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?

My name is Ricardo Fuertes. I am currently the director of a harm reduction centre for people who use drugs- IN-Mouraria, implemented by GAT.

GAT created several HIV/STI testing centres for key populations, including MSM, sex workers and people who use drugs. Other interventions, besides testing, are different in each centre, according to the needs of the target group.

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 do many things, as most of those who work in community based organizations: peer support, testing, outreach, information, and also research, advocacy, fund raising, project management, etc. So it is difficult to give a name to the work I do. Usually I just say I am a staff member of IN-Mouraria.

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 do testing, provide information and harm reduction interventions. For me a community health worker is closer to the communities, especially in the case of peer workers, and tries to challenge the rules, the status-quo. We do an additional effort to overcome the barriers created by health services and others.

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?

One of the things that could be improved would be a formal recognition of our work from health authorities. That has been already partially achieved- peer testing and our health interventions are funded by the Ministry of Health and we have protocols with hospitals to do referrals. However, other interventions like accompaniment to services and medical appointments, mediating between clients and health professionals, is not formally recognized nor funded. 

Why do you think CHWs are needed and what are the advantages of community based settings when servicing key populations?

Our clients experience serious barriers to have access to health and social services. Some barriers are related to multiple layers of discrimination: using drugs, sex work, being MSM or transgender, and others. There is also a level of   bureaucracy that can be a real barrier for many of us and many of our clients, especially the ones that are more vulnerable.  Community based organizations help to promote access to existing services and are capable of creating new interventions that are adapted and accessible to our communities. Community based services can also promote political mobilization, and that can lead to more robust structural changes.

However it’s also important that we, community health workers, become aware that we also can become rigid in our procedures or loose contact with the real needs of our communities, so we shouldn’t take for granted that we do a better work just because we are community based.

Last but not least, is there any success/interesting stories that you would like to share?

Drugs services are usually directed to heterosexual male clients. There is generally a very masculine environment. The same thing happens in other settings such as prisons. MSM needs and specificities become invisible and are a non-issue. As a gay man and having worked in specific projects for MSM I try to create an LGBT friendly approach in our harm reduction centre. And I try to call the attention to issues that are key for MSM, but are forgotten by drugs professional such as PrEP. My colleagues have also embraced this intersectionality. Besides that I think that cooperation between different organizations and activisms- LGBT+, people who use drugs, migrants, sex work, etc- should be increased. Drugs services should address the gender and sexual diversity of people who use drugs and make sure that services are friendly for all. I think we were able to make clear and visible that LGBT+ people who use drugs are very welcome in our center. It became more and more common to see same sex couples in our center, to see clients talking openly about their sexual identity and practices, disclosing their health or social needs or having clients preparing their drag shows in our facilities.


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: