AIDSTAR-One Faith-Based Organizations and HIV Prevention with MARPs in Mexico


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The influence of religious groups in parts of Latin America positions them to target most-at-risk populations (MARPs) who may have been overlooked by traditional HIV prevention outreach. In Mexico, La Iglesia de la Reconciliación, VIHas de Vida, and El Mesón de la Misericordia are challenging assumptions about faith-based organizations (FBOs) and the role they can play in HIV prevention. These three FBOs integrate spirituality and a holistic vision of health into their activities, sharing information on HIV and providing other HIV-related services in Mexico City and Guadalajara.

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AIDSTAR-One Faith-Based Organizations and HIV Prevention with MARPs in Mexico

  1. 1. AIDSTAR-One | CASE STUDY SERIES May 2011Faith-Based Organizations andHIV Prevention with Most-at-RiskPopulations in Mexico T he pastor asks again: “What can you add to condoms to make them more exciting?” Even though it is not their turn during this round of La Loteria de Vida (the Lottery of Life),1 various members of the congregation shout out the expected response: “Lubricant!” VIHas de Vida One man, however, leans over and tells his neighbor what he thinks is a better answer: “El contenido (the content).” Laughter and cheers fill the small church, La Iglesia de la Reconciliación“Free hugs.” Community eventshelp raise awareness of HIV in (The Church of Reconciliation) in Mexico City. Eventually, as theGuadalajara. chatter subsides, the individual selected to answer responds correctly and earns his prize: a condom. The pastor draws the next number and proceeds to the next question, keeping the engaging activity moving along as he does every week immediately following the religious service. The congregation is small but loyal; on this day, approximately 20 men and women are attending the service, not quite filling half the church hall. The individuals range in age, and many are presumably mem- bers of the lesbian, gay, bisexual, and transgender (LGBT) community traditionally targeted by La Iglesia’s outreach efforts. By actively seek- ing out LGBT congregants and addressing issues important to them during religious services, La Iglesia challenges assumptions held about faith-based organizations (FBOs) and about the role FBOs can play inBy Heather Bergmann improving sexual health—including HIV prevention.and Aysa Saleh-Ramírez 1 This HIV prevention activity, developed by Population Services International, is an educational tool which has proved effective in getting HIV prevention messages out to people engaging in high-risk behaviors.AIDSTAR-OneJohn Snow, Inc.1616 North Ft. Myer Drive, 11th Floor This publication was produced by the AIDS Support and Technical Assistance ResourcesArlington, VA 22209 USA (AIDSTAR-One) Project, Sector 1, Task Order 1.Tel.: +1 703-528-7474 USAID Contract # GHH-I-00-07-00059-00, funded January 31, 2008.Fax: +1 703-528-7480 Disclaimer: The author’s views expressed in this publication do not necessarily reflect the views of the United Agency for International Development or the United States Government.
  2. 2. AIDSTAR-One | CASE STUDY SERIESFBOs such as La Iglesia are in a position to target activities are necessary not only to address themost-at-risk populations (MARPs) who may be epidemic among MARPs but also to preventmissed by traditional outreach. La Iglesia and two transmission (“bridging”) to the general population.other Mexican FBOs—VIHas de Vida (a play on For example, MSM, who often do not self-identifywords in Spanish for “Ways of life” and “HIV”) and as gay or bisexual (Cohen 2006), frequently reportEl Mesón de la Misericordia (Inn of Mercy)—are having sex with female partners as well as malebridging the gap between the faith community and partners (Strathdee and Magis-Rodriguez 2008).MARPs: these organizations serve as models forengaging marginalized groups in HIV prevention Although MARPs have higher rates of HIV testingactivities in innovative ways. when compared to the general population, many members of MARPs have not had a recent HIV test (Joint UN Programme on HIV/AIDS 2007). MexicoHIV and Faith-Based will soon receive approximately U.S.$80 million from the Global Fund to Fight AIDS, TuberculosisOrganizations in Mexico and Malaria (GFATM) to implement prevention programs targeting MARPs, including MSM, IDUs,HIV prevalence in Mexico among the general and sex workers. One recent development haspopulation remains low at 0.3 percent (Bastos et al. been the acknowledgment of the importance of2008; Centro Nacional para la Prevención y Control targeting indigenous groups, who are generally notdel VIH/SIDA 2010). Within MARPs, however, rates considered MARPs but who are still at elevatedof HIV infection are much higher. Injecting drug risk for HIV when compared to other populations inusers (IDUs) account for a growing proportion of Mexico (Secretaría de Salud 2008; Centro Nacionalinfections, but HIV is mostly concentrated among para la Prevención y Control del VIH/SIDA 2010).men who have sex with men (MSM) and amongsex workers. More than half of all new infections Given the influence of religious groups