by Alejandra Cabrera, Regional Strategic Communications, PASMO
Fernando was only 11 years old when he joined the circus.
As a young child growing up in the coastal port-town of Puerto Barrios, Guatemala, Fernando would perform circus shows with his siblings and cousins who couldn’t afford tickets to an actual show. Using old pieces of fabric and pipe scrap, Fernando created a “circus tent” for their performances.
Fernando soon dropped out of elementary school and joined a local circus to support his family full-time. “I took my first trip with the circus at age 14,” recalls Fernando with a hint of nostalgia. “…I’ve been traveling around the country ever since.”
By age 23, Fernando had dedicated more than a decade of his life to the circus. He began to experience a budding sexuality which included an attraction to a male performer, but he never dared express his feelings for fear of rejection and discrimination. Because of this, he kept his brief relationships discreet.
But Fernando longed for a more enduring connection. In October of 2017, while performing in the western city of Quetzaltenango, this longing persuaded him to open a mobile phone app to meet other nearby men. A profile that mentioned HIV testing got his attention: it was the profile of a cyber-educator who worked for USAID’s Combination Prevention Program for HIV in Central America, which aims to make HIV testing and counseling services available to men who have sex with men (MSM) and transgender women in the area, both of which are at greater risk of HIV infections.
Despite some doubts and lingering fear, Fernando agreed to take a rapid HIV test after his Sunday afternoon performance. The counselor informed him that it was reactive. After the initial shock, Fernando allowed the counselor to accompany him to Quetzaltenango’s comprehensive care clinic to confirm his test result the following day.
“[The night before the test confirmation] was the longest night of my life”, Fernando says. “I used to know someone in the circus with HIV, but he was forced to quit. He went into hiding because of how his friends and family discriminated against him and mistreated him. I was so scared.”
Fernando’s fears were realized when his HIV status was confirmed at the clinic. He was immediately put in contact with Roberto, the Combination Prevention Program’s “online patient advocate” for follow-up and support via mobile phone calls and messaging apps. Though heartbroken, Fernando remained in contact with Roberto, who checked in on him every regularly to motivate him to begin his treatment and get linked to care. As the months went by, Fernando traveled with the circus through towns and cities across Guatemala but didn’t find the time or opportunity to take the next step. Finally, in March of 2018, Fernando visited his hometown of Puerto Barrios, five months after his initial diagnosis. It was there that Fernando finally heeded Roberto’s recommendation and visited the local comprehensive care clinic, where he was found to have an advanced stage of the infection. Fernando immediately began treatment and was in constant communication with Roberto, who told him about the side effects of the medication and supported him through the emotional consequences of his diagnosis.
Cyber-educators and online patient advocates like Roberto work to achieve the global “90-90-90 goals”: that 90 percent of HIV positive individuals know their status, 90 percent of those who know their status are on antiretroviral therapy medication and 90 percent reach viral load suppression. Throughout Guatemala, El Salvador, Honduras, Nicaragua and Panama, they work to detect new cases of HIV among at-risk MSM and transgender women with online outreach and referrals, as well as field-based promotion of HIV testing and counseling services and online or mobile phone support for individuals living with HIV.
From October 2017 to September 2018, one of every 20 tests the program performed was reactive. With these results, the Combination Prevention Program detected a regional HIV prevalence rate of five percent and more than 450 new cases of HIV such as Fernando’s, all of which received extensive follow-up to ensure their entry into the HIV continuum of care. Online patient advocates throughout Central America provided support to 1,057 persons with HIV via mobile phone calls, text messages and WhatsApp. Using these digital tools, the advocates provide their patients with reminders for appointments or to take medication, motivational messages, responses to queries related to treatment, side-effects and nutrition, and emotional support for topics such as stigma and discrimination.
By October 2018, nearly one year had passed since Fernando first learned he was HIV positive. Now on the road to an undetectable viral load, he credits his improved health to the support of the counselor who first tested him. He remained in contact with Roberto, who helped him tell his mother and sisters about his diagnosis.
“Having HIV doesn’t mean you’ve lost it all,” Fernando asserts. “In fact, I feel like I’ve gained so much. I appreciate being alive and having the opportunity to lead a full life.”
Banner image courtesy of Alejandra Cabrera