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?