in Latinreported in Mexico each year are attributed to America, churches and other FBOs are wellunprotected sex among MSM. Those people who positioned to reach both MARPs and the generalbelong to more than one MARP have increased population. In Mexico and elsewhere, FBOsvulnerability to HIV. For example, HIV prevalence have traditionally been involved in providingamong male sex workers in Mexico City and palliative care to people living with HIV (PLHIV).Guadalajara is estimated to exceed 20 percent But few funding opportunities from the Mexican(Bastos et al. 2008). government exist for FBOs that implement HIV prevention activities with MARPs, thusUntil recently, HIV services for prevention of forcing FBOs to rely on donations from privatemother-to-child transmission (PMTCT)—a organizations or individuals. Despite limitedless controversial HIV prevention activity for a resources for HIV prevention, FBOs can leverageconservative national government—had been their leadership in the community to reach MARPsMexico’s funding priority. But in 2006, the Mexican with information about healthy sexuality, includingnational government began funding civil society prevention of HIV and other sexually transmittedorganizations and academic institutions to target infections (STIs), and can expand access to HIVHIV prevention effort to MARPs. HIV prevention testing, care, and treatment.2 AIDSTAR-One | May 2011
  3. 3. AIDSTAR-One | CASE STUDY SERIESFaith-Based Organizations of FBOs offering HIV services, VIHas de Vida conducts important outreach to remote indigenousThat Implement HIV populations—not a traditional MARP, but still an at-risk, vulnerable, and underserved population—Prevention Activities in Jalisco state. VIHas de Vida maintains an association with the Instituto Tecnológico y deLa Iglesia de la Reconciliación: La Estudios Superiores del Occidente (ITESO;Iglesia was founded in Mexico City in 1981 with the Western Institute of Technology and Higherthe mission of providing spiritual support to the Education), which is the Jesuit university inLGBT community. It was initially affiliated with the Guadalajara. ITESO and the Catholic OverseasMetropolitan Community Church, an international Development Agency are two of VIHas de Vida’sProtestant Christian denomination with a tradition of major donors.reaching out to LGBT individuals and communities,but later became a separate entity. In response El Mesón de la Misericordia: El Mesón wasto the HIV epidemic in Mexico, in 1986 La Iglesia founded as a collaborative effort between the civilbegan implementing activities, such as workshops hospitals in Guadalajara and Jesuits in 1996 asthat disseminate information on HIV transmission an alternative health care option for PLHIV. Atand prevention and that focus on safer sex, condom that time, patients in Jalisco state (where the citydistribution, and human rights advocacy. The of Guadalajara is located) had no access to continues to focus on HIV prevention today PLHIV experienced high levels of mistreatment,by sharing information during Sunday services, stigma, and discrimination within the health careby leading discussions in self-support groups, system. Staff members at El Mesón sought toand by providing counseling for individuals and demonstrate that it is possible for PLHIV to livecouples. La Iglesia also promotes adherence to longer and healthier lives; the El Mesón staff thenantiretroviral therapy (ART), self-care, and patient set out to improve the quality of life for PLHIVeducation among PLHIV. An important part of La and to provide them with hospice services.Iglesia’s mission is to encourage reflection on the With the advent of ART and other advances inlink between sexuality and spirituality and—as the managing HIV, El Mesón has moved toward a moreFBO’s own name indicates—on the reconciliation of comprehensive health care model. By incorporatingboth aspects. spirituality into its services, El Mesón provides physical, psychological, and social services toVIHas de Vida: Jesuit priests working in PLHIV and their caregivers.Guadalajaran shelters in the 1990s observed thestigma and discrimination experienced by PLHIV. In1999, VIHas de Vida was founded in Guadalajarato provide 1) integrated care for those living with Integrating Spirituality and aHIV and 2) prevention services for those at risk. By Holistic Visionfilling gaps in HIV services in the Guadalajara area,VIHas de Vida has expanded its scope to include MARPs and other vulnerable populations oftenHIV testing and counseling, as well as training of engage in behaviors that are at odds with traditionalcommunity health promoters. Part of a network religious teachings. Instead of using religious Faith-Based Organizations and HIV Prevention with Most-at-Risk Populations in Mexico 3
