It was a very hot and humid day, like almost every day in Sambo Creek. Don Alfonzo was sitting on a white plastic chair outside the home of a relative. At age sixty, he shifts his feet on the dirt floor below his chair and looks off into the distance with sadness.
“I cried,” he says, describing the day he learned he was HIV positive.
A village of 8,000 inhabitants on the Caribbean coast of Honduras, Sambo Creek has one of the most concentrated and rich Garifuna communities in the world. This small ethnic group native to Honduras has an estimated HIV prevalence rate of up to 14 percent.
When Don Alfonzo received his diagnosis, he was contacted by a community-based outreach worker with the Pan American Social Marketing Organization (PASMO), PSI’s network member, under USAID’s Combination Prevention Program for HIV in Central America. The program works to reach vulnerable and at-risk members of the Garifuna communities of Honduras with services such as HIV testing and counseling. They also link their clients to care and treatment and accompany them on appointments. Anatolia, known as “Ana,” joined the Program’s team in Sambo Creek as a “recruiter” responsible for generating HIV awareness in her community, the importance of knowing one’s status, referrals to HIV testing services and promoting the benefits of initiating specialized care and treatment for improved health.
“Ana had already invited me to take a test a few days earlier,” describes Don Alfonzo, “but when I got to the community clinic, I saw some people I knew so I just left.”
There are barriers to testing and treatment at clinics in Garifuna communities affected by the HIV epidemic. Most prominent among these barriers are discrimination and social isolation, not only due to their ethnicity but also their HIV status. HIV-positive members of Garifuna communities also fear losing job opportunities and rejection from partners and family members, among other reasons.
As a member of Sambo Creek’s Garifuna community and a facilitator for a local support group for persons living with HIV, Ana was aware that Don Alfonzo lived alone and was known to engage in risky behaviors such as sex in exchange for money. After skipping his first appointment for the HIV test, she contacted him again to help address some of his concerns and was able to reschedule the test.
When it the test returned with a reactive result, “I didn’t know what to do”, recalls Don Alfonzo. When his counselor asked if he wanted to be accompanied to a comprehensive care clinic, he thought of Ana. “I trusted her, so I asked her to go with me to La Ceiba, where no one would recognize me”.
Don Alfonzo is one of more than 450 new cases of HIV identified by the Program among vulnerable and at-risk populations in Guatemala, El Salvador, Honduras, Nicaragua and Panama from October 2017 to September 2018. In an effort to contribute to the global 90-90-90 goals—90 percent HIV positive persons know their status, 90 percent of those who know their status are on antiretroviral therapy and 90 percent reach viral load suppression—recruiters like Ana, as well as other outreach workers and cyber-educators, help identify at-risk users, motivate them to know their HIV status and provide each case with follow-up to ensure their entry into the HIV continuum of care.
In the following months, Don Alfonzo’s health began to improve. He joined the local HIV support group, and more recently discovered the good news that his viral load was undetectable. He shows off one of the small plastic bags of medication that Ana and the nurse helped pack for him.
“This is the beginning of a new phase in my life,” says Don Alfonzo with a shy grin. “I’m grateful for each person who accompanied me every step of the way.”
Banner image: Ana and Don Alfonzo sit outside of his relative’s home in Sambo Creek, Honduras. Image courtesy of Alejandra Cabrera