Outreach Worker delivering daily necessity to the young PLHIV community
Jeremy Tan, Malaysia
I am currently a Programme and Project Officer at the Federation of Reproductive Health Associations, Malaysia (FRHAM). My work centres around project implementation regarding strengthening service delivery and information dissemination for HIV/AIDS and STIs, as well as capacity building to empower the key population.
This position has given me the opportunity to work with young people on their sexual and reproductive health by disseminating information and referral of services, through Comprehensive Sexuality Education.
Besides, being the youth representative of Country Coordinating Mechanism under the Global Fund, this has provided me a platform to look into sustainable initiatives regarding delivering health care services, implementing information disseminating mechanisms, which are often utilised for youth-centred approaches regarding development processes that are meaningfully engaging with young people. This includes marginalised groups, such as PLHIV, refugees and LGBTQIA+.
What was life like before COVID-19 hit Malaysia, and service availability for young people in terms of HIV, and LGBTIQ?
Before the Movement Control Order (MCO) was implemented with the objective to flatten the curve, young people who are living with HIV and LGBTQIA+ teens had more access to health services, such as treatment, support, and care.
For instance, young PLHIV can still make appointments for their regular blood test, go to a hospital to obtain their supply for ART, and meet up with case workers for support or counselling. LGBTQIA+ teens can still attend a peer support group organised by different NGOs and meet up with other community member for support session etc.
Even for the sexually active LGBTQIA+ teens, access to PrEP and PEP are still available, even though not all of them are using it. At the same time, they can still get access to condoms and contraceptives, either from convenient store or NGOs. The transgender teens are still able to visit clinics for a blood check and hormonal injections. For those who are experiencing mental health issues, they are able to contact and reach out to mental health professionals for counselling and relevant services.
With the effect of COVID-19 outbreak, how did you respond to this? Can you detail the evolving service needs of young people during lockdown, and how community groups are able to address the issues?
Firstly, my organisation has its own WhatsApp group for young people. When the pandemic happened we quickly reached out to them to seek information checking whether the pandemic has affected their basic needs. For example, regarding young people who are living with HIV, we quickly contacted the outreach workers who can take the medication and requests from hospital for at least 3 month stocks of ART as we are still unsure of the duration of the Movement Control Order (MCO) at the initial stage of the MCO.
Even during the MCO, when social distancing was implemented, we work together with other organisations in getting the ART medication for clients. Because of the MCO as well, the young Transgender community who works as sex worker s could not be able to go out and serve the clients. Hence they have to rely on the food aid programme community groups have served.
The community organisations or groups who have the permission to travel will bring some daily necessities. At the current stage where the MCO is less strict than previously before, the community groups have gathered funds to launch food aid programmes for the communities who have lost their job.
Also, we continue our HIV information dissemination by creating content and info- graphics for young people, focusing on being more alert of HIV during the lockdown. We also contacted universities where students are staying in the dormitory and information kits have been distributed to them, including a referral to a counselling service and other services.
What were the issues that young people in Malaysia experienced during this time? What are the gaps in terms of addressing the issue?
Access to condoms and lubricants have been an issue raised by young people. Because of the Movement Control Order (MCO), young people who are stuck at home with their partner have reported higher sexual activity without using a condom and lubricants as their usual usage often relies on community based organisations.
Those who usually purchase condom and lubricants online also face similar problems. This condition has put young people, especially the young key population at an extremely vulnerable stage of getting infected with HIV and STI. Unfortunately, sexual and reproductive health services were not considered by the government as one of the most essential services during the MCO, which allowed people to obtain only certain services. Because of the restriction, young PLHIV do not have the chance to engage with others. The lack of support and care resulted in a situation of not adhering to their ART medication, which lead to depression etc. Also for those who have had unsafe sex during the lock down, they were not able to go out and get access to HIV testing services, which might delay their initiation with ART medication.
How have you, staff, and volunteers working for NGOs been able to stay safe from COVID-19?