  4. 4. AIDSTAR-One | CASE STUDY SERIESdoctrine as justification to avoid or to shun MARPs beyond providing health care services for physicaland other vulnerable populations, the three or biological needs to address all aspects of anFBOs mentioned use their faith as a motivation individual and his or her social environment. Familyand means to reach marginalized populations. members may also gain access to services andSexuality is approached from a holistic perspective, support at El Mesón, both for their own healthintegrated with faith, and interwoven with messages and, because the family members are often theon HIV prevention and care. caregivers, for the health of the family member with HIV. El Mesón also attends to its clients’ spiritualityAt La Iglesia, themes of human sexuality are beyond a Catholic—or religious—context. Ainterwoven into more traditional church activities functioning chapel is located on the same premisessuch as prayer circles, homilies, and Bible as El Mesón’s health clinic. Yet because thestudy. Messages include not only information on Catholic Church does not officially recognize Elprevention of HIV and other STIs, but also how Mesón, the chapel is used more often as a spaceto demonstrate respect for others and lessen for personal reflection and prayer than for officialdiscrimination. La Iglesia’s staff members view Church services.sexuality as but one aspect of a person. Differentactivities—Sunday sermons, charlas (talks), andprayer circles—address sexuality and spiritualityin different ways. The sermons borrow from the HIV Prevention with Most-at-field of psychology to help explain behavior and to Risk Populationsprovide models for a more constructive sense ofself, thereby emphasizing self-respect and respect Information sharing: The three FBOs usefor others. different approaches to reach MARPs and other vulnerable populations with information about HIVVIHas de Vida provides HIV prevention services and related services. La Iglesia uses an innovativethrough sharing information and providing approach by recognizing sexuality and spiritualitytraining. While it conducts periodic outreach to the as integrated within an individual, not as conflictingcommunity, VIHas de Vida also trains community components. During services, La Iglesia usesleaders—who are well positioned to serve as gender-neutral language so the messages worktrusted sources of HIV information—so those for both men and women. The primary focus ofleaders can give talks on HIV prevention. Because the information from La Iglesia is religious orit is faith-based, VIHas de Vida works to help its spiritual; HIV is integrated into the services, butclients strengthen their faith and relationship with HIV is not the main message. HIV is addressedGod, which is the basis for a spiritual support group as one of many cross-cutting issues that affectfor PLHIV. VIHas de Vida and El Mesón, both individuals and the community. In addition tolocated in Guadalajara, provide complementary providing information during its Sunday services,services, referring and counter-referring clients: La Iglesia hosts talks and workshops after eachVIHas de Vida focuses more on prevention service. Every Thursday, La Iglesia staff membersinformation and training, while El Mesón places a produce a weekly publication that covers a range ofgreater emphasis on care and support. topics, including HIV, other STIs, and other issues affecting the LGBT community. La Iglesia alsoVIHas de Vida coordinates spirituality support maintains a library that is open to the public andwith El Mesón. As part of its integrated response features reading materials about human HIV prevention and treatment, El Mesón goes The library’s hours coincide with the counseling4 AIDSTAR-One | May 2011
  5. 5. AIDSTAR-One | CASE STUDY SERIESschedule, thus increasing opportunities for inviting local families to participate in arts projectsinformation sharing. to encourage reflection and conversation about HIV. El Mesón also holds informational events at localVIHas de Vida takes a more direct approach to universities to raise awareness.information dissemination. Trained facilitators andcommunity health promoters bring information to the Referrals: La Iglesia and VIHas de Vida providecommunities via informational talks. VIHas de Vida referrals to other organizations and government-runprovides supportive supervision visits to those health clinics for HIV-related services which they do notpromoters where possible, but given the remote provide. VIHas de Vida is one of several institutionslocation of many communities, this supervision may in Guadalajara that refers clients to El Mesón forbe carried out by email or telephone. Using manuals HIV-related services.developed by VIHas de Vida, the community healthpromoters are sensitized to sexual diversity and As a provider of comprehensive care and supporthow it relates to HIV risk behaviors. In collaboration services, El Mesón receives referrals. Publicwith other groups, VIHas de Vida also develops the hospitals and clinics will refer clients to El Mesóninformational materials used in the talks and targets for management of ART, opportunistic infections, orthe materials for different topics and audiences. STIs, and will send stabilized patients to El MesónThe manuals used in the talks cover workshops on for continuing and follow-up care. Although Elsexuality and human rights for PLHIV, with a special Mesón does not prescribe antiretroviral drugs, clientfocus on both women living with HIV and indigenous medications received from hospitals and clinicspopulations. may be stored at El Mesón’s on-site pharmacy. El Mesón staff members monitor client adherenceEl Mesón links directly with other health facilities