140 As the case presented above indicates involvement in singing was found to be therapeutic. It helped this particular participant to cope with stress-related symptoms. For these particular individuals, faith in God and involvement in church-related activities were important coping strategies that helped them overcome some of their difficulties and live successfully with the realities of being HIV positive.
141 Data from FGDs and discussions with KIIs also indicated that PLHIV maintained their social relationships, especially those with family members, relatives, neighbors and friends. Since PLHIV also lost some social relations because of their status it was important for them to always seek to find other modalities of still remaining socially engaged. This was not always within the context of the family or the circle of friends. More often than not, most PLHIV indicated finding meaningful relationship within the context of their support groups. In this regard, the support groups occupy a very prominent role in the lives of PLHIV in Kisumu County and it would not be an exaggeration to say that support groups are the fulcrum around which the lives of PLHIV oscillate.
5.4.2 Joining Support Groups
The most important of the social strategies employed by PLHIV was joining and participating in support groups. Almost all PLHIV were members of some support group since it is recommended to them from the PSCs to join support groups.
After knowing my status, the counselor released to me my result. After that she introduced me to some support group and I joined that support, support group. So after joining the support group, I started coping with life (R47: married woman aged 36-45 years, 27).
By policy, the PSCs help in the formation and management of various support groups catering for the needs of the PLHIV based on considerations such as gender and age.
Examples of support groups include those for male adults, female adults, and for male youth, female youth, discordant couples, and for CHWs by themselves. According to one PSC coordinator, “apart from that, we are forming support groups. Like in this facility, I have 15 support groups. And at times, I am forced to form support groups according to the nature of the people” (KII-001, PSC in-charge).
Support groups were instrumental in helping the participants to not only overcome powerful stigmatizing notions but to also find a place where they could feel at home. Within these support groups, PLHIV also found people with a similar condition with whom they could share their experiences and obtain mutual support. As the following quotation from a 36-year-old indicates, support groups were used as avenues for providing support with income-generating activities as a way of strengthening livelihoods of PLHIV.
We have support groups. There we have Income-generating activities (IGAs), and there we learn. We were given some goats for milk. The milk can be taken at home to support nutrition and can also be sold and if the goats get young ones, these are given out to members (R24: 36-year-old widow, 127).
142 Support groups also provided a forum where PLHIV learnt from the experiences of others who had lived with HIV for long periods. They had the chance of knowing some of the methods these fellow group members have used, the challenges they have faced, and how they have overcome such challenges.
Okay, the support group members, just as I have informed you that it was a support group of PLHIV, the members of the support group…By then sometimes I would disclose while crying because those days, what was happening. But in that place I found that those who were there are the same. I found people saying that they got to know their status in the nineties [1990s].
So that gave me courage. When they were saying that they got to know their status in the nineties, and when I look at him without him telling me, there would be nothing to show that he had HIV. So this gave me courage that if someone has already lived [with HIV] for 8 years, 10 years, then I can also live. Coupled with the teachings that we were getting there, we were being treated equally like the children of one family (R37: 42-year-old widow, 13).
As can be seen from the above quotation, the support group context provided a safe environment where PLHIV could easily and freely disclose their status to people who share the same status with them. Disclosure within the group is considered therapeutic and as some of them indicated, it had enabled many PLHIV to bravely embrace positive living.
Support group is what has made it possible for me to talk to you the way I am talking to you.
Because before I joined the support group, I was a shy man and stigmatized and whenever I was coming to the clinic here, I would cover, I would try even if I did not have money, I would buy...I would look for something like a newspaper to block my face [demonstrates].
But through the support group, I can come into this place to discuss with you confidently.
Because I know that the fact that I am HIV positive, it has happened so I have to accept it. So the support group has helped me through many different teachings and counseling. I could not even get into this place (R31: Widower aged ≥46 years, 66).
Support groups also enabled the PLHIV to find new friends. Most of them mentioned having gained new friends by joining support groups. So they did not feel worried or bothered when some friends deserted them after learning of their HIV status.
Support groups enabled PLHIV to meet other people who were in similar circumstances.
Consequently, support groups were important in helping PLHIV to develop the right attitude useful for overcoming and resisting stigmatizing attitudes from the community. They also found a home where they could feel a sense of belonging and meet friends from whom they could obtain mutual support and with whom they could share experiences. Additionally, they
143 met individuals who had lived longer with HIV from whom they could learn how to successfully cope with HIV.
5.4.3 Changing Interaction Patterns
Another important social coping strategy was the restructuring of social interaction patterns.
The PLHIV deliberately took a proactive step in creating a social network that worked best to advance their interests. They were involved in rational calculations to find out what relationships worked and what did not work and discarded those that no longer worked. In other words, they engaged in a simultaneous process of diminishing the significance of certain friendships or associations and of enhancing the role of other sets of relationships.
This strategy was also considered as one of the effects of HIV on social relationships. One female participant commented that:
Before I knew my status, I was in some groups even for gossiping, gossiping, gossiping, varieties of gossip, gossip such as that so and so has HIV. I knew that HIV kills, you hear my mum. But since knowing my status, I joined groups that are church-related, those that are development-minded and concerning someone especially with regard to his health I would not want to delve into. And if I want to talk about it, I would go to him straight and settle it with hi….him (R38:44-year-old widow, 37).
The case of R38, is a clear indication of a complete change of interaction patterns where one set of interactions which did not serve a constructive purpose are discarded for more constructive ones. This aspect of restructured social engagements was reflected in the kinds of groups the PHIV engaged with. For R37, a 42-year-old widow, her new identity as someone who is HIV positive has become the more salient in her life since even her choice of social relations is largely from among members of the support group of PLHIV.
No, till now since I joined the ‘HIV world’, most of my friends, they are people who are HIV positive. The reason, this is the person, who even when I am not feeling well, I can share with them; because they know what I am. So I can share with such a person deeply. And then me, also since I lost my husband, I did not have many friends. First, I did not want friends…So when I joined the ‘HIV world’ it made all my friends had to be people with whom we are in the support group. These are the people I can leave to go and visit; we can share stories concerning our life, and how we are faring on (R37:42-year-old widow, 33).
The other vital theme within the change of interaction patterns was the notion of selection of friends. This came out clearly when some indicated that they were actively involved in sifting who could belong to their social circles. Those who would be friends were vetted by proving
144 them to see if they could keep information confidential.
Secondly, I select the people from whom I can seek advice, who can...can give advice. Okay a group geared towards development, which even if I want to initiate something “you say this and this” and then they give you some advice. Because you know, you must have a goal, you know you must now have a goal…I share a lot with the people we are living with HIV. I do not hold my things to myself. When I have shared the things that bother me or what I want to do, then you find that you get advice. Yes, advices come. Yes advices come... I do not keep silent with the things that I want to perform (R47: married woman, aged 36-45 years, 65).
According to the accounts presented above, PLHIV realized the importance of social engagement in coping effectively with HIV. PLHIV recognize and take advantage of the potential of social relationships to help them make meaning of their HIV status and adopt pragmatic coping strategies. They maintained social engagement, joined support groups and changed their interactions patterns. All these efforts helped keep them socially connected and receive mutual support from others.