Summary by Jackson Kesale
The National Council for People Living with HIV and AIDS in Tanzania (NACOPHA) in partnership with Stay Awake Network Activities (SANA) conducted a one week training from 7th to 11th November, 2016 on Positive Health Dignity and Prevention (PHDP) in the Arusha Region. The training used the National AIDS Control Programme of Tanzania (NACP) curriculum and was targeted to health workers providing HIV related services in the region. Key issue addressed in this training was how health workers could provide friendly services to members of key population groups with specific respect to Men having Sex with Men (MSM) and Female Sex Workers (FSW).
Health Workers of Arusha, Representative of GNP+ Ms. Saima Jiwan, Government, Stay Awake Network Activities (SANA) and NACOPHA officials  in a group photo.

The last day of the training the health workers were joined together with PLHIV members of Key Populations who narrated of their experiences while seeking for health services.  The training was financed by the Global Network for People Living with HIV and AIDS (GNP+) and addressed the following topics.

·         Introduction to PHDP and its application in the HIV response among members of the Key Populations
·  Sexual and reproductive health including sexually transmitted infections among members of the key populations Addressing stigma and discrimination for members of key populations  living with HIV among health care providers  Key strategies to promote PHDP

The training was coordinated by Ms Edna Edson, the NACOPHA Zonal Coordinator for Dar es Salaam Zone and Mr. David Laser, the Human Resource Manager of SANA. It was facilitated by Dr. Rosemary Daniel (MD) and Ms. Shida Amon, a clinical counselor. The training was also graced with the presence of the donor’s representative, Ms. Saima Jiwan and the Secretary General of the National Council of NGOs in Tanzania (NaCoNGO), Mr. Ismail.  Nine health workers from six major hospitals in Arusha attended the training. These hospitals included Levolosi Hospital, Kaloleni Hospital, Mt. Meru Hospital, St. Elizabeth Hospital, Marie Stopes Hospital and Daraja II Hospital. Other participants of the training were government representatives (NACP,  DACC and CHAC) and the Chairman, Ms. Janeth Mwagiego and Secretary  of the NACOPHA’s Arusha MC PLHIV cluster.

The training was opened by the government representative, representing the National AIDS Control Programme (NACP). He congratulated SANA and NACOPHA for initiating the PHDP training endeavor among the healthcare workers of Arusha. He outlined some of the key highlights as provided in the NACP-PHDP guideline of 2015. He indicated that the government is keen to leave no one behind in line with the Sustainable Development Goals (SDGs) and is also keen to serve well all the PLHIV in the country. The government is also very keen to fight against stigma and discrimination of any kind. Lastly he extended his gratitude to GNP+ for funding this activity and invited them to continue their collaboration to continue building capacities in the country. On her part, Ms Saima Jiwan of GNP+ expressed her satisfaction and expressed optimism that the PHDP training will have a positive impact on the quality of service provision to the KP living with HIV in the Arusha region. She expressed her organization’s willingness to continue collaborations meant to build local capacities on HIV response in Tanzania.

The main facilitators of this training were Dr. Rosemary Daniel and Ms. Shida Amon who explained the concept of PHDP using simple and understandable language and provided vivid examples to the health workers. The training provided an ample time for health workers to evaluate how they offered services to the community of key populations. Most service providers were open enough to admit that they had in many instances failed to provide friendly services to them. “It is true that we receive a lot of patients in our centers, the biggest challenge is that we are very few health workers responding to a huge demand. It is therefore really difficult to be highly effective to all clients as we would have wished, more so to clients requiring special attention such as members of the key populations” stated one health worker. Other challenges outlined by the health workers included poor office layouts that pose a challenge to confidentiality and privacy of the clients and the attitude of some of the health care providers.

But during the dialogue, many of health workers admitted to lack knowledge about key populations. What most admitted was that the members of the key populations were behaving contrary to the norms and values of the society and that they were a complex lot to serve. But they promised that since they had widened their knowledge from this training they will provide education to their colleagues and will start implementing PHDP strategies as soon as possible so as to remove stigmatization in the health facilities. At the end of the training all health workers and others in attendance were satisfied and admitted that they had gathered new knowledge and new perspectives. They also developed a PHDP based plan of action which would require some investments to help implement it.

During the training, the Chairman of Arusha MC PLHIV Cluster mentioned that the stigma and discrimination faced by PLHIV was quite high. “The PLHIV are not only stigmatized by health care workers but other service providers too. However, key populations living with HIV are more stigmatized and more likely to face hostility and violence from service providers and community members more than others.  I therefore suggest the PHDP training should also be conducted among government officials and specifically LGA officials. This training would have two effects one being to help in the uptake of PHDP concept and secondly being to help them understand how the members of key population groups are more susceptible to contracting HIV. This training would help provide a humane approach in dealing with key populations and promote milestones in the HIV response in the country” stated Ms. Janeth.

On the last day of training a dialogue was held between health workers and members of key population groups which was very successful as all participants were very cooperative. Female sex workers complained that health care workers sometimes used bad language while serving them. “I went to one of health facilities here in Arusha, and asked for condoms because I know they are provided for free. The nurse attacked me with insults because she knew that I am a sex worker. She gave the condoms to me and then later snatched them back. She then told me that I do not deserve to get any service from that health facility for being a prostitute” stated one Participant. The dialogue was quite vibrant with both sides talking to each other despite a few tension-filled moments among the two groups. At the end of the dialogue the healthcare providers apologized to the key population groups and promised to effect a number of changes in their service delivery. KPs living with HIV also admitted to have benefitted from the dialogue and promised to cooperate closely with health workers and also be good ambassadors to their fellows KPs. “I feel really good, today I was part of the human family. I can’t believe that I sat and exchanged my feelings with healthcare workers and they listened to me!” Said one key population participant.


The end of the dialogue was graced by Dr. Richard Muko, the Program Manager of NACOPHA who provided a closing speech. “This training takes all of us deeper into our humanity and raises the dignity of each one of us as service-providers and the served. So, we all leave here as better human beings. Service providers have become better and so do those who receive services. We may all have treated each other badly before, but now  we must not only seek for forgiveness, and forgive ourselves but also change for the better.” He said.  “As we step out of this training we should have a new beginning and make sure that this meeting will also be an opportunity to make a great friendship between service providers and the KP-PLHIV. This friendship will promote friendly service and bring respect among each other”. With these words he closed the entire event.