Belize's HIV epidemic is concentrated in men who have sex with men (MSM) and transgender (TG) women and is characterized by an overall HIV prevalence of 1.8 percent. These groups are especially vulnerable, facing both high rates of HIV diagnoses yet exhibiting lower rates of testing, highlighting a critical gap in reaching these key populations effectively. The COVID-19 pandemic further intensified healthcare access challenges for people living with HIV (PLHIV) in Belize due to disruption in essential services, lockdown measures that affected public transportation for persons living in rural communities and reassignment of medical personnel to manage surges in patients, which in turn affected access to clinics and treatment.  PLHIV often face stigma and experience heightened anxiety due to their health condition, barriers that can impede their access to healthcare. In addition, the COVID-19 pandemic exacerbated the precarious economic conditions which would have undoubtedly affected PLHIV. In response, the Pan American Health Organization/World Health Organization (PAHO/WHO) in partnership with civil society organization (CSO) GOJoven Belize, launched a training programme for peer navigators (PN) under the Framework of Engagement with Non-State Actors (FENSA).The initiative aimed to enable PN to better connect community and clinical care and support services for PLHIV. As a result of this training, PN are now better equipped to engage key populations, promoting healthier behaviours, and enhancing sexual and reproductive health outcomes for PLHIV and their communities to reduce disparities within Belize's HIV epidemic. This training contributed to the output 4.1.a the PAHO/WHO Strategic Plan 2020-2025 as well as the SDG indicator 3.3.1. It also contributed to the GPW13 triple billion targets of one billion more people benefitting from universal health coverage and one billion more people enjoying better health and well-being.

"Participants exhibited enhanced proficiency, indicating that they had continued to engage in practice activities during the period between the post-training assessment and the supervised practicum."

 Michelle Cox Hoare, Trainer from PAHO/WHO Belize

How did Belize, with the support of the PAHO/WHO Secretariat, achieve this?

To access an array of services from testing to viral suppression, PLHIV navigate a multifaceted healthcare system. Their treatment journey includes interactions with diverse healthcare professionals, including clinicians, psychologists, nutritionists, and counsellors. In Belize, a comprehensive support network comprising social workers, adherence counsellors, community health workers from the Ministry of Health and Wellness, Peer Navigators (PNs), National AIDS Commission (NAC) District Committees, and Civil Society Organizations (CSOs) assist PLHIV. Despite this wide-ranging support structure, challenges remain due to gaps in service provision and inequitable access to services.

PNs, who often share ethnicity, socioeconomic background, language, and personal experiences including medical diagnoses, with community members, are uniquely positioned to address these gaps. In Belize they play a critical role in facilitating interactions between the community and healthcare providers. PNs offer education, practical assistance, and support across various aspects of healthcare, including disease prevention, diagnosis, management, treatment options, and lifestyle changes. Their personal experiences and established community relationships enhance their effectiveness in linking individuals with crucial health services.

PAHO/WHO acknowledged the crucial role of PNs and implemented a three-day intensive training program for two PNs from each of Belize's six districts. This program encompassed both technical and practical aspects to enhance the PNs’ knowledge, skills, and leadership abilities. Key areas of training included HIV guidelines and algorithms, sexual behaviour practices in key populations, and HIV testing promotion, as well as managing chronic diseases like hypertension and diabetes. The goal was to enable them to promote healthier behaviours, reduce risks and vulnerabilities associated with HIV/AIDS and other sexually transmitted infections (STIs), and bolster engagement with the primary healthcare system for improved sexual and reproductive health outcomes.

To support the practical elements of the training, WHO Belize provided essential tools like blood pressure monitors, glucometers, test strips, digital thermometers, and masks.

“Since attending this training, I have been able to build stronger relationships with people from ‘key populations’ in my community. I can talk to people about HIV/AIDs as well as guiding and providing blood pressure and glucose checks. I believe that I am now better able to serve my community.”

– Adrianne Alpuche, Peer-Navigator and Program Officer for the National AIDS Commission of Belize

Recognizing Jamaica's successful peer navigator program, which included a well-developed manual, PAHO Belize collaborated with PAHO Jamaica, which obtained approval from Jamaica’s Ministry of Health to adapt the Jamaican peer navigator manual for the Belizean context. This manual was then adapted, printed, and distributed by PAHO Belize, providing peer navigators in Belize with a customized, relevant, and effective resource for their crucial work.

The implementation of this comprehensive training initiative in Belize marks a shift towards a more practical, inclusive, equitable, and people-centred approach in providing services to PLHIV in Belize. The initiative embodies a vision for the future where every person, irrespective of their circumstances, has access to the necessary resources and support to manage their health effectively. It stands as a testament to Belize's commitment to creating a more inclusive and equitable healthcare system and showcases the value of sharing resources across borders to improve health outcomes.

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Photo caption: Peer Navigators (PNs) engaged in scenario-based exercises as part of their training in HIV/AIDS.

Photo credit: WHO Belize.

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Photo caption: Peer Navigators (PNs) attend trainings in HIV/AIDS.

Photo credit: WHO Belize.