Stories

“You work with people who have HIV? Why?” That was the question Dr. Gregory Boyce was asked by the young intern that stood before him. He had come to the hospital ward to visit a client who was known to be living with HIV. He approached the intern at the desk and gave his name and designation. The intern looked at him, confused and somewhat amused and asked the question that he has neither forgotten, nor understood to this day.   However, this young intern’s question comes from a mindset that Dr. Boyce is working fervently to change. As Deputy Director of the Medical Research Foundation of Trinidad and Tobago (MRF), Dr. Boyce provides clinical and administrative support to a team of doctors and nurses providing care to their clients who are living with HIV. Due to MRF’s long-standing work in HIV research and healthcare, the Family Planning Association of Trinidad and Tobago (FPATT), has referred many clients to Dr. Boyce and his team, and especially clients from the LGBTI+ community.   Providing specialist care and support  “Persons coming to us from key populations, have very layered needs. They are facing unique challenges in addition to living with the virus. There is still that myth that being HIV positive means that you will positively die. Added to that, there’s the discrimination that the community faces in every aspect of their lives on a daily basis. As a staff, we’ve had to seek special training to guide the way we interact with these clients so that we can meet all their needs appropriately and sensitively,” explains Dr. Boyce.   “Apart from medical interventions which are needed to ensure that our clients continue to live healthy lives, we focus heavily on their psychosocial needs. It’s easy to think that because a client is physically healthy that they are also emotionally healthy. We have clients that won’t leave abusive relationships because they think no one else would accept them. We have other clients that are dealing with long-term medication fatigue because they have been taking pills for over 10 years. With that sometimes comes depression and other drug addictions, which is why it’s necessary for us to maintain open and honest relationships to address those accompanying issues.”  Making HIV a non-issue  Dr Boyce has been committed to providing treatment and care to clients living with HIV for over 20 years. He had worked at the Port of Spain General Hospital after graduating, during which time, medicine for persons living with HIV was expensive and out of reach for many. A few years later, through government programmes, medicine became more affordable, and treatment centres were opening up across the island. However, Dr. Boyce realized that the mortality rate had not changed by much. He wondered why people were still dying from a virus when medicine was easily accessible.   “That first conversation – giving a client the news that they’ve tested positive – is very important. We get to show them that HIV is not an impediment. Most times, with the wrong information, they start to draw up a list of things that they can no longer do, like go after a promotion or start a family. Then they go through life shrunken and unrecognizable, not the person they once were. So to answer that intern’s question about why I work with persons living with HIV: I want to make HIV a non-issue,” he states.    Dr. Boyce hopes to see HIV disclosure become as acceptable as other chronic illnesses such as cancer or diabetes, where an entire family would work towards caring for the affected person, instead of alienating them. He also hopes to see more inclusion and tolerance towards persons living with HIV, especially those within the LGBTI+ community.   “Until a gay or transgender person can walk the streets freely and not be jeered at by passers-by, we still have a long way to go. Until they can access treatment at any public facility without fear or judgment, we have a lot of work to do. It would take a lot of education to change the stigma and discrimination but there is absolutely no reason why another person’s life should be miserable because their expression is different to ours.”   He commends the work of FPATT in upholding the sexual and reproductive health and rights of the LGBTI+ community, through ensuring that they have a safe and non-judgmental environment for treatment and care. He says that the Medical Research Foundation values the great relationship that the two organizations have had for years, even as FPATT works towards becoming its own full-service antiretroviral treatment site for persons living with HIV.    