to treatment and provide over-the-counter drugs,in Guadalajara through a referral system that gives such as aspirin and acetaminophen. El Mesón alsoclients information about HIV and about services receives referrals from outside clinics and hospitalsthat are available through El Mesón. In addition, for self-help and support groups (see PositiveEl Mesón plays an active role on World AIDS health, dignity, and prevention section). Although ElDay, both distributing informational materials and Mesón provides many care and support services on an in-house basis, it refers clients outside for confirmatory HIV testing. The three FBOs make referrals for prevention and treatment of intimate partner violence, but their staff members say that their screenings rarely identify cases of partner violence. The FBOs’ various referrals are made on an informal basis and, because of resource limitations, little follow-up occurs. Condom promotion and distribution: VIHas de Vida Because some religious institutions are openly opposed to condom use, condom distribution can beCommunity members at an informational talk in a difficult issue for FBOs to navigate. As a part of itsGuadalajara. counseling and testing program, El Mesón distributes Faith-Based Organizations and HIV Prevention with Most-at-Risk Populations in Mexico 5
  6. 6. AIDSTAR-One | CASE STUDY SERIEScondoms supplied at no cost by the State Council and testing as a prevention strategy and placesfor AIDS Prevention (COESIDA, its acronym in strong emphasis on pre-test counseling for generalSpanish, provides condoms to HIV prevention groups HIV information and post-test counseling fortargeting MSM). Condoms are also distributed personalized risk reduction. Staff members areto PLHIV as part of El Mesón’s secondary HIV trained to identify risk factors when clients seekprevention efforts. El Mesón reports to COESIDA on non–HIV-related services so that staff memberscondom distribution, including how many condoms can appropriately offer HIV testing and counseling.are distributed and to which populations. VIHas deVida does not receive condoms from COESIDA Although it does not offer HIV testing, Labecause VIHas de Vida does not officially target Iglesia does provide HIV counseling for bothMSM, although it does promote use of condoms as individuals and couples. Information impartedan HIV prevention method. During Sunday services, in the counseling sessions includes facts aboutLa Iglesia distributes condoms, which are supplied different STIs—including HIV—and methods ofby Population Services International, as prizes. prevention. Again, La Iglesia adopts a holisticCondom distribution has been a component of La approach to STI prevention within the context ofIglesia’s HIV programming since its activities began relationships. Emphasis is placed on interpersonalin 1986. In addition to its condom distribution, La communications, affection, and pleasure. La IglesiaIglesia also provides demonstrations on correct use makes referrals for HIV testing and encouragesof condoms. clients to use existing health care systems.Service through counseling and testing: El Prevention of mother-to-childMesón began its HIV testing program as an outreach transmission services: In 2004, in responseservice to staff members at private companies in to the clear need for services, El Mesón began theGuadalajara in 2008—at the companies’ request. “Salva a tu Bebé del SIDA” (Save your Baby fromSuch testing is done confidentially in private spaces AIDS) program to provide pregnant women withon company premises, along with group pre-test information about HIV, about preventing mother-counseling, individual risk assessment, and individual to-child transmission of HIV, and about caring forpost-test counseling. In an effort to offer counseling babies. Salva a tu Bebé del SIDA, which identifiesand testing to more workers, some companies have women living with HIV early in their pregnancies byrecently asked for such services for their employees using rapid testing, is coordinated with hospitals,who work the night shift. Lately, El Mesón has public health institutions, COESIDA, and otherstruggled to meet the demand for HIV testing on-site organizations. The El Mesón program providesat local companies because it has been hampered support to the mother throughout the pre-, peri-,by a shortage of trained staff members who can and postpartum periods, including counseling andprovide counseling and testing services. El Mesón support related to diagnosis, birth, and infant feeding.also provides testing at its own facility, as well asdrop-in testing and counseling at universities and Women are encouraged to bring their partners in forother public spaces, including community events. testing so that both parents may access services at El Mesón. The mother-baby pair is followedStaff members at both El Mesón and VIHas de for up to two years, during which time the motherVida received training from the AIDS Healthcare receives counseling on infant feeding and the babyFoundation about use of the rapid HIV test. VIHas is tested for HIV. A two-year follow-up period isde Vida began providing HIV counseling and rapid considered a best practice in PMTCT programs,testing in 2009. VIHas de Vida views counseling but few programs carry out this activity for the full6 AIDSTAR-One | May 2011
