Alex Freyre

For many years, Alex has been a well-known public figure in Argentina around the topic of HIV. Now he is extending HIV/AIDS prevention, diagnosis, and care to vulnerable groups most at risk of contracting the virus. In Argentina’s traditional society, discriminated “invisible” groups such as prostitutes, transvestites/ transsexuals, and prisoners have not been targeted for HIV/AIDS interventions. Alex addresses many aspects of this problem at once – reaching out to these groups to spread awareness of the virus, empowering them through discussion and alternative lifestyle opportunities to cope with HIV/AIDS if they have it, and lobbying for key changes in public health policy that make all the difference in access to diagnosis and care.

Alex is pioneering the extension of HIV/AIDS prevention, diagnosis, and care, to vulnerable groups that would otherwise not have access to it. In a traditional society like Argentina, discriminated groups such as prostitutes, transvestites/transsexuals, and prisoners, are invisible to many people, and have not been targeted for HIV/AIDS interventions by other organizations. Alex addresses many aspects of this problem at once—reaching out to these groups to spread awareness of the virus, empowering them through discussion and alternative lifestyle opportunities to cope with HIV/AIDS if they have it, and lobbying for changes in public health policy that makes all the difference in access, diagnosis, and care. Change in public policy represents important progress toward the inclusion of these vulnerable groups, for example, hospitals calling transvestites by their gender names; more accessible time schedules for HIV/AIDS testing; establishing testing centers in red light districts; and the free distribution of condoms in prisons, are among a few.

Another significant part of Alex’s work is centered on youth aged 15 to 25, one of the segments of Argentine society statistically most at-risk to contract HIV/AIDS. Because this age group has such a high rate of infection, for the past five years Alex has increasingly focused on strategies to reach a maximum number of youth in his prevention and education efforts. He started with trainings in public schools, particularly in low income areas, that have reached almost 50,000 adolescents. In the last year, Alex entered a partnership with the Ministry of Health to develop a project to train peer leaders to spread awareness-raising workshops throughout the country. This project has already reached more than 300 teens in five provinces.

In Argentina, 150,000 people live with HIV/AIDS. According to official statistics, 23.7 percent of those infected are women and 75.8 percent are men. Marginalized and impoverished populations are most affected by HIV. Sixty percent of those living with HIV are not aware of their infection, because they do not have knowledge about the disease or access to facilities for diagnosis.

Various social groups are more vulnerable than others to HIV infection, such as transvestites, transsexuals, male and female prostitutes, and prisoners. According to Fundación Buenos Aires SIDA, 80 percent of transvestites in Argentina earn their living from prostitution, and 60 percent die of AIDS. Many prostitutes accept sexual relations without protection because they will earn more money. The Fundación’s research also shows that 90 percent of prostitutes—people at permanent risk of being infected with HIV—would be interested in leaving prostitution if they could get other jobs. But this is near impossible, given societal discrimination, the employment crisis in Argentina, and the fact that many left their homes as adolescents and have not finished their studies. The Argentine government and social organizations have not promoted or pushed for changes in public policy to include these groups in HIV/AIDS interventions.

Prisoners are also a vulnerable group. According to government statistics, 5 percent of prisoners in Argentina, or 60,000 people, have HIV/AIDS. Prisoners are vulnerable to infection through overcrowding, rape, and poor living conditions; as well as the lack of prevention-related prison health policies. In these conditions, the enormous potential for a rapid spread in infection is quite dangerous.

For the general population, HIV tests are offered at public hospitals under conditions that make it difficult for marginalized groups to be tested. Those who want to be tested must dedicate three working mornings to do so: The first to get an appointment; the second, for the test; the third, to pick up the results. In addition, the gender names of transvestites and transsexuals is not respected at public hospitals, which would suggest that some may not take the test to avoid discriminatory situations.

