Thursday, July 11, 2013

Peer support in Cambodia helps HIV-infected teens transition to adulthood

At Takeo provincial hospital, nurse Ken Nim leads 16 young people (10 girls and six boys) through the agenda of their meeting of ‘Mondul Mith Chouy Mith’ (known as ‘mmm’).
©UNICEF Cambodia/2013/Shepherd-Johnson
Chantrea, Bopha, Vichet and Syha are four friends aged between 14 and 20 who live in Takeo province in southern Cambodia. They meet monthly to socialize and exchange news, discuss good nutrition and how to stay healthy. They are all HIV positive. On the last Thursday of every month they get together with other young people as part of the peer support group Mondul Mith Chouy Mith (friends helping friends), known as ‘mmm’.

The forum for adolescents and young people was developed in 2007 as a follow-on to the support group for HIV-infected children (aged 18 months to 14 years) which was established in 2005 by Cambodia’s Ministry of Health, with UNICEF support, as part of its paediatric care service. The ‘mmm’ aims to provide on-going support to those who officially transition at age 14 from the paediatric AIDS care programme to the adult programme, but do not feel ready to be classified as ‘adults’ and are apprehensive about getting check-ups in an unfamiliar environment.

Mondul Mith Chouy Mith forums for adolescents are held in 35 locations across Cambodia. Twenty-two forums are supported by UNICEF and made possible with funding from the French Committee for UNICEF.

The Takeo ‘mmm’ meets at the provincial hospital where nurse Ken Nim leads discussions on topics including HIV transmission, nutrition, anti-retroviral therapy, physical changes and adolescent development. “They talk about love, relationships and how to protect themselves,” said Nim. “They worry about their future, stigma, discrimination and the risk to relationships if they disclose their status. They are concerned about having to take ARV drugs for the rest of their lives. At the ‘mmm’ they get support as a group but there’s also individual counselling.” Meetings begin at 8:00 a.m. and last for three and a half hours. Transport and meals are provided as an incentive for young people to attend.

Helping young people affected by HIV to build self-esteem

Over the years, nurse Ban Sinoun has seen young people grow in self-esteem thanks to the safe environment created by ‘mmm’. “One girl has been transformed compared to when she first came to ‘mmm’,” she said. “She used to be very quiet but now she expresses her opinions. I said to her, ‘Now you participate and talk more than before’. She told me ‘It’s because I have learned a lot from the meeting and now I can say what I know’.”

Chantrea is 17 years old. She aspires to be a fashion designer. On her left hand she wears her mother’s wedding ring as a memento and touches it occasionally as she talks about learning her HIV status five years ago. “My parents had passed away and I had a lot of illnesses so then I was tested at the [Voluntary Counselling and Testing] centre. When I found out I was HIV positive I was so afraid because there is no cure and I was worried about discrimination and wondered if I would die. I started coming to the ‘mmm’ when I was 13 and now I have friends. I don’t feel lonely anymore and I get lots of useful information.”

(Left to right) Syha* (17), Bopha* (14), Vichet* (20) and Chantrea* (17) watch television at Takeo provincial hospital as they await transportation home following an ‘mmm’ meeting. (*Names have been changed)
©UNICEF Cambodia/2013/Shepherd-Johnson
Twenty-year-old Vichet was 12 when he found out he was HIV positive. His parents died when he was nine. “I was sick a lot and my uncle took me to hospital for a blood test. I had three tests. I was told not to worry [about the outcome] because there is medication but I was scared. I worried that I would lose my friends, about my future and if I could go to school,” Vichet said.

Like Chantrea, Vichet joined the Takeo ‘mmm’ group at 13. He has grown in confidence since attending the group and has even shared information about his status with others. “I told my close friends,” said Vichet. “They said, ‘No problem’ because they know and understand, but I don’t tell everyone because I’m not sure they would understand.” Vichet is soon to start a construction job in Phnom Penh but dreams of becoming a pilot. He says he will use a day’s leave each month to continue to attend the monthly ‘mmm’ meetings in Takeo. “I’m concerned about my health, so I will keep coming here and taking my medication.”

A transition for young people from paediatric care

Bopha, aged 14, transitioned from the ‘mmm’ for children to the group for adolescents. “When I was seven, I was told I had HIV and I didn’t believe it. I started attending the ‘mmm’ at nine. I didn’t know much about HIV but through the meetings, I came to understand what it is, how it is transmitted and how to prevent it,” said Bopha. “Outside it’s not possible [to tell people about my status] because of discrimination and they might not want to be my friend. I trust the counsellor here because she will not tell anyone else. Coming here reminds us about taking our medication and about hygiene...I know about treatment and there is no discrimination here. My dream is to be a doctor and have a family. Physicians help people and save lives, and based on my experience, I would like to help others and prevent them getting infected with HIV.”

Seventeen-year-old Syha has plans to be a singer. Hospital staff members say he used to be depressed but now he confidently performs a popular Khmer song in front of his peers. “My father died when I was seven. I was ill and taken to the hospital and then I was found to have HIV. I started to come to the ‘mmm’ at 13. I told some of my friends and they passed the information on, so most people in my village know my status. They also see me coming to the hospital regularly. But at school I have only told very close friends,” said Syha.

For these four friends, the ‘mmm’ provides a safe space to relax, meet others in similar circumstances and receive support without stigma or discrimination. According to Dr. Te Vantha, Deputy Director of Takeo Provincial hospital and Chief of the Paediatric Ward, the ‘mmm’ can show them nutrition, hygiene and explain adolescent growth. “As they change from children to adolescents they think about their lives differently, and not in the same way as children. Some adolescents have refused to go to the adult clinic saying, ‘I’m still young’. The ‘mmm’ [for young people] encourages them to keep up with drug adherence.”

*Names changed to protect identities.