Erin: Peer Educators

ICAP has multiple projects underway at over 230 sites throughout Tanzania. While ICAPs main goal is to promote diagnosis and treatment of HIV/AIDS by providing infrastructure and training to healthcare facilities, one of the most interesting programs to me is the peer educator program. Peer educators are HIV+ patients from the HIV care and treatment centers (CTCs) who are trained to be model patients and provide support to patients and health staff alike. They are vital in encouraging adherence to clinical treatment and to reducing the stigma that HIV positive patients face within their families and communities.

Peer educators work on a voluntary basis, but are provided benefits or incentives by ICAP for their hard work, including bicycles, umbrellas, income generating items like sewing machines, and are introduced to ward and district leadership. Their work is intensive and varied. Every clinic day two peer educators design an educational talk on nutrition, care for the HIV patient, or adherence to anti-retroviral therapy, which is presented in the morning to patients and family in the waiting room of the CTC. Afterward they are available for individual counseling sessions with patients per request. They assist the function of the CTC by filing charts and tracking down patients who have been lost to follow-up. They also play an important role in encouraging patients to disclose their status to family or trusted individuals so that they can build a support network to help them deal with their illness, and encourage attendance at village support groups for people living with HIV.

Steen and I were first introduced to some peer educators at the Rubya District Hospital. Two women, Maria and Aurora, spoke with us at length about their own experiences with HIV and ART, and about the stigma that many HIV/AIDS patients experience. Both women had been diagnosed after their husbands passed away. Aurora was tested in the mid-90s and Maria was tested and diagnosed in 2004 after presenting with AIDS, and they were started on ARVs in 2006 and 2004. Maria said she had decided to become a peer educator after health workers talked to her about disclosure of her HIV status. She wanted to disclose her status to all and help to reduce stigma surrounding the disease. Aurora had similar sentiments. After her husband died, she herself had experienced significant stigma; her husband’s father and other family members had come to her demanding their share of her property because they said she would soon die of HIV as well. Thirteen years later, her father-in-law now denies that his son could have had HIV given how healthy she still appears. Fortunately, such attitudes are starting to change, and HIV positive people are less often separated at restaurants or refused rides by taxis or bicyclists, although discrimination at the workplace still occurs.

The women agreed that the hardest part of their job was tracking down those who missed their appointments. Many patients who were unwilling to deal with their diagnosis would put claim a fake address, or travel long distances to a further CTC so that family and friends wouldn’t find out their status. Some patients were afraid of having peer educators to their houses without their neighbors drawing certain conclusions, and so the peer educators would have to befriend them or find other excuses to go visit.

The women we met struck me as being very intelligent and extremely dedicated to their cause. They spoke emphatically about the problems that HIV+ patients had to deal with on a regular basis, and were adamant that the support groups and peer educator programs had been vital in reducing stigma and mitigating some of these daily struggles of people living with HIV. In addition, the CTCs would have much more difficulty operating if they did not share the administrative tasks and provide a friendly, approachable face to the sterile health centers.