118 CHAPTER 7


taking ARVs, and also to promote sustained weight gain, increase body mass index (BMI), and reduce anemia among adults (Silva et al. 1998; Schwenk et al. 1999; Semba, Shah, and Vlahov 2001, cited in Gillespie and Kadiyala 2005, 56; Verweel et al. 2002). Kenya’s Cash Transfer for OVC plans to provide refer- rals to programs that provide ARVs for beneficiaries who voluntarily declare that they are HIV positive or living with AIDS (Kenya, OVPMHA 2006, 9). Of course the provision of ARVs does not guarantee their benefits; compli-


ance with the drug regimen is critical. It may be possible to use cash transfer programs as a means of strengthening communications systems and counsel- ing around drug regimen adherence, for example, by using lay providers and expert patients (van Damme and Kegels 2006). In Uganda, a study by Weidle et al. (2006) found that adherence interventions, including individual and group counseling, personal adherence plans, and weekly home delivery of ART, improved adherence. Cash transfers can also improve adherence through enabling the purchase of food, reducing the side effects of the drugs.


Home-Based Care The World Health Organization defines home-based care as any type of care given to sick people within their homes, such as physical, psychosocial, pallia- tive, and spiritual interventions (WHO 2002). A study by ActionAid in Zambia showed that 90 percent of HIV-affected individuals prefer to be cared for in their own homes (Voluntary Service Overseas 2006). HBC can include physical palliative care, such as treating illnesses and managing pain; nutritional coun- seling and support; support for ARV adherence and mitigating side effects; and psychosocial support for people living with AIDS (PLWA) and their families (Slater 2004). In Zambia, community nurses provide examinations and care plans, home visits and consultations, prescription and provision of drugs free of charge, general nursing care, training for family members about how to care for patients, patient assessment and referral, pre- and post-test counseling, counseling for family members and children, provision of information and awareness raising, and training for community volunteers. Community HBC volunteers, in turn, identify patients with chronic illness and provide information, basic nursing care (including drug provision), and practical household support (for example, help with household activities, farming, and funeral arrangements). They also counsel individuals before and after HIV tests as well as family members of people with HIV, often incorporating spiritual and emotional support (Nsutebu et al. 2001). Zimbabwe’s Red Cross HBC program has been operational since 1992 and benefits an estimated 40,000 patients (McCord 2005). As noted ear- lier, there are various ways in which HBC programs could build mutually sup- portive links with cash transfer programs. In Malawi’s SCTS, CBOs, extension


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