Peer Power: Engaging Men with HIV to Reach Men with HIV

by Shawn Malone, Project Director for HIV/AIDS (Gates Project), PSI and Kasey Henderson, Advocacy Coordinator, PSI

“I find it easier to connect with men with HIV because I am one of them,” says Raphic, a young man from Mbombela in northeastern South Africa.

Raphic, who is part of a pilot coaching program called “Coach Mpilo,” knows the importance of staying on treatment. “When I go out there and reach out to these men, it becomes a journey for us to embark on together. Slowly but surely, we are able to get them back to care.”

Reaching men with HIV testing and treatment has never been easy – a reality certainly not helped by the ever-evolving COVID-19 pandemic. A combination of social, cultural and economic barriers makes men less likely to test, less likely to start and stay on treatment, more likely to be diagnosed late, and more likely to die of AIDS-related causes.

PSI’s Breaking the Cycle project in South Africa has talked to more than 2000 men about their views and experiences of HIV, and many say that it leaves them feeling alone, ashamed and afraid. They often feel like their life is over. When we asked them how they might manage to cope with a diagnosis, a common sentiment was, “Show me another man who has done it. If I can see someone who has been through it and is doing fine, maybe I can do it.” They imagined this person as a coach of sorts—someone to teach you the ropes, show you tough love, and ultimately help you become a winner.

This is the idea behind Coach Mpilo, which reframes the HIV counselor or case manager as a coach and mentor who provides ongoing guidance and support–borne out of personal experience–from the point of diagnosis to the point of viral suppression and treatment stability. Coaches are based in the community but work closely with clinic staff, receiving referrals from nurses, accompanying men to clinic visits as needed, and engaging in joint problem-solving.

PSI and Matchboxology are currently piloting the model with implementing partners BroadReach Healthcare and Right to Care as well as the National Department of Health in three districts of South Africa. The pilot rolled out in March 2020 with 60 coaches and hopes to double that amount by the end of this year.

The program recruits men who are stable on treatment and confident in speaking openly about their own experiences living with HIV. They serve as coaches and mentors to newly diagnosed men, men who were diagnosed but never initiated treatment and men who were once but are no longer on treatment, for a myriad of reasons.

“These men may find it really hard to start treatment, but we don’t give up on them. Building a relationship with them is the first step. From there we check in on them and slowly win them over by explaining the importance of starting and staying on treatment.”

Adapting to COVID-19

Just as the pilot was getting started, South Africa, like the rest of the world, was hit by COVID-19. The pandemic created a challenge: The COVID-19 lockdown did not stop the need for treatment. But how could coaches safely identify and engage men with personalized advice and support on living with HIV when the country was in lockdown?

While ensuring that coaches were protected, we also realized how valuable they could be during the pandemic in helping men stay healthy. Coaches continued to interact virtually with men as much as possible, allowing for continued support without creating undue risk. In cases when in-person contact was essential, coaches received guidance on taking all possible preventive measures.

Using COVID-19 as a Messaging Framework

If the pandemic has a silver lining, it is that health is now at the front of people’s minds. Coaches have adapted by shifting their focus to helping men stay healthy overall, supporting anti-retroviral treatments (ART) linkage and adherence while supporting COVID education and screening. Although HIV testing numbers are down, Coaches’ visibility in the COVID response has allowed them to continue connecting with men who may need support.

“Some men hardly find the time to watch the news for updates on COVID,” says Raphic. “I found that if you call them to give them updates personally, then they feel that someone is looking out for them and they will take the precautions to stay healthy.”

Coaches are also finding that COVID-19 provides motivation for men to want to maintain a strong immune system. HIV counseling has traditionally framed the benefit of treatment as “better health outcomes” and “longer life,” which can be too distant and abstract to be compelling. Staying healthy during a pandemic is much more concrete and immediate. Coach Mpilo posters display messages like “Corona is here, and it likes a weak body!” and “Make sure you are taking your iMpilo to boost your immunity!”.

As the pilot gains recognition, other clinics in the area have been reaching out to the team to inquire about linking to a coach.

Coaches are in-the-flesh proof that everything is going to be ok—that a man with HIV can live a great life as long as he stays on treatment. As Raphic says, “Finding out I was to be a coach gave me so much courage. I’ve learned to love my work and I know there is so much light after the diagnosis. I hope to share this light with others in the future.”

Banner image credit: Unitaid/Eric Gauss

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