The results of a new study done by FACES (Family AIDS Care and Education Services), a joint program of University of California – San Francisco (UCSF) and the Kenya Medical Research Institute (KEMRI) has shown that micro clinics cut in half the normal rate of disengagement from care, which was defined as missing a clinic appointment by 90 days or more, when compared to the control group, and reduced the perceived stigma of HIV by 25% within the larger community.

According to Avert, in 2011 there were an estimated 23.5 million people living with HIV in Sub-Saharan Africa which is an increase from 2009, when an estimated 22.5 million people were living with HIV.

A community meeting during a FACES program
Photo credit: Rachel Burger

The study was done on Mfangano Island in Lake Victoria which has a population of about 21,000; 30% of these are HIV infected. FACES researchers and clinicians partnered with Microclinic International and the Organic Health Response to assess whether its social network model would help retain HIV patients in care. Of the situation before the study, co-lead author, Charles R. Salmen, the founding director of Organic Health Response, had this to say “The rural communities on Mfangano Island where we are working have tremendous stores of social capital. People help each other when an individual or family is in need. If someone gets sick or injured, needs help farming or getting together the money for school fees, friends and family pitch in to help. But, that often was not true when the need was due to HIV. For example, a breadwinner became sick with AIDS and everyone knew what was going on, but no one talked about it. He fell through the cracks of his social network, and without support, he was lost to care and did not manage to take his medications faithfully. Eventually, he died of AIDS,”

FACES then got to working within the community using micro clinics which ”redefines the unit of care from an individual to an individual and his/her social network and is a cost effective, scalable initiative that could help governments meet their targets,” according to study co-author, Craig Cohen, UCSF professor of obstetrics, gynaecology and reproductive sciences.

The study’s lead author Matthew D. Hickey notes “Previously, stigma blocked access to social support because patients didn’t disclose. Micro clinics opened up discussion and became the catalyst for destigmatizing HIV. This led to access to support within social networks. Friends and family supported patients in getting to clinic appointments and, in turn, expected appointments to be kept. They supported patients’ taking medications as directed and expected patients to take them. Silence was replaced by active support,”

In their vision 90-90-90 UNAIDS  notes that

• By 2020, 90% of all people living with HIV will know their HIV status.
• By 2020, 90% of all people with diagnosed HIV infection will receive sustained antiretroviral therapy; and
• By 2020, 90% of all people receiving antiretroviral therapy will have viral suppression.

This study goes a long way in making that vision a reality. FACES has been supporting HIV care, treatment and prevention in western Kenya, including the island, in collaboration with the Kenya Ministry of Health since 2004.