Normalizing HIV Care in Honduras

Normalizing HIV Care in Honduras

Mill Valley, United StatesPunta Gorda, Honduras
Organization type: 
nonprofit/ngo/citizen sector
Project Stage:
Scaling
Budget: 
$250,000 - $500,000
Project Summary
Elevator Pitch

Concise Summary: Help us pitch this solution! Provide an explanation within 3-4 short sentences.

Siempre Unidos is fighting the HIV/AIDS epidemic in Honduras with effective medical treatment, compassionate emotional support, and community education.

About Project

Problem: What problem is this project trying to address?

Honduras was the first Spanish speaking country identified with a high prevalence of HIV infection. Despite availability of antiretroviral (ARV) treatment, many Hondurans do not seek screening for HIV or treatment when infected because of stigma & lack of confidentiality. Siempre Unidos (SU) is the only non-government program in Honduras that provides ARV treatment (450 patients) & one of the very few organizations that offers confidential HIV screening. We run 3 community-based clinics, predominantly for HIV+ clients, providing the only alternatives to stigma-laden "AIDS only" clinics in public hospitals. Initially, most SU clients presented with advanced AIDS & our clinics became known as AIDS-oriented facilities. This perceived HIV emphasis has limited our growth, especially in Roatán.

Solution: What is the proposed solution? Please be specific!

It is our goal to expand services at our Roatán clinic to both HIV+ &HIV- clients. Not only will this provide needed services to the general public, it will de-stigmatise & lower the profile of those seeking HIV care. Our Roatán clinic is in a rural area where everyone literally knows everyone. The population is mostly Garifuna, an ethnic group with an 8% HIV rate. This approach makes sense because: 1. our current 60 HIV+ patients are healthy with ARV treatment & require less intensive medical care 2. many indigent persons live near by who lack affordable medical care 3. if we attract HIV- persons, those with HIV will be less fearful to present for care 4. effective reduction in infection requires early identification & treatment of those infected to lower their viral loads & make them non-infectious to others 5. stigma will be reduced 6. clinic security will be enhanced by having more community members present 7. funders are interested in a more general care model.
Impact: How does it Work

Example: Walk us through a specific example(s) of how this solution makes a difference; include its primary activities.

Roatán presents some special challenges. It is an island measuring 33 by 3 miles & has a population of around 55,000. Most people live & most tourists visit the western side of the island. The eastern side, where our clinic is located, has changed little over the years. It consists of a series of small fishing villages that are predominantly inhabited by either poor Garifuna or poor English black families who have lived in these villages for decades. Transportation from one side of island can be very expensive (~$25) & often unavailable when cruise ships visit. People know each other’s personal business & are quick to stigmatize those infected with HIV. To attract more general medical patients in to our clinic, we plan to: 1. transport our doctor & nurse to neighboring towns to run outreach clinics we set up at schools or churches 2. purchase additional general medications to be distributed as needed to indigent patients 3. provide coupons for free follow-up visits at our clinic in Punta Gorda following an outreach clinic visit 4. offer transportation from other villages to our clinic on a predictable schedule. To provide more HIV screening tests, we 1. have hired a nurse who is certified by the government of Honduras to perform HIV screening tests (there are very few people certified in the country; our prior nurse at this clinic was not; there is only one other person certified on the island) 2. apply for funding for additional test kits 3. offer screening at our clinic building as well as at outreach clinics 4. assure privacy.
Sustainability

Marketplace: Who else is addressing the problem outlined here? How does the proposed project differ from these approaches?

The public hospital on the western side of Roatán has an AIDS clinic that serves about 20 HIV+ clients. Some wealthy patients choose to fly to the mainland of Honduras for care to maintain their privacy. There is a non-HIV general clinic on the western side of the island that provides inexpensive general medical care. Our clinic would be the only clinic on the island to provide care to both HIV+ & HIV- persons in the same setting at the same time. We would also be unique by providing affordable transportation to our site. Our staff & current patients are committed to confidentiality. By expanding care to underserved persons from the eastern side of the island we will both improve their health & reduce HIV transmission by enabling more HIV+ persons to seek diagnosis & treatment.
Team

Founding Story

Our “aha” moment occurred when we realized that our HIV+ clients are now indistinguishable from HIV- persons in terms of health & appearance. In the early days of SU, our patients died painful deaths from opportunistic diseases & were easily identified by their wasted appearance. Half died within 6 months of diagnosis. In 2003, when our clinic offered some of the first ARV treatments in the country, our patients were extremely ill. Many were infected with tuberculosis & other contagious diseases. They needed emotional support & specialized treatment that could be best provided in a setting limited to HIV+ clients. Over the years, most of our HIV+ clients have thrived, gained weight & learned that they now are likely to live a normal lifespan. It is time to open our clinics to indigent HIV- persons to improve their care & to make it easier for HIV+ clients to inconspicuously seek medical treatment. Our tagline is AIDS=LIFE (SIDA=VIDA). We want to dispel the idea that AIDS= rapid death.
About You
Organization:
Siempre Unidos
About You
First Name

Denise

Last Name

Main

About Your Organization
Organization Name

Siempre Unidos

Organization Country

, CA, Mill Valley, Marin County

Country where this project is creating social impact

, IB, Punta Gorda

How long has your organization been operating?

More than 5 years

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Innovation
How long have you been in operation?

Operating for more than 5 years

Which of the following best describes the barrier(s) your innovation addresses? Choose up to two

Access, Equity.

