Cleaning the House – Addressing Stigma and Discrimination directed towards Peer Counsellors working in the HIV Clinic- Kampala Branch, AIDS Information Centre as presented by Dr. Hilda Kizito, Seremba E. and Ivan Nume at the 14th International Virtual Conference

Background: Peers may be defined as trained HIV positive medication-adherent role models but may also be HIV negative leaders who belong to key and priority groups. The use of peers has been incorporated into HIV programming to facilitate mobilization for service uptake and to provide psychosocial support to address stigma and promote adherence and retention for clients on PrEP, PEP and ART. Peers working in HIV clinics also perform multiple roles through task shifting of some of the trained health workers’ roles and as such these clinics are assumed to be their workplaces.

Materials & Methods: In April 2018 through funding received from the CDC funded IDI Kampala HIV project, AIC contracted seven peers to work in the Kampala branch clinic predominately for peer-to-peer counselling and client tracking activities. These peers include a peer mother, community linkage facilitators and others to perform assigned tasks in the clinic and community for clients on ART. They were also integrated to perform other activities through task shifting in the clinic like registration of clients at the reception and conducting health talks. During the course of their work the peers encountered stigma and discrimination from the health workers they worked with at different sections in the clinic which included public disclosure of their HIV status and health issues in waiting areas, being referred to as patients, disrupting peer-to-peer counselling sessions and discrediting information given by peers. Additionally, peers experienced stigma when they developed illnesses particularly cough. This directly impacted their performance with some developing anxiety, withdrawal and missing working days.
To address this, the following were put in place: monthly peer meetings with their supervisor, assigning peers to staff counsellors to address their mental health and other issues particularly related to stigma, mandatory attendance/ participation of peers in staff meetings and activities including expanded task shifting activities (e.g. preparation of activity and project required reports); staff and peers screening for TB regularly.

• Challenges the peers encountered were discussed in the peers’ meetings and subsequently addressed with resultant reduction in complaints of stigma and discrimination.
• Emerging peers’ mental health issues were and continue to be addressed and they now feel like part of the program/ staff and not just “patients”.
• Staff and peers are accountable to each other for health-related events, and these are addressed in a timely manner by the clinicians. This has allayed fears of contracting infections like TB from the peers. Regular screening has excluded presence of active TB cases among staff and peers.
• Through attendance of staff meetings and trainings the capacity of peers has been built and they have attained certification in some disciplines like counselling.

Conclusions: Peers are susceptible to stigma and discrimination from within HIV clinics from health workers and therefore mechanisms should be put in place to protect and promote a safe working environment for them.

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