  7. 7. AIDSTAR-One | CASE STUDY SERIEStwo years, and even fewer programs have the high Because of its better monitoring practices, El Mesónretention rates achieved by El Mesón, which also has more detailed information on the results of itsprovides counseling on family planning (for more activities. In 2008 and 2009, El Mesón providedinformation on El Mesón’s retention rates, see on-site HIV testing and counseling to more than 300Program Results). Small gifts are provided to the employees of private companies, reaching a total ofmothers as incentives to stay with the program. 40 to 100 people at a time. During those two years,VIHas de Vida forms part of a network that refers El Mesón provided nearly 1,000 rapid HIV tests atclients to PMTCT services in Guadalajara. other group events. Since 2004, a total of 98 women have participated in Salva a tu Bebé del SIDA, givingProviding services and referrals is not the only way birth to 91 babies—and all 44 babies who have beenby which El Mesón and VIHas de Vida contribute followed to the age of two remain PMTCT programming in Guadalajara. Both Although the numbers for the three FBOs may seemorganizations participate on a PMTCT advisory low compared to the numbers in larger programs,board for the state of Jalisco. This advisory board the small groups demonstrate success for smalloversees the quality of PMTCT services throughout populations served by FBOs operating with limitedthe state and coordinates services. resources.Positive health, dignity, and prevention:PMTCT programs are not the only way that ElMesón targets women with HIV programming. El What Works WellMesón operates support groups for women livingwith or affected by HIV. The women involved have Despite limited formal monitoring and evaluationidentified their own needs, leading to the formation activities, the innovative approaches used by theof groups for mutual support among PLHIV or three FBOs demonstrate success in HIV preventionfor serodiscordant couples. La Iglesia also hosts activities for MARPs and other vulnerable groups for PLHIV. Adherence to plans and objectives: Clear acknowledgment of organizational goals helps to focus both staff and activities. La IglesiaProgram Results is unambiguous in its mandate: attending to the spirituality of its clients is its top priority. ImportantLa Iglesia has a small but loyal following. In addition secondary efforts focus on addressing HIV,to weekly attendance at religious services, between substance abuse and addiction, and cancer. La25 to 50 people attend La Iglesia’s periodic charlas Iglesia does not see proselytizing as a goal. Its goalabout HIV, safe sex, and condom use. VIHas de is to fight for human rights and to contribute to theVida provides HIV testing and counseling to as many holistic wellness of 15 individuals each month. According to its mostrecent evaluation (covering 2007 to 2009), VIHas de When conducting outreach in rural communities,Vida met its goals for the number of people trained VIHas de Vida identifies a specific purpose for theand training workshops conducted. VIHas de Vida workshops or talks to be given by its staff or healthhas been successful in positively changing the promoters. While acknowledging that its resourcesattitudes of community leaders, volunteers, and other and services are of limited helpfulness in ruralpeople undergoing training to become facilitators communities, VIHas de Vida remains realistic aboutwho work with MARPs. what referrals it can offer to such remote populations. Faith-Based Organizations and HIV Prevention with Most-at-Risk Populations in Mexico 7
  8. 8. AIDSTAR-One | CASE STUDY SERIESVIHas de Vida is currently refining its organizational may gain access to care and support services at Elgoals and objectives to make them more practical, so Mesón’s on-site clinic, which is staffed 24 hours a daythat staff members can use the goals and objectives by doctors and nurses. Because clients may travelin their daily work, thereby connecting routine from remote areas in Jalisco state or beyond to takeactivities with the broader aims of the organization. advantage of HIV-related services in Guadalajara, El Mesón also operates an on-site hostel where clientsEl Mesón has four coordinators who oversee their may stay while they undergo diagnostic testing ordifferent programmatic areas: 1) counseling and treatment, including PMTCT services.testing, 2) PMTCT, 3) social work, and 4) businessdevelopment. The majority of the organization’s funding Like El Mesón, VIHas de Vida also seeks to sensitizecomes from donations. The coordinators conduct health care personnel to HIV issues. VIHas de Vidastrategic planning every four years, which helps El staff members collaborate with El Mesón’s staff toMesón respond to the needs of its target populations, fill in personnel gaps and to create a more balancedmanage a range of activities, and coordinate with interdisciplinary team. The multidisciplinary team atother groups such as VIHas de Vida. To maintain staff VIHas de Vida focuses on human rights, education,capacities in their designated areas, El Mesón staff and follow-up. Team members conduct trainings andmembers attend an annual