Tabanan, This week I will write about Yakeba’s outreach work and peer support program in the regency of Tabanan. The purpose of this article is to give an overview of the work done by Yakeba’s outreach workers and discuss some of the arising subjects.
Yakeba’s Tabanan office is located in the sub-district of Kediri, in eastern Tabanan regency. The Global Fund supported outreach and peer support program covers the entire regency of Tabanan, which is further divided into 10 sub-districts (kacamatan). With a population of almost half a Million people Tabanan is densely populated (as most parts of Bali) but has maintained a predominantly rural character. To reach all corners of the regency the outreach workers have to cover considerable distances, with road conditions being poor in many areas.
Currently Yakeba employs six outreach workers, who reach out to people living with HIV and AIDS as well as populations at high risk of contracting HIV (mostly sex workers, clients of sex workers, men who have sex with men (MSM) and transgender). The outreach workers are all from vulnerable communities themselves. Some are ex-drug users, others were involved in some form of sex work or are MSM. Some are living with HIV and AIDS themselves. Having similar backgrounds as many of the people they reach out to facilitates their work in several ways. They can not only relate better to the problems and obstacles faced by their clients, but are also more easily trusted by them. As many clients are marginalized by society as a result of their occupation or sexuality and the issues of HIV and AIDS are surrounded by secrecy and stigma, gaining the trust of their clients is crucial to successful outreach and support.
The duties and responsibilities of the outreach workers are manifold. Educating high risk populations and to a lesser degree the general public, about issues surrounding HIV and AIDS, stands at the core of their work. They regularly frequent so called HIV hotspots, such as kafe (local bars), lokalisasi (red-light districts), massage parlors and places where MSM and transgender congregate. There, the outreach workers distribute free condoms and water-based lubricant sachets along with information leaflets about its correct usage and HIV and STI prevention. During individual or group counseling the importance of regular STI check-ups and their treatment at a cost free STI clinic are stressed. Clients are actively encouraged and referred to one of the VCT (Voluntary Counseling and Testing) sites in the region to know their HIV status. Mobile VCT and STI testing on the spot (mostly at kafe) was organized a number of times, in conjunction with the local health department and AIDS commission. Apart from the prevention work the outreach workers help to fight the widespread discrimination and stigma related to HIV and AIDS within the community by organizing educational gatherings with local community leaders and the local population. Issues such as drug and alcohol abuse are also raised during outreach activities.
Some of the outreach workers also serve as buddies for clients living with HIV and AIDS. The buddies themselves are living with HIV and AIDS. That way clients get the chance to talk to another person with the same disease, get first-hand information about the buddies experiences as well as general information about HIV and AIDS. They have someone who listens to their own stories, problems and worries. Thus the buddies provide emotional and psychological support, provide social support and friendship and connect their clients with other PLWHA. They also provide practical support like home visits, accompany clients to hospital and help them access financial assistance from the relevant authorities. Clients also have the possibility to discretely contact their buddies through text messages. For some of them that is the main mode of interaction with the outreach workers, as they keep their HIV positive status a secret and are afraid that visits from Yakeba buddies would make family members or neighbors suspicious.
Yakeba’s outreach workers also attend to AIDS patience at the hospital. They regularly visit their clients at the AIDS ward in Tabanan Hospital. Especially for patients who have no family or friends to look after them, these visits are of great importance. Recently for example one of the outreach workers helped to feed and wash a terminally ill woman, who was dropped there a couple of days before by some family members who rejected her (her husband and child already passed away because of AIDS). Nothing but skin and bone, she lay there dying alone. The medical personal neither washed her nor assisted in feeding her, things which are supposed to be done by family members. In such situations, an assisting hand and some supportive words by an outreach worker can restore the dignity of a patient.
Unfortunately, despite encouragement by our outreach workers, many people at high risk of HIV infection are still reluctant to test for HIV. Consequently late diagnosis of HIV remains a serious problem, with a majority of people already having developed AIDS at the time of HIV diagnosis. Many patients are diagnosed only after having been hospitalized as a consequence of one or several opportunistic infections. This not only reduces the chances of survival but also reinforces the image of HIV and AIDS as something untreatable and inevitably deadly. Routine VCT of people at high risk of HIV could not only prevent the further spread of the disease, but also reduce the morbidity and mortality of people infected with HIV. But as free antiretroviral treatment is only available for people who have already reached the stage of AIDS, early diagnosis could not safe the vast majority of people who have no means to pay for their medication themselves.
Being confronted with tragic destinies, disease and death on a regular basis, outreach workers need to have a thick skin. But asking my colleagues how they deal with their often difficult work, they emphasize the many success stories. Helping to prevent people from becoming infected with HIV, reducing discrimination and stigma against PLWHA and seeing people literally rising from deathbed to become strong and active members of society again is rewarding indeed.
By Felix Neuenschwander