Increase and Expand HIV Testing Options Program (Quero Fazer)

Category 1

The Increase and Expand HIV Testing Options Program, or Quero Fazer as it is socially known, focuses on increasing HIV testing rates and coverage for socially excluded gay, MSM, and transvestite populations. It also aims to increase the number of gay, MSM, and transvestite individuals who receive their test results using rapid test at alternative and conventional testing sites. The practice focuses on strengthening linkages between target communities and local public health care systems and combines the training of counselors, mass media, and innovative approaches such as mobile units to target vulnerable populations not traditionally reached. The program was implemented as a collaborative effort between local NGOs and the public health sector. For example, state and municipal programs were asked to provide vehicles to transport trailers to mobile VCT testing sites, local NGOs were asked to host VCT services, and Brazil’s National AIDS Programs provides rapids testing kits. Three pilots (two static and one mobile) were started by the end of FY2009 that provided counseling and testing. As of May 2010, 33,280 people have been reached by educational activities including peer educators. A total of 8,131 people have been tested for HIV by the end of May 2010. 1,611 people from gay, MSM, and transvestite population who self declared their sexual orientation were tested using rapid test. 45% of people tested in mobile testing services reported never being tested for HIV.

Goal of the Practice
  • Increasing HIV testing rates and coverage for socially excluded gay, MSM, and transvestite populations
  • Increasing the number of gay, MSM, and transvestite individuals who receive their test results using the rapid test at alternative and conventional testing sites.
Core Components
  • Installation of VCT services using the rapid test in NGOs with strong histories of serving the gay population in Rio de Janeiro and Recife
  • Implementation of mobile HIV testing services using the rapid test in Recife and Brasilia
  • Formation of partnerships between NGOs and public VCT testing services in Recife and Rio de Janeiro to promote the realization of the rapid test
  • Realization of information, education and communication campaigns with peer educators and electronic technologies such as internet sites, a blog, and SMS to promote VCT services offered as part of the project
  • Design and implementation of a mixed-method case study, conducted in three stages by an external consultant, to test each pilot strategy and make recommendations for public policies on prevention services directed at vulnerable population groups
Noteworthy Results
  • Total of 8,131 people tested for HIV in the services supported through this program by the end of May 2010, including 2,561 in the trailer, 534 tests in the NGOs, and 5036 in the public health services (including indirect beneficiaries in public health service)
  • 1,611 people from the gay, MSM and transvestite population who self-declared their sexual orientation were tested using the rapid test in supported services, including 1,136 in the trailer, 336 in the NGOs and 139 in the public health services
  • 45% of the people tested in the mobile testing service reported never having been tested for HIV
  • 33,280 people reached in IEC activities realized by peer educators
  • Program’s website averaged 800-900 hits a month, grew to 4,500 in March 2010
  • Partnerships formed with and between 10 public health service organizations and NGOs formalized
  • -3 pilots services outlets providing counseling and testing according to national and international standards
  • 246 MSM, gays, and transvestite people receiving HIV test results
  • 2 websites dedicated to the gay population, disseminating HIV and VCT information through partnership with Pact
Lessons Learned
  • Access is key: offering high quality VCT with the rapid test in locations that are of easy access to a variety of population groups in a trailer that circulates enough to create an environment of curiosity and interest to those who see it, combined with peer educators that promote a service that is immediately available, has contributed to the mobile testing strategy being the most successful of the three strategies to date
  • Public health services do not have to be confined to buildings; this project has proven the importance of thinking outside the box and incorporating public health professionals and networks in new locations to expand the reach of public health services
  • Barriers to HIV testing in general include the persistence of stigma towards gays, transvestites, and people living with HIV, which are linked to a fear of positive test results and being seen entering public HIV testing services
  • Service delivery design can contribute to a reduction of stigma and discrimination by creating spaces for interaction across population groups, as demonstrated by the general population seeking out the trailer and NGO service, despite both being openly directed towards the gay, MSM and transvestite community
  • Mass communication strategies (in buses, subways, and public spaces outside gay community) are key to reach the MSM population
  • Weaknesses in the public health services in terms of guaranteeing HIV treatment and care and the extensive bureaucracy for contracting health professionals and procuring equipment led to the creation of informal mechanisms to implement the pilot services, posing challenges for sustainability and highlighting the need for a more efficient public health system in addition to project structures that allow for more extended periods of implementation
Focus Areas
Counseling and TestingPrevention
Implemented By
Pact Brasil
Participating Organization
N/A
Region
Latin America & Caribbean
Country
Brazil
Environment
Clinic/Health facility
Setting
Urban
Target Population
  • Adults (over 18)
  • Males
  • Men who have Sex with Men (MSM)
Scope
25000 - 50000
Implementation Years
10/2008 - 09/2010