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Browsing by Author "Neema, Stella"

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Acceptability and adherence of a candidate microbicide gel among high-risk women in Africa and India
(An International Journal for Research, Intervention and Care, 2010) Greene, Elizabeth; Batona, Georges; Hallad, Jyoti; Johnson, Sethulakshmi; Neema, Stella; Tolley, Elizabeth E.
Vaginal microbicides currently under development are substances that may prevent the transmission of HIV. Qualitative, in-depth post-trial interview data from a Phase III clinical trial of 6% Cellulose Sulfate microbicide gel in two sites in Africa (Uganda and Benin) and two in India (Chennai and Bagalkot) were examined in order to better understand factors that influence microbicide acceptability and adherence in a clinical trial setting. Women found the gel relatively easy to use with partners with whom there were no expectations of fidelity, in situations where they had access to private space and at times when they were expecting to engage in sexual intercourse. Adherence to gel seemed significantly more difficult with primary partners due to decreased perceptions of risk, inconvenience or fear of partner disapproval. Findings suggest that women in a variety of settings may find a microbicide gel to be highly acceptable for its lubricant qualities and protective benefits but that adherence and consistent use may depend greatly on contextual and partner-related factors. These findings have important implications for future trial designs, predicting determinants of microbicide use and acceptability and marketing and educational efforts should a safe and efficacious microbicide be found.
Acceptability of male circumcision for prevention of HIV infection among men and women in Uganda
(AIDS care, 2011) Alberta, Lisa M.; Akol, Angela; L’Engle, Kelly; Tolley, Elizabeth E.; Ramirez, Catalina B.; Opio, Alex; Tumwesigye, Nazarius M.; Thomsen, Sarah; Neema, Stella; Baine, Sebastian O.
In the last decade, three randomized controlled trials in Kenya, South Africa, and Uganda have shown that medical male circumcision (MMC) reduces the sexual transmission of HIV from women to men. Objectives of this assessment were to measure acceptability of adult MMC and circumcision of children to inform policies regarding whether and how to promote MMC as an HIV prevention strategy. This mixed-method study, conducted across four Ugandan districts, included a two-stage household survey of 833 adult males and 842 adult females, focus group discussions, and a health provider survey. Respondents’ acceptability of MMC was positive and substantial after being informed about the results of recent randomized trials. In uncircumcised men, between 40% and 62% across the districts would consider getting circumcised. Across the four districts between 60% and 86% of fathers and 49% and 95% of mothers were supportive of MMC for sons. Widespread support exists among men and women in this study for promoting MMC as part of Uganda’s current ‘ABC ’ HIV prevention strategy.
Adolescent Sexual and Reproductive Health in Uganda: A Synthesis of Research Evidence
(New York: Alan Guttmacher Institute., 2004) Neema, Stella; Musisi, Nakanyike; Kibombo, Richard
In Sub-Saharan Africa, the majority of new HIV infections are sexually transmitted and among the population infected with AIDS, women outnumber men.Limited access to education and to economic resources characterizes the lives not only of women but also of young people of both sexes. Young people’s limited access to resources gravely undermines their health and healthcare–seeking behavior. Most young people are aware of the dangers of HIV/AIDS but continue to be involved in sexual behaviors that place them at high risk of contracting the disease.2 There is also a growing body of evidence confirming that in many countries, most young people do not routinely seek appropriate sexual and reproductive health information and care. The overburdened and under-financed public health and education systems that are in place are often unable or reluctant to provide such services—let alone high-quality services—to young people.
Adolescent Sexual and Reproductive Health in Uganda: Results from the 2004 National Survey of Adolescents
(Alan Guttmacher Institute., 2006) Neema, Stella; Ahmed, Fatima H.; Kibombo, Richard; Bankole, Akinrinola
Adolescents in Sub-Saharan Africa face many hurdles,including balancing the expectations of the traditional,often conservative, norms against the increasing exposure, through the mass media, to modern ideals. The sexual and reproductive health of adolescents is one area in which this struggle is often apparent, and many young people engage in sexual activities with little or no knowledge about how to protect themselves against the risks of infection and unwanted pregnancy. An estimated 6.9 percent of women and 2.2 percent of men aged 15–24 in the region were living with HIV at the end of 2004. Furthermore, about one in 10 young women have had a premarital birth by age 20. In Uganda, evidence from the AIDS Information Centre shows that, among 15–24-year-olds who were first-time testers, HIV seroprevalence was 3% among men and 10% among women in 2002. Furthermore, in 2000–2001, 39% of recent births to Ugandan adolescents were either mistimed or unwanted.
