We are family: How peer testing is breaking down the barriers for HIV testing
Having grown up gay in a Muslim family, Arslan Ahmed understands some of the barriers New Zealand men can have when it comes to talking about sexual health and getting tested for HIV.
The 24-year-old came to the country as a five-year-old when his family emigrated from Pakistan and he enjoyed a “fairly normal childhood” living in the Auckland suburb of Mt Eden.
But having studied health sciences at university and after carrying out research into gay and bisexual health, he realised he could use what he’d learnt “in a real world setting” by joining the New Zealand AIDS Foundation and working as a peer tester.
The peer testing model, says Arslan, “challenges many assumptions about how healthcare should be delivered and who should deliver it. Often conventional medicalized spaces create barriers for marginalized people when they access services. As a peer tester I am able to test members of my community for HIV and other STIs and have informed conversations about safe sex. Being a part of the community, provides a more accessible environment for testing
Only three years ago, registered social worker Susan Mundt, shared research with the NZAF which showed nearly half of people living with HIV experienced stigma from healthcare providers, which means peer testers play a vital role in Ending HIV’s goal to get Kiwi men who have sex with men (MSM) to know their status.
“As a peer tester I’m considered a health professional but I’m also a part of the community,” Arslan says. “I’m 24, I go out every weekend and so there’s a visibility about what I do. That creates a more accessible situation because – especially for first-time testers – people can be apprehensive about coming in, but when they see a young guy like me that creates a dialogue. There’s a far greater degree of relatability.”
Arslan is quick to point out that peer testers are not counsellors - although they can act as the perfect conduit for clients to access counselling. One of the things he really likes about being a peer tester is having the opportunity to meet other MSM and talking to them about their experiences in a safe and confidential situation; empowering other MSM to take control of their sexual lives. “When you have people every day telling you sensitive information about their sex lives, confidentiality and professionalism is a huge part of the role.
Removing barriers so that guys find it easier to test regularly is a major part of the peer testing scheme. One of the ways the NZAF is doing that is taking testing out of the clinic and into sex-on-site venues or events in the community. Arslan who freely admits his “anxiety was running through the roof” when he went for his first HIV test and understands why people may be wary of the experience. He says the anonymity of sex-on-site venues, like Centurian in Auckland, can be especially appealing for some of his clients.
What a positive result means for people from different cultures is also hugely important to consider, and Arslan says his own background in public health helps him understand why some men don’t get tested. He adds that peer testing is helping to change that.
“We had one guy who made several appointments with us and told me he even parked up outside, but never came in,” he says. “He came from an Asian background which definitely influenced that – HIV still invokes shame and embarrassment in many Asian cultures, so his fear of a positive diagnosis actually prevented him from testing. He ended up testing at a sex-on-site venue instead because he would go there regularly anyway, and being able to see that another gay man was going to be the one doing the test made it easier for him.”
“You have to take into account how Asian MSM individuals view sexual health. Often there is a general reluctance to be open about sex and it can be extremely confronting to talk about something like HIV. I can attest to that because I grew up in a Muslim household and I know that these barriers really do come into play. Certainly it’s not a surprise when someone who might want to get tested doesn’t show up for his appointment.”
Becoming a peer tester also meant Arslan had to confront some of his own preconceptions about HIV. For example, he’s now got used to testing people he has met in different contexts (it can be awkward at first but he always puts the client’s needs first and treats everyone with the same high level of professionalism), and has learnt to overcome a stereotypical idea he had of having to break the news of a positive test.
“The very first time I had to relay a positive test result was in a sex-on-site venue and this guy was so accepting of it – he already knew the risks and what he was going to do,” he says. “He just wanted to get treatment, get his count down to zero and then get back to having sex. That first time set the benchmark and made me realise, okay, HIV means something different to every single person.”
Arslan says one of the key pieces of feedback he gets is from men who say they feel really comfortable talking about their “secret lives” with peer testers because of the level of confidentiality.
“It’s on that human level that it works. At the end of the day peer testers are gay and bi men providing services for other men who are having sex with men; and, because I come from a Muslim background I can also relate to a lot of Asian men and their secret lives - they can’t come out because of family.
“That’s what I’m constantly telling clients. 30 years ago it was illegal to be gay in New Zealand and so it’s a privilege for me to be doing this role, talking openly and being as gay as I want. It gives me so much joy to be part of ending HIV, so that 30 years in the future, if HIV doesn’t exist, then it would have been incredible to have played a part in that."
What does Arslan have to say for first-time testers, who may be worried about getting tested?
“Just come with an open mind. Do some of your own research and come with questions you want answered,” Arslan says. “Because this time is about you. If you just want a test that’s fine, but it’s also about utilising the people you’re talking to and asking questions about sexual health, because this is time allocated for that and you get to talk about all this stuff in a safe space, confidentially.”