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.