Adults’ Perceptions of Adolescents’ Sexual and Reproductive Health: Qualitative Evidence from Uganda
(New York: Guttmacher Institute, 2008) Kibombo, Richard; Neema, Stella; Moore, Ann M.; Ahmed, F. Humera
Over the past 15 years, adolescent sexual and reproductive health (SRH) has increasingly received special attention in many African countries mainly due to the HIV/AIDS pandemic that has swept across the continent with devastating impact, particularly among young people (15–24 years old) who account for about half of all new HIV infections. However, adolescents frequently do not have access to appropriate sexual and reproductive health services due to a host of factors ranging from dysfunctional health care systems to stigma regarding seeking reproductive health care. While research has been done on adolescents’health-seeking behaviors, little is known about the attitudes and perceptions of adults who play a key role in adolescents’ lives, adolescents’ sexual behavior and access to reproductive health services. It is for this reason that the Guttmacher Institute, in collaboration with the Makerere Institute of Social Research, conducted 60 indepth interviews with parents, community leaders, teachers and health workers in one urban and one rural setting in Uganda to learn about their perceptions, attitudes and experiences of adolescents’ sexual and reproductive health issues.
Caregivers’ Experiences With Major Depression Concealed by Physical Illness in Patients Recruited From Central Ugandan Primary Health Care Centers
(Qualitative Health Research, 2008) Muhwezi, Wilson Winstons; Okello, Elialilia Sarikiaeli; Neema, Stella; Seggane, Musisi
In this article, we present caregivers’ grapples with major depression seen among their physically ill patients. A thematic analysis of 29 in-depth caregiver interviews identified four themes: (a) caregivers’ perceptions of depression, (b) barriers to caregivers’ focus on depression, (c) resources and opportunities for managing depression, and (d) caregivers’ perspectives on consequences of depression. Patients’ physical illnesses concealed depressive episodes. Caregivers could not apply the label of “depression” but enumerated its indicative features. Stigmatization of depression, common with other mental illnesses and poverty, undermined caregiving. Vital caregiving resources included caregivers’ willingness to meet patients’ basic needs, facilitating patients’ access to health care, informal counseling of patients, and ensuring patients’ spiritual nourishment. Caregivers’ management of depression in physically ill patients was expensive, but they coped; however, caregiving was burdensome. Ongoing support should be given not only to patients but caregivers, as well. To provide appropriate care, caregivers deserve sensitization about depression in the context of physical illness.
Closing the Gap between People and Programs: Lessons from Implementation of Social Accountability for Family Planning and Reproductive Health in Uganda
(African journal of reproductive health, 2018) Boydell, Vicky; Neema, Stella; Wright, Kelsey; Hardee, Karen
Globally, women‘s access to modern contraception can be attributed to poor service conditions and care. Growing evidence from across the health sector has found that social accountability approaches have the potential to improve the quality of care and therefore the utilization of health services, little of this evidence relates to family planning and reproductive health programs. This paper therefore assessed the results of retrospective implementation research into a five-year social accountability project in Uganda that focused on family planning and reproductive health. A mix of methods was used examine the project‘s implementation in three districts in Uganda between 2009 to 2013, including political economy analysis, document review, and in-depth interviews. Interviews were coded using ATLAS.ti software and analyzed with a thematic framework, organized by stakeholder groups and across districts. The research found that while the project broadly delivered as intended in local accounts, a wider range of activities and outcomes also occurred. Community participants in the three districts were much more likely to remember more personal changes, such as increased confidence when interacting with health care providers, in their health seeking behavior or in their ability to represent themselves. The research revealed a web of accountability relationships at play. These ranged from formal opportunities for community participation in institutional processes, to the more personal direct relationship between the service users and the health care provider compared to the less direct relationship between the community and local officials. In addition, ways in which elements of social accountability can be combined with features of FP program were seen, such as including outreach activities with civic and rights education. This appears to extend the reach and credibility of these services among community members while also counteracting barriers to women‘s and young people‘s participation.
