Positive Life NSW

Robert Baldwin talks about his experience working with Violet Home in Thailand.

Violet Home is a small community based organisation located in the northern Thai city of Chiang Mai. It serves MSM (men who have sex with men) who are also living with HIV. All of the five staff are positive MSM. They also have twenty positive MSM volunteers, and have so far reached over six hundred positive MSM from across the north of Thailand.

Rob describes how his initial contact with the group came about:

"I originally got involved with Violet Home in early 2007 as I was facilitating the new APN+ MSM working group (Asia Pacific Network of PLHIV now with over 30 members from 15 countries). I was approached by the International HIV/AIDS Alliance, to assist Violet Home to develop a specific safe sex training curriculum for positive MSM (staff, volunteers and clients). After the success of that initial work we have continued a working relationship with me providing ongoing technical support” he says. “The International HIV/AIDS Alliance are the core funder of Violet Home and also fund our MSM working group," Rob added.

Reaching out to diverse positive MSM

Robert Baldwin & Violet Home participantsViolet Home has been operating since 2003 and does much of its good work through reaching out to positive MSM (including transgender people and male sex workers) in the community. The staff and volunteers do this via confidential peer based phone counselling, support group meetings, and home and hospital visits. They also advocate to local service providers and health authorities to provide and improve services for positive MSM.

“I find the guys so inspiring because they have really taken on the community development model of working collaboratively together to try to make life better for themselves and their peers.” Rob enthuses and also adds, “In spite of the fact that none of the VH staff have any professional background in health or community work they have been willing to learn & try new ideas, plus continue to challenge a status quo in Thailand where MSM issues, and particularly positive MSM issues, have largely been ignored”.

Peer based success – breaking new ground in Asia

The idea of a peer based approach to dealing with the HIV epidemic may seem quite natural to Australians where we have seen many continuing and successful government supported peer based approaches such as from Positive Life NSW. However in much of the Asia Pacific Region, Violet Home is on ground breaking territory with their approach to reaching and supporting positive MSM who are often near invisible to the general population. Violet Home is also working in a challenging environment where a rapidly escalating HIV epidemic among Thai MSM is only now being recognized and actions implemented such as establishing clinical services specifically designed for MSM. A large-scale seroprevalence study in mid-2003 among Bangkok MSM revealed a startling 17 percent HIV prevalence rate. The men surveyed were largely Thai males who have sex with other Thai males, rather than foreigners. A follow-up study in 2005 found the HIV prevalence rate among Bangkok MSM had jumped in only two years to 28 percent.

This follow-up study also included Chiang Mai where the HIV prevalence among local MSM was found to be a high 15 percent .

“Through the good ongoing work of Violet Home and other organisations such as TNP+ (Thai Network of PLHIV) and Mplus (Chiang Mai based msm org) they have managed to get the government & health agencies to now listen & start responding to their needs”, Rob says when asked about the success of the organisation.

Funding and workspace challenges

Violet Home also faces other challenges such as a largely inadequate work space with no air conditioning or private counselling rooms, skills limitations, reluctance by local authorities to support innovative interventions and continually having to seek out funding from foreign sources. The International HIV/AIDS Alliance (www.aidsalliance.org ), utilising USAID funds, are the current core funder of Violet Home and also fund the APN+ MSM Working Group.

Focus groups and evaluation reveals greater need

Violet Home conducted focus group discussions in late 2007. They gained some very interesting and useful insights including that their clients wanted more information and educational experiences on healthy living with HIV, like dietary advice and exercise. Their clients also wanted more opportunities to overcome their social isolation through social and fun activities, chances to gain employment that are appropriate to their capacities, and a greater understanding of safe sexual behaviors and how/when to disclose their positive status to sexual partners.

In the recent evaluation report for this AFAO funded project it was noted that staff/volunteers seemed to feel more confident in sharing knowledge and beliefs on safe sex and STIs and that evaluation workshop participants believed volunteers and clients are accessing local STI clinical services more readily. Violet Home, it was also noted, would like a longer-tem relationship with an organisation like AFAO to assist them in developing appropriate and effective resources, funding proposals, tips on how to analyse their work and also assistance with human resource management.

Looking ahead

In spite of the challenges Violet Home has been moving ahead and in 2008 secured two small grants to allow them to expand their work. The first was funding for six months from the AFAO International Small Grants Project to develop promotional materials and training resources, conduct training for volunteers and clients on safe sex and STIs (sexually transmitted infections), and produce a regular newsletter targeted at their clients and supporting organisations.

The second small grant received by Violet Home in 2008 was funding for twelve months from the Collaborative Fund (via the Asia Pacific Network of PLHIV www.apnplus.org ) to support training on ARV (anti-retroviral medications) and OI (opportunistic infections) for staff, volunteers and clients. It has also allowed them to produce new media specifically for positive MSM and increase field visits by volunteers.

Both these relatively small grants have enabled Violet Home to attempt to fulfill a growing need by local positive MSM for information and training on HIV issues as they specifically relate to men who have sex with men who are living with HIV.

A regional inspiration

Violet Home is indeed out there at the forefront of implementing innovative responses to the HIV epidemic for MSM and TG in northern Thailand. They are also an inspiration to other positive MSM in the Asia Pacific Region, demonstrating that life for MSM living with HIV can be improved through working collaboratively together. The very motivated staff and volunteers hope to continue to expand their reach to work with even more positive MSM in the near future, and help challenge the prejudice and isolation they often feel from other MSM, health services and the general Thai population.

Strategic Plan

The Violet Home Strategic Plan 2007-2011 lists its mission goal as ‘To improve the quality of life of MSM and TG (transgender people) who are HIV positive by enabling them access to prevention and treatment services and by helping to reduce stigma and discrimination against them, allowing them to live in society happily’. They have five strategic objectives:

1. Mobilizing HIV positive MSM and TG in local support groups, and linking these support groups in to larger networks such as TNP+ (Thai Network of PLHIV);
2. Helping HIV positive MSM and TG access to treatment and healthcare, either by informing them about options, referring them to appropriate services, or by providing support at home or in the hospital;
3. Improving access to, and quality of, information and health education for HIV positive MSM and TG;
4. Countering stigma and discrimination on the basis of sexual orientation and HIV serostatus by advocating with stakeholders, locally, nationally and regionally;
5. Representing Northern Thai HIV positive MSM and TG in national/international forums, and bringing the newest information and strategies back to them.

Robert Baldwin is the Technical Advisor to Violet Home. He is a northern NSW based consultant working in the HIV field with 20 years experience in over 14 countries. You can contact Robert via email: tuntable@ aol.com or if you want to know more about Violet Home visit: www.violethome.org

1. The term MSM is used in this article in a purely behavioural sense i.e. to define males who have sex with other males. While some may think this is not ideal terminology for communities to use, it is what Violet Home has chosen to adopt for the time being when talking about themselves.
2. D.Baxter, Bangkok’s MSM HIV Explosion – Precursor for Asia’s Mega-cities, HIV Australia. Vol.5. No.2. 2005. www.afao.org.au