Public perceptions, a lack of education, and government policies contribute to the barriers and challenges to achieving equality for all. In a country as diverse as Trinidad and Tobago, this is especially acute for certain key populations, including the LGBTI+ community.  For Brandy Rodriguez, Healthcare Navigator at the Family Planning Association of Trinidad and Tobago (FPATT), the struggle is both real and personal. In 1999, Brandy began her transition to womanhood and since 2006 has been working with FPATT in their HIV programme for the LGBTI+ community.    “Back in 2004, very little was said about HIV infection, transmission and prevention. In fact, if there was any information, it was misconstrued and meant to stigmatize the LGBTI+ community. I was fairly new to the transgender community, so I made it a mission to research and find out the truths behind HIV and how I could protect myself. I then felt like I had to share what I found with others who were searching as well,” she said.  Overcoming prejudice and stigma   That’s when FPATT asked Brandy to join their team in educating the LGBTI+ community on the types of healthcare available. Stigma surrounding the community forced many to stay hidden and avoid seeking care. Even if a member of the LGBTI+ community wanted to test for their HIV status, they would never dare to go into a public health centre, because of the fear of being judged by the healthcare professionals.    “It’s a simple case of this. When a transgender or non-binary person walks into a health centre or hospital, and the triage nurse has to fill in a form that asks for gender, the only two options there are male and female. So usually, the non-binary person knows that if they want to access that healthcare, free of judgement, they would have to dress as the gender that would bring less attention. At the end of the day, the healthcare provider does not receive accurate information about the client, and the client doesn’t receive the scope of assessment and treatment that may be necessary. So part of what I do, is to simply accompany the client to the appointment so that it’s a less stressful experience and they don’t feel like they are alone,” says Brandy.   The importance of access to HIV treatment and care Apart from a great lack of healthcare professionals that are willing to treat the LGBTI+ community non-judgementally, the community also lacks social support. Most of the members of the community face barriers to housing and employment, which often means earning a livelihood through sex work. Over 95% of skilled and employable persons within the LGBTI+ community have turned to sex work because they are constantly denied employment within other industries.   “When I began my transition, I was fortunate to have the support of my family; they understood my heart and my need to be my authentic self. Not everyone has that support and so some either migrate or are left homeless because of the fact. Having to work within the sex industry means that they are now at greater risk for HIV or other STIs. My job as an Educator and Navigator is to promote condom use and ensure that they make use of FPATT’s regular HIV testing. If they do test positive, we then have that conversation about U=U, which means that if they [their HIV viral load] are undetectable, they will be untransferable, and then get them to that place of undetectability.”    Brandy explains that being undetectable means that the client’s viral load is suppressed, and they are living healthy lives. The team works hard to ensure clients living with HIV enrol in the FPATT Programme, which supports the importance of adhering to consistent treatment, healthy eating, and rest. As well as testing, the Programme offers sexual and reproductive health education on prevention against STIs and both group and one-to-one sessions to anyone who needs it.  Advocating for support  FPATT has, for many years, advocated for the sexual and reproductive rights of the LGBTI+ community, ensuring that it remains a safe place for HIV testing and counselling. It holds a vision of a world where gender or sexuality are no longer a source of inequality or stigma.   FPATT is poised to become a full-service HIV treatment site, offering antiretroviral treatment as well as psychosocial services for persons affected by HIV. FPATT’s goal is to stop discrimination and stigma against persons living with HIV and ultimately end the spread of HIV within Trinidad and Tobago by 2030.       October 28, 2021 - We celebrate our much beloved colleague Brandy, LGBTQI+ Healthcare Navigator for FPATT and Trinidadian champion of human rights. She has long been a defender of the rights of LGBTQI+ people, and a pioneer in ensuring access to services while fighting stigma and discrimination in the community. We honor her dedication to equality across the Caribbean, her passionate advocacy for Trans rights. The fight continues in her powerful memory.   Conmemoramos a nuestra querida colega Brandy, defensora por la salud LGBTQI+ para FPATT, y referente en Trinidad y Tobago por de los derechos humanos. Ha sido durante mucho tiempo una defensora de los derechos de las personas LGBTQI+, y una pionera en garantizar el acceso a los servicios de salud, al tiempo que luchaba contra el estigma y la discriminación en la comunidad. Honramos su dedicación a la igualdad en todo el Caribe y su apasionada defensa de los derechos de las personas trans. La lucha continúa en su memoria.  

