January 15, 2016
On December 4, Adam's Love, the online HIV outreach initiative targeting gay men, other men who have sex with men (MSM), and transgender individuals (collectively, GMT), cut the ribbon on its new clinic in the heart of Bangkok. The clinic, established through support from amfAR, aims to appeal to discreet, harder-to-reach GMT individuals who might be hesitant to visit public government clinics for HIV testing and care by providing them with private, appointment-only services from knowledgeable, GMT-friendly staff.
"Many of our patients are first-time testers, and only come in for HIV testing because they first built a relationship and trust online with an Adam's Love counselor. Many do not want to go to a public testing spot and encounter other MSM in the waiting room," says Tarandeep Anand, director of Adam's Love. "Because of this, we think this private setting will really reduce barriers to HIV testing and treatment in Bangkok."
MSM accounted for an estimated 40% of new HIV infections in Thailand between 2012 and 2016, and in Bangkok approximately 30% of MSM are currently living with HIV. Thailand is striving to end its AIDS epidemic by 2030, in part by ensuring that at least 90% of individuals living with HIV know their status and that at least 90% of those diagnosed are linked to care. While the country has made significant progress towards accomplishing these ambitious goals, it will not achieve them without reaching MSM and transgender individuals. However, only 29% of Thai MSM get tested for HIV annually, and many have never been tested at all. Until 2015, national statistics grouped transgender individuals with MSM, so less is known regarding their infection rates and risk behaviors.
A client prepares for an HIV test
"Thailand has diagnosed around 80% of people living with HIV, but it's reaching that last 10-20% who we have not been able to reach in the past that is going to be hard," says Dr. Nittaya Phanuphak from the Thai Red Cross AIDS Research Centre. "Traditional outreach strategies will not be sufficient."
The Adam's Love Clinic was established as part of a new amfAR Implementation Science study, led by Dr. Phanuphak and designed to test three innovative HIV outreach and care models -- each targeting a different subset of the GMT population -- in order to find the best ways of reaching the remaining 20% of undiagnosed people. "This study will show what is working and what is not and who is being reached through each arm, so we know where and how the available funds should be spent in Thailand," says Anand. "It could also be scalable and replicable in other countries."
The study began enrolling participants in November. In one arm, outreach workers from community-based organizations are reaching out to sex workers and other GMT individuals who frequent areas of Bangkok known to be community "hot spots," and then referring those who are interested to HIV care at community-run clinics. Testing and treatment services in the second arm are provided entirely online through the Adam's Love website, which primarily reaches younger MSM. Patients can chat with a counselor online, take an at-home HIV test with online guidance from the counselor, and, for those who test positive, fill prescriptions and monitor their lab results online through an electronic health records system. The final arm is a hybrid of online outreach and offline clinic-based care. Patients in this arm first make contact with the team online through the Adam's Love site, but then opt to receive testing and care in person. Those interested in a more private setting will be referred to the new Adam's Love Clinic.
"I was aware that I had some risk of HIV, and Adam's Love was one of the first places that talked about HIV that I came across on Facebook and the Internet," says Ae, 17, who visited the Adam's Love Clinic for his first-ever HIV test. "Right now I feel relieved because everyone here is so friendly, and before I came, I worried about if the place would be friendly to me because I am an MSM, but I feel safe here."
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