Condom use within marriage: an assessment of changes in South Africa and Uganda
(Psychological and Socio-medical Aspects of AIDS/ HIV, 2012) Maharaj, Pranitha; Neema, Stella; Cleland, John; Busza, Joanna; Shah, Iqbal
The aim ofthe study is to measure trends in condom use in marital and cohabiting relationships in South Africa and Uganda. The data for the study come from two cross sectional surveys conducted in 1998 and 2008 among adult men and women and their partners in KwaZulu-Natal, South Africa and the Jinja district, Uganda. The findings suggest that consistent condom use has risen substantially in both countries. The percentage reporting consistent condom use in the South African sample of husbands increased from 2.5% in 1998 to 12% in 2008 and from 5.5 to 12.5% among wives. In Uganda, the corresponding trends are 1.1 8.3% for husbands and 4 8.6% for wives. In both countries, condom use was considerably higher among the minority of couples where one or both partners were thought to be HIV positive. Increasingly, in both countries condoms are also used for contraceptive purposes. Condoms play a role in preventing HIV infection but the challenge is for prevention programs to broaden their focus toward meeting the needs of married and cohabiting couples.
Conducting Successful Focus Groups and Analysis: Experience from a Pilot Study on Family Planning and Sexual Behaviour in the Era of HIV/AIDS and STDs
(African Journal of Reproductive Health, 1998) Neema, Stella
The pilot was a qualitative study using four focus group discussions (FGD's). It was undertaken district among sexually active men and female contraceptive users and non-users. The pilot focus discussions were conducted to test FGD guidelines developed to collect contextual and attitudinal family planning and issues related to sexual health in the community. A further aim of the pilot to develop a coding schedule for the analysis of focus groups discussions and to formulate tips ducting and analyzing successful FGDs and their analysis to ass
The dilemma of safe sex and having children: challenges facing HIV sero-discordant couples in Uganda
(African health sciences, 2009) Beyeza-Kashesya, Jolly; Kaharuza, Frank; Mirembe, Florence; Neema, Stella; Ekstrom, Anna Mia; Kulane, Asli
Sixty percent of new HIV infections in Uganda occur in stable relationships between HIV discordant couples. Given the importance of fertility in Uganda, we hypothesized that unsafe sexual practices may be used to found a family/replace a dead child. Thus, we explored sexual practices to understand to what extent these are influenced by the desire to have children and the implications for HIV transmission among discordant couples. Methods: A cross-sectional survey of 114 HIV discordant couples in Kampala, and in-depth interviews with 15 purposively selected couples. Quantitative data were analyzed using STATA. Multivariate logistic regression analysis done to identify factors associated with consistent condom use. Thematic content analysis of qualitative data was done using NVIVO 2.
Explanatory Models and Help-Seeking Behavior: Pathways to Psychiatric Care Among Patients Admitted for Depression in Mulago Hospital, Kampala, Uganda
(Qualitative health research, 2007) Okello, Elialilia S.; Neema, Stella
In this article, the authors present findings from a qualitative study exploring how people diagnosed with depression conceptualize their condition and how their conceptualization shaped their efforts to seek help. They used an interview guide based on an explanatory model framework for data collection. Four major themes emerged from the analysis: (a) somatization, social meaning of illness, and help seeking; (b) meaning and perceived consequences of illness; (c) How did I get here? Making sense of psychiatric admission; and (d) variations in the causal attribution and the role of significant others in help seeking. Somatization of emotional problems, variations in causal attribution between patients and their significant others, the nature of the available health care system, and burden of infectious disease complicate access to care. These findings suggest the need to raise the awareness of primary care providers on how to recognize and help people with depression appropriately in this setting.
Focus group discussions on social cultural factors impacting on HIV/AIDS in Uganda.
(Makerere Institute of Social Research., 2003) Asiimwe, Delius; Kibombo, Richard; Neema, Stella
Uganda is one of the countries in Sub-Saharan Africa worst hit by HIV/AIDS, but at the same time among the few nations that have successfully stemmed the escalation of the epidemic. HIV prevalence among the adult sexually active population is estimated to have dropped from 18% in 1992 to 5% in 2001. Consequently Uganda is internationally considered a leader in responding to HIV/AIDS and many countries are keen to learn the approaches that have been used and where possible replicate them. The early political commitment spearheaded by President Museveni provided ground for mobilizing communities against HIV/AIDS, harnessing donor support and the efforts of government and civil society. These, together with the multi-sectoral approach, are some of the factors commonly cited to be behind Uganda’s success. However, it is noted that these same approaches have been applied by some other countries in Africa, but have not resulted into similar success as seen in Uganda. It is therefore believed that only country and context specific factors such as cultural norms and social patterns of people and communities could have played significant roles in Uganda’s success.
