Prevention, Care and Support
A place for NAMWEZA in Africa
The first version of NAMWEZA was developed in Uganda by a group of health professionals who had observed the success of “STEPPING STONES” as a training package on gender, HIV, communication and relationship skills. (This programme was developed by Alice Welbourn, herself living with HIV, as a response to her own diagnosis in 1992.) The NAMWEZA team sought to build on this to develop a different and much shorter package that could be used as a public health intervention to help support people living with HIV. They sought ways to support people living with HIV to feel more empowered to be part of the ‘solution’ rather than being considered as the major public health ‘problem’ – the perspective with which most view them. The creators of NAMWEZA avoided all use of negative messages and instead employed the affirming techniques of Appreciative Inquiry to help build self-esteem and self-awareness.
In Tanzania NAMWEZA is being rolled out by people affected by HIV, whether they test positive or not. There are about 30 million people living with HIV in Africa at this time and many of them are disempowered and stigmatized by society. They often present to health services late and are often sick and have often also lost their jobs. These people are caught in a downward economic spiral; they are often very poor, living on less than a dollar a day, being looked after by their relatives and unable to afford school fees for their dependents.
Fortunately this abysmal downward spiral scenario is no longer necessary. Highly effective antiretroviral medicines (ARVs) are available throughout Africa and those living with HIV can contemplate an ideal situation where they can live in good health. The cycle of ill-health, poverty and stigma needs to be abolished. Those living with the virus could and should have an opportunity to change the views of their social networks and through them eventually the views of communities and of society in general.
NAMWEZA seeks to build the skills of people living with HIV so that they can be the ‘change agents’ for “positive health dignity and prevention”, for their families, friends and their communities. People living with HIV are the ones who are best placed to lead the way in supporting others to understand what HIV is and what it isn’t. People living with HIV can also support others to learn how to stay HIV-free. Behaviour change is not easy but preventative behaviour could make a big difference, and could reduce the pandemic transmission of HIV.
There are several interventions to reduce HIV transmission but prevention of HIV transmission is not easy. ABC standing for Abstinence, Being faithful to one partner and regular use of Condoms, has been promoted as a cornerstone of prevention in many places. However, it is rarely recognized how gender-insensitive this can be, since many women are unable to have the choice of following any of these options. Many have little choice over whether or not they can use a condom when having sex – or even whether or not they can decide who to have sex with and when. Reducing sexually transmitted infections (STI) is an important principle, including early treatment of STIs. Male circumcision has been shown to reduce transmission in males. However, to date there has been minimal follow-up of many young men who have been circumcised, who may now think that they are wearing a permanent condom. This puts both themselves and their sexual partners at risk of contracting or transmitting HIV and other STIs. Use of vaginal microbicides may provide an option for women in future but the research is yet to be translated into availability. Most useful of all is the treatment of HIV with ARVs, such that the viral load is reduced so that the individual does not transmit (or acquire) the virus. While all these approaches are important and additive, they are expensive, are not without potential drawbacks and may not be available to everyone at crucial times.
NAMWEZA provides another dimension to this spectrum of interventions. Moreover, NAMWEZA supports people living with HIV to feel empowered, as they interact with their social networks, including their sexual partners, family and friends.
In Tanzania a research project is being conducted to evaluate NAMWEZA in the training of Agents of Change for Prevention of HIV transmission.