Social Impact
Please describe the goal of your initiative; outline what you are trying to achieve

The goal of our initiative is to provide medical care to persons living in the eastern side of Roatán regardless of HIV status. We believe this will encourage more HIV+ persons in this small community to seek care, thereby lowering the spread of HIV on the island. We will also provide well child & reproductive care as well as treat persons suffering from chronic conditions like diabetes, hypertension & HIV. At the same time, our clinic can become a resource to provide education regarding ways to effectively prevent HIV transmission. By treating all patients in one setting, we seek to lower the stigma against those who are infected as well as improve general health. This approach is novel in Honduras & very needed given the high prevalence of HIV infection among the Garifuna people (~8%).

What has been the impact of your solution to date?

To date, our program has primarily focused on treating HIV+ Hondurans. While we continue to attract many new HIV+ patients in our two urban clinics, our Roatán clinic, with its lovely building, has been identified as an AIDS treatment clinic (or at least predominantly so). On this small island, where those with AIDS face major stigma, many clients are reluctant to be seen entering our clinic. We are, of course, working to change this image. We advertise in local publications that our doctor sees HIV- clients, we started neighborhood outreach clinics & last month we hired a driver & van to provide reliable transportation to our clinic. We have also increased donations/purchase of needed general medicines. And not without some success. The number of HIV- persons seen has increased over the past few months from 12 per month to 48 per month. But there is much more to do.

What is your projected impact over the next five years?

Our five-year goal is to run a comprehensive clinic for adults & children in Roatán that welcomes all persons without regard to HIV status. At the same time, we expect that the number of persons undergoing ARV treatment at our clinic to at least double from 60 to 120. We anticipate that this approach will significantly decrease the incidence of new HIV infection in the community. We further anticipate that the stigma against those living with treated AIDS will decline as people realize they are healthy & are not a threat of disease transmission. Assuming this approach works, we will seek to extend it to our two other clinics in San Pedro Sula & Siguatepeque. An additional specific focus at each site will be to work to empower girls & women to control their financial status & sexuality.

What barriers might hinder the success of your project? How do you plan to overcome them?

One of our biggest challenges is the worsening security in Honduras. Honduras reports the highest murder rate in the world (82/100,000, equivalent to Kabul, Afghanistan). The Peace Corps has just withdrawn its volunteers. We will need to maintain enthusiasm & US-based funding for this project while suspending our volunteer trips to our clinics. We also need to invest more in security, such as armed guards, which increases our overall expenses. Fortunately, given our 13-year history, we have a competent, stable & dedicated Honduran medical & administrative staff. Our program depends upon the government of Honduras for the continued donation of ARV medications & HIV screening kits. This depends upon foreign support from the Global Fund & other funders.

Winning entries present a strong plan for how they will achieve and track growth. Identify your six-month milestone for growing your impact

SU Roatán will provide a minimum of 100 medical visits per month for HIV- patients.

Identify three major tasks you will have to complete to reach your six-month milestone
Task 1

Arrange & conduct 2 outreach clinics per month (20 / year) in neighboring villages where our doctor & nurse will provide care.

Task 2

Encourage HIV- persons to return for care at our clinic in Punta Gorda by providing a voucher for a free follow-up visit.

Task 3

Arrange for reliable transportation to bring both HIV+ & HIV- patients from different parts of the island to our clinic.

Now think bigger! Identify your 12-month impact milestone

SU Roatán will increase the number of HIV+ patients by 15% (from our current number in Roatán of 60 to 69).

Identify three major tasks you will have to complete to reach your 12-month milestone
Task 1

Increase the number of HIV screening tests to at least 20 per month on Roatán.

Task 2

Maintain careful patient confidentiality within the clinic so no one attending can determine a patient’s HIV status.

Task 3

Maintain home visitation program & support group for HIV+ clients who previously had clinic to themselves. Offer transportation.

Sustainability
Tell us about your partnerships

Siempre Unidos is an established Honduran program affiliated with the Episcopal Church established in 1999. Medical & support services are open to all regardless of gender, religion, race, sexual orientation, or ability to pay. Our staff is very dedicated & includes 3 physicians, 3 nurses, a social worker, a psychologist, home visitors, several administrative & cleaning staff, & armed guards.
Siempre Unidos CA works in the US to provide financial support, medical supervision, & vision. Incorporated in 2004, it has 6 active board members as well as many US volunteers.

Are you currently targeting other specific populations, locations, or markets for your innovation? If so, where and why?

Currently one of our main focuses is to expand general medical care in Roatán where we have a large, yet underutilized clinic, located near an underserved, highly HIV+ community. Once we succeed in Roatán, we will extend this approach to our clinic in Siguatepeque (mid-sized city in central Honduras). We also plan to fund raise for a new larger clinic building in San Pedro Sula to allow space for general medical care.
We also hope to increase sales of fair trade jewelry in the US to make the employment portion of our program self sustaining & ideally contributory to clinical expenses.

What type of operating environment and internal organizational factors make your innovation successful?

Siempre Unidos is fortunate to have 2 very committed leaders, 1 in Honduras & 1 in California, who have been involved since the organizations inception, & who work closely & tirelessly to develop key activities. Additionally, there is a stable Honduran staff of over 20, most of whom have worked at Siempre Unidos for 4-5 years. Similarly, there is a small cadre of very active US volunteers who work relentlessly to support Siempre Unidos as well as a larger group of intermittently involved, long-term volunteers. Siempre Unidos is incorporated as a nonprofit public charity, has excellent branding with secure trademarks. It is a member of the Fair Trade Federation & receives quality pro bono marketing as well as medical & legal assistance.

Please elaborate on any needs or offers you have mentioned above and/or suggest categories of support that aren't specified within the list

There is much to do, and we are constantly working to attract new volunteers / board members with expertise in social media, Web development, fund raising & grant writing. We also need help with the sale, marketing & design of fair trade products.
Siempre Unidos can provide help with medical advise, human rights & medical information in Spanish, & information regarding Central America.

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