three-day training course. workshops on different themes related to HIV, such as rapid testing, and on HIV risk, such as that fromCoordination with complementary injecting drug use. The topics and venues vary andservices: Since its inception in the mid-1990s, are tailored to the specific participants and audiences.El Mesón has developed a diverse network withother organizations, both governmental and La Iglesia promotes adherence to medically prescribednongovernmental, including FBOs and community- treatment (including antiretroviral drugs) and healthbased organizations, public health facilities, and education while encouraging clients to use existingeducational institutions. El Mesón works to create health care systems. Clinics run by Mexico’s sociallinkages between medical staff members in local security and public health systems have protocols andinstitutions and its own clinic, thus increasing the informational materials on HIV, but clients often havecadre of health care providers who are sensitized to specifically request this information. La Iglesia urgesto HIV issues and are trained in HIV care. PLHIV its clients to keep using the government-run clinics, but encourages them to ask questions of the clinic staff and use all the services available at the clinics. La Iglesia’s staff members attend meetings of other groups, such as Alcoholics Anonymous, to give charlas about sexuality and HIV, thus linking diverse clientele to the church services and further encouraging clients’ use of health care systems. Challenges Reaching most-at-risk populations and El Mesón other vulnerable populations: MARPs are difficult to reach, but the three FBOs target bothEducational session on HIV in the world. MARPs and the general population. La Iglesia has8 AIDSTAR-One | May 2011
  9. 9. AIDSTAR-One | CASE STUDY SERIEStraditionally reached out to LGBT populations in Mexico HIV risk behaviors are condemned by Judeo-City, but is seeking to broaden its audience by inviting Christian teachings, so MARPs may be wary ofmore members of the general public to its church. approaching a religious institution for fear of stigma and discrimination. Thus, FBOs working in HIVIndigenous groups often live in remote areas with prevention must work to establish rapport with thelimited access to health services. Since 2005, communities they seek to serve. La Iglesia has builtVIHas de Vida has conducted near-annual visits trust with its community; word of mouth spreadsto rural communities to bring services and to awareness about a church that embraces sexualgive informational talks. Because local leaders diversity instead of denouncing it.often request specific topics for such communitypresentations, deviating from the scope of the visit Although it is managed by secular staff members,may be difficult. Given the limited resources in VIHas de Vida is affiliated with and supportedmany rural communities, VIHas de Vida is reluctant by the Jesuits and receives funding from otherto promote services that are not available in those religious organizations. Program coordinatorsareas. However, wherever possible, VIHas de Vida sit alongside Jesuit priests on the board, andprovides contact information for other organizations pastors of small churches help spread informationthat are closer to home and accessible to such about VIHas de Vida and its services in theirremote populations. communities. This mix of secular and religious board members provides a balance to the VIHasIn many places worldwide, MARPs are hidden de Vida approach and maintains credibility inpopulations, and Mexico is no exception. By different groups.targeting the general population through itsworkplace HIV testing and counseling campaigns, Also following the Jesuits’ approach, El Mesón allowsEl Mesón hopes to reach MARPs who do not seek more traditional Catholic services to be conductedHIV-related services on their own. Partners and in its chapel, but because El Mesón is not officiallychildren of PLHIV often come to El Mesón for HIV sanctioned as a Catholic church, its clients maytesting; many women clients know or suspect that also use the space for broader purposes. Instead oftheir husband or partner is HIV-positive. Testing depicting images of suffering, guilt, and punishment,partners is another strategy to indirectly reach El Mesón’s space is furnished with images of hopeMARPs. El Mesón also hopes to increase HIV to create a more open space for worship. El Mesóntesting among pregnant women to reach MARPs works with community organizations to promote itsfrom a more general population approach. public perception and work in the community.Challenging assumptions about faith-based organizations: The public often assumes Reaching sustainability: Many community-that organizations with a religious affiliation have a based organizations depend on a single leader tomissionary agenda, which can impede the activities organize and promote their work. Reverend JorgeFBOs try to implement. One assumption is that Sosa, founder and religious leader of La Iglesia,FBOs—uncomfortable with activities such as the was charismatic and visionary; his unexpectedpromotion of condom use—offer only palliative care, passing in late 2009 left La Iglesia without his energyif the FBOs deal with HIV at all. and passion. Today, the two remaining part-time staff members keep the church’s activities goingIndeed, for some FBOs, just working with MARPs but acknowledge they are struggling to maintainmay conflict with certain religious tenets. Many Sosa’s momentum and have been forced to reduce Faith-Based Organizations and HIV Prevention with Most-at-Risk Populations in Mexico 9
