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.  

“I've heard kids yelling on the street that there was a program to space pregnancies. I've always wanted to do that for the long term. Until then, I'm still trying with the three-month-old pills. Besides, listening to one of the people advertising these services, the address was not very far from my home." Claudine, aged 27, is a sex worker. "In the past, I was wary of 'contraceptive' methods. But once I tried them and I didn't notice any negative impact on my body, I made it a habit in order to not get pregnant". Like all young girls interested in the Women’s Integrated Sexual Health (Lot 1) programme services, Claudine arrives shyly at the center where Association pour le Bien-Etre Familial-Naissances Désirables (ABEF-ND) distributes contraceptive methods. "When I arrived at the center, I thought that there would be no paperwork to do, but I was pleasantly surprised that the organizers want to find out about me and maybe one day they will be able to set up a health centre to follow us regularly," she hopes. In the DRC, few women raise the subject of sexual violence because they are afraid of being rejected and that "poverty sometimes leads us into sex work," she says. "But the consequences are enormous and sometimes harmful. Girls who are not sensitized will have unsafe abortions and catch sexually transmitted infections." Claudine has expectations and hopes regarding this kind of activity: "However, if awareness-raising is regulated, even every three months, we will, I think, have fewer young mothers because they will be more knowledgable about family planning". The WISH project has seen a positive change in women and girls' access to integrated family planning and sexual and reproductive health care. WISH promotes a variety of contraceptive methods and sexual and reproductive health support, ranging from referrals to services for those who need it most.   "I want to feel free in my sexual activities". I have a boyfriend but that doesn't stop me from doing my life. "I make my livelihood as a sex worker and he is a carpenter. That's how we've been trying to make ends meet since we moved to the capital two years ago." "We're going back to the village to take a break, it's not a permanent departure." Claudine and her boyfriend are both from Boende, the capital of the Tshuapa province, in the north-west of the country, 2,285 km from Kinshasa. She was encouraged to move to the capital at the insistence of one of her uncles who had been living there for several years. "The reality is quite different. We have been able to raise enough money to send goods to the village for the past two years. My companion and I will go back there to rest and maybe come back if we get bored in the village again.” “Pakadjuma is a place where almost everyone comes from the village, but it is only here that I see enough interest from associations to sensitize young girls on family planning by distributing condoms to prevent early pregnancies and sexually transmitted diseases. It's all very interesting. It's an opportunity for us and I think it's one of the things I'll miss the most when I go back to the village. I hope to still have friends here who can send me these methods.”

After her parents divorced, the family dissolved and Ruth found herself in Pakadjuma where she rented a small house. "My boyfriend helps me pay the rent," she says. She thought she would continue with school but could not afford it. After a few years of a relationship, Ruth became pregnant, and explain that "it was late to get an abortion, and I didn't want to put my life in danger." "I would have liked to get my bachelor's degree, but I don't regret it; I loved my child right away." Ruth, aged 19, like other young girls, queues up to learn about the different contraceptive methods the WISH programme offers for girls and women living in Pakadjuma. Some of them sign up directly to take them. Others find out and promise to come back after talking with their companions. The Women’s Integrated Sexual Health (WISH Lot 1) programme offers quality integrated sexual and reproductive health services across the Democratic Republic of Congo through IPPF Member, Association pour le Bien-Etre Familial – Naissances Désirables (ABEF-ND). Ruth is trying the service for the first time. She is in favour of receiving a contraceptive method for the next three months. "Some people have discouraged me because they believe that the 5-year method can destroy the body. But before deciding to come here, I asked around with the neighbours who have already tried it. I didn't have any negative experiences." Ruth asked the organizers about the consequences: "They said it's just to protect me so that I don't get pregnant for 3 months and then I can renew if I feel like it.” Ruth feels that many parents do not discuss sexual matters with their children. They probably feel it is inappropriate. Yet, if young girls get pregnant before they are socially stable, it is also due to a lack of guidance and orientation. "This should be a regular initiative," she says. "It's not late to receive sex education but above all to have free contraceptive methods, because I would have preferred a thousand times to buy milk for my baby than to pay for a condom or a Jadelle. Ruth has an 8-month-old baby, "I didn't want this and having many children will be disadvantageous for me especially as I am not yet married". She lives from small businesses and the money to support from her companion. Ruth says she took this contraceptive method without her partner's advice. "Since the birth of our child, we have been abstinent, and that's good. "He encourages me to go back to school, and I think that's what I should do.”