Over the summer, I visited Brazil with representatives from USAID’s Caribbean Regional HIV Program. The Caribbean team was interested in learning about USAID/Brazil’s innovative HIV counseling and testing program, Quero Fazer, which is implemented by the Associação Espaço de Prevenção e Atenção Humanizada (EPAH).
EPAH manages Quero Fazer, a project designed specifically to reach most-at-risk populations (MARPs)—primarily transgenders and men who have sex with men—with HIV prevention and counseling and testing services. We visited Quero Fazer’s mobile clinics in Recife, on the northeastern coast, and in Brasília, the capital. The mobile units provide services at night and in areas where the target populations gather.
We also went to Rio de Janeiro, where Quero Fazer manages a late afternoon to night-time counseling and testing clinic within the office of Arco-Iris, a nongovernmental organization (NGO) that focuses on gay, lesbian, bisexual, and transgender issues.
Through the mobile units and the NGO site, Quero Fazer has forged, with USAID/Brazil’s support, a unique partnership between NGOs and public health programs. In all of its sites, community members serve as peer educators and work to mobilize patients to access the free services. Meanwhile, municipal and state health officers work at the sites to provide the counseling and rapid HIV testing. For patients who test positive, clinic workers make appointments for them at specific clinics and hospitals, where health providers have been trained on working with MARPs. This level of government support is critical to the success of the pilot program, which operates off of minimal funding, and helps to foster expansion and sustainability.
Quero Fazer experiences such success because of their innovative and creative planning. The project’s ability to make the mobile units a social space helps them administer 50 – 100 tests in a single night.
This was most evident in Brasília, where the trailer is stationed next to an outdoor bar in a park. In this location, people leave the dance floor to hang out near the mobile clinic, talking with friends among the dance music and waiting their turn for an HIV test.
In Recife, we saw firsthand how the presence of a mobile clinic can spark one’s interest in obtaining an HIV test. While we were there learning about the clinic our taxi driver decided to get an HIV test.
I did not notice this at the time, but as he drove us back to our hotel, he told us that he had gotten his first HIV test while we were there. He was very excited and relieved to find out he was negative, and told us how nerve-wracking it had been to wait for his results. He said it was something he had been meaning to do, especially since his mother is a nurse and had worked with AIDS patients. After the stressful experience, he was adamant that he wouldn’t engage in any behavior that would put him at risk for acquiring HIV and having to go through waiting for an HIV test results again.
It is clear that together, the government of Brazil and USAID have been successful at piloting and expanding a much-needed service for MARPs. While USAID provides resources to support overall implementation of the program, the government of Brazil supports the program at the federal, state, and municipal levels by providing rapid test kits and staff to work at the clinics. Learning about this experience has reminded me how much can be achieved with small amounts of money and collaboration at all levels.