Community at the Center: HIV Peer-led Services
In Nepal, HIV most notably affects transgender people and gay, bisexual, and other men who have sex with men, with added burden among sex workers from these groups; in response to this, over the past two decades, civil society has built a robust response in meeting the unique health needs of each of these stigmatized groups. For example, under the leadership of the Blue Diamond Society (BDS), Nepal’s first and oldest LGBTQI+ organization, over 6800 individuals are annually reached with HIV prevention, treatment, care, and support services, saving thousands of lives.
However, a few months ago the US government terminated HIV programing for our communities, and the BDS was forced to close 20 community clinics serving communities in 21 districts throughout Nepal; tossing hundreds of service receivers off lifesaving HIV treatment services, and closing safe space drop-in centers for community members to receive other critical health services, including HIV/STI testing, distribution of condoms and lubricants, HIV pre-exposure prophylaxis services, mental health screening, counselling and referral for treatment; and home based care for community members hard to reach. These programs were effective because they were delivered by our communities and addressed social determinants of health–offering stigma and discrimination reduction interventions, economic empowerment efforts, and simply put a place for community members to be themselves, dress up, and put on makeup in a social context where Queerness is still not accepted. With these disruptions in services, especially among urban centers along the Indian border, it is expected that a public health crisis will grow, increasing HIV morbidity and mortality among other health challenges.
To address this urgent need, BDS proposes a revitalized and integrated program that builds on our existing highly efficient and low-cost awareness efforts by deploying one peer navigator in each of the 21 previously served districts. These trained peer navigators are from communities impacted by HIV and they play a vital role as counselors and peer leaders who provide support to HIV treatment anti-retroviral treatment (ART) initiation of the newly diagnosed people living with HIV including partner-testing services, screening and prevention of interruption of treatment while also delivering home-based care and adherence support for people living with HIV who cannot leave their home or make it to HIV treatment centers. Peer navigators will also provide stigma and discrimination reduction sessions, ensuring friendly services for people living with HIV, diverse genders, and youth are available at government-run ART centers. This approach not only sustains vital services with limited resources but also ensures that our communities are not left behind in Nepal’s national HIV response.
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