| Ela Anil, IRC’s reproductive health program manager, recently interviewed Rose Wahome about her work helping to prevent HIV/AIDS in one of the world’s largest refugee camps.Rose is a nurse midwife who started with IRC in 2005 in South Sudan, and now works in the Kakuma Refugee Camp in Kenya. The IRC has worked in Kakuma since 1992, when we started a primary health care program that includes a network of clinics and community outreach services.
Could you please describe your HIV work with the IRC?
I started working with IRC in the August of 2005 in and stayed there for 22 months. When I got there, the HIV program was in its fourth year and I realized it was mainly a prevention program, focusing on raising awareness. IRC and ARC were working together, in different sites, but funded under the same USAID program. IRC was based in Rumbek. They had just finished an assessment survey when I started. The survey showed us a few things to work on: there was very low condom use and high rates of sexually transmitted infections (STIs). People were having multiple sexual partners and sexual debut was very early, sometimes younger than 15, for both boys and girls. Culturally, polygamy and wife inheritance were accepted. HIV prevalence was low, at 0.4 %, so we focused on prevention activities.
After the survey, we continued raising awareness on HIV prevention and transmission, but this time in a much more targeted way. We worked with uniformed forces, in school and out of school youth, and women. For all the groups we had peer educators, from their communities. We got educational materials from Kenya and Uganda and translated them.
What were some of the challenges you faced in your HIV prevention work?
One big challenge was language. Many people hadn’t gone to school during the war, literacy was low and we couldn’t have gone out and conducted our activities in English. Finding local staff was a challenge. So we worked with the English speaking community members we could find and trained them to be peer educators.
Also, remember, this was a post-conflict situation. People didn’t think about AIDS, it was not a priority. They were trying to settle down, build their own shelters, trying to get access to food and water. The same applied to donors, HIV/AIDS was not coming through as a priority.
Was stigma an issue in your work?
Yes, stigma was a big problem. People who tested positive were not accepted in the community. Especially women – of a woman tested positive she was blamed and abandoned by her husband. Most husbands were in denial, we tried to get them to the VCT centers as well.
Many of those who had been repatriated from Uganda and tested positive chose to return to Uganda. This was not so easy for women.
How did you work with these challenges?
We kept reaching out to people. People were generally open to our messages once we were able to communicate with them. But, because the materials we were using were from Kenya and Uganda, sometimes they were able to say “this [HIV/AIDS] is a foreign problem. It is not our problem.”
We encouraged community members to make use of IRC’s voluntary counseling and testing centers and know their status. As time went by and Sudanese refugees were repatriated, we started getting more positive results. We were working with partners and had set up counseling centers in our partners’ facilities where we could provide treatment for STIs.
To reach out to women, we worked with lady peer educators and offered VCT services with ante-natal care. We explained to women that testing could help protect the heath of their newborn. Most women wanted to be tested when they realized their newborn could be protected.
Could you speak a little bit about your work in Kakuma Refugee Camp in Kenya?
Here I am working with the health team to strengthen our behaviour change communication (BCC) strategy to change people’s risky behaviours. Actually, here in the camp, conditions are similar to South Sudan in some ways. As refugees, people are very focused on improving their means of livelihood and HIV/AIDS is not a priority. But it is easier to reach people in the camp community; it is a closely knit community and IRC has a very a strong presence.
The total population of the camp used to be 92,000. Since many Sudanese have been repatriated, now we are serving about 62,000 people. We are focusing on reaching out-of-school youth who constitute one fourth of the population and we’re working with Sudanese and Somali staff who are refugees themselves.
How do you feel about your work? What motivates you?
I have come to really like working on HIV prevention. We can help people change their behaviour and this actually helps them avoid HIV. Once we reach out to people, sit down with them, give them facts and accurate information, they are open to change. This is what motivates me.
When I was working in South Sudan, there was a pregnant woman who came to the antenatal clinic and tested positive for HIV. She was advised to come to get Nevirapine at 28 weeks, to prevent transmission to her baby. She did, and when her pains began and she went to the clinic for delivery, her baby was given Nevirapine as well. She gave birth to a very healthy baby.
But right after delivery, her condition started worsening, she became very weak and started showing signs of AIDS, everything went down very quickly. In Sudan, we didn’t have anti-retrovirals (ARVs) so the hospital sent her home because they couldn’t do much. Her husband didn’t want her back, so she went back to her parents’ home. I wanted to find her and follow up so I found out where she lived and visited her. The baby was health but the mother was so weak she couldn’t walk.
I appeared to the World Food Program in Rumbek and got food for themother and formula for the baby. 3 months later the mother was walking. On World AIDS Day in 2006, she came to the field and participated in our activities. This made me very happy. This is what keeps me going.
I am asking everyone to work on preventing HIV transmission. The day we break the chain of transmission is when we achieve prevention. And we have to work together, in partnerships, no one can do this work alone.
Photo: Dorothy Peprah/The IRC
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