MELBOURNE’S peer-led HIV rapid testing clinic PRONTO! could serve as a model in other countries, but may need to adapt to overcome the criminalisation of homosexuality in many parts of the world.

On a tour of the government-funded clinic run by the Victorian AIDS Council, politicians from Sri Lanka and Nepal visiting Melbourne for the AIDS 2014 conference discussed ways of making a similar service work in their home countries. PRONTO! is based on San Francisco’s Magnet clinic, with testing by trained facilitators from within the gay community.

Pathmanathan Sathiyalingam is the health minister of Sri Lanka’s Northern Province, and while he was interested in bringing a peer-led clinic targeting men who have sex with men (MSM) to Sri Lanka, the country’s criminalisation of homosexuality would make it difficult.

“I’d prefer to have a service like this, but in our country MSM, lesbians, homosexuals, the gay community, we can’t identify people like that because it is illegal, and not accepted by the community, culturally,” he told the Star Observer.

Although the laws criminalising homosexuality in Sri Lanka are not enforced, LGBTI people living in the country face discrimination and harassment.

Sathiyalingam said if a rapid testing clinic also offered a range of other services, it would provide some anonymity and help reduce stigma associated with being seen using the clinic. While HIV prevalence in Sri Lanka is thought to be relatively low, Sathiyalingam said barriers to testing for MSM meant there could be a lot of undiagnosed HIV in the community.

“People in the community with the disease don’t come and check—there’s no way to come and check,” he said.

“I think if we have a facility like this, even though we don’t identify people who are MSM and other communities like the gay community or lesbian community, of course they will have access to this service.”

While a peer-led service couldn’t be advertised to the gay community in Sri Lanka, Sathiyalingam said he expected peer networks would be a way to get men who have sex with men into the clinic to be tested.

Nepalese MP Rajeev Bikram Shah said there would be fewer problems with implementing a peer-led clinic in Nepal, a country that has made significant advances in LGBTI rights in recent years.

Despite social stigma and discrimination, the country has been implementing widespread anti-discrimination protections, and in 2011 recognised a third gender in addition to male and female.

“People will be scared to come into government clinics, and these sort of peer-led clinics could play a role in reaching to the community who are most vulnerable,” Shah told the Star Observer.

He praised the work of renowned Nepalese LGBT rights organisation Blue Diamond Society, but said a lack of funding, and a lack of coordination between these groups and government was a major barrier to establishing a service like Pronto. Shah hoped to be able to facilitate that coordination.

HIV rates in Nepal are low overall, but the country faces concentrated epidemics in at-risk communities including MSM, female sex workers and injecting drug users.

The PRONTO! rapid testing clinic has seen a gradual ramp up of appointments since opening in August last year, and recently added rapid syphilis testing to its services.

Recent data from the clinic has indicated the majority of gay men using the service are younger—80 per cent are under 39 years of age—in contrast to slightly older demographics at some of Melbourne’s other high caseload clinics for HIV testing, such as Prahran Market Clinic.

The service will expand over the next few months, with plans to open a satellite clinic at one of the Victorian AIDS Council’s sites in Melbourne’s inner-south.

(Image: Pathmanathan Sathiyalingam (right) and Rajeev Bikram Shah (middle) with Victorian MP Clem Newton-Brown (left) seeing HIV rapid testing kits at Pronto. Photo: Benjamin Riley; Star Observer)


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