Gender Dimensions, Food Security, and HIV and AIDS in Internally Displaced People’s (IDPs) Camps in Uganda: Implications for HIV-Responsive Policy and Programming
(Social Work and Social Administration, 2008) Bukuluki, Paul; Mugumya, Firminus; Neema, Stella; Awich Ochen, Eric
This study set out to investigate in specific terms how gender relations influence the interaction between food insecurity and HIV/AIDS in two armed conflict-affected districts, Gulu, in northern Uganda and Katakwi. The study largely embraced qualitative and ethnographic approaches of investigation supplemented by quantitative approaches. An exploratory and descriptive study design largely applying an ethnographic approach was employed. This facilitated the research team to gain a clear understanding of the local meanings and contextual issues that influence interactions between gender, food insecurity, and risky sexual behavior in situations of internal displacement. Quantitative variables were also generated from the ethnographic phase of the study. The ethnographic phase helped to clarify the key variables and indicators, such as the extent of food insecurity, risky sexual behavior, perceived and actual risk to HIV infection, that were followed up and measured using quantitative research instruments. Since the whole philosophy underlying this research is to improve policy and programming, the approach employed was a collaborative one that involved deliberate consultation with relevant government departments as well as local and international agencies involved in activities related to food security and HIV/AIDS in internally displaced peoples (IDPs) camps.
The impact of health policies and health sector reform on the readiness of health systems to respond to women’s health needs, with special focus on reproductive health, reproductive rights and HIV/AIDS
(United Nations Division for the Advancement of Women (DAW) Expert Group Meeting, 2005) Neema, Stella
This paper examines how health policies and health reforms that have been implemented have impacted on the health and well-being of women, with emphasis on reproductive health, rights and HIV/AIDS. It tries to consider how health policies and reforms have tried to improve health systems to respond to health needs of women. Women’s health has been the focus of both international and national state policies. However, many current health policies have tended to regard sexual and reproductive health and rights of women as insignificant. Further health sector reforms that have been implemented by many countries have tended to focus on their implications for the poor, with a few policy makers explicitly taking gender issues into consideration. What needs to be understood is whether the health sector reforms are reducing gender inequality. Some evidence suggests that reforms can produce negative impacts on maternal health service provision and use as changes can strain working relationships or overload health workers (MacIntyre and Klugman, 2003). Yet in other settings, indicators such as maternal mortality rates, decreased as a result of the reforms (Parkhurst et al, 2004). It has been observed that Health sector reforms are complex processes affecting the local systems in which individuals work – shifting incentive structures, regulatory mechanisms, and paths of accountability. They can also change the macro environment of health systems, reorganizing staff numbers and placements, and creating new structures and hierarchies within the health sector (Parkhurst et al 2004).
Is the glass half full or half empty? A qualitative exploration on treatment practices and perceived barriers to biomedical care for patients with nodding syndrome in post-conflict northern Uganda
(BMC Research Notes, 2015) Mwaka, Amos Deogratius; Okello, Elialilia S.; Abbo, Catherine; Odwong, Francis Okot; Olango, Willy; Etolu, John Wilson; Oriyabuzu, Rachel; Lagoro, David Kitara; Mutamba, Byamah Brian; Idro, Richard; Opar, Bernard Toliva; Aceng, Jane Ruth; Lukwago, Assuman; Neema, Stella
Nodding syndrome has increasingly become an issue of public health concern internationally. The etiology of the disorder is still unknown and there are yet no curative treatments. We explored perceptions about treatment practices and barriers to health seeking for nodding syndrome in Pader and Kitgum districts in northern Uganda in order to provide data necessary for informing policy on treatment adherence and rehabilitations.We used focus group discussions and individual interviews to gain deep insights into help-seeking and treatment practices for nodding syndrome. Purposive sampling was used to identify information-rich participants that included village health teams, community members not directly affected with nodding syndrome, district leaders, healthcare professionals, and caregivers of children affected with nodding syndrome. We used qualitative content analysis to analyze data and presented findings under distinct categories and themes.Caregivers and communities sought care from multiple sources including biomedical facilities, traditional healers, traditional rituals from shrines, and spiritual healing. Nodding syndrome affected children reportedly have showed no enduring improvement with traditional medicines, traditional rituals, and prayers. A substantial minority of participants reported minimal improvements in symptoms of convulsions with use of western medicines. Challenges involved in health seeking included; (1) health system factors e.g. long distances to facilities, frequent unavailability of medicines, few healthcare providers, and long waiting times; (2) contextual and societal challenges e.g. lack of money for transport and medical bills, overburdening nature of the illness that does not allow time for other activities, and practical difficulties involved in transporting the physically deformed and mentally retarded children to the health facilities.Help-seeking for nodding syndrome is pluralistic and include use of traditional and biomedical practices. Western medicines admittedly showed at least short term control on nodding syndrome symptoms, especially convulsions and led in a few cases to regain of functional abilities. However, multiple barriers hinder health seeking and interfere with adherence to biomedical treatments. Regarding cure, there are hitherto no treatments participants perceive cure nodding syndrome.
