Back to Life: How Psychosocial Support Can Facilitate HIV-Therapy
Ruedi Lüthy Foundation - With an infection rate of around 15 percent among 15-to-49-year-olds, the HIV/AIDS epidemic in Zimbabwe is far from over. Though a growing number of affected individuals now have access to drug therapy, this is not enough in itself to end the epidemic. People with HIV/AIDS also need to receive parallel psychosocial support. The around 6,000 patients at Prof. Ruedi Lüthy’s Newlands Clinic in the capital city of Harare, who come from very poor circumstances, are being supported with group therapies, home visits and peer counselling. The concept is meeting with success and leading to a marked decrease in incidences of treatments being abandoned and the consequent build-up of resistance to HIV drugs.
In the Newlands Clinic in Harare around 6,000 patients from the poorest of circumstances receive free-of-charge HIV treatment. One of them is the 22-year-old Tafadzwa. In spite of his young age he already has a real odyssey behind him: the death of his mother from AIDS when he was eight signalled the start of a very unsettled life. Tafadzwa was first looked after for a few years by his stepfather. But when this man remarried and money became increasingly tight, the boy spent years being sent from one relative to the next. At one point he lived with his uncle, then with relatives of his deceased mother – all complicated by burdensome family disputes. Tafadzwa who, following his great loss, needed a stable environment more than ever, became depressed during puberty and even spent some time living on the streets.
With Combined Efforts against Dangerous Drug Resistance
In some respects, Tafadzwa’s story exemplifies those of many other patients at the Newlands Clinic. Their lives are marked by poverty and deprivation: many children and young people grow up as orphans because their parents have died of AIDS; women suffer from domestic violence; mothers and fathers do not know how they can afford to feed their children and send them to school. People are under a huge amount of pressure and the hopelessness of their situation often leads them from resignation right up to depression or even suicidal thoughts. In these circumstances, following HIV treatment in a disciplined way is almost impossible. For this reason, in 2013 Ruedi Lüthy established a department for psychosocial support. The team is lead by a psychologist and includes a social worker as well as peer counsellors who are HIV-positive themselves and share their experiences with the other patients.
The demand for support is high: in 2016 over 10 percent of the patients benefited from the provision which includes individual therapy and counselling, group therapy, supported self-help groups, home visits from the social worker as well as a vocational training programme for young patients. «Mostly the patients are referred to us by the nurses or doctors treating them because they have poor blood values and psychological problems» says psychologist Bahati Kasimonje. With reference to HIV, «poor blood values» means that the viral load is too high, which is usually an indication of an irregular uptake of drug therapy. And this is very dangerous: when the virus is allowed to multiply it also mutates. This rapidly leads to resistance and the drugs becomes ineffective.
At the Newlands Clinic youth meetings, young patients can exchange experiences with their peers. They are specifically supported through workshops and group therapy. The chief goal is to prevent the abandonment of drug therapy. (Photo: Patrick Rohr)
«I Felt Totally Lost»
The psychosocial department was also called in to help with Tafadzwa’s case when it became clear that he was not consistently adhering to his drug therapy. «I felt totally lost», recounts the young man about the time when he was constantly moving from one place to the next. His visits to the Newlands Clinic, where he has been treated since 2009, became more and more irregular and he totally interrupted the therapy for a few months because he was living on the streets – with devastating consequences: the standard drugs failed and Tafadzwa became sick, first with tuberculosis and then meningitis. His ill health forced him to abandon the vocational training programme which had given him the prospect of becoming a painter. Tafadzwa fell into a depression and even suffered from hallucinations.
«In Tafadzwa’s case, the gravity of the situation led us to call in an external psychiatrist» says Bahati Kasimonje. However, it was the mobilisation of the people around him that proved to be decisive. «With the help of our social worker, Tafadzwa found a home with a pastor and his congregation and this gave him the stability he needed.» The young man was able to rent a small room from a woman and the congregation supported him through his illness. In addition, with their help he was able to re-establish contact to an uncle who had previously cared for him. The support of this social network finally helped Tafadzwa to turn a corner: the young man recovered from his illnesses and found a new lease of life. «Before the intervention, his viral load was chronically too high» according to the psychologist. «Now, with second-line drug therapy, he has spent the last seven months with a fully suppressed viral load.»
Preventing Abandonment of Treatment through Group Therapy
Tafadzwa’s is not an isolated case: the fight against drug resistance is a huge challenge, especially amongst teenagers. Group therapies to promote treatment adherence are therefore a central provision of the department for psychosocial support. They usually last between six to eight weeks and are based on motivational counselling techniques and cognitive behavioural therapy. This approach is recording encouraging results: thanks to the group therapies, in 2016 the dangerous abandonment of treatment by patients was prevented entirely and 77 percent subsequently had a suppressed viral load. Among comparable patients who did not undergo group therapy, only 50 percent achieved such suppression and 8 percent even abandoned their treatment altogether. Currently around 80 percent of all patients can be treated with the standard drugs. This is very important because second and third-line drug therapies are much more expensive and, in Zimbabwe, third-line drugs are still almost completely unavailable.
Meanwhile, Tafadzwa has taken up the drug therapy again and his blood values are good. His landlady (left) supports him on a day-to-day basis. Every so often he receives a visit from the Newlands Clinic social worker (right). (Photo: Patrick Rohr)
Educating and Strengthening Children with HIV
Another common problem is the stigmatisation of HIV patients. Special groups – known as «Post Disclosure Groups» – therefore focus on children and young people who only recently have been told of their illness. This is a delicate moment during which many questions and fears surface. «The majority see the diagnosis as a death sentence. This initial shock must be overcome with detailed information about the positive prognosis of a well-treated HIV infection and also by exchanges with peers, so that the children and young people can regain a positive attitude to HIV therapy» says Bahati Kasimonje. Further provisions are aimed at particularly vulnerable patient groups, such as young mothers overwhelmed by caring for their babies or those who are in violent relationships, as well as girls and young women whose poverty and low self-esteem could lead them into prostitution, or who are already prostitutes.
Psychosocial Provision is Essential
«Ultimately it is a synergy of different measures that leads to success» says Bahati Kasimonje. The central treatment remains the drug therapy that holds the virus in check. However, the accompanying psychosocial provision can make a big difference because it returns a measure of independence and, with it, meaning of life to the patients. Today Tafadzwa understands how important it is to strictly adhere to the drug therapy. He continues to receive help from the church community but now he cooks and cleans for himself and is seeking commissions as a painter. In face of the precarious economic situation in Zimbabwe, his life will still be difficult but he has returned to good health and he now has a social network to rely upon in an emergency. (Photo: Young patient Tafadzwa (22) talks to his nurse. He regularly attends the Newlands Clinic in Harare for check-ups to ensure his HIV treatment is working / Patrick Rohr)
Janine Haas, Ruedi Lüthy Foundation
The Ruedi Lüthy Foundation
The Ruedi Lüthy Foundation (formerly Swiss Aids Care International) was established in 2003 by Swiss AIDS specialist Prof. Ruedi Lüthy. Its goal is to deliver comprehensive treatment to HIV and AIDS patients in Zimbabwe. The Newlands Clinic in the capital city of Harare provides long-term treatment for around 6,000 outpatients. The Foundation places a special focus on the treatment of women, children and young people. In parallel, the Foundation is training local specialists from other clinics and carries out research into HIV/AIDS in developing countries.