“I was diagnosed HIV positive in 1995 in Mexico City. I had moved out of Belize the first chance I got, because it was too difficult being an openly gay person. I met my partner, who was HIV positive, in Mexico. I was accessing medical services through him, but after he died, I couldn’t access them anymore, so in 2008 I decided to come back to Belize. I was shocked at what I found here. The HIV services were terrible compared to what I had been used to in Mexico City, and if I said I’m a gay person, the nurses started talking to me about Jesus and god and how I could change.” —Eric Castellanos, executive director of CNET+
1. Train peer educators to do outreach among HIV-positive GMT, including performing house visits that promote antiretroviral therapy (ART) adherence, positive health, and HIV risk reduction
2. Offer a text message service to remind clients with poor adherence to take their ART
3. Reduce stigma and discrimination against GMT in Belize
4. Distribute condoms and lubricant
Members of CNET+ perform a survey that asks patients to evaluate the quality of their HIV care.
CNET+ began in 2009 as a support group for HIV-positive people. At the time there were very few pyschosocial support services targeting people with HIV in Belize, and Castellanos reports that in the beginning it was very difficult to locate people with HIV to invite them to join the group. “I realized HIV-positive people were totally isolated here in Belize, so I decided to help get us organized,” he says.By 2010, the group had grown to 35 people, and they decided to apply for membership in the Central American Network of Persons Living with HIV (REDCA). REDCA provided them with the technical assistance and guidance necessary to form their own network for HIV-positive people, and in 2011, CNET+ became a legally registered organization.
In addition to providing a sense of community and mental health support, CNET+ offers its clients essential guidance about treatment adherence and daily health practices, which they often do not receive in formal healthcare settings. “The most you are with the doctor is five minutes, and they just look at you and give you your medication without doing a proper medical checkup, or a viral load test,” says Castellanos. “People here are shocked when they hear that I have been living with HIV since 1995, because we don’t have a lot of people with HIV in Belize that live beyond ten years.”
Belize has an HIV prevalence rate of 2.3%, the highest of any Central American nation, and it does not track HIV rates among GMT. Only four of the 12 English-speaking Caribbean nations collect HIV data for GMT, and each of those reports rates higher than 20%—suggesting the rate among GMT in Belize is much higher than among the general population.
CNET+ used its initial grant from amfAR to establish a peer education program that provides clients with the HIV information they need from people dealing with health issues similar to their own. The program begins with a two-week training workshop for the peer educators, at the end of which they take a test and receive a diploma. Graduates then make weekly visits to HIV-positive clients, often visiting them in their homes, to counsel them about mental health, improving adherence to treatment, reducing their viral load, and improving their HIV transmission risk reduction abilities. “The curious thing is, it didn’t take a lot of effort from us to convince these people to change and adopt healthy behaviors,” says Castellanos. “Just the fact that they could identify themselves in a group, and were able to see other people who have lived beyond five, six years—that was enough to put the fire inside of hope.” The educators also do outreach in public places such as beaches, cafes, and parks, and send out text messages to remind clients with poor adherence to take their pills.
Since launching the peer education program, CNET+ has expanded its services to improve the overall health and wellbeing of HIV-positive people in Belize. Their programs now include a nutrition assistance program and a scholarship program that sends clients who don’t know how to read and write to school for one year. They also recently completed a survey asking patients across Belize to evaluate the HIV care they receive at healthcare facilities. Additionally, as a partner in the GMT Initiative’s Evidence in Action program, CNET+ is currently working with an expert evaluator to formally analyze the success and cost-effectiveness of their treatment adherence program. After the evaluation is complete, CNET+ will use the results to market their evidence-based, community-led program to larger donors, such as PEPFAR or the Global Fund.
Homophobia remains widespread in Belize, and anti-gay rights protests erupted across the country this summer, deterring many GMT from accessing CNET+’s services or from becoming peer educators. To combat the homophobia, CNET+ is launching a weekly radio show about HIV and vulnerable populations, using funding from amfAR. The show will feature openly gay and trans individuals, along with doctors and other medical experts. In addition to discussing HIV, the show will include personal stories about how marginalization negatively impacts the lives of HIV-positive and LGBT people, who are often abused by their families and communities and forced out of schools and jobs. “We are going to try to counteract all the bad publicity out there with facts, and inform people that we are human beings and we have the same rights as human beings,” says Castellanos.