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“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 feel satisfied as a service provider and as a member of the outreach team." Shodunke Mary, 53, has been a midwife from the Local Government Area Council for seven years. Now she is working with PPFN providing family planning counselling and a range of integrated sexual and reproductive health services. In addition, Mary also conducts on the job training to other facilities which are providing services for the PPFN model. "The model used by PPFN is successful because the services we provide are free for those in need, the providers are motivated and the community leaders are also involved in the implementation. Also, the commodities and equipment are always available." As seen above, Mary administers an implant to Bukola Akami, who has one baby. The number of new contraceptive users has dramatically increased by 400,000 in less than a year as a result of PPFN's outreach and service delivery. Yetunde, 26, like Bukola, is a client with a young baby and was also seeking family planning. She says: "I don't want to have another baby in the next three years. I have a lot of things I want to do and I want to have time to take care of my children. My baby is really affecting my work and I always have to leave her with my mother-in-law. I will be recommending PPFN's family planning to my friends so they can also know what to do when they don't want to get pregnant again." The team Read more about the team behind Nigeria's amazing success

"As a child I loved the medical profession so much. I always wanted to go with my aunt to the hospital for her antenatal check-ups. The neat and well-tailored uniform of the health workers always caught my eyes. And I knew one day, I would be wearing one of those uniforms serving my community.” Latifat Balogun explains how her childhood experiences led her to decide to train and work as a Community Health Extension Worker with the Planned Parenthood Federation of Nigeria (PPFN), where she has worked for 20 years. She plays an integral part in delivering a wide range of services to women in her community. Here she is about to treat Zainab Akinsola, 52-years-old, who is waiting to have cervical cancer screening during a PPFN outreach programme at the Eni Ayo clinic in Ibadan, South West Nigeria. As a result of the strong integrated service delivery, non-contraceptive services increased from 42,700 in 2014 to 226,000 in 2015. Latifat's colleague, Adeyinka, is a faith-based health worker who encouraged a friend to undergo cervical cancer screening. "I counselled her and she went for screening, not knowing that she was going to test positive. If it wasn't for PPFN she might have died of cancer. I so nearly lost a friend. So I cannot forget that day. But now my friend is bouncing up and down, so excited about the project! During our last outreach she brought so many people."   The team Read more about the team behind Nigeria's amazing success

"How do I feel about my role? I'm excited!" Emiade Kudirat, 24, is a Community Health Extension Worker doing outreach with the Planned Parenthood Federation of Nigeria (PPFN) for the last 18 months. She specializes in the Sayana Press - a three-month, progestin-only injectable contraceptive favoured for its convenience in administration and portability. "I go from house-to-house to provide health education and introduce family planning services. I do counselling and provision of these services too. The PPFN model can really reduce the mortality rate of women in the community. We're taking the clinic to women at the market, to their homes and to their work." One patient, 24-year-old Bukola Polpoola, says she is happy that her treatment was free and easy. "In my village we don’t have any information about this. At first I was afraid it would stop me from getting pregnant again. I’d heard stories of side effects. I’m a nurse and even I began to wonder about it. But I called the clinic and they counselled me and reassured me.” She talked to her partner before she decided to get an implant. Now, she says, she’d recommend it to anyone. "I would be happy to spread the word in my village. Taking this will help you plan your life. For example, you know that for the next two years you can’t get pregnant and you’ll be able to plan your life properly because an unwanted pregnancy can stop you from getting an education or a job. This removes that fear for a time."   The team Read more about the team behind Nigeria's amazing success

"I find this work very interesting. I love to interact with the women in the markets. And I get to work all day with my 10-month-old baby, Bejide, with me!" Olusula, 40, is a Community Health Extension Worker, conducting outreach for the Planned Parenthood Federation of Nigeria (PPFN). In 2014, PPFN received a one year grant from the Bill & Melinda Gates Foundation through IPPF. The purpose of the grant was to expand family planning and reproductive health services. PPFN used this grant to improve on its current model of service delivery known as the Cluster model. PPFN piloted a successful project over 9 months around family planning. This project exceeded targets significantly and has the potential to be rolled out in Nigeria and other countries. "I refer clients through vouchers to the facility of their choice for long acting and reversible contraceptive methods too", explains Olusula. She works closely with her local community providing information and choice about contraceptive methods. Women and men are able to make informed decisions that ensure suitability to them and their circumstances. Choice promotes convenience and acceptability. "This PPFN outreach and service model will reduce a lot of abortions in our community. It also encourages women to space their children and lets them do the other things they want."   The team Read more about the team behind Nigeria's amazing success

