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.  

Humanitarian crises Largely brought on by sudden onset and slow-onset natural disasters, humanitarian crises are increasingly prevalent in the Pacific. During responses to humanitarian crises in the Pacific, sexual and reproductive healthcare is often under-prioritised and under-resourced. As a result, women and girls of reproductive age and vulnerable and marginalized groups are disproportionately affected and facing increased health and psychosocial risks. Share on Twitter Share on Facebook Share via WhatsApp Share via Email Fragile environments Low topography, rising sea levels and insufficient fresh water supply leaves Kiribati’s population vulnerable to the effects of the climate crisis. The fragility of the outer islands of Kiribati during natural disasters is compounded by their geographic isolation, which makes transportation and communication during post-disaster relief and response both expensive and difficult. Share on Twitter Share on Facebook Share via WhatsApp Share via Email Coastal exposure The majority of the population of 115,000 people live a subsistence lifestyle. Communities are geographically dispersed across 33 atolls covering 3.5 million square kilometres in the central Pacific Ocean. The population and infrastructure within Kiribati are largely concentrated on the coast, where communities face increased exposure to climate threats and natural hazards such as tsunamis, earthquakes, king tides, flooding, droughts, and occasionally cyclones. Share on Twitter Share on Facebook Share via WhatsApp Share via Email Takaria, leader and youth organizer in the Tebikenikua community Takaria will be running to be a Member of Parliament in Kiribati in 2020. “I assist the youth with family problems and family planning and disasters. In our community there are unforeseen pregnancies, domestic violence, and disasters such as high tide waters and strong winds, which can also affect this community. The Kiribati Family Health Association (KFHA) is the key point for us with outreach and training so people in this community know how to prevent and treat STIs, etc. They all know where the KFHA clinic is and that they can get counselling or services there. The problem now is you can’t survive with the sea rise levels. I want all members of my community to live better and have better health and peace.” Share on Twitter Share on Facebook Share via WhatsApp Share via Email Susan*, sex worker Susan receives care at the Kiribati Family Health Association (KFHA) including a pap smear. Susan*, 28, is a sex worker from the town of Betio on the main island of Kiribati. Originally from an outlying island, she moved into Tarawa to seek work. Unable to find employment that would fulfill her dream of sending money back to her two children, she was introduced to sex work. With other sex workers, she regularly travels out to the large cargo ships from China, Philippines and Korea anchored off the coast of Kiribati. Despite her new income, she still can’t speak with her children or see them due to the restrictive costs involved of travel between islands.*pseudonym Share on Twitter Share on Facebook Share via WhatsApp Share via Email Theta, 25-year-old mother and youth volunteer Theta is part of the Humanitarian Youth Club set up by the Kiribati Family Health Association in her village. “We face a lot of situations here, one of them is disasters and the second is unemployment and school drop out with our youth. I have helped the Humanitarian Youth Club to apply for financial grants from the Australian High Commission [for $1,000] I am recognized as the smartest member who can write in English. We have learned how to design a disaster plan for the community and share our ideas on sexual and reproductive issues such as STIs. We discuss what we can do for the next strong tide, where we can gather as a community and what we can do if even the maneabe (town hall) floods? If the tide and wind is too strong, we need to go to another safer place, such as another community’s town hall. For now, I want to enjoy the chance to be in our own beloved country. I won’t move until the majority have already left. I want my daughter to grow up in the same place I grew up in.” Share on Twitter Share on Facebook Share via WhatsApp Share via Email Beitau, youth volunteer Beitau is the Chairperson of the Humanitarian Youth Club. “I was lucky to be selected as Chairperson as the Humanitarian Youth Club. I feel like I get more respect from the community now I am in this position. I would love advanced training on leadership now, to further assist the club. As I am the Chairperson of the HYC, my main target is to help people during a disaster. I have attended training through KFHA. What I took from this is that when a disaster strikes, we have to do our best for pregnant women, small children and people with disabilities. They more vulnerable and less able to survive a disaster.” Share on Twitter Share on Facebook Share via WhatsApp Share via Email Abe, youth officer Abe was involved with KFHA since 2012. “I was inspired by what they KFHA was doing and the issues they were addressing that affects youth. I was surprised to see how many young people come to the clinic as they are affected by STIs, HIV and teenage pregnancy. The lack of education here is a big problem, most people here have a lot of children and yet can’t afford to send them to school. Sexual and reproductive health is our responsibility and we must talk about it with young people. Climate change affects many countries, but Kiribati is small and low lying. I used to go visit a very nice beach with a lot of nice trees and plants. Now, the trees are gone, and the waves have taken over, and the houses have disappeared so no one can build there. In my role as a youth worker and activist, I tell people to fight climate change: to grow more mangroves, to clean up the beach, because we love our Kiribati.”©IPPF/Hannah Maule-Ffinch/Kiribati Share on Twitter Share on Facebook Share via WhatsApp Share via Email