In a small private room at the offices of Lighthouse, a social enterprise led by men who have sex with men (MSM) in Hanoi, 20-year-old Dung sits comfortably. He is here to get tested for HIV. He chats easily with Thanh, a Lighthouse staff member and a trained HIV testing provider. Dung has recently had unprotected sex, and he sought out his friend Thanh for testing. Thanh tests Dung using an oral-fluid-based rapid diagnostic test—swiping a small swab across his gum, before placing it in a tube of developing liquid. After a few minutes, one line appears on the screen on the test stick, showing that Dung does not have HIV. Once this quick and painless procedure is complete, Dung tells us about the first time he got tested.
"I come from Thanh Hoa, a small rural province in northern Vietnam. The LGBT+ community in Thanh Hoa is quite quiet, and so back home I never really worried about HIV and never got tested. But once I moved to Hanoi to go to college, I got involved in the vibrant LGBT community and had unprotected sex. I knew I needed to get tested as soon as possible."
Dung had got to know Thanh through MSM groups on Facebook. As well as working for Lighthouse, Thanh is an Online Change Agent—an online counselor who connects people to offline HIV services. Thanh was trained to provide both community-based HIV testing and online counseling by PATH’s Healthy Markets project, which is funded by the United States Agency for International Development (USAID).
Soon after Dung’s experience with unprotected sex, he got in touch with Thanh for advice. Thanh advised Dung to come to Lighthouse for testing with a quick and easy-to-use rapid diagnostic test, either administered by Thanh or by Dung himself.
"I felt very worried while waiting the 20 minutes for the results, but while we waited Thanh told me what would happen either way: if the result is negative, he will give me more information about safe sex, and if it is positive, he will comfort me and help me enroll in treatment. I knew that even if the results are positive or negative, he will still keep in touch with me and be my friend."
Community-based testing is an effective strategy for reaching people most at risk of HIV.
Community-based services supported by Healthy Markets, such as those provided by Lighthouse, provide friendly, convenient, and confidential HIV testing to MSM like Dung, as well as other people at high risk of HIV, including transgender women, people who inject drugs, and female sex workers.
“ Since December 2015, 100,655 people have opted for community-based testing, 4,528 (4.5 percent) of whom were since diagnosed with HIV (4,268 have since been linked to treatment). ”— USAID/PATH Healthy Markets project
In contrast, Vietnam’s Ministry of Health reports that 1.6 percent of people who are reached by conventional testing services are diagnosed with HIV—meaning that community-based testing services may be more effective at reaching people most at risk of HIV. Dung says he prefers to go to Lighthouse, because the people who are providing the services are like him.
"I have never gotten tested at a conventional testing center, but my friends have told me that public hospitals are really crowded, the doctors weren’t friendly, and they didn’t provide any advice or counseling. Coming to a place like Lighthouse is totally different. Here we can share our personal stories and share those struggles we are really facing. Now I focus on safe sex but come back for testing whenever there’s a chance of HIV transmission. I’ve referred a lot of my friends to Thanh."
Thanh has been working with Lighthouse as a lay tester and Online Change Agent for around two years.
"I was very keen to become an Online Change Agent because I know that a lot of people in the LGBT community do not know that much about HIV, but they can be reached easily online. So, I really wanted to use social media to reach and help them. My main motivation every day is that I can bring good things to people in the LGBT community."
However, it’s not always easy.
"I’ve been through a lot of emotions on this job. When I’m able to help people, I feel very satisfied and happy, especially when I meet some people who know nothing about HIV—some even still have misconceptions like they can get HIV when touching HIV-positive people, etc. When I can talk with them and give them better information, I feel that I’m making things better. But, I still remember the moment I found my first reactive [potentially HIV positive] case. I was so sad and shocked that I nearly cried, and I found it very hard to break the news to the client. After that, I talked to more experienced counselors and realized that by helping someone find out their HIV status, I can help them to get early treatment. I accompany [especially those who are HIV positive] throughout their journeys, and we often stay in touch [after they have been enrolled in treatment]."
Both Dung and Thanh feel strongly that community-based testing is an absolutely essential service for people in the LGBT+ community and others at risk of HIV.
"As you know, LGBT people in Vietnam have already faced a lot of stigma and discrimination in their daily lives, especially those who move from small provinces to big cities like Hanoi— they are not equipped with knowledge about gender, sexuality, and safe sex. Therefore, when they come to the big cities, they can be easily exposed to HIV and sometimes they do not know any credible place to ask for HIV-related information and support."
“ Community-based testing is a revolutionary movement for people in LGBT community. ”— Thanh, community-based HIV testing provider, Glink
The monumental response to and results of the community-based HIV testing pilot run by Healthy Markets has led to agreement by the government of Vietnam that these services should be made available to all who need them. With technical assistance by Healthy Markets and others, community-based testing was included in the revised National Guidelines on HIV Testing in Vietnam, launched in April 2018, and changes in the law were made to support the provision of fee-based HIV testing services by civil society organizations and social enterprises like Lighthouse. The final piece of the puzzle to enable community-based HIV testing is the availability of HIV self-test kits, which are easy to use by those at risk of HIV but are not yet registered for commercial use in Vietnam. PATH continues to work with the government of Vietnam, HIV self-test kit manufacturers, distributors, and civil society to remove unnecessary barriers within the regulatory environment for diagnostics and make these lifesaving devices available to all who need them.