During the pandemic, my organisation has followed the guidelines given by WHO as well as Malaysia’s Ministry of Health. For the initially stage of the MCO, we have implemented working from home as required by the government’s pandemic crisis management which was put into action. Guidelines and tips about physical distancing have been sent out by the Human Resource department. This is to ensure that officers and staff are aware of the rules of keeping distance, using PPE and referrals to services regarding COVID-19 testing.
Our outreach worker and case workers were given Personal Protective Equipment (PPE), such as sanitisers, gloves, and a mask together with the permission from police and authority to reach out to the community. Besides, we have hailed workshop, training and seminars which required face to face engagement or took place in a room without good air circulation or enough space.
As Malaysia come out of the lockdowns, what services will young people in Malaysia continue to require, and what would you cease, and what would you add?
The access to information and services regarding HIV is still highly needed. For example, counselling, referral to services and community engagement are in demand. What can be strengthened, is the delivery of ART medication to PLHIV. Rather than having them to collect it in person, the hospital or NGO can consider delivering it to those by postal service, which can significantly reduce the risk of COVID-19 infections.
Besides, HIV self-testing is inevitably a crucial service that needs to be incorporated into the HIV response in Malaysia. Young PLHIV and LGBITQ+ need to be given the practical and convenient option of HIV self-testing as the surge of homophobia in this country will impede young people from visiting hospitals and clinics for HIV testing, due to the fear of stigmatisation and discrimination. This being said, more youth friendly health establishments need to be in place so that young people feel safe and confident to seek for health services. Also more online outreach and information dissemination needs to be given, especially Comprehensive Sexuality Education for young people to raise awareness about the risks of sexual practice.
How has COVID-19 outbreak changed the way that you/your organisation and other NGOs will be working in the future?
The conventional approach of educational meetings, workshops, trainings and seminars will significantly change from a physical manner to an online approach. These capacity building events and other events would have to be done digitally, for example via Zoom and Skype. Unequivocally it will reduce the level of active interaction, but it is cost effective, convenient and able to reach a huge target audience. Considering the fact that COVID-19 will stay with us for a while, this seems to be a change that is inevitable. Besides, the work of grassroots movements will also be drastically impacted as the workers have to be more precautious in terms of communicating with clients, physical distancing and giving accurate information.
What are the worries from your community about the ‘new normal’?
Young people feel that the pandemic has built barriers for them to engage with other people, due to the safety issues and physical distancing.
With the awareness about COVID-19 transmissions, they are worried that peer support sessions for young MSM and PLHIV would not be attended by the community as actively before. The support session would be done in an online manner and this approach might not deliver the level of care that occurs during a face-to-face meeting.
Also the young transgender community who relied on sex work as their source of income, would have to adapt to the increase of usage of condoms and lubricants as well as the frequency of going to the hospital for testing. This is not only for HIV but for COVID-19 as well. The inability to wear a mask while providing services to their client, has caused a surge of fear among the young TG for getting in close contact with COVID-19.
Are there any positive lessons learnt from the effects of COVID-19?
People are more cautious about their health. For young LGBITQ+ members who relied on hook up apps in the past for sex and etc., they seem to pay more attention to the use of contraceptives, such as condoms and regular HIV testing.
This pandemic made young people realise the importance of practicing hygiene and being precautious, as we are vulnerable to these infections.
Another interesting scenario I noticed amongst social circles between youngsters, is the increase of awareness and need for discussions about how HIV and COVID-19. Information on HIV and COVID has been shared in our social circles and on social media platforms, in order to increase knowledge and awareness during the pandemic.
How we extend our help, is by providing daily necessities to the young community members and the attempt of delivering ART medication for those who are living in university dormitories or lack transportation. Besides, the new “normal” of using digital platforms for advocacy and information dissemination allows the community based organisations to react in a much more effective way when it comes to intimate partnership violence and access to care and support.