At a local bar, we meet nine women from Kirundo. They’re all sex workers who became friends through Association Burundaise pour le Bien-Etre Familial's (ABUBEF) peer educator project. Yvonne is 40 and has known that she’s HIV-positive for 22 years. After her diagnosis she was isolated from her friends and stigmatized both in public and at home, where she was even given separate plates to eat from. “I started to get drunk every day,” she says. “I hoped death would take me in my sleep. I didn’t believe in tomorrow. I was lost and lonely. Until I got to the ABUBEF clinic.” ABUBEF has supported her treatment for the past six years. “I take my pill every day and I am living example of having a good life even with a previous death sentence,” Yvonne explains. “But I see that the awareness of HIV, protection and testing provided by ABUBEF is still very small.” Yvonne became a peer educator, speaking in public about HIV awareness, wearing an ABUBEF T-shirt.  The project spread to the wider region, and volunteers were given travel expenses, materials and training, along with condoms for distribution. But funding cuts mean those expenses are no longer available. Yvonne says she’ll carry on in Kirundo even if she can’t travel more widely like she used to. Her friend, 29-year-old Perusi, shares her experience of ABUBEF as a safe space where her privacy will be respected. It often happens, she says, that her clients rape her, and run away, failing to pay. Since sex work is illegal, she says, and there’s no protection from the authorities, and sex workers like her often feel rejected by society.  But at ABUBEF’s clinics, they are welcomed.

Monica has never told anyone about the attack. She was pregnant at the time, already had two teenage sons, and rape is a taboo subject in her community in Burundi. Knowing that her attacker was HIV-positive, and fearing that her husband would accuse her of provocation - or worse still, leave her - she turned to a place she knew would help.   ABUBEF is the Association Burundaise Pour Le Bien-Etre Familial. Their clinic in Kirundo offered Monica HIV counselling and treatment for the duration of her pregnancy.  Above all, ABUBEF offered privacy.  Neither Monica nor her daughter has tested positive for HIV. “They saved the life of me and my child,” Monica says. “I hope they get an award for their psychological and health support for women.” Three years on from the attack, Monica, now 45, raises her children and tends the family farm where she grows beans, cassava, potatoes and rice. She’s proud of her eldest son who’s due to start university this year. She educates her boys against violence, and spreads the word about ABUBEF. Monica speaks to other women to make sure they know where to seek help if they need it. Her attacker still lives in the neighbourhood, and she worries that he’s transmitting HIV. But the ABUBEF clinic that helped Monica is under threat from funding cuts. The possibility that it could close prompted her to tell her story.    “This is a disaster for our community,” she says. “I know how much the clinic needs support from donors, how much they need new equipment and money for new staff. I want people to know that this facility is one of a kind - and without it many people will be lost.”

On Friday afternoon in Municipal Lycee of Nyakabiga, Burundi,  headmistress Chantal Keza is introducing her students to the medical staff from Association Burundaise pour le Bien-Etre Familial (ABUBEF). Peer educators at the school, trained by ABUBEF,  will perform a short drama based around sexual health and will answer questions about contraception methods from students. One of the actresses is peer educator Ammande Berlyne Dushime. Ammande, who is 17 years old is one of three peer educators at the school. Ammande, together with her friends, perform their short drama on the stage based on a young girls quest for information on contraception. It ends on a positive note, with the girl receiving useful and correct information from a peer educator at her school. A story that could be a very real life scenario at her school. Peer programmes that trained Ammande, are under threat of closure due to the Global Gag rule.   Ammande says, “I am afraid what will happen when there will be no more projects like this one. I am ready to go on with work as peer educator, but if there are not going to be regular visits by the medical stuff from the clinic, then we will have no one to seek information and advice from. I am just a teenager, I know so little. Not only I will lose my support, but also I will not be taken serious by my schoolmates. With such important topic like sexual education and contraception, I am not the authority. I can only show the right way to go. And this road leads to ABUBEF.” She says “As peer educator I am responsible for Saturday morning meetings at the clinic. We sing songs, play games, have fun and learn new things about sex education, contraception, HIV protection and others. Visiting the clinic is then very easy, and no student has to be afraid, that showing up at the clinic that treats HIV positive people, will ruin their reputation. Now they know that we can meet there openly, and undercover of these meetings seek for help, information, professional advice and contraception methods” Peer educator classes are a safe and open place for students to openly talk about their sexual health. The Global Gage Rule will force peer educator programmes like this to close due to lack of funding.   Help us bridge the funding gap   Learn more about the Global Gag Rule