particularly since, in this country, the need is not being met in the general population in addition to those affected by HIV (396-45-USNGO).
Some interviewees discussing the providers for such care commented that few trained professionals are available for service provision (272-15-PCNGO; 461-10-PCNGO). In one country, qualified social workers were described as difficult to recruit and retain, particularly in rural areas (272-15-PCNGO). An interviewee in another country observed that ‘counselors and clinical psychologists are cadres that don’t really exist in the public service payroll’ (461-10-PCNGO). PLHIV have played an increasingly important and direct role in offering individual, family, community-, or hospital-based psychosocial or spiritual support. As volunteers or recipients of stipends, they offer such support primarily by means of organizing and facilitating HIV support groups, providing peer education that involves psychosocial support, and serving as role models (331-9-PCNGO; 240-15-USG; 240-25-PCGOV; 331-32-PCNGO).
Social support Social support services supported by PEPFAR may include social and legal protection for PLHIV as well as the training and support of caregivers (OGAC, 2010b, 2011a). Interviewees mentioned various programs and activities that offered “social support” or in some cases described an unmet need for social support. However, as was the case with “psychosocial support,” it was difficult to establish a clear understanding of exactly what this entailed in terms of a service or set of services across the scope of PEPFAR-supported programs (196-20-PCNGO; 396-21-USG; 396-32-PCGOV; 396-50-PCGOV; 461-10-PCNGO; 331-8-PCNGO).
Several interviewees identified efforts to provide training and support for caregivers of PLHIV. One partner described caregivers as “wounded healers” for whom care is provided in some programs (272-11-PCNGO). Another highlighted the role of women as caregivers:
‘In terms of care, women are the primary caregivers. This role has been acknowledged and there have been efforts to lighten the burden. “Women have borne the brunt of HIV/AIDS.”’ (934-7-PCGOV)
Economic strengthening activities Recognizing that a lack of economic assets increases vulnerability, PEPFAR supports activities that “supply, protect, or grow physical, natural, financial, human, and social assets” (OGAC, 2009g, p. 17). These activities may include vocational training; microfinance and microcredit programs to expand access to financial services; and income-generating activities, including communal gardens (which