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The GIPA Concept ‘Lost in Transition’

The Case of Expert Clients in Swaziland

Thandeka Dlamini-Simelane

Abstract

Following the call by UNAIDS in 2006 to involve people living with HIV (PLHIV) in treatment programmes, expert clients were recruited to provide services within healthcare settings as volunteers alongside paid health workers. Swazi law requires employment contracts for anyone working in a full-time capacity for three months, complicating the status of expert clients. This article traces the genesis of the volunteer framework used to engage PLHIV in the provision of HIV care in Swaziland and describes how the quest for PLHIV to be involved coupled with donors’ promotion of the Greater Involvement of People Living with HIV/AIDS (GIPA) principle have together resulted in PLHIV serving as low-cost workers, disempowering the very people GIPA was meant to empower. I call for review of GIPA-based policies and a paradigm shift regarding a non-medically trained cadre of workers in an era of acute health-worker shortages in resource-limited countries hard hit by HIV.