In November 2017,  Planned Parenthood Association of Zambia (PPAZ) received the news that they must cease all USAID funded programmes. The stop order was a result of the 'Global Gag Rule' (GGR), also referred to as the Mexico City Policy. The reinstatement of the policy has resulted in Planned Parenthood Association of Zambia losing 46% of its funding. You can learn more about the Global Gag Rule here. “When I lost my job as service delivery manager [at PPAZ USAID's Open Doors project], I felt like a part of me had died, I’m very passionate about this. I look forward to seeing a day where everybody will be free to access health services without stigma and discrimination, especially public health facilities. That’s what I’d like to see, [I] want to see integrated services, being provided to key populations, without stigma and discrimination, and fear of being arrested." The Global Gag Rule The reinstatement of the ‘Global Gag Rule’ resulted in the termination of Planned Parenthood Association of Zambia grant for the USAID Open Doors being terminated.  Chipili says “We didn’t expect its implementation to come with the termination of the grants suddenly. We thought that we were going to be given time, a year, one year to work and complete the project and hand over to the partner that was going to take over the responsibilities that Planned Parenthood Association of Zambia handled.” The termination of the project means progress that has been made, especially the work done to help reduce the number of HIV and STIs cases among the key populations will be undone. Progress, that is desperately needed to meet Zambia’s targets on HIV reduction. “We are losing precious time. We have got targets to meet as a nation, we need to ensure that by 2020 we reach the 90/90 goals, set by UNAIDS, and also the country has a broader vision of eliminating the threat of HIV, HIV as a public threat by 2030. So if we have such stumbling blocks, then the targets might not be met.  And then these key populations are also linked with the general population, we have men who sex with men, they also have partners, some of them are married, and if we don’t get into their networks, HIV and STIs will end up in the general population, therefore putting everybody at risk." Other impacts have been the increased vulnerability and the lost investment of peer promoters from the key populations and loss of safety and security that was provided by the organization.  Loss of safety and security “For safety and security, key populations cannot freely go to facilities they don’t know very well. The clinic setup was the most ideal set up for them. No one would question them, because this is open to everybody. But now what the project is doing, they are renting houses, the USAID is renting houses where they are providing services, so a house is very different from a clinic, that also affects the element of sustainability. The element of sustainability has also been lost because PPAZ has been here for a long time, since 1972, so we were hoping that the project was going to build the capacity for PPAZ to continue providing services to key populations that are free from stigma and discrimination. That has been lost. To me it’s a lost opportunity.” The Zambia National AIDS/HIV Strategic Framework for 2017 to 2021, bears a strong emphasis on leaving no one behind when it comes to stopping the HIV/AIDS epidemic. “No one should be left behind, if we are to reduce HIV infections to zero, if this is not done, the dream, the vision will not be achieved, we cannot afford to start pointing fingers, we have to use the public health approach and eliminate the risk of HIV infection amidst our people”.

In November 2017,  Planned Parenthood Association of Zambia (PPAZ) received the news that they must cease all USAID funded programmes. The stop order was a result of the 'Global Gag Rule' (GGR), also referred to as the Mexico City Policy. The reinstatement of the policy has resulted in Planned Parenthood Association of Zambia losing 46% of its funding. You can learn more about the Global Gag Rule here. "My name is Thomas, I’m 34 years old. At PPAZ I worked as a peer educator and counsellor, I used to work on the outreach programmes in the community to offer access to health services like voluntary counselling and testing, we also used to sensitize women on the importance of family planning. We also used to refer women we would find had different problems, to the facilities so they can access health services. We also used to help by giving information on things like HIV prevention and signs and symptoms to look out for.  At other times, since the places were very far, we would take the services from the facilities to where the people were, so PPAZ used to help us do that.  I was at the clinic when they came to tell us that PPAZ would no longer be involved in the project because the funding had been stopped. It was a challenge for us because the services that people had become accustomed to in the communities, HIV counselling and testing services levels reduced because we couldn’t manage to go and take these services to them in the places where they live.  When we worked with PPAZ we used to put condoms in these places for them, in the bars and taverns, and even pool tables. Now that PPAZ is gone, the government cannot meet the supply of condoms needed in these places, even the services can’t be offered on the same scale. Unable to meet needs in rural areas Like you can see here, I look after my grandmother and other family members and that money [peer educators' allowance] used to go a long way in helping us look after our children and buy food, and other things. At the moment it is very difficult. Nyangwena is a very big place, it also includes 14 villages, so there are many people in this area. With the money that we were given through PPAZ, my friend and I would manage to get tyres for a bicycle and go to these places, we’d cycle distances as far as 14Km away. It was very helpful; the community really appreciated the services we were offering because we used to take them to the people. We would be very happy if PPAZ were to start them again because we would really help our communities a great deal with these services. Even school children would go and access them, at the youth-friendly corner twice a week. Information is really needed amongst these school children."

