Nairobi, Kenya—Mary Mugambi, 40, describes working with HIV-positive patients as a calling. “It can’t be about the money,” Mary says. “You need a lot of compassion because everyday you are listening to people and their problems, and, on really bad days, you lose your clients. These are people you have come to know and call friends.” Mary is the District AIDS Coordinator for Nairobi County, and was trained by Jhpiego on HIV care, treatment and prevention. She has been working with HIV-positive patients for the last eight years after losing a close relative to the illness.
Denial: The HIV Tragedy
Mary’s passion is Prevention with Positives (PWP) program. She says that the tragedy of HIV is denial, and she observes that despite all the funding dedicated to HIV prevention and treatment, without disclosure and acceptance, the epidemic will live on. “There is still so much stigma associated with HIV,” Mary says. “An HIV-positive diagnosis robs you of your sexuality and your life. You are a slave to medication forever, so acceptance does not come easy for most people.” Working within the central business district has been a great challenge for Mary. This area is where most-at-risk populations (MARPs) reside. MARPs is a classification for groups of people disproportionately at higher risk for acquiring or transmitting HIV, including commercial sex workers, men who have sex with men, injecting drug users, truckers and prisoners. In 2007, Jhpiego-Kenya introduced the PWP program, focusing on increasing access to HIV care and treatment services for vulnerable populations by decreasing barriers to such services and introducing innovative, effective approaches to HIV prevention among MARPs.
- Mary’s Take-Away Messages for Health Professionals Working with HIV-Positive Patients
- It’s not about the money—it’s a calling. You get great satisfaction from knowing that you have made a difference in someone’s life.
- HIV goes beyond medicine—it’s a social problem. So, you have to be willing to listen and be compassionate to your patients.
- There is a lot of burnout, so learn to debrief. Every two weeks, take time to speak to a counselor about the things that have put you down.
- HIV is real—stay safe. As a health professional, get tested regularly.
In the Nairobi central business district, there are more than 10,000 sex workers attending to between 2 and 10 clients per day. This puts them at very high risk for contracting and spreading the HIV virus. Compounded by poverty, stigma and poor access to health care, many at-risk individuals suffer in silence. Mary says that the greatest barrier for MARPs is negative provider attitudes. She recounts the case of “Robert,” a man who has sex with men, who was humiliated when trying to seek treatment in a health facility. “He was displayed as an exhibition piece while nurses discussed his problem without any discretion,” Mary says. She notes great improvement, however, from health providers who have received attitude training. “Most health professionals were unable to separate their beliefs from their professional practice,” Mary says. “It was commonplace to find a nurse preaching repentance to a commercial sex worker; however, with training, things are changing.”
Finding Strength in Each Other
Other than training health care providers, Jhpiego has also trained 60 HIV-positive sex workers on the PWP package. The package provides HIV-positive people with information on how they can protect their own health and that of their partners and children.Because of poverty, many commercial sex workers have difficulty resisting the demands of clients for “skin-to-skin” intercourse without a condom, which pays significantly more. To respond to this problem, Mary is working with the trained commercial sex workers to educate others on how to best live positively. “It’s like using a thief to catch a thief,” Mary says. To date, almost 1,000 commercial sex workers have been trained in the PWP package.
Mary says that the PWP program for MARPs provides a crucial link in care and treatment for HIV because it facilitates the natural connections that exist among MARPs. The groups facilitate counseling, improve retention with treatment and provide psychosocial support to others living with HIV. Looking back, Mary is hopeful about the future. “Of course, we still have a long way to go, but we are getting somewhere,” she says.