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?
Mitja Ćosić, Association Legebitra, Ljubljana
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?’
At our organization, my colleagues and I (that is, those of us who work in the field of HIV and MSM sexual health, as other colleagues work in other fields, e.g. LGBT rights) call ourselves peer counsellors. This “title” encompasses everything we do: counsellors on safer sex and prevention, community-based testing counsellors, counsellors who provide support to people living with HIV. We don’t just do counselling, of course. We are also advocates and policy planners. We do not just interact with our clients (MSM and PLHIV – the former regardless their gender identity or sexual orientation) but also with other stakeholders in the field of HIV, STIs and sexual health. Therefore, a counsellor may not be the best choice of word. But in lack of better, we call ourselves peer counsellors. Or sometimes, community workers in the field of HIV.
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?
As I already mentioned, We do all sorts of things that are related to HIV, STIs and sexual health, and also emotional wellbeing, especially of PLHIV. We work as counsellors on a 24/7 hotline, intended for information on PEP and facilitation of access to PEP, and everything related to HIV. We provide counselling service as part of the community-based testing for HIV&STIs (the only one in the country). We educate people about health and STIs. We cooperate in research projects. We are buddies to our HIV+ clients, providing emotional and practical support. Apart from that, I personally am also providing useful information and other types of support to PLHIV (finding GPs and dentists, getting appointments with healthcare professionals, help in cases of HIV-related discrimination) and am active in HIV related advocacy, on an individual (for individual clients) and systematic level (on behalf of my organization, and as a member of the national AIDS Commission).
What skills in your opinion are needed to be a good Community Health Worker?
Apart from theoretic knowledge on HIV, STIs and sexual health and practices, having sex with men and knowing various sexual practices, being a regular client at testing, or being a PLHIV, or all of that, obviously helps. Therefore, sharing one or more experiences or characteristics with your clients. Being part of the same community your clients are part of.
But most of all, being non-judgmental, sex-positive, empathic, a good listener, discreet, available, making clients at ease. And not doing this just as your job, but something more. A passion, a mission, a sincere desire to help your peers and serve your 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?
We are not healthcare professionals and our organization, while providing a health service in a way, is not a healthcare institution. That is a line we cannot cross. We provide information, we do the tests, we educate people and help them to be empowered to make informed choices; but we do not look at the symptoms and do not give out diagnoses and do not prescribe treatment. We help people adhere to therapy and support them in health and lifestyle changes and choices. But we never try to play doctors even if some of us are healthcare professionals by profession.
Why do you think CHWs are needed and what are the advantages of community based settings when servicing key populations?
CHWs are needed because we have a very different approach to a very stigmatized subject than medical professionals. I am not saying that all doctors and nurses are insensible; to the contrary, most healthcare professionals working in the field of HIV and other STIs, or sexual health of MSM, are quite sensible. But in the end, they are still healthcare. Their job is to recognize and treat diseases and prevent their transmission. They have a medical approach to the subject of MSM sexuality. And it is this where problems in their interaction with MSM can arise. Too many from the medical community still talk about ABC, monogamy and condoms, which is totally at odds with the realities of life of so many MSM.
We, the CHW on the other side, are peers. We have sex with men, we have sex with many or few men, protected or not, with steady or casual partners, with strangers. Just like our clients. Our non-judgmental and sex-positive approach is what makes our services a necessity for our communities. We acknowledge the realities of life. We don’t judge people for who they are or what they do. We encourage them to be what they are. When I counsel a client who comes in to do the tests, and he’s afraid because he thinks he might have an STI, I always tell him, of course, make sure to look after yourself but never to forget that sex is something beautiful, something to enjoy. That’s something he won’t hear from a doctor.
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