In November 2017,  Planned Parenthood Association of Zambia (PPAZ) received the news that they must cease all USAID funded programmes. The stop order was a result of the 'Global Gag Rule' (GGR), also referred to as the Mexico City Policy. The reinstatement of the policy has resulted in Planned Parenthood Association of Zambia losing 46% of its funding. You can learn more about the Global Gag Rule here. “My name is Joyce. I live in Sopoloyi with my grandmother. I tested positive for HIV, around November, but was doubtful about starting treatment. I stayed away for three months and came back in January, to retest, when they asked if I wanted to start treatment right away, I refused, because I wasn’t ready.  I told my sister what happened and explained that I had tested positive for HIV, so she advised me to go back and start treatment as soon as possible, because the longer I waited the more I was wasting away.   I returned to the clinic and I was given medication for two weeks. I was changed and put on another course for a month. I would go back every two weeks to get medication, then gradually I was given a course for two months. From the time I commenced treatment till now, there’s a clear difference, my body is slowly coming back to normal. I felt very safe, I was happy that they protected me, if I hadn’t come at that time to get help I would have been seriously ill, the medication wouldn’t have helped me at all, but now I have been on medication I feel much better and my body is also getting better. They are still giving me medication. They need to continue giving us the medicines and the information, because at least they tell us that once we start we are not supposed to skip any dose, even when you feel fit, you can’t stop because the virus multiplies everyday by a thousand, so the more you take your medication it keeps the virus levels low, so I would say they need to continue. All I am asking is that they don’t stop giving us this treatment because a lot of people will suffer or even die without these medicines.”

Leiti is a Tongan word to describe transgender women, it comes from the English word “lady”. In Tonga the transgender community is organized by the Tonga Leiti Association (TLA), and with the support of Tonga Family Health Association (TFHA). Together they are educating people to help stop the discrimination and stigma surrounding the Leiti community. Leilani, who identifies as a leiti, has been working with the Tonga Leiti Association, supported by Tonga Health Family Association to battle the stigma surrounding the leiti and LGBTI+ community in Tonga. She says "I started to dress like a leiti at a very young age. Being a leiti in a Tongan family is very difficult because being a leiti or having a son who’s a leiti are considered shameful, so for the family (it) is very difficult to accept us. Many leitis run away from their families." Frequently facing abuse Access to health care and sexual and reproductive health service is another difficulty the leiti community face: going to public clinics, they often face abuse and are more likely to be ignored or dismissed by staff. When they are turned away from other clinics, Leilani knows she can always rely on Tonga Health Family Association for help. 'I think Tonga Family Health has done a lot up to now. They always come and do our annual HIV testing and they supply us (with) some condom because we do the condom distribution here in Tonga and if we have a case in our members or anybody come to our office we refer them to Tonga Family Health. They really, really help us a lot. They (are the) only one that can understand us." Tonga Family Health Association and Tonga Leiti Association partnership allows for both organisations to attend training workshops run by one another. A valuable opportunity not only for clinic staff but for volunteers like Leilani. "When the Tonga Family Health run the training they always ask some members from TLA to come and train with them and we do the same with them. When I give a presentation at the TFHA's clinic, I share with people what we do; I ask them for to change their mindset and how they look about us." Overcoming stigma and discrimination  With her training, Leilani visits schools to help educate, inform and overcome the stigma and discrimination surrounding the leiti community. Many young leiti's drop out of school at an early age due to verbal, physical and in some cases sexual abuse.  Slowly, Leilani is seeing a positive change in the schools she visits.  “We go to school because there a lot of discrimination of the leiti's in high school and primary school too. I have been going from school to school for two years. My plan to visit all the schools in Tonga. We mostly go to all-boys schools is because discrimination in school is mostly done by boys. I was very happy last year when I went to a boys school and so how they really appreciate the work and how well they treated the Leiti's in the school." In February, Tonga was hit by tropical cyclone Gita, the worst cyclone to hit the island in over 60 years. Leilani worries that not enough is being done to ensure the needs of the Leiti and LGBTI+ community is being met during and post humanitarian disasters. "We are one of the vulnerable groups, after the cyclone Gita we should be one of the first priority for the government, or the hospital or any donations. Cause our life is very unique and we are easy to harm." Despite the hardships surrounding the leiti community, Leilani is hopeful for the future, "I can see a lot of families that now accept leiti's in their house and they treat them well. I have a feeling the future will be better. Please stop discriminating against us, but love us. We are here to stay, we are not here to chase away."    Watch the Humanitarian teams response to Cyclone Gita