  10. 10. AIDSTAR-One | CASE STUDY SERIESservices. An additional staff person was receivingtraining in 2010 to help distribute the workload. Until RecommendationsLa Iglesia completes the registration process as a Focus on staff technical capacity: Equippingnongovernmental organization (NGO), thus making staff members with appropriate technical knowledgeit eligible to receive government funding, La Iglesia’s and supportive supervision will improve the qualityoperations must depend on donations from the of services and may help diminish staff turnover.congregation and volunteers. The small but loyal Staff members of the three organizations are eagercongregation helps keep the church going, and the to improve their ability to provide the best servicesdifferent backgrounds and approaches of the two main possible to their clients. Staff members identifiedstaff members—one is a university professor, the improving specific activities as a priority. La Iglesiaother is a psychologist—lend balance to the church uses La Loteria de Vida in its Sunday services tostructure. La Iglesia recognizes its sustainability promote HIV education. Although the Loteria activitychallenge and strives to build for the future while is entertaining as well as educational and impartsmaintaining routine activities. An additional challenge important information, La Iglesia’s staff wouldis the legal status of the organization—limited until La like external assistance to expand the game or toIglesia becomes a registered NGO—along with the establish different educational activities that are alsoresultant increased access to resources. entertaining, to keep both the content current and the participants engaged in learning.Although the situations of VIHas de Vida and ElMesón are less precarious, neither is immune to the Staff members at both El Mesón and VIHas dechallenges of sustainability. Both FBOs operate with Vida have received training to provide HIV testing,a small cadre of staff members and volunteers and a but their training so far has been focused on themix of funding sources. To ease transitions between administration of the test itself. To better serve theirleaders, VIHas de Vida is developing a process to clients, staff members at El Mesón and VIHas demanage coordination of its governing body; there is Vida could benefit from further training in HIV riskalready a six-month overlap between incoming and assessment and in risk reduction counseling.outgoing staff members for orientation and training.Ensuring continuity in human resources minimizes Maintain linkages and strengthendisruption of activities, thereby allowing both staff outreach: As small organizations with limitedand management to focus on overall program budgets, the three FBOs recognize their ownoperations and to secure regular funding. strengths as well as the areas where they need to refer to other service providers. The FBOs conductHowever, the small size of the FBOs may be a outreach in communities of MARPs and otherbenefit because it allows for more flexibility in vulnerable populations, thereby linking the populationsprogramming. Specific churches or individuals to the services they need. La Iglesia is keen to expandoften conduct work—such as HIV prevention—that its congregation beyond the LGBT community.may not fall under the mandate of a larger religious La Iglesia fills a unique niche in Mexico City, andorganization. The energy and dedication of the staff expanding its reach to more women and youth—twoare perhaps the greatest assets of the three FBOs. priority groups—would help attract more peopleOnce an area of need is identified, the staff can to its services. Groundwork for collaboration withchoose to adapt activities at a rate faster than a other groups has been laid, with the La Iglesia stafflarger organization might, provided the resources are attending meetings of other local community-basedavailable. organizations to strengthen ties and referrals.10 AIDSTAR-One | May 2011
  11. 11. AIDSTAR-One | CASE STUDY SERIESVIHas de Vida is ready to expand its network to include MSM and IDU, but no special provisions have beenmore groups. VIHas de Vida does not have a contact made to support FBOs or reach other vulnerablein many indigenous communities to help facilitate entry, populations, including women. Moreover, as reportedbut it hopes that word of mouth in the region about its by the International HIV/AIDS Alliance (2009),work will continue to expand its reach into new groups community-based organizations have had difficulty inwith educational sessions and HIV testing. accessing GFATM grants. Other donors, such as the U.S. Agency for International Development (USAID),Invest resources in program monitoring: may be approached to cover the gaps in coverageMaintaining a monitoring system is essential to track left by GFATM.progress toward goals, demonstrate