High quality counseling and testing is vital to reducing the HIV epidemic. It helps people to assess their risk of infection and identify ways to change their behaviour. It also opens the door to other HIV prevention and care services.
Highly stigmatized populations in Antigua – including sex workers and men who have sex with men – experience various barriers to HIV testing. Migrant Spanish-speaking sex workers face greater obstacles due to fear of being reported to immigration authorities if tested HIV positive, and because there are no Spanish-speaking HIV counsellors.
Spanish speakers account for approximately 10,000 of Antigua’s 70,000 people and around 70% of the women work in the sex industry.* Many Spanish-speaking sex workers and migrant sex workers from Guyana and Jamaica choose to test in private laboratories. They prefer to receive a same-day result and are keen to avoid both real and perceived stigma from health workers at government sites.
Private laboratories conduct far more tests than public sites but do not provide pre- or post-test counseling, despite reporting a rise in positive results. Some labs require personal ID, which may act as a deterrent to migrants who fear deportation.
To address these issues, Antigua plans to be one of the first islands in the region to introduce rapid testing in government facilities. The Ministry of Health is preparing to launch a pilot programme and is training twelve community nurses to conduct the tests.
The Caribbean HIV/AIDS Alliance (CHAA) is supporting this effort. Earlier this year CHAA staff attended a training programme on quality assurance in rapid testing, conducted by the US Centers for Disease Control and Prevention (CDC). This was the first in a series of sessions involving CHAA and partner organisations.
To reduce demand on health workers, CHAA is building parallel capacity in the community by training community- and peer-based counsellors and testers according to the regionally recognized standard.
Between 27 April and 1 May, CHAA hosted a baseline training session for these workers conducted by CHART (the Caribbean HIV/AIDS Regional Training Network) and JHPIEGO in collaboration with Antigua’s National AIDS Program.
Among the eighteen people certified were five CHAA Community Animators. These peer educators take sub-culturally specific prevention messages to harder-to-reach, most-at-risk populations in Antigua, who are not covered by mainstream services.
“It was inspiring and another step in making our work complete,” said Community Animator Rickenson Ettiene. “The training helps us because soon rather than referring our clients to other services, and having them re-hash all their issues with another person, we will be able to provide counselling and testing in a one-stop shop for our clients. It’s ground-breaking to be involved in.”
The training also produced the first four Spanish speakers to be certified in HIV counseling and testing in Antigua. These included two native Spanish speakers who work with CHAA as peer educators reaching migrant sex workers.
For the first time a laboratory technician was trained, setting a precedent for integrating counselling in the testing process performed in private labs. This new capacity will ensure stronger referrals to the National AIDS Program and Clinical Care Coordinator to ensure clients can receive prevention, care and support services.
Another pioneering step of the CHART/JHPIEGO training was the certification of representatives from community-based organisations such as the Health, Hope and HIV Network, a support group for people living with and affected by HIV, which seeks to operate a testing site. These developments all move towards decentralization of HIV rapid testing in the region.
Following the first baseline training, CHAA, Intrahealth and CDC hosted an advanced and new counseling and rapid testing curriculum for most-at-risk populations between 20 and 24 July 2009 for both community and government HIV counselors. CDC also introduced its new technology of Dried Tube Specimens Proficiency Testing (DTS) to help ensure quality assurance of rapid testing.
CHAA and the National AIDS Program will continue to work closely with the newly-trained Community Animators, community-based groups and laboratories to support and mentor their HIV rapid testing activities.
* COIN, Centro de Orientacion e Investigacion Integral, Trabajo Sexual, Trata de Peronas VIH/Sida, Abril 2008.