Setting the standards for sexual health support for MSM - Community Health Work in Cyprus

www.ECHOESsurvey.eu

Hello, could you introduce yourself and tell us where you work?

My name is Christos Krasidis and I am an activist focusing on HIV/AIDS, humans rights and the LGBT+ community. I am a volunteer of the “AIDS Solidarity Movement - Cyprus (ASM)”. I am a Board member of ASM since 2015, and at the same time act as the Communications Representative. I am also a trained “Community Health Worker” at “Cy Checkpoint”, ASM’s Prevention and Testing Centre for HIV and Other Sexually Transmitted Infections, providing pre- and post test peer-counselling and linkage to care. ASM operates in a very diverse environment, as Cyprus is a small country of a population close to one million, which includes a variety of cultures, attitudes, and with three languages used: Greek, Turkish and English. Under these circumstances, our main aim is to reach key populations, such as MSM, sex workers, migrants, people who use drugs, and of course the wider public. We have been supporting People Living with HIV (PLWH), their families, partners and friends since our establishment in 1989, as a non-governmental and a non for profit organisation.

In the ECHOES we’re using the term ‘Community Health Workers’ to describe you and your colleagues. Community Health Workers are known by a variety of titles such as outreach worker, health promoter, peer educator etc, but in ECHOES we mean: Someone who provides sexual health support around HIV/AIDS, viral hepatitis and other sexually transmitted infections to gay, bisexual and other MSM. A Community Health Worker delivers health promotion or public health activities in community settings (not in a hospital or clinic). Does this definition apply to you? We know you probably don’t call yourself a Community Health Worker right now, so what do you call yourself?’

I use different terms to describe what I do, depending on my role at each time. Some of the terms are “peer counsellor”, ‘’trained testing counsellor’’, “human rights activist”. The term “Community Health Worker” is also a current term I have been using lately, as I feel it is practical, inclusive and precise at the same time. 

Tell us, what kind of things do you do as a CHW? What makes you a Community Health Worker? Why do you identify as CHW?  What skills in your opinion are needed to be a good Community Health Worker?

The way “Cy Checkpoint" operates, offering Outreach Rapid Testing currently for HIV and Syphilis, is extremely important, not only because it provides an easy access to routine testing, but also because it gives the opportunity for people to get free counselling, from the community to the community. I feel that a CHW needs to be trained to provide testing, as well as pre- and post-test counselling. However, the ability to advise without judging, to be accepting and inclusive, to be knowledgable and understanding, in order to make the client feel safe and secure, are virtues a CHW must develop and exercise. I believe this is what differentiates CHW and makes them special, compared to services offered in the public sector.

A CHW needs to have a comprehensive knowledge and competence on sexual health issues, especially concerning HIV, STIs and hepatitis. He/she needs to develop counselling skills and to be a warm, welcoming, non-judgmental person. It is also important to be well trained in the delivery of testing services, in managing stressful situations and in working within a team. 

What are the barriers that you experience, meaning what you can and cannot do as CHW in your country and what support do you need?

There are two main barriers I feel are the most important obstacles for our work to continue, to develop and to flourish: lack of funding and non-official recognition of our work.

The first, lack of funding, is of great important, especially for small communities and small countries like Cyprus. We strive to get financial support to continue our outreach testing activities all around Cyprus and and to expand our services through a permanent space to house the Cy Checkpoint. We do get a warm welcome from various venues we offer testing, such as gay night clubs, saunas, bars and at festivals/events like the Cyprus Pride. The of funding is crucial for us, as the test-kits are more expensive due to making orders of smaller quantities, and thus the unit cost is higher. Volunteerism is great but has limits, as people need to offer their services as CHW on top of their daily jobs.

The second barrier is the non-official recognition of our work. The Ministry of Health in Cyprus supports our activities, but it hasn’t yet officially recognised the importance of Checkpoints as a successful community-based model that just works. The lack of a Pan-European umbrella of CBVCT Centres is also not helping, in order to make us stronger and sustainable. We could have had a far bigger impact in our communities, and towards reaching the first 90% of the 90-90-90 target, only if we united and demanded an official strategy by the State, that would support our work and allow us to expand. Unfortunately, NGOs in Cyprus are primarily struggling to survive.

Do you have any success/interesting stories that you would like to share?

Simple stories are the ones closest to my heart. The number of times a beneficiary (this is how we often call clients in greek) has a non-reactive test and starts crying, only to ask for a hug in order to express their happiness and gratitude, is so genuine and real. The times when a reactive test is at place and the beneficiary agrees that you accompany them to public care, achieving linkage to care are of true importance, only to find out that a few months later they decide to join ASM and become our volunteers. The times you discover exceptional journalists, who agree to help any way they can, in order to combat stigma around HIV/AIDS and PLWH, treating this sensitive issue with humanity and maturity, is of great importance. The anonymous messages sent to the Cy Checkpoint via various channels, expressing gratitude and support in our work gives us the courage to continue. Simple stories from simple people are our success stories :)

Find out more information at: http://asmcyprus.org/asm/ETW2017_-_en.html

And on our Facebook page here: https://www.facebook.com/asmcyprus/

Further information:

ECHOES is part of ESTICOM project funded by the European Health Programme 2014 – 2020. ESTICOM also includes EMIS 2017 the survey addressing gay men and other MSM and a training programme for CHWs in order to improve access and quality of prevention, diagnosis of HIV/AIDS, STI and viral hepatitis and health care services for gay men and other MSM. The project is coordinated by the Robert Koch Institute in Berlin.

The Project is an important opportunity to strengthen community response und raise awareness about the persisting legal, structural, political and social barriers hindering a more effective response to the syndemic of HIV, viral hepatitis B and C, and other STIs among MSM. Early findings are expected in the Spring of 2018.

To take part in the ECHOES survey go to: www.echoessurvey.eu

To find out more about the project go to: www.esticom.eu