Setting the standards for sexual health support for MSM - Community Health Work in Finland
This interview was produced in the framework of the first ever Europe-wide online survey aimed at community health workers who provide sexual health support including counselling, testing, and psychosocial care for gay, bisexual and other MSM. European Community Health Workers Online Survey (ECHOES) is available online NOW in 16 languages and will remain open until 31st December 2017. To take part, please go to
Hello, could you introduce yourself and tell us where you work?
I’m Erik Mattsson and I work at Positiiviset (HivFinland). We offer free of charge support and counselling for those living with HIV positive status and their close ones such as partners, parents, siblings and friends. We offer our support and counselling services on face-to-face get-togethers or via chat, Skype and phone. You can contact us anonymously and confidentially. You will get from us up-to-date and accurate information about HIV.
In the ECHOES we’re using the term ‘Community Health Workers’ to describe you and your colleagues. Community Health Workers are known by a variety of titles such as outreach worker, health promoter, peer educator etc, but in ECHOES we mean: Someone who provides sexual health support around HIV/AIDS, viral hepatitis and other sexually transmitted infections to gay, bisexual and other MSM. A Community Health Worker delivers health promotion or public health activities in community settings (not in a hospital or clinic). Does this definition apply to you? We know you probably don’t call yourself a Community Health Worker right now, so what do you call yourself?’
I’m working as MSM Project Coordinator and Sexuality Counsellor.
Tell us, what kind of things do you do as a CHW? What makes you a Community Health Worker? Why do you identify as CHW?
I am openly a gay man who is working in a community setting that provides service (also) to gay, bi and MSM men. Every person is welcome to join our activities regardless of gender, sexual orientation, religion, race, socioeconomic status, etc.
My own work duties concentrate specifically in the wellbeing of men who have sex with men. My tasks include implementation of HIV awareness campaigns, HIV rapid testing, peer-to-peer support, accompaniment to services and medical appointments, sexuality counselling and confidential discussions about any topics that people feel like talking about.
What skills in your opinion are needed to be a good Community Health Worker?
Good social skills are a must. A non-judgemental approach is also crucial. In addition, it helps if the CHW is part of the community. E.g. a gay Community Health Worker will have a different understanding on what are the needs and what is going on within the gay community.
What are the barriers that you experience, meaning what you can and cannot do as CHW in your country and what support do you need?
Cooperation with the infectious disease clinics in Finland is working well. They encourage individuals with HIV diagnosis to get in touch with us. Peer-to-peer support can be extremely valuable not only for newly diagnosed persons but also for those, who have been living with HIV many years. There are still many individuals who have never told about their chronic infection to anyone else except the health care personnel. It’s not good for the mind nor the body to live with a secret burden. I have met so many guys who have felt so relieved after they have had the courage to disclose their status.
We need to talk more about what is HIV nowadays. Many people still think getting an HIV diagnosis is a death sentence. Silence fuels ignorance. Ignorance fuels fear. Fear fuels stigma. Stigma fuels discrimination. We need to stop this vicious circle!
We still have barriers to HIV and other STI testing. It is difficult for NGO’s to get funding to arrange testing, and bureaucracy also plays an important role in hindering us from being more efficient. Finnish health authorities demand a nurse to be at site when rapid HIV testing is offered. In my opinion, it should be enough to have a person with qualified first aid skills at site just in case the person who gets tested, faints.
Do you have any success/interesting stories that you would like to share?
We still have a lot of work to do. We conducted an online survey for MSM in Finland. We got some 1 000 replies. The result shows that still 45% of respondents would not want to have ANY kind of sex with a person living with HIV. We need to do more work to help people understand, that HIV cannot be passed on when viral loads are undetectable. Many people still cannot believe the advancements in medicine and hold on to old behavioural patters.
We also conducted another survey on life quality. The results show that people living with HIV who are involved in activities with Hiv Finland feel much better than those who are not involved with us. Meeting peers can help to avoid feelings of loneliness, shame and self-stigma. People like and need to share emotions, feelings, thoughts and encourage each other to carry on with everyday life. Peer-to-peer support is unique and it can never be fully replaced by any other means. We not only understand our community, we are part of it.
ECHOES is part of ESTICOM project funded by the European Health Programme 2014 – 2020. ESTICOM also includes EMIS 2017 the survey addressing gay men and other MSM and a training programme for CHWs in order to improve access and quality of prevention, diagnosis of HIV/AIDS, STI and viral hepatitis and health care services for gay men and other MSM. The project is coordinated by the Robert Koch Institute in Berlin.
The Project is an important opportunity to strengthen community response und raise awareness about the persisting legal, structural, political and social barriers hindering a more effective response to the syndemic of HIV, viral hepatitis B and C, and other STIs among MSM. Early findings are expected in the Spring of 2018.
To take part in the ECHOES survey go to: www.echoessurvey.eu
To find out more about the project go to: www.esticom.eu