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“I Can Improve Things”: An HIV Peer Counselor in the Dominican Republic

This post originally appeared on the CapacityPlus blog.

“It was very, very bad treatment that I received,” recalls Mercedes (not her real name), a young mother living with HIV.

Five years ago—at one of the largest maternity hospitals in the Dominican Republic—she was diagnosed as HIV-positive. Although she enrolled in the hospital’s program to prevent mother-to-child transmission (PMTCT), she felt discriminated against for her status, and that the health workers’ actions toward her lacked compassion. But she decided her experience as a victim of stigma would not stand in her way of helping other HIV-positive pregnant women. “I can provide better information to patients” Two years later Mercedes met a staff member at the hospital who asked if she wanted to work as a volunteer HIV peer counselor. This was her chance to make a difference. “I can be there,” Mercedes replied. “I can improve things. And I can provide better information to patients.” Although the Dominican Republic is characterized as a low-prevalence country, HIV prevalence among pregnant women has been estimated as high as 4% in some regions. Stigma makes it difficult for clients to ask questions and get the information they need to cope with their diagnosis and navigate treatment. HIV peer counselors play an important role in countering this. They are able to relate to clients’ situations; provide resources on treatment, support groups, and clients’ rights; and if appropriate, share their own stories of how they have managed the disease. Mercedes received training and studied hard. And just a few months ago, after serving three years as a volunteer, her position became official and she began to receive a salary.

“I never thought they would give me a salary”In the Dominican Republic, CapacityPlus works with the Ministry of Health to improve the availability and quality of PMTCT services through strengthening human resources management policies and practices. CapacityPlus provided technical assistance to the Ministry to include HIV peer counselors and other types of health workers in the Civil and Administrative Career Track and integrate them into the Health Career Track. To do so, the Ministry redirected funds it saved through an ongoing process to eliminate ghost workers (individuals who receive a salary but are not working) from hospital payrolls. The Ministry identified over 10,000 ghost workers through a payroll analysis supported by CapacityPlus.    “I never thought they would give me a salary,” Mercedes says. “And when the salary arrived, thanks be to God because I needed it! I have two children; and their father, he died [from HIV].” While Mercedes is grateful for the monetary recognition of her work, the only real difference is the paycheck. Her commitment to pregnant women and preventing the transmission of HIV to infants has always come first, and being a volunteer did not limit her daily tasks and responsibilities. “I am here because I like to work with people living with HIV,” says Mercedes. Most importantly, she is able to foster hope as she shares her own experience. “I am here to help”Every day Mercedes seeks to combat discrimination and stigma against PMTCT clients in her hospital.  And she sees the impact of her work in the lives of her clients. She says they attend more prenatal visits, adhere to their antiretroviral treatment, and bring their infants for recommended follow-up visits. These changes are the best type of feedback that she could receive.

One young woman stands out to her. “There was a patient who came in with her grandmother, her brother, her entire family. She came crying and screaming, ‘I don’t know what they’re bringing me here for. Enough! Let me die! I’m already positive, I’m no longer able to be saved. People who have AIDS are going to die.’” Mercedes relived what she’d felt at the time she was diagnosed.

She told the client, “I am here to help. I’m here to show that yes, you can. I have a child that was born in this program and my child is negative. If you do your part, you can too.”Throughout her pregnancy, the young woman returned to the hospital whenever she had a fever or a headache to get Mercedes’s advice. The young woman gave birth and keeps pushing ahead. She is studying psychology now so she can also help others. “She calls me and tells me, ‘Mercedes, I don’t know how to thank you, because I thought I was going to die.’ To me that is something I will never forget: to know that I helped someone get out of such depression.”

Mercedes sees her situation as a counselor living with HIV as an advantage. “Sometimes, the patients don’t like talking with everyone,” she explains. “But if you tell them, ‘I am also HIV positive just like you,’ the patient opens up. It’s not the same to talk to a person who is not positive. And for me this is very pleasing.”  Photo by Wendy Tactuk (women wait outside of Maternidad Nuestra Señora de la Altagracia Hospital in Santo Domingo, Dominican Republic)