Peer educators explained that health workers suddenly stopped them from undertaking adherence counselling and health talks. According to health workers, peer educators were stopped because formal adherence counselling, as described in Chapter Three, was not part of their duties. They were rather trained to counsel their peers referred to them by health workers in the clinic. Before this sudden change, peer educators often joined health workers in adherence counselling sessions to help counsel new clients before treatment started. This was usually done through group counselling and each group, made up of about ten clients, had at least a health worker and a peer educator as counsellors. Peer educators also sometimes gave health talks to clients on nutrition and personal hygiene. Thus, peer educators were relegated to doing counselling and health talks in an informal way, as described earlier in the case of the informal peer educators. In reaction to these decisions by the health workers, the peer educators also asked them not to mention their treatment success as examples in counselling sessions and health talks in which they were not involved.
According to peer educators, they were told later that the decision to exclude them from counselling and health talks was based on allegations that some of them were performing tasks reserved for health workers. They denied this and said that at least health workers should have given them the opportunity to tell their side of the story. Misaa, a peer educator, argued that the decision of the health workers was motivated by the fear that they were becoming too popular with the clients.
According to her, health workers think their involvement in these activities had brought the clients closer to them and that most of the clients preferred to deal with them instead of with health workers.
The peer educators pointed out that although health workers stopped them from undertaking the two core duties, this has not discouraged them from coming to the clinic. They said that their role in the clinic was mainly for the benefit of their peers and their absence would negatively affect clients’ use of services. Boafo articulated this opinion as well. In the interest of their peers, they were prepared to continue working in the clinic by carrying out any tasks assigned to them. Kwaa, a peer educator, summed up their response to the change in their duties in the clinic with the following words:
We have decided to continue coming to the clinic as peer educators in spite of these problems. But we cannot come and sit idle in the clinic everyday while we can do something little to help our peers to access services smoothly… The little things we are doing now are better than staying at home doing almost nothing… So, we continue to be here…
Kwaa contended that the decision of the health workers was informed by the view that their training as peer educators did not change their status as clients of the clinic and that they should therefore be seen as clients and not as peer educators with special skills. He thinks that this has led the hospital authorities not to support them either in kind or in cash. Kwaa said that instead of finding ways to motivate them for the good work they were doing in the clinic, health workers were interested in stopping them from performing adherence counselling and health talks. According to him, the only benefit they got from the clinic was the fact that they did not join queues to access care and treatment. Likewise, their spouses and children did not join queues whenever they visited the clinic for treatment. He said that as volunteers in the clinic, they expected to be re-supplied with medicines every month free-of- charge, but this was the not case. They are supposed to make out-of-pocket payment for their drugs rations like other clients, but they were not discouraged from the peer educator work. The peer educator contended that the most important thing is that they are able to meet their peers in the clinic and counsel them to adhere to treatment.
To Pokua, also a peer educator, the decision of health workers to sideline them in adherence counselling had not changed her determination to continue helping her fellow patients. Pokua said that before she was trained as a peer educator, she had been unemployed for more than two years. She indicated that staying at home without work to do had been a boring and frustrating experience. Following the training, the work she did in the clinic has often given her satisfaction. She explained that every day she came to the clinic to meet her peers some of who had become ‘relatives’ and friends to freely chat with them. Besides, whenever she saw that most of her fellow patients she counselled were doing very well on the
treatment, she felt she had done something good to save lives. Pokua added that sometimes she did not have money to pay for transport to and from the clinic but she borrowed money just to come and see her friends. The mere fact that she got up every morning, dressed up and told people in her house that she was going to work gave her a mental boost and the feeling that she was also employed. Pokua ended her views on their work in the clinic with the following comment:
… For me, whether we join health workers to do counselling or not … I think that as people who have benefited from the treatment, we owe it as a duty to help educate our peers to adhere to treatment as well as others who do not know much about the disease… I believe that by sharing our experiences of the disease with other clients, they would be encouraged to continue with the treatment …
Another peer educator, Menka, expressed his surprise about the decision of the health workers to restrict them to peripheral duties in the clinic. He argued that the decision of the health workers was due to the relative increase in the number of health workers providing services in the clinic: when there were not many health workers, they recognised the important role of peer educators in the clinic. He recalled with some nostalgia their work in the clinic in the early days, after their training:
During that time, we were very happy with the peer educator work. The t-shirts we used to wear gave us a presence in the whole hospital. This made patients and some health workers to give us respect... In fact, we were well motivated at the time to work and help our peers who do not understand the disease and the treatment… Those were the good days of the peer educator work…
Nimo, another peer educator, said in a conversation that the work had enabled him to acquire some skills to manage his positive persons association very well. Through various training programmes and workshops, he had learnt how to efficiently manage his positive persons association. The Ghana AIDS Commission and other non-governmental organizations, which often support positive persons associations financially, organized some of these programmes. Nimo explained that the per diem, allowances, appearance fees, the honorarium he received for attending workshops, conferences and seminars had served as a source of income for him. He also said that he was sometimes overwhelmed with the number of invitations he received for such programmes, conferences and workshops in a week or a month. Whenever he was not able to attend some of the programmes, he gave the opportunity to some of his association members to participate and earn some money, too. He added that the peer educator work had exposed him to politicians, policy makers and influential people in the fight against the spread of the disease, locally and internationally. It is for these reasons that Nimo said that he would continue to work in the clinic notwithstanding the lack of recognition for their work, because he receives recognition from others outside the clinic.
Finally, Asabea, a peer educator said that apart from using the clinic to meet most of her colleagues to counsel them and talk about issues of interest, the place served as a market for her to sell doughnuts. In reaction to the seeming lack of interest in their welfare by the hospital management, she said:
These days, I would not spend much of my time doing this peer education work like before. Even now, I only give out the CD4 count test results to clients … What worries me is that some of our peers, positive persons, think that we are being paid like health workers for the work we are doing here... In fact, I need to concentrate more on my small business to make a living. I think this is the benefit I would also get from the clinic ...
The observations of peer educators on the change of their duties show that they are not really happy in the clinic. They are however willing to continue with the work in the clinic because they still benefit from it.