We left the hospital for our next engagement: a psychosocial support group meeting being held under the canopy shade of a wide flat tree. As we drove up, excitement ruffled through the group, and a crowd of school children in yellow and brown uniforms scampered around the car. We introduced ourselves, took a seat on a wooden bench that had been set out for us, and rather than sitting in and observing a psychosocial support group, the ceremonials began. We sat in a row as an audience to their full attention, and listened to a welcome and background story given by a male community support agent (CSA). Much of what was said was lost to lack of translation but some prize bits of information were relayed to me in English. The groups name translated as “People living with HIV take care of ourselves.” A truly voluntary group, unsupported by lunch provision and transport allowances, this group formed to offer one another psycho social support and to conduct income generating activities. As they have no land they pool their resources collectively to hire the land which they now farm on. They also do bricklaying to earn money for the group. International HIV/ Alliance presented the group with a cow last year to use for ploughing the land. That cow has since given birth and they are training the calf to plough too so that they can lease the wee beast to others.
The CSA explained that they provide nutrition advice, follow up those who have not been attending the services they referred them for, support anti retro viral therapy adherence and refer pregnant mothers to prevention of mother-to-child transmission services etc. He also mentioned that he teaches against witchcraft as a cause of illness. At that point however he also mentioned the importance of believing in God. As far as I know missionary services are, like reproductive health services, yet to be streamlined into the community support agent model. The latter is something I hope to work on over the next 6 months. The CSA repeated the phrase “a tug of war” in relation to getting men to join groups and access services. One of the reasons he attributed this hesitance to was the self stigma that men with HIV attach to themselves. This particular psychosocial support group tries to set an example to others by revealing their HIV status and showing others how to live positively. It was all very positive.
We asked how the group thought men could be encouraged to access services. An old woman suggested that women should not be treated unless their husbands come to the clinic with them. In response to this it was noted that this approach had been tried and that it failed miserably, resulting in far fewer women being treated, and no more men. No more suggestions were offered. I asked how the group was started and was told that it was thanks to a nurse who had put three HIV positive people in contact with one another, and supported them to begin a group in absence of formalized services.. She arranged for them to attend CSA training with NACWOLA. While NACWOLA aims to bridge the gap from the community to the health service provider by starting at the community, many persons at health service providers have begun bridging the gap from the opposite side, as the nurse did here.
On asking the group how being part of this group made them feel , some bold and confident women stood up to share their answers. Their answers attributed this new found confidence to psychosocial support which offered them feelings of unity, a new life, shared experience and knowledge, joy away from the stigma of HIV and empowerment through realising that the power to prevent the spread of infection begins with themselves. We thanked the group for their time, and turned to leave, but not before being presented with a fanned out hand of miniature bananas. The CD handed over UGX 20,000 (about £6). I wasn't sure which was worse; to reinforce the stereotype of "donors" arriving in white 4 by 4s,spending a pitiful amount of time before handing over cash and disappearing for ever more, OR to challenge those expectations and break the stereotype by not giving any much needed and well received petty cash. It had been a private donation borne of the generosity of the Country Director, but arriving in the branded vehicle that Irene had (fortunately) arranged to use through hr own agency, changes the context of everything you do.
We piled back in the car and set off down a rough dirt track, flanked by lushly planted fields sprouting avocado, jack fruit, maize and cassava among other crops. The CD requested to be dropped en route so that he could pray in the mosque. We arrived at the site of a home visit that the CSA with us was due to make, and followed him into the house. We greeted the young girl (maybe 14), her tiny baby and her grandmother who lived there, accompanied by 5 other aids orphans. Once seated on the sofas, a rakishly elegant man stooped down and up into the house through the low entrance. Dressed in a long flowing white tunic and an islamic cap, he bent to shake the hands of all of us in the room, greeting people in the local language, before reaching me. At that point, he took a dramatic pause before exclaiming 'Good Morning!' in a comical voice that induced a long laugh from the room.
The CSA looked to us for guidance as to what to do next. I suggested that he continue to do as he would if we weren't there, if that was ok, and that we would just observe quietly and conspicuously. We learnt that the CSA had been passing through the village when he saw that the girls baby had been looking ill. He had taken a measurement of her upper arm and referred her to the clinic. It was unknown whether the baby had been ill from HIV, poor nutrition, or more likely, a combination of the two. The girl had run away to "the island" and returned pregnant. It was therefore suspected that the father was a member of a fishing community who characteristically have very high HIV infection rates. After receiving treatment and services the baby was in visibly better health. As we sat talking, the driver rang Irene's mobile repeatedly. She was hungry and the CD had finished praying. That was our summons to leave. I avoided being completely rushed though, and dawdled a few extra precious mins to talk with the women and take photos.
Travelling back in the car we passed the absurd site of a man sitting on a low stool in the middle of a field in a smart suit and tie. It was the country director. We reversed, picked him up and all had a good laugh.
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