Strategies for empowering people living with HIV, to be part of the solution in resource restricted settings AMREF Health Africa International Conference, November 24-26th, 2014, Nairobi Keith McAdam Emeritus Professor of Clinical Tropical Medicine, London School of Hygiene and Tropical Medicine Associate International Director, Royal College of Physicians, London People Living With HIV (PLWH) • • • • 68% PLWH worldwide ±30 million in Africa ARVs bring life BUT Challenged socially (stigma) economically (school fees) • Need to be part of the Solution for HIV prevention • Train ‘Change Agents’ NAMWEZA Elspeth McAdam, Kicki Oljemark, Alice Welbourn, Charles Steinberg, Keith McAdam • Life skills training • Learning-by-doing, participatory, future focused appreciative inquiry • 10 sessions, designed as a public health intervention – Appreciate skills in others – Ask questions that induce reflection on how their behaviour affects others – Assertiveness: ‘I’ statements – Dreaming the future – Relaxation skills: mindfulness Background NAMWEZA is a ten sessions participatory program for training of Change Agents (CA) affected by HIV, using an appreciative approach, focusing on what people are good at. Through interviewing and listening to each other, the Change Agents become a network of supportive people who are recognizing and naming each other’s skills and abilities. Namweza importantly has a future focus, encouraging people, as they appreciate their competences, to dream/imagine their futures including future entrepreneurial activities. Randomised Clinical Trial in Tanzania to train Change Agents with Sylvia Kaaya and colleagues at Muhumbili and Mary Kay Fawzi et al at Harvard and with CDC, PEPfAR as funding partners • Stepped wedge design • Evaluate effect on Change Agents and on their Social Networks • Using Swahili and ACASI • Qualitative results compelling • Quantitative results: highly significant differences before and after training (p<0.0001) – for increased self esteem, self efficacy, self efficacy for safe sex, social support and – for reduced depressive symptoms and physical abuse victimisation (p=0.0003) Male Circumcision Microbicides for women Auvert B, PloS Med 2005, Gray R, Lancet 2007, Bailey R, Lancet 2007 Abdool Karim Q, Science 2010 Treatment of STIs Grosskurth H, Lancet 2000 Female Condoms Oral pre-exposure Prophylaxis Male Condoms Grant R, NEJM 2010 (MSM) Baeten J , 2011 (Couples) Paxton L, 2011 (Heterosexuals) HIV PREVENTION HIV Counselling and Testing Coates T, Lancet 2000 Post Exposure prophylaxis (PEP) Scheckter M, 2002 Treatment for prevention NAMWEZA Donnell D, Lancet 2010 Cohen M, NEJM 2011 Behavioural Intervention - Abstinence - Be Faithful How to rollout NAMWEZA in Africa? • Would like to work with implementing organisations • Incorporate NAMWEZA in strategic planning for Prevention of HIV Transmission • Please contact me to help make this happen! • In India & UK : Street children and in Schools • Role of the Radio, TV and Social Media?