"We capture the data directly into this app. It maps out what the demand will be and ensures that we never run out of those supplies.” Monitoring and evaluation officer, Babatunde, is responsible for ensuring the supply of contraceptives for all the cluster facilities. "My job entails the use of a mobile app built for direct data information capture (DDIC). I created an account for each of the 10 facilities that were under the Clusterplus Model. Before I stock up their store, I audit their supplies and can review their monthly report via the app. I put this into the mobile app as well as the commodities I have supplied them. Every two months, the app will forecast what a particular facility will need based on the contraceptive demand.” "I provided training on the mobile app for the store keepers at the facilities we worked with. All through the nine months of the Clusterplus Project, no facility ever ran out. This meant family planning methods were always available to those that needed them.” Babatunde has developed a wealth of knowledge about family planning and the many methods available. Clients favour long-acting methods Implanol and the IUCD. Two of Babatunde's colleagues Afolabi and Olufemi tell us they have both had some very memorable experiences during their careers as Community Health Extension Workers. Afolabi, 32, says the crux of her work is in breaking down the meaning of family planning to rural communities. "I discovered lots of misconception and misinformation, fears and rumors about family planning. But my job is to educate them on the benefits of family planning and allay their fears. We keep educating them and breaking down the 'walls' they have built around family planning methods, like the false thinking that implants require an operation." "I so much look forward to the outreach sessions. It is a time to help women make better choices that will help them plan for their family and future. The fact that the family planning method is administered free has contributed to its high level of acceptance by the people." "In some of our communities, the people are so poor that they can't feed themselves properly. Let alone to have money for family planning. Poverty is real and not planning your family, escalates the challenges of having a poor quality of life. No money should mean fewer children. But the reverse is the case and poverty goes together with low level of education." Olufemi agrees. "I counselled a woman who I thought was 50-years-old. But I was surprised to find out she was just 29-years-old and had 12 children. The burden and labour of delivering 12 children could be seen all over her". "It was a pathetic case for me. I imagined, how can a 29-year-old have 12 children? We spoke about the different family planning methods available. She decided to have a long term method that will last for five years. "Months later, she called me to thank me. I was so happy knowing that she appreciated it. Because I wondered, how will she raise all those children without a good livelihood? I was glad to have contributed to helping her plan her family." The team Read more about the team behind Nigeria's amazing success

"We saw changes, broke barriers, removed myths. My joy will be to see this approach rolled out across the country. I am to be helping and empowering women in our rural communities to make informed choices about their health." Ambibola is a programme officer for IPPF's Member Association in Nigeria, working on the ambitious Cluster Plus model. “The project was a one-stop shop which brought services together. So a woman could have screening for breast and cervical cancer, counselling and have access to all methods of family planning at the same place. Also if a woman was detected with early stage of cervical cancer, we were able to carry out a curative operation." "Our success is due to our grassroots approach. We asked the communities to nominate the community health workers they would like to work with. These workers go into the community to counsel people about their health issues. This gave the communities a sense of ownership and kept them fully engaged.” "We also held meetings with traditional and religious leaders who then went into the community to tell people about our projects. Now many private centres want to adopt our approach. In these communities the rate of teenage and unwanted pregnancies has gone down, maternal and abortion mortality has also been cut. We were able to take family planning to the doorsteps of the women in our rural communities the ones who needed family planning but couldn't afford it."   The team Read more about the team behind Nigeria's amazing success

"I decided to use this clinic because I heard a lot of success stories about it.   I trust their judgment that is why I am here.”   Taiwo Ogunfayo, a 33-year-old interior decorator, is a client at the Liberty Stadium Clinic – one of Planned Parenthood Federation of Nigeria (PPFN) facilities in Ibadan, the Oyo State capital in South West Nigeria. “One day, I was in the market when I came across a PPFN outreach. The way the Community Health Extension Workers were explaining the different family planning methods was very simple to understand. “I have come across a lot of women since my first visit to this place and they all assured me that family planning works and it won't fail like a previous experience, but I didn't let that stop me from trying family planning again." Lack of adequate information is creating misinformation and wrong perceptions about family planning. She says that 'a lot of women have all sorts of beliefs about family planning, tied to religion and culture', hence the need for more PPFN community outreach services. "It was through the outreach service in my community that I found out about PPFN. The interesting thing about the Planned Parenthood Federation of Nigeria project in Oyo state is that all the family planning methods are free if you can't afford to pay. There is no cost to the patient."   The team Read more about the team behind Nigeria's amazing success