Life events and depression in the context of the changing African family The case of Uganda
(World Cultural Psychiatry Research Review, 2007) Muhwezi, Wilson Winstons; Ågren, Hans; Neema, Stella; Musisi, Seggane; Koma, Albert; Koma Maganda, Albert
Traditionally, the African extended family gave psychosocial support to all members, which cushioned any illness effects including depression. Recent changes in the African family, notably urbanization and market economies, have changed that structure. Changes, especially roles of the family and its relationship to life events and depression, have not received much research attention. Aim: To compare depressed and non-depressed patients in terms of their demographics, family structure, life events and depression. Methods: We compared quantitative data from 85 DSM-IV depressed patients that sought care at three Primary Health Care (PHC) centres with 170 unmatched non-depressed patients. To each group, we administered three questionnaires covering socio-demographics, family structure and an adapted Interview For Recent Life Events (IRLE). Results: Of the depressed patients, over 70% were females giving a M:F ratio of 2.3:1; 71.8% were aged < 39 years and 50.6% were married; the single were 14.1% and 73.9% belonged to male-headed households. Depressed patients significantly differed from the non-depressed in having less post-primary education (p=0.02), fewer singles (0.04), fewer had regular incomes (p=0.01), more were single parents (p=0.02) and separated (p=0.01). Family structure in the two groups never significantly differed. For life events, depressed patients had more deaths of close family members and poor harvests (p=0.003), deaths of children and funeral rites (p=0.014) and sexual health problems (p=0.002). Positive exciting events were more common among non-depressed patients from extended families (p=0.047) while saddening and bereavement events were more common among depressed patients from extended families. Sexual problems were more common among depressed patients and from nuclear families (p= 0.001 & 0.006 respectively). Being a regular income earner was protective against depression [OR=0.45 (95% CI: 0.23-0.85)]. Conclusion: Depressed patients were often single, separated and had children signifying family break ups. They had less income, lower education and had experienced more negative life events, highlighting the weakened family ties in times of modern adversities. This calls for training of more mental health workers and informal helpers for vigorous family therapy interventions in modern Africa, in the face of the weakening extended family.
Life Events Associated With Major Depression in Ugandan Primary Healthcare (PHC) Patients: Issues of Cultural Specificity
(International Journal of Social Psychiatry, 2008) Muhwezi, Wilson Winstons; Ågren, Hans; Neema, Stella; Koma Maganda, Albert; Musisi, Seggane
The study compared life events experienced by depressed patients seen at primary healthcare (PHC) centres with those among healthy community controls. Method: Data was collected from 74 depressed patients and 64 unmatched controls from village locales of patients. Interview instruments included the depression module of the Mini International Neuropsychiatric Interview (MINI) and Interview for Recent Life Events (IRLE). Associations between type of respondent and demographic variables were examined. Statistical comparisons were done for the two groups on other variables. Results: Most depressed patients were single by marital status, lacked formal employment and had less post-primary education. They had experienced more life events; job changes, discomforting working hours, unfavourable working conditions, and job losses; personal health problems; loss of valuables; difficulties with intimate partners and family members’ marital problems. Independent life events were more among depressed patients and clustered around work, health, bereavement and marriage. Most events reported by depressed patients had high negative impact ratings compared to controls. Conclusion: Compared to healthy community controls, depressed patients reported more undesirable life events. The relationship between life events and depression implies that in PHC settings of poor countries, deploying mental health-oriented workers to manage life events may lessen escalation of distress.
