patterns of access to home - based care programmes for people living with hiv /and aids (plhiv):a study of peri- urban settlements in kisumu district, kenya

Abstract

This study sought to understand the patterns of access to home-based care programmes, among people living with HIV and AIDS in Kisumu District, specifically: to study the nature and process of home-based care programmes; to determine the client selection process of home-based care programmes and to establish factors influencing access to community home-based care services for people living with HIV and AIDS. Of particular interest was the role of social capital in access. The research was conducted in Kisumu District, Nyanza Province in Kenya, where the impact of HIV and AIDS over the last twenty years has been devastating. This has seen a number of development agencies implementing HIV and AIDS programmes on prevention, treatment care and support, in the district as part of impact mitigation. Three home-based care organizations were purposively selected for the study and other stakeholders interviewed as key informants. A qualitative, cross-sectional study involving in-depth interviews and focus group discussions (Rubin and Barbie, 2001) with individual and key informants, from peri-urban, rural and urban areas was conducted. The study found a significant role of social capital and degree of illness in the access to HBC programmes. Descriptive factors mainly age, sex, marital status and income levels were also factors in access. Social capital was demonstrated by the role of communities, mobilized mainly through churches, community based organizations and NGOs in CHBC programmes. Partnership between communities, HBC organizations and government health and administrative facilities played a key role. The huge role that HIV related stigma continues to play in exclusion of potential clients from HBC was noted. Stigma was both instrumental and symbolic. Linked to this was the fear of lack of client confidentiality in HBC programmes. The design of the CHBC programmes and inadequate resources was also a factor in exclusion. Main groups cited as excluded from CHBC included men, young people (including children under 5 years born to HIV positive parents; and those under 18, living with HIV), young women, those in the higher income groups and persons subscribing to certain religious and traditional affiliations. Others were the disabled, street-children and those in prison. The study recommends the following: HBC programmes should implement stigma reduction initiatives addressing the social and psychological factors contributing to stigma, empowering on HIV testing and benefits of CHBC, whilst enhancing client confidentiality; have specific programme strategies targeting males; recognize the needs of children and young people living with and affected by HIV in the design of programmes; outreaches including the 'upper' low income and middle classes. Governments and HBC organizations should increase resources to

improve quality of HBC and expand coverage - this should address volunteerism through motivation and capacity building for communities and enhance more effective partnerships and collaboration between stakeholders in HBC programming.