A Motivated HIV Counselor Never Gives up on Her Clients
While civil society organizations in Angola have improved their ability to reach key populations (KPs) through the cascade of HIV prevention and testing services, they faced challenges linking those who test positive to care and treatment. The rate of initiation of antiretroviral treatment (ART) in the first seven months of the LINKAGES Project was only 19 percent (11/53).
To improve this rate, LINKAGES began investing in strategies to strengthen the bond between HIV counselors and clients. Partnering with Cuidados da Infância (CI) proved to be beneficial to the program due to its exemplary ability to build trust within the sex worker community.
In April 2018, during a visit to a hot spot in Viana Municipality, CI HIV counselor Indira tested Liliana*, a 27-year-old sex worker, for HIV. Her test was positive and so, as usual, after receiving counseling Liliana was directed to a health facility more convenient to her home to begin ART the next day. However, Liliana did not show up and no longer answered her phone. Indira returned to the hot spot but did not find her.
More than a month later, Indira ran into Liliana by chance in a supermarket in Viana. She spoke with her for a half hour and discovered that Liliana actually had another name and address. Indira accompanied her to her home and then they went to a nearby health facility so Liliana could begin ART.
Between May 2016 and August 2019, nine CI counselors tested 20,237 key population clients and successfully linked 85 percent of the total patients who tested positive for HIV (739 of 868 individuals) to ART. This was a dramatic increase over the rate of 19 percent at the beginning of the project and demonstrates the success of committed counselors.
Some of the strategies to improve the bond between HIV counselors and clients that LINKAGES and CI implemented were:
- Expanding the package of services beyond HIV prevention and testing to include screening and treating common sexually transmitted infections such as chlamydia and gonorrhea, as well as awareness-raising about key population rights under Angolan law, especially in situations of gender-based violence. CI teams found that by introducing these services, KP clients were more likely to open up about their risk for HIV and trust the LINKAGES program.
- Spending time to build a relationship with hot spot owners who are often the gatekeepers at the hot spot. Educating them about the importance of the HIV-related services they were bringing, facilitated in turn the access that CI teams could have to KP clients, especially when they were hard to find.
- Adding HIV-infected clients to their teams, to play the role of peer navigator. These individuals, staff from LINKAGES partner the Associação de Mulheres Vivendo com VIH, MWENHO, accompanied CI’s staff to hot spots and talked to KP clients about what it is like to live with HIV.
- Building good working relationships with over 21 ART facilities in Luanda Province. Key population clients would see that CI’s community teams were respected by doctors, nurses, and administrators at these facilities. Sensitized medical personnel would often help in decreasing the waiting time for KPs who were accompanied by LINKAGES’ partners.
Lastly, CI and other LINKAGES’ partners also realized that their relentless follow-up was also important in winning trust, even when clients were in denial about their HIV status. By showing up at the hot spot looking for them, sending a text message, or making a phone call just to say hello and find out about their wellbeing, would eventually convince key population clients that peer educators, HIV counselors, and peer navigators were committed for the long run, to improving their health.
In the words of a patient: “I was always feeling sick but I did not care.... [My counselor] convinced me and got me into the treatment program at a health facility and I finally accepted to be introduced to MWENHO’s support group. I really like the group. I now want to help my peers to join the project’s programs.”
* Pseudonym to protect identity.
The Linkages across the Continuum of HIV Services for Key Populations Affected by HIV (LINKAGES) project, a global cooperative agreement led by FHI 360, was implemented in Angola by MSH in partnership with civil society organizations (CSOs), government stakeholders, and key population (KP) individuals, with support from the U.S. Agency for International Development (USAID) and the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR).
Created in June 1995, CI ́s mission is to promote the development and well-being of communities in general, especially women and children. Based in Luanda, CI enhances community prevention efforts regarding HIV, other sexually transmitted infections, malaria, and child protection. CI contributed to LINKAGES between 2015-2019. It offered HIV prevention and testing services to 23,641 sex workers, 3,066 men who have sex with men, and 163 transgender women (as of August 2019).