The Response to HIV in the Indigenous Population of Guatemala
In Guatemala, there’s a majority population which faces minority conditions: indigenous peoples. Social inequality puts them at a disadvantage compared to the non-indigenous population in many areas, and health is no exception.
More specifically, talking about HIV with indigenous peoples requires taking into account that 24 of them settle in Guatemala, each with their own language and with different views of the world. To bring together prevention and care services such as those offered by AHF Guatemala, strategies have been carried out that take this diversity into account.
An Invisible Population
The 2018 population census recorded that, of the 14.9 million Guatemalans, 44% are indigenous. However, other studies indicate that the indigenous population amounts to 60%, that is, the majority of the country’s inhabitants.
However, according to what Saúl Paaú, Program Director of AHF Guatemala recalls, just a decade ago, when the organization arrived in the country, the health services did not record this data about their users. “It was a very big challenge for us because how do we justify the actions with this population? How did we make it visible? “
These questions arose because the funding agencies required data to be able to grant resources to interventions in the indigenous population. As no such data was generated, they assumed that there was no problem to address.
On this point, Humberto López, AHF Guatemala’s Prevention, Testing, and Linkage Manager, agrees and points out that indigenous groups have historically been marginalized, “with little or no access to education or health services in general, let alone quality health services”.In addition to this is the diverse geography of the country. It is a small territory but with long distances between one community and another, which contributes to limited services and many people having to travel for hours to get to a health center.
“We Bring Services to the Population”
Marleny Negreros is an Advocacy Manager at AHF Guatemala, and also recalls the beginnings of the organization’s work in the Central American country. One of the innovations they implemented was the HIV detection sessions in open spaces, an activity that the Ministry of Health did not conceive of until the moment any service of this type was provided within the clinics.
“The ministry did not believe in open spaces, there was no work outside the walls. Those were barriers to be broken to tell the ministry that this does work because we are taking a confidential and rapid test to the population, and the population does not have to go looking for it ”, explains the activist.
It was this same approach with indigenous peoples that allowed them to have a more realistic view of their needs, and the impact of HIV on this population could be seen more clearly.
“The result of that work was that they began to have the training, meetings with other allied organizations, to be able to make those diagnoses that were so important and necessary to do,” he says. “You cannot generalize because each region has its peculiarities, but building these bases is what has helped the work to be successful.”
The Impact of HIV
When AHF began to work in Guatemala, almost 65% of the population with HIV was diagnosed in the AIDS phase, that is when they already had the syndrome triggered by the virus (and that is avoided by taking treatment). “Of these, almost half were lost, who did not return after diagnosis and did not have access to treatment. Surely those people passed away ”.
The organization’s work was then focused on trying to change the practices of the health system, promoting the use of the most modern technologies such as rapid tests, the result of which is ready in 20 minutes and people no longer have to wait 24 hours. Time it took to deliver a result.
Advocacy in this regard worked and today the Ministry of Health also offers rapid tests at the community level, as do other civil organizations. Currently, the population diagnosed in the AIDS phase is 50%, that is, 15% less than at the beginning.
Tagless Strategies
Faced with the great diversity of indigenous peoples, one of the great challenges involved in working with them is the language barrier. To overcome this, Saúl Paaú explains that the way of working that AHF replicates around the world has been very effective: looking for personnel who belong to each community. This not only solves the communication problem but also provides first-hand advice to approach the local culture in the most respectful way.
And local culture also involves the vision of the world that these peoples have. An important characteristic that has been observed is that indigenous people are not comfortable with labels. In other words, indigenous peoples do not usually distinguish sexual orientations, but rather what each person does in private is not a matter for public discussion.
“For example, nobody is questioned if someone is not married. If you are a woman and you do not have a male partner, you will not be questioned; If you are a man and you do not have a female partner, or if you have a relationship with another man, you will not be questioned, it is thought that to typify the population is to begin to subdivide it, to begin to offend it ”, clarifies Saúl.
Thus, AHF Guatemala services are open to the public. People can access our services regardless if they are a housewife, a man who has sex with other men or women and men who are engaged in sex work. Both sexual practices and the way in which each person identifies are data collected for statistical purposes only, the services are provided without distinction.
Currently, AHF Guatemala has five testing centers, called Centers for Health Orientation for Men, where they provide information on HIV and other sexually transmitted infections, carry out rapid tests for HIV and syphilis, and deliver condoms, all of this for free and strictly confidential.
The work of these centers was initially focused on men because it was observed that they were the ones who, in some way, were first exposed to HIV, for example, when they migrated from their community to a larger one to work, and in that time had unprotected sex. They then returned to their place of origin and passed HIV to their wives.
However, the care in the centers is not exclusive to them, since anyone, even young people and teenagers, can benefit from the services.
Future Challenges
In caring for the indigenous population, there is still much work to be done. As the first pending issue, Saúl Paaú considers that it is necessary to make an alliance with the council of spiritual guides, a kind of council of elders that is the highest symbolic, cultural, and legal authority of the indigenous people of a certain territory. “We have lacked approaching these elderly people in the areas where we are working,” he acknowledges.
Likewise, it is still necessary to bring services closer to more areas. For example, the area of Quiché, which has more than two million people and almost 90% of them are indigenous. “No one does rapid tests there, they don’t have clinical services; they have to travel to the city and that trip lasts almost 8 hours”, so he considers that the next step for AHF Guatemala should be there.
For Humberto López, one of the parts of the work that the organization must strengthen is the promotion of condom use. Here, as in many other parts of the world, a high percentage of HIV infections are due to unprotected sex. For this reason, it is important to emphasize the message that this tool is essential to prevent transmission.
But these and other challenges face a very adverse political landscape. The current government has reversed some of the achievements in sexual and reproductive health that had been achieved before 2020.
This is how Marleny Negreros explains it: “Before this government took office, a lot of progress had been made. We had the Social Development Law which enacted training of girls and boys from the fifth grade of elementary school in sexual and reproductive health issues. But now, a public policy on the protection of life and the family has been approved, indicating that the only one who has the power to decide whether to educate their children in these matters is the family itself”.
In addition, Marleny mentions, the law on civil organizations was modified and public demonstrations are prohibited because they are considered a disturbance of public order. All of this will make the organization’s work difficult, since “they no longer see us as allies but as enemies.”
Thus, it will be necessary to change strategies to remind the government that AHF Guatemala is “an organization interested in contributing to the response to HIV, in continuing to help the population, in avoiding more deaths and that more lives can be saved,” he concludes.