By: Melissa Wintz and Joyce Macharia
ELDORET, KENYA–Claris Ojuangio was diagnosed with HIV in 1998 at age 32. At the time she was battling alcoholism and was an intravenous drug user. She recognized her problems, but found there were few places she could turn.
Four years later, Ojunagio was running an organization devoted to providing a place HIV-positive people like her could turn to.
In 2002, Ojunagio founded the Psychosocial Department at AMPATH, the Academic Model Providing Access to Healthcare, a partnership between Indiana University and Moi University in Eldoret, Kenya. AMPATH provides general healthcare, but is best known for its 10-year fights against HIV/AIDS. It operates out of a center on the campus of the Moi Teaching and Referral Hospital (MTRH) and at 23 remote clinics in the three westernmost provinces of Kenya.
The Psychosocial Department uses a peer-counseling method, meaning all of the program supervisors and counselors are HIV-positive. They meet with their HIV-positive clients in individual and group therapy sessions to overcome their mental health or substance abuse problems. The department is run almost entirely on referrals.
In most cases, according to Ojuangio, clinicians must acknowledge a psychological problem in a client before the client is told about the services the Psychosocial Department offers.
Ojuangio said they are proud to treat the problems related to HIV that the medical departments cannot handle. “How do you give ARVs (antiretroviral medication) for domestic violence?” she asks.
Ojuangio and her team serve over 67,000 AMPATH clients at 17 of the remote sites. They provide direct care and counseling to both rural and urban areas, but supervisor Cornelius Agaro notes the stigma against HIV is strongest in rural areas.
They call the last Thursday of every month “education day.” They bring in experts on substance abuse, depression, youth, or any other problem their clients may be facing.
They counsel cancer patients, children and adolescents, widows and widowers, and older adults (40+) in mixed sessions and in sessions divided according to sex.
“The therapeutic value of two people with the same problem is unparalleled,” said Ojunagio, who knows from personal experience what the healing powers of group therapy can do. What sets this Psychosocial Department apart, supervisor Robina explains, is that the supervisors understand the challenges faced by the clients.
The Psychosocial Department also uses “adherence counseling,” working with clients to ensure they take their antiretroviral medications according to schedule. Ojuangio says most of their clients have already failed to adhere to their drug regimens and are sent to them for help. She says too few of the clinicians fully understand the value of group therapy and in some ways they are like an invisible department.
The medical facility often feels too sterile to clients with substance abuse problems, she says. The Psychosocial Department is located in a corner in the basement of the AMPATH Center with small offices and a hallway. The group therapy sessions are held in the hallway lined with plastic chairs. It is small, but it is alive with conversation during sessions.
Facilities are not the only limitation. The department has been underfunded since 2006 and they have been unable to adequately train their staff. Ojuangio says the training is vitally important because even though the department’s work often goes unnoticed, when it’s done well, it’s life-changing.
Stress can strain a person physiologically, says Ojuangio. The Psychosocial Department treats the psychological damage done by the HIV virus in order to facilitate physical recovery.
“We have problems that cannot be cured with ARVs,” says Robina. The motto of the Psychosocial Department is that life must continue. They strive to provide hope to clients who struggle the most. They counsel the depressed, and try to give strength to all of their clients.
Ojuangio says, “We are not just people living with HIV. We are people.”