In Guatemala, HIV Self-testing Brings Care and Hope During COVID-19

By The Global Fund

January 28^th, 2021

When COVID-19 arrived in Guatemala, the community health center where Bryanna and her fellow sex workers got tested for HIV closed its doors. “It was like the end of the world to many of us,” says the 25-year-old transgender woman. “We were afraid because we had to continue working and we had lost our support groups.”

In Guatemala, HIV Self-testing Brings Care and Hope During COVID-19

For Ben Kei Chin, an openly gay television personality, it seemed that a vital link had been broken that day, leaving many members of the LGBT community isolated and vulnerable. “Many people stopped getting tested,” explains Ben, 37. “Our services and programs were interrupted because of COVID-19, and people did not feel comfortable going to other health centers. It was like coming out of the closet all over again.”

With support from the Global Fund, a pilot of self-testing kits is helping people like Bryanna and Ben get access to HIV prevention and diagnosis in times of COVID-19.

COVID-19 has disrupted health programs in Guatemala, particularly damaging HIV services tailored to key populations which are already disproportionately affected by HIV. In Guatemala, transgender people and men who have sex with men often confront stigma, discrimination and social exclusion, and rely on community health centers and peer support groups. Confinement measures further cut off lifesaving services and emotional support.

The kits, which are being promoted through Facebook, Twitter, Instagram and YouTube, are delivered by post and include a self-test, condoms, lubricants and brochures on how to stay healthy. The test is easy to use and requires no blood. Using a swab, the tester collects oral fluid from the gums. The swab is then inserted into a test tube and the results are ready in just 20 minutes. Implemented by two community-based organizations – Colectivo Amigos Contra el Sida (CAS) and Organización Trans, Reinas de la Noche (OTRANS) – the pilot was launched last May in Guatemala City, and there are plans to extend it to other parts of the country, given its positive reception. Cesar Galindo Arandi, director of CAS, says the kit has been sent to people who use pre-exposure prophylaxis (PrEP), as well as those who get tested for the first time. “Thanks to the self-test kits, we managed to maintain the same level of HIV testing during the crisis,” Cesar says.

Bryanna, who makes a living as a sex worker, says she found out about the kit through social media. “The kit is very easy to use, and I can do it at home, so now I can test myself periodically.”

Bryanna has been spreading the word about self-testing to other transgender sex workers. “At the beginning of the crisis, many of us put ourselves at risk. I’ve been telling my friends about the self-test, and many have signed up for the kits. Now we feel safer and more protected. Health always should come first,” she says.

Bryanna says she studied business but never managed to get a job in her field “because of the way people look at me.” Like many transgender people in Guatemala, she makes a living as a sex worker, braving stigma, harassment and violent street gangs. Transgender women in Guatemala experience very high health risks. HIV prevalence among transgender women is over 23% compared to less than 1% among the general population.

At OTRANS, Bryanna and other transgender women have found emotional support during times of crisis. “When people stigmatize you, the best thing is to ignore it and go on with your life, because after all, life is but the blink of an eye.”

Ben, who works as a journalist and is an activist for LGBT rights, says COVID-19 profoundly affected health services for the LGBT community. “HIV services for key populations were severely affected, so our links were broken. Many people missed out on testing for months. Our friendly community services were no longer there and people found themselves alone and lost confidence in going to other services because they had to open up about their sexual orientation. Many people were left behind.”

Ben says he found out about the self-test kit through an HIV-positive friend who introduced him to CAS. “There is a lot of word of mouth going on about the kit. It is an excellent opportunity to keep up doing your tests without going to a clinic.”

Ben, who is very active on social media, says social media has played an essential role in supporting vulnerable groups during COVID-19. “Social media has kept alive many of the links in the LGBT community that disappeared with COVID-19, such as community groups and health education. We learned to organize ourselves differently.”

COVID-19 has taken the focus away from other infectious diseases such as HIV. But Ben says the fight against HIV should not lose its momentum. “In Guatemala, many young people still don’t know their status. It is important to remain visible and fight stigma. There is still a lot of prejudice, but we have many allies. We will turn the page on hate.”