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  2012-07-16
CHAA Weekly Brief For the period 9th to 13th July 2012   “Antigua and Barbuda is a p...
 
   
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CHAA Supports National Response in Antigua
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CHAA Retools its Counsellors
CHAA Empowers Most At Risk Population with Training
Delivering Counselling and Testing where it is most needed - a Community Approach
Donovan's Story: Leading by Example
Althea's Story: A Positive Influence

CHAA Empowers Most At Risk Population with Training


                                       


Discrimination against men who have sex with men in the Caribbean is well documented and often institutionalised by state services due to buggery laws which make sex between men illegal (Human Rights Watch, Hated to Death, Nov. 2004).  In Antigua, terms used to describe Men who have Sex with Men (MSM) are often derogatory and mainstream culture and music are openly judgmental and discriminatory towards this community.  The result, expressed by a Community Outreach Worker (Animator), who targets gay men and men on the down-low with behaviour change communication interventions in Antigua, is that "MSM don't access healthcare primarily due to stigma and discrimination in health services."

In Antigua many sex workers are migrant workers and with a population of almost 70,000 in 2007 an estimated 8-9,000 were Dominicans, with an estimated 70% of these women involved in some way in the sex industry (COIN, Centro de Orientacion e Investigacion Integral, Trabajo Sexual, Trata de Peronas VIH/Sida, Abril 2008).  Many other sex workers are mobile Jamaican or Guyanese migrants.  Stigma and discrimination towards sex workers in general is high and sex workers are frequently seen as the carriers of HIV and STIs.  This combined with strong xenophobic feeling towards migrants in general creates barriers for sex workers in accessing sexual reproductive healthcare, including pap smears, STI tests, and condoms from public clinics, and many pay for private healthcare which is perceived to be more confidential.

A Community Animator targeting migrant sex workers in Antiguan brothels says,"I think the biggest barrier for sex workers in Antigua to accessing healthcare is that they are not from here.  Because a lot of people here say non-national women come here to take the men.  Combine that with being a sex worker and it means women don't want to go to a clinic.  The only reason sex workers do the HIV test is to get time in their passports (a condition imposed by club owners is that sex workers show a HIV negative test), they don't do other check-ups as much, for STIs or pap smears.  Overall a sex worker prefers to go to a private lab rather than a health centre (where no counselling is done) because they feel it is more confidential." 

CHAA's Eastern Caribbean Community Action Project has been tackling stigma and discrimination from all angles in the past year and a half of its implementation through its peer-led BCC interventions with target populations.  It has now scaled up its efforts to increase most at risk populations access to community HIV and STI services by joining forces with the US Centers for Disease Control and Prevention and Intrahealth to bring a new and advanced curriculum for HIV Rapid Testing and Counselling to the Eastern Caribbean.  The focus is on working with most at risk populations including sex workers, men who have sex with men and, injecting and non-injecting drug users.  The curriculum is the first of its kind in the Eastern Caribbean, and was combined with HIV rapid test practical training, teaching participants lab safety, record keeping, blood collection and finger prick testing as well as, running HIV rapid testing algorithms.



The MARP specific counselling and testing training was piloted in Antigua between 20th and 24th July to train 25 community based rapid counsellors and testers, including three staff from the National AIDS Programme, five Community Animators, as well as two staff from the Directorate of Gender Affairs, two members of the Health Hope and HIV Network, two representatives from the Anglican Church youth outreach programme, a member of the Antigua Barbuda HIV and AIDS Network, and the Director of Antigua Planned Parenthood Association. 

The Antiguan government is currently rolling out its rapid testing pilot at three sites and all counsellors and testers involved in the pilot were included in the training.  In addition, all counsellors and testers recently trained by CHAA in the baseline Counselling and Testing (CT)  for the region offered by CHART JHPIEGO attended, meaning they will be able to offer advanced and MARP specific counselling at community and mobile testing centres.  Building this capacity in community organisations and peer educators will help in creating a decentralised counselling and testing model.

The MARP counselling method is being implemented all over the world and is based on the RESPECT 2 study conducted by Mary Kamb and has been validated by a series of international investigations.  The programme trains counsellors to use a risk reduction, client-centred approach, and ensures that counsellors are knowledgeable about the specific behaviours of MSM, sex workers and drug users so they can adequately help clients to identify appropriate ways to reduce their risk.  The module on sex workers and MSM cover risk reduction steps such as how to negotiate safer sex, condom use and recognising STIs; the curriculum is designed so it can be conducted along with CDC's rapid testing training.
 
Since this training, Community Animators have been seconded to the offices of the National AIDS Programme where they are providing counselling and testing and are supervised by experienced staff members.  CHAA will be partnering with regional organisations to provide two further trainings in Antigua in September, including harm reduction, and stigma and discrimination trainings.

"Commercial sex workers, men who have sex with men, and injecting drug users are several vulnerable populations that are at high risk for HIV and are contributing to the number of new HIV infections each year. HIV testing and counselling is fundamental to defeating HIV and AIDS. Testing provides an opportunity to receive counselling about risks, and early knowledge of HIV status helps link people to care. Given the barriers that many MARP face in accessing CT services, there is a great need for training and sensitising health care providers and counsellors on how to provide safe and confidential counselling and testing services for MARP."
                                                                                                                                                                                      Stephanie Behel
                                                                                                                                           Epidemiologist, Global AIDS Programme
                                                                                    HIV Prevention Branch, US Centers for Disease Control and Prevention.













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