The 2nd HIV Capacity Building Partners’ Summit

Increasing Access to HIV/AIDS Prevention, Treatment and Support

for PWDs in KenyaRATN FUNDED INSTANT PROJECTS

19th -21st March 2013Johannesburg, South AfricaPresenter – Cecilia Rachier - KAPC

To: 'abstracts@hivcapacityforum.org

Abbreviations

• KAPC – Kenya Association of Professional Counsellors• PWHI – Persons with Hearing Impairment (including

Deaf)

• PWVI – Persons with Visual Impairment (including Blind)

• HCWs – Health Care Workers• BSL – Basic Sign Language, SL – Sign Language• SLI – Sign Language Interpreting• PE – Peer Educators , PEL – Peer Educator Leaders • DEK – Deaf Empowerment Kenya• KSB – Kenya Society for the Blind• KUB – Kenya Union for the Blind

KAPCA registered NGO since 1991. Programs include:• Professional counselling and supervision

training, services and consultancies• Membership Association and conferences• Employee Assistance Programs (EAP)• HIV/AIDS prevention work – through

counselling services, training, consultancies, research, projects and contribution to policies in Kenya and ESA region. RATN MI since 1995

• PWDs counselling services, training, projects

PWDs in Kenya: Statistics for the 3 highest disabilities

KAPC has worked with all the above 3 disabilities

Total Male Female

1 Physical 337,212 169,217 167,995

2 PWVI 331,593 153,781 177,812

3 PWHI 187,816 89,842 97,974

PWDs Increased Vulnerability to HIV/AIDS because of:

• Barriers to health information and services due to restrictive cultural norms, stigma and prejudice. Also mobility problems and difficulty following audio/visual messages

• High poverty levels, low education, unemployment, low self esteem, negative attitudes by employers and the society, discrimination, risk of sexual and other abuse

• Invisibility of PWDs in many programs• Most interventions not disability friendly

UN Convention on Rights of PWDs

• Discourages viewing PWDs as ‘objects’ of charity, medical treatment and social protection and encourages viewing them as ‘subjects’ with rights, who are capable of claiming those rights and making decisions for their lives based on their free and informed consent as well as being active members of society. It reaffirms that all PWDs must enjoy all human rights and fundamental freedoms.

KAPC PWDs Projects for PWHI&VI:

Objectives• Improve/ increase HIV/AIDS awareness, HTC

and other health care services access and uptake for PWD’s - specifically PWHI and VI

• Empower PWDs to protect themselves• Greater involvement of PWDs• Advocate for PWD enjoyment of health rights• Obtain statistics regarding the number of

PWHI and VI seeking HIV/AIDS services.• Create awareness of PWDs’ needs and plight• Network with partners – All signed MOUs

Project 1: Increasing access and uptake of HTC and other health care services for PWHI by integrating HTC

for PWHI in Government Health Centres

• 1 year project done in 2 phases in 2011/12 in 4 H/centres in 3 Nairobi districts

• 10 HCWs from 4 H/Centres trained in BSL&SLI • 10 HIV/AIDS counsellors with HI from around

the 4 H/Centres trained in HTC & health topics • Then deployed in the 4 H/centres to provide

HTC services to PWHI• HTC counsellors supervised monthly by KAPC• DEK assisted in mobilising PWHI community

Project 2: Increasing HIV/AIDS awareness among PWVI through Peer Education by PWVI.

• The 6 months project began in Nov 2012 targeting PWVI around Nbi, Eld, Ksm and Msa

• 24 participants (20 PWVI PEs and 4 sighted PELs) from the 4 towns trained in Nairobi on HIV/AIDS Peer Education for PWVI using Braille

• The 24 trained PEs and PELs returned to the 4 towns to provide HIV/AIDS peer education to PWVI with support from KAPC branch offices

• KSB assisted in mobilising PWVI community

Successes: General Project 1 and 2

• Improved HIV/AIDS awareness and increased access and uptake of HTC and other health services by PWDs

• Improved communication and acceptance between persons with and without disabilities

• PWDs confidence, self esteem and CV boosted• HIV AIDS statistics for PWDs obtained• Disability-friendly services acknowledged• Networks established and partners benefited

Successes: Specific Project 1

• Increased access and uptake of HTC and other Health services by the PWHI.

