Entebbe Uganda: Emotional health care for PLHIV is both a basic and primary care equivalent
When HIV care is looked at as an assembly-line with the expectation of numbers of people treated, other than their single needs met then it misses the very intention of treatment.
Rehema (not her real name), is in her late 40's and resides in Kawuku along Entebbe Highway. She is the oldest daughter of a family of six, five of whom are all living with HIV. A bigger part of the family land is semi-wetland. She has used the land to plant perishable green vegetables. She has been doing this for the last 15 years. She produces: carrots, cabbages, onions, lettuce, tomatoes, amaranthus and other types of perishable vegetables. She uses the money to provide food and other attendant needs necessary for a person living with HIV and on ARVs.
To keep 4 adults who are above 18 years healthy and active, she engaged them in the tailoring project she runs at their home. She has contracts with schools to make or repair uniforms. This same tailoring project has been an opportunity to train boys and girls in tailoring skills. This project shattered many myths about people living with HIV. It also points us to three very important principles that promote adherence when beneficiaries are taking ARVs.
The first principle is committing to take ARVs for a lifetime; the second is ensuring the person taking ARVs has shelter safety and security; assured of engaging in activities that promote health, growth and development; having a caretaker who is reliable.
Committing to take ARVs for a lifetime means so many things including: having a health worker with whom one can ask questions about drugs, lifestyle and reactions; having plans to regularly take their medication; keeping attention to CD4 status; maintaining a CD4 count around or higher than 500 cells per cubic millimeter to avoid complications ensuring CD4 does not drop below 200 cells per cubic millimeter. This is when Opportunistic Infections cause devastating effects for people with HIV/AIDS. In the case of Rehema's family they could afford food; regular visits to clinic; receiving counselling about any reactions and changes. All members with HIV have maintained undetectable levels of HIV and have a CD4 count around or higher than 500 cells per cubic millimeter.
Ensuring the person taking ARVs has shelter safety; assured of engaging in activities that promote health, growth and development such as sexual-reproductive health.
Having a caretaker who is reliable, who understands you may not stay on the same antiretroviral therapy throughout your life. You may find you need to change it. Reasons for needing to change include:
- drug resistance
- decreased drug absorption
- poor adherence to the medication schedule
- an ineffective combination of medication
This is what constitutes the emotional health of a person living with HIV. Dealing with one's medical, nutrition, psychosocial experiences and linkage to post-test clubs is basic, should be made the standard of care and provisions of this goal should be made clear in written guidelines of primary care.