achievements,and identify opportunities for expansion when La Iglesia hopes to complete the registration processseeking funding. Given current resource limitations for official NGO recognition by early 2011. Gainingand staff size and training, it is not surprising that NGO status will open opportunities for La Iglesia’sthe three organizations have minimal program funding from the Mexican government and othermonitoring in place. Of the three, VIHas de Vida donor organizations. (VIHas de Visa and El Mesónhas the strongest monitoring system. Evaluations are both registered NGOs.)take place every six months to monitor progress, butthe methods change annually, making it difficult to Working with FBOs may be difficult at times becausecompare indicators from year to year. VIHas de Vida of the challenges involved in identifying organizationsis working to systematize its program evaluations with the staff capacity and operational ability to reachto reduce inconsistencies. The model selected is large numbers of people. However, La Iglesia, VIHasintended first to establish a baseline and then to de Vida, and El Mesón demonstrate the potentialtrack data to look for evidence documenting the for success. Through their work with the generaleffects of its HIV prevention work. population and by providing outreach and HIV-related services such as counseling and testing, VIHasLa Iglesia carries out informal surveys to monitor de Vida and El Mesón have the potential to reachcondom use among clients; an initial survey is MARPs with critically important services. Additionalfollowed up one month and six months later. However, support for the three FBOs and their efforts to improvetracking of client visits or referrals is not documented. operations could increase the reach of preventionSimilarly, El Mesón collects only basic statistics on services among MARPs in Mexico. nthe number of people accessing services. For dataon overall effects, El Mesón depends on specialstudies by universities or other groups. It is currently REFERENCESreviewing its monitoring strategy. Both organizations Bastos, F. I., C. Cáceres, J. Galvão, M. A. Veras, and E.currently lack the capacity in both human and financial A. Castilho. 2008. AIDS in Latin America: Assessing theresources to design and implement additional Current Status of the Epidemic and the Ongoing Response.monitoring activities. International Journal of Epidemiology 37(4):729–737. Centro Nacional para la Prevención y Control del VIH/SIDA. 2010. Mexico 2010 Country Progress Report. AvailableFuture Programming at country_progress_report_es.pdf (accessed June 2010)Mexico was selected for eligibility for funding in 2011 Cohen, J. 2006. Land of Extremes: Prevention and Careby GFATM. The focus of Round 10 funding is on Range from Bold to Bleak. Science 313(5786):477–479. Faith-Based Organizations and HIV Prevention with Most-at-Risk Populations in Mexico 11
  12. 12. AIDSTAR-One | CASE STUDY SERIESInternational HIV/AIDS Alliance. 2009. Report on Access to Population Services International. English website available atGlobal Fund Resources by HIV/AIDS Key Populations in Latin and the Caribbean. Available at Joint U.N. Programme on HIV/AIDS. English website availableresources_ENG.pdf (accessed August 2010) at Spanish website available at www U.N. Programme for HIV/AIDS. 2007. Mexico CountryFact Sheet. Available at VIHas de Vida. Spanish website available at www.vihasdevida.factsheet.aspx?ISO=MEX (accessed June 2010)ía de Salud. 2008. Programa de Acción Específico2007-2012: En respuesta al VIH/SIDA e ITS. Available ACKNOWLEDGMENTSProgAc2007-2012.pdf (accessed February 2011) AIDSTAR-One is grateful for the information provided by the staff members of La Iglesia de la Reconciliación, VIHasStrathdee, S. A., and C. Magis-Rodriguez. 2008. Mexico’s de Vida, and El Mesón de la Misericordia. Their energy,Evolving HIV Epidemic. Journal of the American Medical dedication, and willingness to share their experiences madeAssociation 300(5):571–573. this case study possible. Many thanks also to Lindsay Stewart of the Bureau of Latin America and the Caribbean at USAIDRESOURCES headquarters in Washington and to Nancy Alvey with USAID/ Mexico for their support and guidance.Centro Nacional para la Prevención y el Control del VIH/SIDA.Spanish website available at Global Fund to Fight AIDS, Tuberculosis and Malaria. RECOMMENDED CITATIONEnglish website available at Bergmann, Heather, and Aysa Saleh-Ramírez. Faith-Spanish website available at Based Organizations and HIV Prevention with Most-at-Risk Populations in Mexico. Case Study Series. Arlington, VA:El Mesón de la Misericordia. Spanish website available at USAID’s AIDS Support and Technical Assistance Resources, AIDSTAR-One, Task Order 1. AIDSTAR-One’s Case Studies provide insight into innovative HIV programs and approaches around the world. These engaging case studies are designed for HIV program planners and implementers, documenting the steps from idea to intervention and from research to practice. Please sign up at to receive notification of HIV-related resources, including additional case studies focused on emerging issues in HIV prevention, treatment, testing and counseling, care and support, gender integration and more.12 AIDSTAR-One | May 2011