Reaching Out to Groups on the Margins

Ms. Jenny Walsh from Australia presented an innovative model for Community Participation, developed by Ms. Pearl North. This model is based on intervening at the level of the social determinants of health, to address the fact that those who are most socially disadvantaged experience the worst health. In this model of community participation, the "target group" - those who are socially disadvantaged, from groups on the margins - are involved in sexual health projects from the perspective of employees, rather than subjects, targets or beneficiaries. The recruitment process emphasises "no experience necessary". By paying people to be involved in the project; providing transport, childcare and lunch; and providing job skills in the training, the barriers to participation for many of the most marginalised in the community are broken. Ms. Walsh noted that some of the most important outcomes of the model were not necessarily increased knowledge about sexual health, but rather "pride, confidence and raised self esteem".

In her description of work in a quite different setting, social worker Ms Parichart Wonglue from the Thai Department of Corrections described a collaborative model for addressing the HIV prevention, care and support needs of Thailand's some 228,000 prisoners. NGOs, the private sector and government work in collaboration to address HIV prevention, as well as the treatment and care needs of the many HIV infected prisoners (for example through the provision of treatment to pregnant women who have HIV infection). This collaboration extends to addressing the many other needs of prisoners (for example through counselling, supply of prosthetics, payment for dental procedures and provision of eye glasses), and particularly to trying to ensure social support for prisoners on their release. Unlinked sero-surveillance has found that ten percent of male prisoners in Thailand are infected with HIV, making this a vital "group on the margins" to reach.

Dr Endang Sedyaningsih Mahamit from Indonesia highlighted that the thousands of children who live and/or work on the streets of Jakarta are one of the most marginalised groups in that country. Dr Endang presented the results of a study investigating sexual behaviours, and the prevalence of STIs amongst male street children in Jakarta. In order to reach this marginalised group, the study collaborated with NGOs who already work in the area of street outreach, and who have established the trust of children on the street. The finding of high levels of asymptomatic sexually transmitted infections amongst these young men highlighted the need to provide prevention, treatment and care services which reach out to these young people vulnerable to HIV infection. Finally Mr Bernard Gardiner from the Red Cross gave an overview of a regional workshop on the Greater Involvement of Vulnerable People in the Mekong sub region. Building on Red Cross principles, the participation of people with HIV/AIDS was integral to the workshop approach.