Q&A with Dr. Jorge Fernandez: Human Rights and HIV Services for Most-at-Risk Groups in Honduras
The AIDSTAR-Two project in Honduras, funded by US Agency for International Development/ Honduras and led by Management Sciences for Health (MSH), is working with local non-governmental organizations to improve the provision of HIV prevention services to most-at-risk groups, such as men who have sex with men (MSM), commercial sex workers, and the Garifuna, the Afro-Caribbean ethnic group living along the country's northern coast.
Dr. Jorge Fernandez is the Chief of Party for the AIDSTAR-Two project in Honduras, and discusses the intersection of access to services and the importance of human rights in working with these populations.
Describe the profile of the HIV & AIDS epidemic in Honduras.
The HIV epidemic in Honduras is considered a concentrated epidemic with a prevalence rate of 0.68%, representing about 56,000 people living with HIV and 28,000 people estimated to be living with AIDS between the period of 1985-2010. For the most-at-risk populations, prevalence rates range from about 5% for both commercial sex workers and Garifuna individuals and to about 10% for men who have sex with men.
What are some of the challenges in working with the most-at-risk population?
This population carries the highest burden of the HIV epidemic. In addition to having the highest HIV prevalence rates, they are the groups that are most discriminated against and marginalized. They have the hardest time accessing HIV prevention and care services, and they live, for the most part, in situations of extreme poverty. Unfortunately, the HIV prevalence rate among these groups is decreasing more slowly than the rate among other populations.
Can you explain more about the problems of stigmatization and discrimination?
Men who have sex with men and commercial sex workers are two groups that are living in a Honduran society that is very conservative. Society wants to make these groups invisible. They are ridiculed for their sexual conduct and behavior. In general, health service providers and those that offer education and other services are not well disposed to providing care and support to these specific populations. Unfortunately, overall, our society does not want to recognize their human rights as individuals.
Last year, AIDSTAR-Two Honduras launched a small-scale social mobilization program in collaboration with MSM, transvestites and transgender leaders, with the goal of building consensus regarding the barriers to accessing HIV & AIDS prevention services, engaging other sectors, and implementing activities to address the social and structural barriers to HIV & AIDS programs. Where are you now in this process?
This initiative was very welcomed by the organizations that work with MSM, which are primarily formed by men who have sex with men themselves. We were able to work with 11 organizations to form what we call the core group, in charge of leading the planning and implementation of the social mobilization efforts. We did an internal analysis of the social environment from the perception and experience of MSM, on transgender and transvestites in four geographic areas (San Pedro Sula, La Ceiba, Comayagua and Tegucigalpa) complemented by an analysis done by the core group.
The analysis concluded that the machismo issue, the use of drugs and alcohol, having multiple sex partners, and the low or inconsistent use of prevention methods, within the center of MSM communities were the main factors contributing to the HIV epidemic.
We moved forward into developing a strategic plan that included the promotion of human rights, advocacy at very high levels with stakeholders of the public institutions, such as the fiscal unit of the government, the human rights commissioner at the National University, the secretaries of health and education, the National Autonomous University of Honduras and others. We are currently reviewing the strategic plan to ensure that activities not included in the first draft will be included, such as communication, education and outreach to the general population; increasing most-at-risk populations' access to services such as education, housing and comprehensive health care; and organizational strengthening for both local NGOs and the public sector.
Some of the NGOs we support are advocating for these most-at-risk groups' rights. It is going well. There is cooperation from various ministries and the police to end stigma and discrimination.
What is the connection between human rights and the work of the AIDSTAR-Two project?
The direct link is that these populations live in situations where they have limited enjoyment of their rights and freedoms. In addition to the factors I already mentioned, violence is the most critical one, affecting primarily MSM and commercial sex workers in their own communities and their families.
Very limited information has been included around all aspects of sexual health in the education curricula used with the general population. At the individual level, among MARPs we see psychosocial and psychosexual conflicts that lead to very low self-esteem, drug abuse, and increased exposure to other sexually transmitted infections, in general, because all of these factors are connected to the environmental context of poverty.
This work is hard and takes a long time to see changes. What are your hopes, in terms of impact, for changes for MARPs over the next few years?
My vision is that the Honduras society gets to see these individuals as humans and that they are allowed to enjoy their civil rights and freedom. Working together, with partners from the public and private sector, we can improve access to health care and other services that meet their needs and help improve their quality of life.
Dr. Jorge Fernandez has been working on HIV issues since the first case of the infection was detected in Honduras in 1985. He worked for the Secretary of Health to design and establish the National AIDS Program and served as its director for two years, leading the development and implementation of prevention, care and treatment programs. He is a member of CONASIDA, the Honduras National Commission Against AIDS. He is a medical doctor with a specialty in public health.