardians on their clinic days, she discusses ARV adherence, paediatric psychosocial support and stigma.

"Using HIV-positive people to pass on these messages is really useful - I have often heard them say they know where the shoe pinches most," EGPAF's Simiyu said. "They understand exactly what people are going through and can deal with them on the same level."

He said the support groups had provided a crucial 'safety net' for newly diagnosed HIV-positive people, because stigma and discrimination were still high in Kenya and the groups acted as a good buffer against society's negative attitude.

"In our talks at the centre, and during community outreaches, we also emphasise the importance of forming or strengthening [HIV/AIDS] support groups, disclosure, behaviour change and healthy eating, and discuss opportunistic infections," said Zablon Kithinji*, an official of Meru's Kagendo support group.

Local health workers said the ZM project and its involvement in the community had had a significant impact on the care and treatment of people living with HIV in the region.

"The support groups system has encouraged people to freely discuss AIDS, there is widespread knowledge dissemination at the community level and, interestingly, more people are now keen to know their [HIV] status," said Meru's Medical Officer of Health, Dr James Gitonga.

Simiyu said the Meru hospital had noticed shorter counselling times, as many patients came to the centre equipped with knowledge gained from the community outreach projects run by the support groups.

Kenya has lost more than 3,000 nurses in the past five years, with most leaving for jobs in Europe and the United States. In an effort to bolster HIV programmes, lay people are increasingly being involved in the less technical aspects of care.

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