Reducing Stigma and Raising Awareness: The APHIA II Nairobi/Central Advocates

This 4-page brief, published by Pathfinder International, shares the experience of the AIDS, Population and Health Integrated Assistance Nairobi and Central Project (APHIA II NC) of using community-based advocates to reduce stigma and raise awareness related to HIV/AIDS. Led by Pathfinder International, APHIA II NC brings together the Christian Children’s Fund (CCF), Malteser International, the Network of AIDS Researchers in East and Southern Africa (NARESA), and Population Services International (PSI) to implement an integrated programme of assistance to government, private, non-governmental, and faith-based partners in Nairobi and Central Provinces. According to this brief, the advocates programme reduces stigma, encourages prevention, and increases knowledge and service uptake, partly because of the programme's links with other support services.

According to the brief, though much effort has been made in recent years to educate the public about HIV, stigma, and misconceptions remain prevalent. Advocates are people living with HIV (PLWH) whom APHIA II NC supports and trains to lead discussions in schools, health facilities, workplaces, markets, prisons, and at community gatherings. Organisers say that their personal testimonies about living with HIV and their solid understanding of the facts of HIV prevention and care are a powerful combination in fighting ignorance and misunderstanding about the disease. The advocates' wide range of ages and participation by both sexes allows them to reach a wide audience.

During a week-long training, the advocates learn about: HIV prevention, care, and support; tuberculosis (TB); sexually transmitted infections (STIs); family planning; gender-based violence; and communication. APHIA II NC advocates also receive training as paralegals to help them understand the rights of PLWH and orphans and vulnerable children and to learn how to use the legal system to seek redress when these rights are violated.

According to the project, many programmes and organisations train PLWH as advocates, but APHIA II NC is different because of the link between advocates and varied services supported by the APHIA II NC programme - from clinical services to community-based care and support activities. Because APHIA II NC advocates can offer referrals for care, support for orphans and vulnerable children, and support groups, they have more credibility with their audiences than if they only offered education and encouragement to test. According to the report, the advocates’ credibility is also enhanced by their open disclosure of their HIV status. This also helps dispel the fear surrounding HIV and, in turn, the attached stigmas, as community members see that it is possible to live positively.

To reach members of the community who are not reached through the advocates’ sessions, the advocates team up with drama groups who act out informational skits. The drama groups have been trained by APHIA II NC to incorporate key messages about HIV and AIDS, TB, STIs, stigma, and other health topics into their plays. The skits are often funny or dramatic to engage the audience.

The report says that through workplace sensitisations alone, the APHIA II NC advocates reached 75,045 people between February 2007 and June 2008. And though the advocates all agree that their work can be trying at times, they feel they have been well prepared and supported. They say that the initial training they receive gives them the courage to do their work, and refresher trainings and bimonthly meetings with the APHIA II NC coordinators provide a chance for them to discuss problems and offer each other solutions. At the meetings, they hand in their reports and discuss questions that they have been asked during their sessions that they didn’t know how to answer. They use the time to discuss their challenges but also share stories about the impact they make. These counselling sessions, combined with ongoing mentoring from the APHIA II NC staff, are designed to help keep the advocates motivated.