Listening to health workers: lessons from Eastern Uganda for strengthening the programme for the prevention of mother-to-child transmission of HIV
(BMC Health Services Research, 2012) Rujumba, Joseph; Tumwine, James K.; Tylleskär, Thorkild; Neema, Stella; Heggenhougen, Harald K.
The implementation and utilization of programmes for the prevention of mother-to-child transmission (PMTCT) of HIV in most low income countries has been described as sub-optimal. As planners and service providers, the views of health workers are important in generating priorities to improve the effectiveness of the PMTCT programme in Uganda. We explored the lessons learnt by health workers involved in the provision of PMTCT services in eastern Uganda to better understand what more needs to be done to strengthen the PMTCT programme. Methods: A qualitative study was conducted at Mbale Regional Referral Hospital, The AIDS Support Organisation (TASO) Mbale and at eight neighbouring health centres in eastern Uganda, between January and May 2010. Data were collected through 24 individual interviews with the health workers involved in the PMTCT programme and four key informants (2 district officials and 2 officials from TASO). Data were analyzed using the content thematic approach. Study themes and sub-themes were identified following multiple reading of interview transcripts. Relevant quotations have been used in the presentation of study findings. Results: The key lessons for programme improvement were: ensuring constant availability of critical PMTCT supplies, such as HIV testing kits, antiretroviral drugs (ARVs) for mothers and their babies, regular in-service training of health workers to keep them abreast with the rapidly changing knowledge and guidelines for PMTCT, ensuring that lower level health centres provide maternity services and ARVs for women in the PMTCT programme and provision of adequate facilities for effective follow-up and support for mothers. Conclusions: The voices of health workers in this study revealed that it is imperative for government, civil society organizations and donors that the PMTCT programme addresses the challenges of shortage of critical PMTCT supplies, continuous health worker training and follow-up and support for mothers as urgent needs to strengthen the PMTCT programme.
Maternal Health Review Uganda
(Makerere University Institute of Public Health, 2003) Ssengooba, Freddie; Neema, Stella; Mbonye, Anthony; Sentubwe, Olive; Onama, Virgil
Uganda has a high maternal mortality ratio, typical of many countries in sub-Saharan Africa, with an estimated 505 maternal deaths per 100.000 live births. While several measures to combat the poor reproductive health performance have been put in place by the government, Maternal and Child Health programs have in the past focused more attention on child-care programs with a particularly strong emphasis on immunization. A number of studies have been undertaken in Uganda to understand the dimensions of maternal health performance and the broader reproductive rights and health issues. In many cases the available literature has been fragmented with little effort to bring it together for policy and health systems learning. The Demographic Health Surveys of 1988-1989, 1995 and 2000-2001 [1,2,3] have been a major source of information on maternal and reproductive health. The Safe Motherhood Needs Assessment of 1995/6, which was conducted in 14 districts, and is the largest recent survey of institutional capacity to deliver maternal services, provides another source of baseline information on maternal health. Several small studies have been undertaken that have important bearings on maternal health and reproductive health in general.
Meaningful involvement of people living with HIV/AIDS in Uganda through linkages between network groups and health facilities: An evaluation study
(Psychology, health & medicine, 2012) Kim, Young Mi; Kalibala, Samuel; Neema, Stella; Lukwago, John; Weiss, Deborah C.
While community-based groups are able to provide vital support to people living with HIV/AIDS (PLHIV), their organizational and technical capacities are limited, and they frequently operate in isolation from PLHIV groups. We evaluated a threeyear project implemented by the International HIV/AIDS Alliance in Uganda to increase the involvement of PLHIV in the HIV/AIDS response and to improve access to and utilization of prevention, treatment, care, and support services for households affected by HIV/AIDS. Information sources included project monitoring data, interviews with 113 key informants, and 17 focus group discussions in 11 districts. The evaluation found that PLHIV groups reached large numbers of people with education and awareness activities and made a growing number of referrals to health facilities and community-based services. The project trained individuals living openly with HIV as service providers in the community and at designated health facilities. Their presence helped to reduce the stigma that previously deterred PLHIV from seeking care and encouraged individuals to disclose their HIV status to spouses and family members. The project has put into practice the widely endorsed principles of greater and meaningful involvement of PLHIV in a systematic manner and on a large scale. A wide audience – ranging from grassroots PLHIV networks and AIDS service organizations to national-level non-governmental organizations, government agencies, and international organizations – can benefit from the lessons learned.

Browsing by Author "Neema, Stella"

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