Kenyan health workers have been missing the opportunity to prevent HIV-positive people from infecting others because they lack the skills and knowledge to counsel this population, say specialists. 

"Health workers have certain misconceptions about people living with HIV... many don't have the training in how to provide messages to those already infected," said Ann Okoth, the district public health nurse in western Kenya's Bondo district. "So people who are positive come to health centres and the opportunity to give information to them is lost. 

"Training and counselling for health workers dealing with HIV-positive people is very important in improving people's health-seeking behaviour and in turn for the success of prevention with positives programmes." 

According to a 2008 report by the Centre for Reproductive Rights and the Federation of Women Lawyers of Kenya, negative healthcare experiences can discourage HIV-positive women from seeking medical care. 

Among other violations, the report noted that women living with HIV were frequently turned away from public health facilities or secluded in an area of the hospital away from other patients; reprimanded for bearing children or being sexually active, and denied access to contraception, family planning and maternity services. 

Training 

National guidelines for promoting prevention among people living with HIV were released in May and the government is now partnering with JHPIEGO, an NGO affiliated to Johns Hopkins University, to train health workers across the country to deliver messages about prevention to their HIV-positive patients. 

"For instance, when you test a mother who has come to the clinic for antenatal care, the priority would be to have her bring her partner for testing also and to help them in disclosure and to prevent mother-to-child transmission of HIV," explained Tom Marwa, HIV/AIDS technical officer for JHPIEGO. 
So far 1,940 health workers - nurses, clinical officers, counsellors and nutritionists - have been trained in counselling as well as how to prevent unintended pregnancies, and how to screen for and treat sexually transmitted infections. 

A 2004 study showed that in Kenya, disclosing HIV status to partners was associated with a four-fold increase in reported condom use, but according to JHPIEGO, before the training, 69 percent of HIV service providers in Kenya did not advise their HIV-positive clients to disclose their status, while 32 percent did not discuss HIV prevention with them. Afterwards, 80 percent of health facilities visited were offering prevention with positives messages. 

Couples' counselling 

Leonida Ojuok is one of the patients at the Bondo District Hospital who has benefited from the training. When she tested positive during a routine antenatal visit, she was terrified of telling her husband. Women are often divorced and thrown out of their marital homes after a positive HIV diagnosis. 

"I told the nurse that I was not going to tell my husband because he would kill me... but she just told me to tell him to come for the next visit," she told IRIN/PlusNews. "When we came together, she talked to us and tested us. 

"Then she told my husband - I was HIV-positive but my husband wasn't. I am happy the nurse convinced him to support me... even today we have come to the clinic together." 

Identifying HIV-positive people 

"The focus should not only be on those whose statuses are already known and on ART [life-prolonging antiretroviral therapy] programmes or some kind of support," Marwa said. "The 'healthy positives' are out there spreading the virus without knowing it." 
According to the results of a 2010 systematic review of behavioural interventions targeting HIV-positive individuals in developing countries, they were useful not only in providing HIV prevention messages but in identifying HIV-positive individuals. 

According to government statistics, an estimated 83 percent of HIV-infected people do not know their status. 

The authors of the review noted that because many HIV-positive individuals had limited contact with health centres, it would be important to move interventions beyond clinic settings and into the community. 

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