Abstract #351  -  Expansion of psychosocial support and counselling services to men, HIV-positive mothers and their families
Authors:   Presenting Author:   Ms Sinah Chaba - Pathfinder International/Botswana
Additional Authors:  Mr. Kenabetsho  Bainame, Mr. Kabo Ditlhakeng , Mrs. Lebogang Gladys Mogapi, Mrs. Tebogo Nkomeng Molosiwa, Dr. Khumo Seipone, Mrs. Koona Keapoletswe,
Aim: Issues: Most HIV and AIDS programs communicate with target groups through mass media or address them in groups. Contact with individuals is rarely systematic. Lacking consistency and follow-up, these strategies develop few positive sustainable behavior changes. Severe stigma and social taboos about HIV thus continue to cut vulnerable men and women off from information critical for making decisions about their health. Despite PMTCT successes, the Botswana program remains challenged by low baby and partner testing rates, mixed feeding (combining breast or cup feeding with other supplements), and poor drug adherence and partner support. Men are identified as key perpetuators of HIV/AIDS because of multiple sexual partnerships, alcohol and substance abuse, inter-generational sexual relations, transactional sex, and sexual abuse/violence. Cultural and religious norms reinforce male supremacy, failing to promote cooperation and support. Pathfinder International programming has achieved significant attitude and behavior change through strong interpersonal counseling that break down these barriers of isolation.
Method / Issue: Project Description: Pathfinder International’s CDC-funded Peer Mother and Male Involvement Interpersonal Communication Project works in 124 sites in Botswana, implemented by six NGO’s in collaboration with the government. A total of 327 mothers enrolled in PMTCT programs have been trained as peer counselors. Through repeated home visits, they have reached out to 11,293 pregnant women, promoting VCT and meeting one-on-one to encourage adherence to PMTCT protocols, teaching RH and family planning, and raising awareness of gender-based violence and equity. A complimentary program has trained 93 male peer counselors who have counseled 12,726 males, reaching them through football clubs, workplaces (mines) and in their homes. One-on-one counseling focuses on changing cultural norms of manhood that promote multiple and cross-generational partners and foster gender-based violence. They provide information on HIV/AIDS prevention and reproductive health and train community leaders as role models for gender equity and a reconsideration of views of manhood. Men and HIV+ mothers are encouraged to attend support group sessions where peer conversations reinforce messages that promote healthy behaviors. Both programs include community mobilization and advocacy meetings with stakeholders. Trained peers conduct risk assessment profiles and formulate risk reduction plans that guide one-on-one contact, support group sessions, health talks, and community outreach.
Results / Comments: Results: The combination of one-on-one peer counseling with positive role modeling has successfully shifted traditional views of manhood and male gender relationships. Similar qualitative progress has been made through one-on-one counseling offered by peer mothers in PMTCT programs. Empowered community leaders introduced to the same concepts provide an important environmental support for the changes instilled at the individual level. The success of the project has drawn interest from government, NGO’s and development partners.
Discussion: Recommendations: An all-inclusive program should be designed to make male and female behavior change mutually relevant and for all the interventions to support one another. Program evaluation should include controls at non-intervention sites to ensure quality and generalization of results. Lessons Learned: Despite limitations in project implementation, some evidence shows that behavior and attitudinal changes are achievable through a well structured person-to-person HIV prevention program.
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