Fifty percent of registered HIV cases are youth between the ages of 15 and 25. Among youth, especially in marginalized areas of the country, knowledge of HIV prevention is alarmingly low. According to the Argentine weekly newspaper Diario Perfil, 99 percent of surveyed teenagers say they are familiar with sexual protection methods but only 35 percent used protection in their first sexual relations, and only 31 percent continue to use it; and three percent of teenagers say they use condoms to prevent sexually transmitted diseases. The majority of these situations are concentrated in the interior of Argentina where sexual education, even on how to use a condom, is not taught in school. It is not a topic parent’s approach, or spoken of in traditional society.

Argentina’s health policies are generally conservative, driven by societal norms that are strongly linked to the Catholic Church. Until 1998, there was no official communication that included the use of a condom as a means to prevent HIV/AIDS. Today, whether free condoms should be distributed in hospitals and health centers as a means to prevent the spread and infection of HIV is still controversial. Although there are citizen organizations in Argentina working on HIV/AIDS prevention, they often concentrate on prevention of the disease through weak messaging—not targeted at specific populations.

Alex created the Fundación Buenos Aires SIDA in the mid-1990s. The Fundación’s work was first targeted at HIV/AIDS prevention among the general population. But in the last five years, Alex and his team (currently forty people, including a diverse mix of teenagers and young adults of different genders and sexual orientations who come from communities where the Fundación is present) have increasingly turned their focus toward at-risk groups contracting the virus; something no other organization in Argentina was doing. Alex combines a diverse array of strategies to tackle many aspects of the problems these groups face in accessing effective HIV/AIDS prevention and care, including a strong tactic to influence public policy.

Alex’s strategies to prevent the spread of HIV/AIDS includes reaching out to marginalized, at-risk groups such as transvestites/transsexuals, homosexuals, and prostitutes, in high-impact places. He provides information on HIV/AIDS and safe sex practices in the city’s red light district, in discos, public toilets, and X-rated movie theatres. In some cases, he accesses these places by creating beneficial partnerships with the owners; agreeing, for example, to carry out a drug intervention programs in several discos. Alex uses a peer-mentoring approach; conducting most outreach efforts with trained members of his target population, including transvestites and HIV+ people. In 2006, transvestites who were trained by the Fundación reached more than 40,000 people. They also led more comprehensive workshops on gender, rights, citizenship, and sexually transmitted infections, for more than 400 people. Alex also develops alternative job opportunities for prostitutes to drastically reduce their constant risk of infection—he started a Hairdressing Academy, financed by the municipality of Buenos Aires, which has graduated more than 80 people.

For prisoners, Alex created the program “De eso sí se habla” or “That’s what it is spoken”, to present a series of simple, pertinent questions and answers related to HIV/AIDS prevention. This content was developed with inmates of two prisons in Buenos Aires, ensuring that it is effective and relevant to Alex’s target population. Alex currently implements this program in six penitentiary units, and has reached 600 men and women. Alex has also been successful in lobbying for health policy for free condom distribution in prisons throughout the country.

This pairing of outreach prevention and lobbying for health policy change for maximum impact is typical of Alex’s strategies. He has done the same with sex workers—making policy changes to expand their access to medical diagnosis and consulting—after they have been educated through his outreach programs. Alex has realized that small changes such as free condom distribution in prisons can make all the difference in access for vulnerable groups. Alex has successfully extended service hours at public hospitals in Buenos Aires so that people can be tested without interrupting their work schedules. For the first time in these types of health centers, appointments for testing can be made by telephone instead of in person, saving an extra trip. Transvestites and transsexuals can be more comfortable seeking medical care at hospitals because they are now called by their gender names instead of the names on their identification documents. In a pilot program with a major Buenos Aires hospital, Hospital Ramos Mejía, a transvestite has been hired to consult and communicate results to other transvestites/transsexuals. Alex hopes this innovative approach will spread to other hospitals. At this same hospital, Alex is working on an impact measurement project; looking at the numbers of people he has reached in his prevention programs who return for HIV testing or treatment. Because of the changes Alex has made in facilitating their access to the hospital, many do return. Additionally, his outreach efforts have empowered them to know and claim their rights, seek attention at public hospitals, and equal treatment by the police.

For those that still do not visit hospitals, Alex has won an agreement from the Ministry of Health to facilitate HIV/AIDS testing. He created a program to take blood samples in a central public square in Buenos Aires, which is then analyzed at the hospital. This program has also enabled Alex to conduct a behavior study on marginalized groups and generate data on the virus that he will later use to influence public policy.

