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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.  

In May 2017, flash flooding in Sri Lanka triggered landslides resulting in many people losing their homes, forcing them to seek shelter in camps. IPPF’s member association the Family Planning Association of Sri Lanka (FPASL) assisted those affected and provided health camps with the support of IPPF Humanitarian. Chathurika Jayalath, a youth volunteer for FPASL, took part in the response. Chathurika is a 24-year-old student from Kegalle, a large town about 80 km from Colombo, and she has been working with FPASL for the last three years. She started out as a youth volunteer and recently became a member of the Youth Technical Advisory Committee. During her engagement with FPASL, Chathurika has learned about sexual and reproductive health and rights (SRHR) and gender issues and has organized workshops on similar topics in her own community. In fact, she runs a youth club at her university to inform her peers about SRHR.  Shortly after the floods began, Chathurika received a WhatsApp message from FPASL where they called for youth volunteers to take part in the response.  “I wanted to volunteer during the response,” Chathurika told us. “As a university student I didn’t have money to donate so I figured I could contribute with my strength instead. I volunteered in the health camp. There, I assisted the medical staff with basic things such mobilizing affected people, making sure they queued up when seeking health care and packed medicine.” Ongoing SRHR needs, even in a crisis Chathurika is keen to learn more about humanitarian work. She received training with FPASL on the needs of people in humanitarian settings in which she and other trainees were presented with different case studies. “There was particularly one story that struck me. We were told that when the flash floods came, women fled without anything, they fled with the only pair of clothes they were wearing,” recalls Chathurika. “When they reached the camp, they received donated water and food. Some of them got their period while living in the camp. They did not have any sanitary pads nor additional cloths. Some of them even fled without underwear. This story made me realize that people’s SRHR needs don’t disappear just because there is a crisis.” Youth empowerment is important to Chathurika and she would like to continue this work while learning more about development and humanitarian work. She is a firm believer “that young people can contribute. Through my own experience I have seen that it is possible.”   

Prijani and Chandana were forced to flee their home during the floods of May 2017 in Sri Lanka. They didn’t have time to take any belongings, so ran with their two small children. After the floods, they attended gender based violence training run by Family Planning Association of Sri Lanka, where they learned about child protection needs. “We weren’t informed that the floods were going to come, but when the water reached our knee level we knew we have to move. We just took the kids and left” says Prijani. “I was worried about two things: my kids, as we were staying at a camp in the school, and losing my house. I allowed a workshop run by Family Planning Association of Sri Lanka to be held in my garden as we had the most room. There I learnt a lot about child protection the teacher gave a lot of examples of child protection and what can go wrong. We learned about sexual violence that kids face from older people”. “One day, I saw my son masturbating and I asked him how he knew how to do that, and that’s when he told me about what happened at school. The workshop taught me to look out for these signs” says Chandana, who is planning to report the incident to the school when it re-opens. “I never thought the issue was that bad. Now, we are a lot more attentive to our kids”.   Stories Read more stories from Sri Lanka

Nimal* and her family were asleep when the floods came into their house on the 27 May 2017. She and her husband took their young children to safety upstairs. Since the floods, Nimal and her family attended the clinic set up by The Family Planning Association of Sri Lanka (FPA-SL), and received medical care and gender based violence training. This training to families enables them to openly talk about issues that can help provide a safer environment for themselves and their children. "We were all sleeping in this house when the flood came in the night," Nimal recalls. "When we woke up we were surrounded by four feet of water in the house. Our van and bicycle were damaged. We specifically constructed this house to be flood resistant, but this flood was higher even than that level. We took the children and mattresses upstairs to be safe." "We found out through word of mouth about the The Family Planning Association of Sri Lanka (FPA-SL) clinic. I went two to three days after the flood to the clinic, which was being held out of a temple. My children were treated there as they had a cold from the flooding. I was also treated as I kept fainting." "I attended the training on Gender Based Violence awareness with my husband, and learnt a lot about parenting adolescents, and how to prevent domestic violence between a husband and wife. For example, by avoiding alcohol and to openly discuss our problems. It’s good to have this knowledge before my children reach adolescent age so I am prepared." *names have been changed at the request of the interviewee  Stories Read more stories from Sri Lanka  

Incessant rains across Sri Lanka during May 2017 affected over half a million people in seven districts. Most affected was the Ratnapura district where over 20,000 people faced flash floods, and where 46 deaths were reported. IPPF Humanitarian, in partnership with FPA Sri Lanka, responded to this catastrophe through the distribution of over 700 dignity kits in Ratnapura Dr. Rohan Jayasuriya and midwife Chaturika Lakmale were on the ground during and after the floods providing family planning services and contraception to women affected by the disaster. “When the floods came our clinic was located on higher ground, so it wasn’t damaged. The floods finished on the 31 May 2017, and we reopened one day later on the 1 June 2017. After the floods, we arranged several special clinics just for family planning, and distributed condoms and emergency supplies of the pill to camps in case women missed their regular form of contraception like injectables, implants or IUDs. In Sri Lanka, approximately 67% of couples use family planning, 26% of which prefer IUDs” We offered condoms and emergency supply of the pill. We told women to keep one packet of the pill in their handbag, and one in their home, should they ever have to run quickly in an emergency. One pregnant woman was delivering at this time, so she had to go on a boat to dry land, and then onwards in a vehicle to the hospital. Once we reopened the clinic, two of our own midwives were unable to attend work as the floods had affected them, but I was here. It was so busy.” Stories Read more stories from Sri Lanka

Incessant rains across Sri Lanka during May 2017 affected over half a million people in seven districts. Most affected was the Ratnapura district where over 20,000 people faced flash floods. “When the flood came, my husband was feeding my eldest child and the baby was asleep in the bed. I was outside of the house. My mother was brushing her teeth outside the back of the house. I looked up and saw trees falling near my neighbour’s house up the hill. My neighbours died. I couldn’t take any possessions – I just had to run for my life. My husband took my younger child. They were all screaming. Since then, I have had my children checked here in the Ministry of Health clinic; their weight, height and nutrition. We had two houses on the one block of land, but we will only get compensation for one house. We can’t live in a tent with a baby so are currently renting a house with our own money, but for a while my mother and father slept in this clinic.” Stories Read more stories from Sri Lanka