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Equal Patronage

EVA’s Development Specialist visited Ekaterinburg to see with her own eyes how patronage support is managed for women with HIV. In Ekaterinburg there is a…

EVA’s Development Specialist visited Ekaterinburg to see with her own eyes how patronage support is managed for women with HIV.

In Ekaterinburg there is a lovely city embankment on which it is very nice to take a stroll in the summer. And Ekaterinburg is also one of five cities where the EVA Association is implementing the Healthy Mother, Healthy Child project. Our Development Specialist Ivetta Sergeeva traveled to Ekaterinburg to learn more about how EVA’s peer counselors help HIV positive pregnant women and women with small children.

In Ekaterinburg peer counselors are staff members at the AIDS Center and they are engaged in providing support to patients in all phases of their path, working side by side with other specialists. Peer counselors do not exist in a vacuum, they are an important part of a large team working for the patient. Doctors, social workers, and psychologists at the Ekaterinburg AIDS Center have called referred to peer counselors as, “our magic wand” and said, “I don’t know what I would do without them” and “we have the most competent peer counselors”.

The target group of this project is rather narrow, but the project’s peer counselors remarked that the needs of women in the target group differ greatly depending on a variety of factors such as:
– one’s experience of life with the disease (whether they learned of their status before or during pregnancy, if they received adequate counseling, if they are supported by their relatives, if credible information about the disease was accessible, etc.),
– the situation with one’s partner or in family situations (if the woman is in an abusive relationship),
– material insufficiencies,
– factors of increased risk for stigmatization and discrimination of women (substance dependence, belonging to a particularly vulnerable group) and others.

An important stage in the development of the project and one of its best practices is the creation of patronage support for families in Ekaterinburg. Valentine, a peer counselor for EVA’s project works closely with the local AIDS center and is specialized in assisting HIV positive pregnant women and women with small children and she provides patronage services. This type of support requires particular skills and that the peer counselor is deeply invested in the situation of the woman and her family. Managing especially challenging cases can be drawn out over many months: from the moment the peer counselor first meets with the woman at the threshold to her apartment to the moment that with his or her help the patient was able to resolve the crisis and make an important decision for her wellbeing. Yet often this painstaking work remains paradoxically unseen within the project reporting, which is oriented towards quantitative indicators.

Therefore the trip for the Development Specialist allowed us to see the real life situations of how the peer counselors work “in the field” and how intense and important work looks behind the reported indicators of the project. Patronage support can be called the practice “from door-to-door”, meaning that the main task of the peer counselor is to practically lead the woman from the door of her apartment to the door of the AIDS center.

Peer counselors say that if the client made it to the AIDS center once, went through the procedures of lab tests and got medication, spoke with doctors and understood that it isn’t anything humiliating or dangerous, then the chance that she will return to the AIDS center for treatment is high. Especially if she will also receive support and patronage from a peer counselor, she will maintain a stable emotional state and undertake actions to get out of a crisis situation.

But convincing women that they must take care of their health and their lives is a task that frequently no one – except a peer counselor – can cope with. In truth, besides peer counselors, no one has the experience and skills to persuasively and delicately work with women, giving them a safe space free from judgement and fear.

The technology and tools that peer counselors use in patronage support (in the experience of Ekaterinburg) include:

— humanitarian support such as ‘entry points’,
— motivational interviews,
— outreach work (mainly visits to specific locations),
— documentation of rights violations,
— assistance with controlling one’s disease and adherence to treatment (such as delivering medication by proxy, controlling taking treatment, psycho-emotional support, providing access to trustworthy information about the disease),
— creating a path to resolve crisis situations (referral to non-governmental and state facilities),
— as needed systematic work on psycho emotional support with family members,
— accompaniment to treatment facilities and assistance in establishing relations with personnel, mediation of the patient-doctor relationship,
— linkage to support groups for PLWH.

Peer counselors, like all other staff at the AIDS Center, take part in trainings and seminars on various topics. There are regular meetings where doctors, peer counselors, and social workers can meet together and resolve challenging situations and issues that have accumulated. It is likely that this plays a role in maintaining the team’s stability.

Our specialist was able to meet with the head doctor at the Sverdlovsk Oblast Center for the Prevention of and Fight Against AIDS, Angelika Sergeevna Podimova. In her words, she is very pleased that the Healthy Mother, Healthy Child project was implemented in Ekaterinburg and is interested in continuing the project and in its expansion. The expert believes that the objectives of the project are relevant and the assistance to this target group is important.

We hope that it will be continued.

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