• Client confidentiality enhanced• 737 persons accessed HTC services (432 in

phase 1 and 305 in phase 2)

• 25 tested HIV positive (12 in ph 1, 13 in ph 2)

• Counsellors/clients follow up at their homes

• Intervened and referred clients for better care

Successes: Specific Project 1 cont.

• PWHI empowered to seek additional services e.g. Assessments, NCPWD registration

• Capacity of PWHI in HTC/health provision built• HCWs capacity to work with PWHI built• Review of KAPC curriculum for PWHI HIV/AIDS

certificate and HTC courses• KAPC trainers and staff trained in SL• Adoption of the PWHI services by others• DEK got Global funds to train HCW in SL• Phase 2 funded after end of phase 1

Successes: Specific Project 2

• Increased access to HIV/AIDS information among PWVI in Nbi, Ksm, Msa and Eld

• Many embraced condoms and HTC services• 577 PWVI seen in the four sites by Feb 2013• 7 HIV turned positive and referred for care • PWVI PE more knowledgeable in HIV/AIDS• PWVI PEs self esteem, CV, confidence to leave

their houses and to speak in public boosted• HIV/AIDS information gap in PWVI bridged• KAPC got braille HIV/AIDS manuals from KSB

Successes: specific Project 2 cont.

• Many PWVI empowered to seek more services e.g. Braille, white cane orientation and mobility classes, scholarships and business

• Some requested Brailed bibles -KUB to provide• Some needy PWVI children referred to EARC

(Educational Assessment and Resource Centre) and school placement.

• One joined form 1 at St. Francis school, another joined Mitoto integrated primary.

Challenges: GeneralProject 1 and 2

• Inadequate referral points for HIV positive PWHI and VI

• Access to support difficult – cost implications• Communication and language barrier with

PWHI and PWVI due to illiteracy, no knowledge of Braille, SL, SLI, English, Kiswahili,

• Inadequate HIV/AIDS brailed resources for PWVI and inability to afford SLI for PWHI

• Mobility issues due to difficulty to access/ use white canes, paying guides, distance, weather

Challenges: General Project 1 and 2 cont.

• Delay in getting phase 2 funds and closure of one centre disrupted & reduced PWHI intake

• Closure of one H/Centre in Ph 2 affected PWHI clients from 4 surrounding estates

• PWVI PEs felt they need more HIV/AIDS knowledge for competence in the field

• PWVI dealing with others’ negative attitude• Dependency –having others write their report• High cost of doing PWDs training and projects• Difficulty in accessing more funds for projects

Lessons learnt: General

• Involving the PWDs in providing services for other PWDs, reduces stigma, increases acceptance and understanding – PWDs also worked with non PWDs clients.

• Integrating HTC services for PWHI in Health centres using PWHI HTC counsellors increases uptake by PWHI client and withdrawing them reduced their uptake of the health services

• PWVI able to reach other PWVI with HIV/AIDS information through Peer education

• Mobility problems hinder PWVI access/uptake

Lessons Learnt: General• Sign language and Braille are essential for

communicating with PWHI and PWVI • Training HCWs in BSL and SLI and PWHI

counsellors in HTC reduces communication barriers and improves confidentiality and privacy for PWHI patients and clients.

• Poor follow up of HIV+ PWHI–language barrier• Statistics show more females PWDs than

male• PWDs have special needs not addressed by

projects and which need budgets and funding• Avoid starting projects if sustainability unclear

Recommendations• Scale up and continuity of the projects• Accessible support groups for HIV+ PWDs• Train HCWs, other professionals, affected

parents, community members and school children in BSL and SLI and Braille

• Train and involve PWDs in HIV/AIDS work• Academic and professional training for PWDs• Disability-friendly services and opportunities • Fund disability friendly HIV/AIDS programs • Address gender issues in PWDs

Conclusion and Way Forward• The PWHI and VI projects includes, involves

and empowers PWDs to protect themselves and others from getting and suffering from HIV/AIDS and should be replicated in other countries and organisations.

• Hopefully this project will help people gain insights into and start to address the area of disabilities and HIV/AIDS in their respective countries.

• KAPC continues disseminating project findings • KAPC continues search for partners/funds

A Deaf HTC Counsellor testing a client

at one of the Health Centres.

Blind Peer Educators and Leaders during their training in KAPC