Twenty-six-year-old Laxmi never imagined she would grow up to be a heroine. When she was 14, she ran away from a miserable childhood in her remote, mountainous village in Nepal and tried to find work as a singer in the country’s third largest city Pokhara. But instead of stardom, Laxmi fell into prostitution and joined the many thousands of Nepali women working in the country’s flourishing sex industry.
Trapped, intimidated and unable to access healthcare, it was a chance meeting with a local volunteer from the Nepal Red Cross which led to her taking an HIV test and awakened her to the reality of the serious health risks facing all those in the often hidden and marginalised sex industry.
Fortunately for Laxmi, her results came back negative but the experience touched her profoundly. Realising many other sex workers in her community could be at risk, she felt compelled to help coax them out of the shadows of fear and ignorance and create a safe space, free of judgement and fear of reprisal, in which they could come forward for help and support.
True to her word, in 2010 Laxmi set up Goreto Nepal, a support group that now helps over 200 sex workers at risk from HIV to get the support so often denied them in environments weighed down by social stigma and criminal punishment.
The life-changing impact of community-led groups such as Laxmi’s Goreto Nepal is a clear example of how local people and their communities can often fill healthcare gaps and extend a hand to those at risk of being excluded, or left behind, due to difficult circumstances or intimidating environments.
HIV in the Asia Pacific may have dropped off the media radar but the disease is still blighting the lives of almost 5 million people across the region. Many vulnerable and most-at-risk populations, such as Asia’s sex workers, are still unable to access life-saving HIV testing and treatment services.
Stigma, discrimination, fear of punishment, and a lack of awareness are just some of the barriers and obstacles that have resulted in Asia’s sex workers having a 29-fold higher risk of HIV infection than the general population. While these populations remain hard to reach and marginalised, one overlooked solution lies in local volunteers working directly with those at risk.
Given human resources and capacity constraints, the HIV and Aids needs of most populations cannot be addressed through professional healthcare services alone. Healthcare workers in Asia do valuable work but are too often overstretched and in short supply, meaning many remote or hard to reach communities either wait for help or simply go without.
But HIV awareness, counselling and testing can be also be performed by lay community members. Therefore shifting basic HIV related tasks to trained teams of local community health workers, including health volunteers from local organisations such as the Red Cross Red Crescent, can ensure higher rates of testing, treatment and adherence, thus containing the spread of the disease in communities which currently lack adequate HIV services.
In terms of economics, it is much more cost-effective to treat infected individuals earlier rather than later. Therefore, scaling up community-led testing and treatment services could potentially generate returns up to three times the initial investment and relieve the burden on ailing national health services
As an African woman, and one who comes from a community and family both affected and infected with HIV, I have seen first-hand the difference that community care and support can make in the life of an individual and the larger community.
By including local people such as Laxmi in community health and HIV support work, sex workers and other vulnerable groups are more likely to come forward for testing and treatment. Despite the goodwill of doctors and nurses, in certain environments the overarching fear of officialdom, judgement or even criminal punishment can discourage people such a sex workers from coming to health clinics for sexual health services and HIV testing. A local face, with the trust and understanding of the community, could ultimately be the solution to breaking down non-clinical barriers such as stigma, fear and discrimination.
The removal of repressive legal, social and economic barriers that reinforce discriminatory laws and stigmatising practices and prevent equitable access to vital HIV-related services for sex workers and other vulnerable populations at higher risk of HIV will be a fundamental aspect of discussions during this week’s 2014 International Aids Conference in Melbourne.
In Melbourne, volunteer-based organisations such as the IFRC will also be calling upon governments to recognise, support and protect community health volunteers and their valuable role in HIV prevention and awareness. The Red Cross Red Crescent has over 17-million volunteers worldwide, many of who are on the raw and difficult frontlines of the HIV response in some of the world’s most troubled and impoverished communities.
The goodwill, determination and ambition of the community health workforce, including health volunteers, should be managed and developed and not simply exploited as a form of cheap labour. Governments and partners need to do more to capitalise on the intimate local knowledge, the dedication and untapped skills of communities and community-led organisations and ensure their presence is taken seriously as part of the global HIV solution.
Dr Tonya Nyagiro is head of the HIV and TB Unit at the International Federation of Red Cross and Red Crescent Societies (IFRC).