Test & Treat – report for 3 Months

Bali Rainbow Community presenting effects of first three month Test & Treat program managed and run by Kerti Praja Foundation.
We want to thank prof. Wirawan and dr. Rowe for writing great program for members of gay community.

Although arguably human immunodeficiency virus incidence is decreasing if not stabilizing in many nations, there is an alarming upward trend of new infections among key populations globally, specifically gay men, Men Who Have Sex With Men (MSM) and trans* women. In contemporary contexts in low-middle income countries such as Indonesia, gay men, MSM and trans* women bear a disproportionate burden of the HIV pandemic, wherein they are reportedly more than 19 times more likely to become infected compared to other populations owing to unsafe sex practices. In Bali there are currently many of these young men in urgent need of support who are unaware they are at risk.

In addition to physiological vulnerabilities such as transmission through unprotected receptive anal intercourse (URAI), biases against MSM and trans* women,

there is limited access to tailored and community friendly information and services, which makes it difficult for these communities to negotiate safer sexual practices or obtain adequate services for HIV prevention and treatment as well as for other sexually transmitted infections (STI), more increasingly syphilis.

Punitive legislation, fear of persecution and SOGI-related stigma along with a paucity of allocated funding and the under-prioritizing from health ministries, continue to impede community efforts and efficacy in halting the spread of HIV within the community.

The social and sexual partner-seeking behavior of MSM is relatively unchanged, and MSM have a history of adopting new technologies to find each other, especially when stigma and discrimination perpetuate. Mobile and social technology channels offer these key populations—particularly youth—a channel through which they can find someone like them, which can make them feel less alienated. Social media apps are extremely popular among gay men and MSM in Bali, and in addition to be an avenue for these men to make friendships and find partners, are one channel for disseminating safe sex messages and information about HIV.

“Test and Treat” is one initiative that has been rolled out both nationally and internationally and is proving to be relatively successful. The Test and Treat approach is based on two theories:

  1. that early diagnosis and treatment will decrease the risk of HIV and non-HIV related health problems in People Living With HIV (PLHIV), ensuring that they are healthier and happier;

  2. reduction of viral load to undetectable levels will dramatically reduce the possibility of transmitting HIV to others through initiation and adhering to antiretroviral treatment (ARV). Test and Treat therefore has two goals, to encourage people who do not yet know their serostatus to undergo testing and to reduce HIV transmission, with the understanding that PLWH who are receiving treatment and living well are far less likely to transmit infection to others.

Concern may be though about the ongoing and continued adherence of newly diagnosed individuals to ARV in the long run, as stopping ARV has serious ramifications for the future health of a client, especially in the sense that people maybe become resistant, therefore treatment options limited. It is crucial that HIV testing becomes normalized and efforts be made to mitigate people’s fear of testing positive, that people living with HIV are provided accurate and pertinent information that resonates with their life situation.

As mentioned above, the earlier a diagnosis, the earlier to begin therapy and have a more hopeful and positive health/virological outcome.

People Living With HIV, especially those living away from their familial support networks and who are sometimes living with the double burden of hiding their sexual orientation, need quality and comprehensive peer support, and this is the vital way in which BRC contributes to alleviating the HIV situation in Bali.

Although the Bali Rainbow Community has been a long-time supporter of the Kerti Praja Foundation and its work, in November 2015 Bali Rainbow Community members officially committed itself to funding an integral percentage of our Care, Support and Treatment program, specifically our Test and Treat initiative for Men Who Have Sex With Men.

Kerti Praja Foundation (KPF), established in 1992 and one of the first organizations in Indonesia to work with HIV-AIDS, is a non-profit, non-government organization that works with the community in health promotion, early disease detection and prompt treatment, clinical services and support for PLHIV. In addition to this, KPF runs programs and projects that promote livelihoods for PLHIV and their support networks.

The specific goal of KPF is to provide care, support, treatment for PLHIV as well as prevention information concerning HIV-AIDS and related issues at-risk populations, such as Men who have Sex with Men, female sex workers (FSW), Male To Female transgender and the intravenous drug use community along with members of the general community. Bali Rainbow Community, by supporting our outreach program with MSM, greatly contributes to alleviating the financial burden on our free clinic, whilst also assisting to improve the quality of support for people living with HIV.

Through support from the Bali Rainbow Community we are financed to provide quality counseling and support in order to encourage people to undergo testing and stay healthy on their antiretrovirals.

Two of our Outreach Staff share their recent experiences contributing to the BRC project:

I have quite a few tricks and tips for outreach but more often than not I use wechat. I use a peer snowballing approach so I ask them to bring a friend in to get tested too. This works well for me as I can’t stay up all night on social media trying to recruit clients- I’m too old for that! I have this one client I know very well, and he never wanted to test! I could see his health declining- loads of STIs. And he has a wife, and many sexual partners. A real mess. His wife lives in Java, so I hope she is OK. His wife doesn’t know about his behavior in Bali. Finally I was able to encourage him to get tested. He used to be so stubborn. But eventually all his conditions and ailments over time have disappeared. Really does prove the benefits of adhering to ARV! I am really worried though about his boyfriend, who refuses to get tested.

He is showing signs of being sick, I am sure he is infected, but he doesn’t believe me and only wants to go to a witch doctor (dukun). It is so frustrating. He calls me stupid to my face. I won’t give up though. Some clients are very difficult. Some will wait until they are on their death bed, only then ask for help.

Although there are so many amazing examples of how well you can be living with HIV!

Nowadays, we do outreach more through social media and no longer through going to hot spots. I try to use a funky status and approachable spunky photo, and put in indirect messages about testing in order to attract interest. Then a client will usually contact me. I have one client who was 18 years old, a young Balinese guy, when he tested, and I asked him why he wanted to get tested, and he told me he had 1 partner who lived in his home town. He had only ever had one sexual partner. I thought he would rebel and get very depressed, being so young and relatively naive. There is a lot of word of mouth between the community about the importance of testing, so he was motivated to get tested because he was suspicious of his partner. You can’t judge someone by their age, this young guy is committed to his health and is responsible. Also, because he had a high CD4 count and was still well it was easier for him to take ARV, and didn’t experience side effects. I am trying to encourage him to tell his family about his HIV+ status, just in case, if one day he gets sick. I have a good feeling about this client that even though he is still young, I can tell from his character that he will stay on his ARV. For example, just now I did couples counselling and I have a bad feeling that they most likely won’t stay on their meds.

When you open the testing result envelope you really only have 2 options – to commit to being healthy or not.

These two from this morning were still hesitant. I won’t give up though, I will keep supporting and counseling them.

To date with Bali Rainbow Community support we have been successful in ensuring that 73 MSM from the local community undergo testing and more importantly start their ARV and stay healthy and well through adherence and positive life changes.

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