New activities have started in Uranga and part of Boro, where a selection of community health workers are taking on new roles – as ‘defaulter tracers’. The term ‘defaulter’ has become widely used in Kenya to refer to people with HIV/AIDS who have failed to adhere to their treatment. HIV treatment basically supresses the virus in an infected person to levels low enough to allow them to live a healthy ‘normal’ life – the virus is still present (there is no cure), its just controlled. Treatment is in the form of pills that have to be taken religiously at certain times of the day, and with clean water, nutritious food and proper ongoing medical care. It can be a massive challenge in poor and remote settings like our project’s, and side effects and stigma only make it harder for people to adhere to the drugs. For many reasons, people with HIV/AIDS default from their treatment. It is terribly risky, as the virus can come back with a vengeance when the drugs are stopped, often causing death if the person isn’t helped in time. It is therefore very important for defaulters to be identified quickly and supported back onto treatment – a timely and sensitive responsibility our new defaulter tracers are taking on. We identify defaulters through records at local health facilities, noting any patients who have not come to pick up their drugs. From there, the defaulter tracer visits the person and talks to them face to face. The defaulter tracer’s personal understanding of living with HIV helps reduce fear and guilt, and they organise small group meetings with others in similar situations so that they can problem solve in an environment where they have a lot in common. Bicycles, uniforms and medical kits help in the process. Through counselling and empowering the defaulters with information and options, we have started to help defaulter tracers back onto treatment, with a strong focus on sustainability – its vital that these people don’t continue to default again in future, as their health risks are great and drug options become more limited after defaulting. This project is set in a place where life and death are very real. Bringing health care to the community isn’t an easy process: however, we have made a positive impact so far. As we start this new phase we wish our defaulter tracers all the best.

As we move into a new phase in Uranga and part of Boro, we thought it wise to take stock of how we’ve achieved so much. Particularly in terms of the outstanding work our community health workers have undertaken – those individuals we trained to care for others with HIV/AIDS. Time and time again our project has been recognised and singled out as leading efforts in home-based local care, even within the shadows of some of the largest, best-known NGOs. We know that it is most probably due to a range of factors, however it’s the clear motivation and commitment of the community health workers on the front line that we suspect we owe our success. To find out more, Positive Aid recently commissioned a small research exercise into this issue. Community health workers across Uranga, as well as project management, were interviewed individually to tease out information that could help us when replicating the project further afield: What attracted the CHWs to undertake their training with us in the first place? What motivated them to volunteer their time in our project, especially when other organisations offered more lucrative rewards? What were their biggest challenges and most fulfilling successes? We eagerly await the report from this investigation and plan to use it when selecting and training new community health workers when expanding into Ugunja later this year.

Since 2007 Positive Aid has supported the training and ongoing upkeep of 96 community health workers. These people were selected from local networks of people living with HIV/AIDS – most of them living with the disease themselves. Over time we came to realise just how powerful this was, as not only did the sick clients they cared for feel comfortable and trusting in an otherwise stigmatised environment, they also offered tangible examples of how you can live a normal life if you adhere to HIV treatment. The community health workers came from various geographic areas as the project grew, covering remote rural villages to give the population close enough access to a health worker if they were in need. Armed with uniforms, medical kit bags, information and bicycles (‘village ambulances’), the community health workers volunteered their time to look after the sick, give them hope, and help them to get tested and treated for HIV. Any one of them will tell you stories of incredible change they witnessed in their clients as they took them step by step from being bed-ridden to regaining their health and confidence to get on with life again. Over the years the community health workers have been active, there has been a distinct impact. When compared with neighbouring areas the project hasn’t reached, Uranga and Boro Divisions have had a high number of people accessing testing and treatment, joining support groups, and the amount of stigma and discrimination has reduced – people now speak openly about HIV/AIDS and there is more understanding in the community. The community health workers have made their mark and achieved so much, its now time for our project to move to another phase so that activities stay relevant and we continue to help the neediest people. We will be introducing home-based care into a new area shortly. However, in Uranga and Boro we will be focusing on a reduced amount of clients so will only be continuing with a small number of community health workers. To all of them, we say thank you for your volunteerism and tireless efforts to help your community. A celebration was held recently to appreciate their work and achievements. Feedback from the day: “Indeed it was good moments full of tears and joy as we remembered the lives of people we have touched.”

A major task Jess was involved in during her trip to Kenya was helping Boro Division to complete its process of becoming independent. Positive Aid has supported HIV activities in Boro for several years now, with workers and volunteers from that Division. Over this time the project has matured and the people there have developed the right skills to carry on independently from the hub where we started in Uranga. We have been careful to wait for the right time for Boro’s independence so that the process is smooth and the project has a strong enough foundation to sustain itself effectively. Discussions and findings on the ground in March confirmed that the time is now right, and together with management from both Uranga and Boro, put in place a transition phase where Boro is now responsible for managing all of its activities and finances independently. Supervision will be provided for a few months from our original management in Uranga to assist as required. When Boro is independent it will mean that Positive Aid will be supporting two separate community projects, keeping a very local focus on each, instead of growing bigger and adding extra layers of middle-men along the way. We wish the team in Boro all the best, in particular Peter who will be our manager there.

Positive Aid has been supporting health activities in Uranga for almost ten years now. We began in 2007 supporting a new team of community health workers to care for people living with HIV, helping them step by step to find out their HIV status, start treatment and gain the health and confidence to regain their lives. In More recently we expanded activities to Boro, a second Division. Thousands of clients in need have benefited, together with their families and wider circles. Other activities have been added along the way including maternal and child health and health literacy. Ongoing monitoring and periodic assessments have demonstrated just what a difference we’ve made in Uranga and Boro, with the situation now in stark contrast to neighbouring areas where the project hasn’t reached. Through thorough discussions and considering a range of factors, we have decided that the time is right to wind up our home-based care activities in Uranga and allow for a new and farther-reaching focus. We will retain a selection of community health workers to continue providing care for clients, with a special focus on helping people adhere to their existing treatment. Maternal and child health as well as health literacy will continue as usual. Things are also in place to introduce home-based care to a third and completely new Division – Ugunja! Our recent needs assessment of the situation in Ugunja showed a great amount of need, with a high prevalence of HIV and no significant projects or support services to help people. Our plan is to train a new set of community health workers in Ugunja who will start offering care to people with HIV in line with what we have learnt in Uranga – the conditions are quite similar to those we experienced when beginning, and after refining things over ten years we are really well placed to succeed in Ugunja. Expansion activities will be carried out by our Project Manager Mordecai, who will mentor local workers in Ugunja, until they have the capacity to manage themselves effectively. We wish everyone involved all the best at this exciting time!