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 January 2017. To take part, please go to

Hello, could you introduce yourself and tell us where you work?

My name is Lella Cosmaro and I work in Italy for Fondazione LILA Milano ONLUS 

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?’

Here in Italy we definitely don’t call ourselves “Community Health Workers”, not even in the Italian translation of such definition. As a matter of fact, we do not have a precise terminology that defines the work that we do – also because many of us, including myself, have many different roles. We can be ‘Project Managers’, and ‘Social workers’, ‘Community Advocates’, ‘Peer educators’ and so on. Anyway, I think that the ECHOES gave most of us the chance to adopt a new definition (that of CHWs, in the English version) that from now on we will understand and use to describe part of our work.

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 part of my organization testing and counselling team. We offer CBVCT services and rapid tests for HIV, HCV and syphilis to different population groups and to the general population as well. We also specifically target MSM and provide specific counselling on sexual health issues.

What skills in your opinion are needed to be a good Community Health Worker?

       A CHW needs to have a comprehensive knowledge and competence on sexual health issues, especially concerning HIV, STIs and hepatitis. He/she needs to develop counselling skills and to be a warm, welcoming, non-judgmental person. It is also important to be well trained in the delivery of testing services, in managing stressful situations and in working within a team. 

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?

In our country we would very much need financial support from our institutions in order to properly run our services. We do not receive any public funding (apart from very little funding every now and then, which is anyway insufficient) and our activities often cannot guarantee continuity, stability, growth and development.

In addition, our CBVCT services are still medicalized: we need a doctor in our teams to perform rapid tests and this represents a big barrier to the expansion of opening days. We hope this will change.

Do you have any success/interesting stories that you would like to share?

Not one in particular.  Here at our service we receive many thank-you messages from people who received support and were tested by our team and this makes us proud and gives us lots of energy and enthusiasm. We will continue to improve and expand our services. In the last months, some Italian CHWs started to offer orientation and support to PrEP users and we are definitely planning to offer community-based PrEP services in the near future.

Further information:

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:

To find out more about the project go to: