nguyen.dan@tufts.edu
This June, I had the honor of working on PASEO, a community-based accompaniment intervention that seeks to improve HIV care and outcomes among adolescents living with HIV in urban Lima, Peru. PASEO was conceptualized in partnership with Partners In Health, locally known as Socios En Salud in Peru, and the Department of Global Health and Social Medicine at Harvard Medical School.
I had the honor of supporting quality improvement of cost data and clinical histories for 160 PASEO study participants and historical controls. Cost data specifically refers to participant-level costs, including transportation, communication, and the time value of money these adolescents spent that could have otherwise gone towards education or work, mental health services, and medical services. Participants were recruited from five hospitals and five CERITSS, which is an acronym for smaller health centers that specialize in sexually transmitted infections. My secondary task was assisting qualitative data collection through conducting and transcribing focus group discussions and interviews with PASEO health professionals, which took place at the Socios office in San Isidro, Lima’s financial district.
For a typical day in the life reviewing cost data and clinical histories, I would wake up around 7:00am, get ready, and grab a pan con palta from my local sanguchería for breakfast. Depending on which hospital or CERITSS I was visiting, I would catch either the Metropolitano, Lima’s extensive bus rapid transit system serving central areas in Lima, or a local combi, a private minibus that goes to the outskirts. My commute in such a sprawling city could range from 15 minutes to an hour and a half.
At the site, I would meet with the on-site técnicos, who are trained community health workers responsible for managing study data, accompanying participants, and answering any questions they have about their HIV care plan. While they scavenged the hospital archives to find the physical files of the patients I was expected to review that day, I would log onto RedCap or SEIS, which were the two online platforms to enter participants’ cost data and clinical history data, respectively. I mainly looked for any discrepancies between the physical and digital copies of both cost and clinical history data, as well as making sure that the clinical history data we collected on specific forms matched what was reported in their notes from their healthcare providers. The latter was more difficult—as a student still in my pre-clinical years, I had a hard time deciphering medical notes, let alone in Spanish, but the técnicos provided a lot of support. In the afternoon, I would either stay at the same site or commute to a different site to review more participant data. On qualitative days, since the interviews and focus group discussions typically took place in the afternoon, I would spend the morning in the San Isidro office, transcribing past interviews and finding any emerging themes I saw across responses. Now back in Massachusetts, I plan to continue my longitudinal support of PASEO through further research analyses, which are still being determined due to funding challenges.
I arrived in Lima during a vulnerable time for the PASEO team, as project staff had to be reduced a bit earlier than expected due to funding cuts made by the Trump administration. Following my time there, I am still in awe of their resiliency and rapport despite the study’s uncertain future. The técnicos approach every patient interaction with such humanity and empathy. Through their accompaniment, the PASEO técnicos are saving lives, and through their research efforts, they are informing life-saving programs.
They recognized that their patients were more than quantifiable viral loads, CD4 counts, and checkboxes, making a meaningful and sustained impact on their livelihoods. Many PASEO participants living with HIV used to be fearful of seeking out care, coming to terms with their socially stigmatized diagnosis, or starting an unfamiliar treatment regimen. Today, they are confident, informed, and prideful young adults who recognize that HIV is not a death sentence, find comfort in support systems with similar diagnoses, and understand that being undetectable equals untransmissible. Their CD4 counts are at healthy levels, their viral loads are low, and they can lead healthy lives while living with HIV.
This is not only because of the hard work of our técnicos, but also due to investments by the United States government in research that seeks to improve health and uplift communities. The Trump administration’s illegal withholding of funds towards research and programs like PEPFAR is ultimately threatening millions of lives among people living with HIV.
I felt uncomfortable as an American, thinking I was intruding in such raw and uncertain circumstances for the team. However, I also felt grateful that I was able to help fill in a huge gap for the short amount of time I was there, while recognizing my positionality and privilege as someone not from this context, as well as the often problematic nature of short-term volunteers.
Outside of my work, I was able to culturally immerse myself in Peruvian culture through its gastronomy, art, history, and geography. Outside of the popular ceviche and lomo saltado, my favorite new flavors included nikkei cuisine (Japanese-Peruvian fusion) like Peruvian-style makis, pollo a la brasa, and arroz con mariscos.
I was culturally enriched in the contemporary paintings of the Barranco neighborhood, pre-Columbian history and artifacts in Museo Larco, historical and contemporary politics at the Lugar de la Memoria museum, and Afro-Peruvian art in a pop-up exhibition of a mutual friend. I hiked Laguna Parón in the Peruvian Andes, Laguna 69 in the Áncash region, and Machu Picchu. Grounding myself in the cultural and historical context helped me confirm my passion for global health and continue discovering my why.
My time in Peru was wonderful, and I cannot wait to return one day. I had the most humbling and rewarding experience working with Partners In Health/Socios En Salud, an organization that I continue to love after formerly interning with them during my undergraduate career.