Alex has been very successful in influencing public health policy largely because he is a member of a group he created, the Sexual Diversity Commission, as part of the Ministry of Health’s National Program on HIV/AIDS. In this capacity, Alex is always working on new policies to facilitate prevention and care and to improve the quality of life of those with HIV/AIDS. Currently, he is advocating a law to sell condoms by the unit instead of the current 3-pack; to remove the tax on antiretroviral medication and government-distributed condoms; incorporating standard facial reparation treatment packages for those who suffer effects from anti-retroviral medication; and providing hormonal treatment to transvestites.

Because youth aged 15 to 25 are at a high-risk to contract HIV, Alex is increasingly focused on reaching the greatest number of youth with effective prevention interventions. Through creative trainings and workshops often led by peers, Alex conveys information on HIV/AIDS and the way it is contracted, prevention techniques, and respect for sexual diversity. Because it is a topic shrouded with societal taboo, this simple information can have an enormous impact. Alex concentrates his expansion efforts on public schools in underserved areas where adolescents do not have access to other information about the disease, such as rural provinces and impoverished zones on the outskirts of the city. Through partnerships with community groups and citizen organizations, Alex has expanded trainings to 10 of the 24 Argentine provinces, reaching almost 50,000 youth.

Alex has partnered with the Ministry of Health and UNICEF to pilot a national program involving youth training youth in HIV/AIDS prevention. Peer leaders spread information and help their classmates learn about sexuality, sexual and reproductive health, drug abuse, gender and sexual diversity, and healthy communication between partners. Alex’s Fundación has developed the training programs for these peer leaders. In 2006, the first year, the partnership trained over 320 in five of the poorest, most traditional Argentine provinces. Alex’s challenge will be to replicate this program throughout the country in the coming years.

Alex is poised to spread all of his programs, well-developed in Buenos Aires, throughout Argentina. His Fundación is training leaders in ten citizen organizations in the interior of the country to spread his strategies. Alex has also training, through workshops, the leaders of local community groups in his methods and approach. He has become a national reference on HIV prevention, participating in more than ten national and international networks of HIV/AIDS groups. Internationally, Alex is a consultant to an organization in Paraguay on prevention tactics for youth and other marginalized groups, and has been asked to advise the Paraguayan government about creating prevention programs in prisons and juvenile detention institutions.

Alex comes from a politically-involved, middle class family. He has demonstrated leadership capacity from a young age—organizing and leading the student council at his high school as his country’s government turned from communism to democracy.

Alex was diagnosed with HIV at age 21. These were very difficult times given that in the early 1990s the issue was only beginning to be explored and in Argentina there was no treatment. In order to overcome his personal situation he became part of self-help groups (the only method that existed to deal with the disease). Soon he assumed the coordination of these groups, a role that he managed for years. Analyzing his own situation and means of infection, Alex realized that his problem was due primarily to a lack of information in a society that barely acknowledged the disease.

After being admitted to hospitals three times in extreme situations, Alex decided to do something to reach as many people as possible. His physician was invited to a television program with a large audience and Alex asked if he could accompany him to tell his testimony (in the mid 1990s it was not common for people to talk about their disease). During the program, as a way to demonstrate that the HIV virus is not spread by a simple social contact, he invited the hostess of the show (an important and traditional Argentine celebrity) to exchange glasses and toast.

For a year, Alex led a column about AIDS on a program emitted in the city of Buenos Aires and in several provinces. It was the first column by someone infected with HIV/AIDS. Many marginalized groups started to contact him, as a public figure and their only reference point with knowledge on the disease, and to help access prevention and treatment. Alex decided to create an organization to influence public policy and work with groups in high-risk situations that were not receiving attention.

Alex is the co-author of the book Salir del Placard (Coming out of the Closet) and speaks at conferences all over Argentina. He was distinguished as Health Ambassador for his commitment to working on teen prevention of HIV/AIDS by the Instituto de Estudio Social y Político de la Mujer.