Author: Timothy Austin

Editor’s note:

This is the second blog by the Surinamese participants of the PANCAP – Integral Orientation and Research Center/ Centro de Orientación e Investigación Integral (COIN) knowledge exchange.  To read about the knowledge exchange click here. 

As part of the south-to-south learning exchange to the Dominican Republic, organized by the PANCAP Knowledge for Health project, we visited TRANSSA, Trans Siempre Amigas (Trans Always Friends), a community-based organization focusing on improving the quality of life of transgender people by offering a variety of services.

TRANSSA focuses on improving the quality of life of transgender persons through psycho-social support, and education on HIV transmission, treatment, care and human rights.

By utilizing a combination of awareness, education and empowerment, TRANSSA builds resilience against stigma and discrimination among transgender people in the Dominican Republic. TRANSSA also achieves this through its close working relationship with the Integral Orientation and Research Center/ Centro de Orientación e Investigación Integral (COIN), which was the primary focus of the south-to-south learning exchange.

The knowledge building facilitates change, which is evident in testimonies given by beneficiaries at the organization’s “safe space.” The organization has helped transgender people to withstand rejection within their immediate family and community by creating a better understanding of who a transgender person is and how gender identity differs from homosexuality. Furthermore, being informed enabled them to educate others within their inner-circle about who they are and the consequences of discrimination on their wellbeing.

Being aware of human rights and the laws of the country facilitates effective communication by transgender persons when faced with abusers. TRANSSA also creates a “safe space” where victims of abuse and violence are guided and provided with care and support. If necessary, they are referred to a hospital for treatment.

Building the self-esteem of transgender people is perceived by their community and HIV stakeholders to be of primary importance for their empowerment. It also provides encouragement to transgender people to work to freely express themselves and to achieve respect and equity for the Trans population. As one of the Trans women stated, “Change may not come easy but it is certainly not impossible. As I start to change because of the knowledge I gain at TRANSSA, I receive positive reactions from my surroundings.”

Achieving acceptance, support, and care for transgender people is difficult, but not impossible. Community-based organizations focusing on the Trans community play a major role. Not only as a “safe space” where Trans persons can come, but also through empowerment in accepting themselves, building self-esteem, dispelling myths and misconceptions and to assist them with navigating the healthcare and legal system.C

Click here to read the first blog in this series.

Editor’s note: 

In June 2018, PANCAP collaborated with the Integral Orientation and Research Center/ Centro de Orientación e Investigación Integral (COIN) for a face-to-face knowledge exchange in Santo Domingo, Dominican Republic.  The objective of the knowledge exchange event was to provide participants with first-hand experience of COIN’s operations.  Nine persons from three countries, Jamaica, Suriname and the Republic of Trinidad and Tobago, were involved in the learning exchange event.  Participants were invited to share their experiences observing COIN’s collaboration with the Ministry of Health, other civil society organizations and stakeholders in delivering comprehensive HIV services in communities and to key populations.   The blog below from the Surinamese participants provides details of their experience. 

During the June 2018 South-to-South Learning Exchange, organized by the PANCAP-Knowledge for Health project in Santo Domingo, Dominican Republic, we were part of a multidisciplinary team which visited various organizations, both public and private, that work together in the fight against HIV and AIDS. The keyword from this entire experience is collaboration.

The Dominican Republic’s Ministry of Health and Social Assistance coordinates the HIV response through its partners. Integral to that response is the involvement of all necessary stakeholders, including representatives of key populations, for achieving the goals and ensuring sustainability.

The national strategic plan, protocols for treating HIV, laws for reduction of stigma and discrimination against vulnerable groups, and training of healthcare workers are among the activities of this strategic alignment.

Integral Orientation and Research Center/ Centro de Orientación e Investigación Integral (COIN), the focus of the learning exchange, is a non-governmental organization (NGO) which focuses on treatment and reduction of HIV in the country. As a non-profit organization, COIN is a very good example of how an NGO with powerful leadership can work together with the Ministry of Health and other NGOs to reach their goals.

Civil society groups in the Dominican Republic should be recognized for being well organized, as they have formed strategic alliances with both the Government and the private sector. Civil society underscored the importance of staying true to their respective missions as this has made them stronger and more articulate in voicing the needs of the most vulnerable populations. Civil society groups also provide leadership to advocacy campaigns to establish clear guidelines for health professionals to ensure a rights-based approach to HIV treatment for key populations.

COIN is one of the NGOs that work closely with the Ministry of Health in the Dominican Republic. Through COIN, other smaller organizations such as TRANSSA, Trans Siempre Amigas (Trans Always Friends) and MOSCTHA, Movimiento Socio-Cultural para los Trabajadores Haitianos (Socio-Cultural Movement for Haitian Workers) receive funding to reach and test key populations and to link the HIV-positive persons from their target groups to treatment. TRANSSA and MOSCTHA also refer people to COIN for services they do not provide, such as hormone replacement therapy and antiretroviral therapy.

In conclusion, leadership, political activism, collaboration, and commitment were common themes heard during the learning exchange and should be considered prerequisites to achieving the sustainability of efforts to end AIDS.

Because I know that the HIV epidemic is much bigger than any of us and affects our daily lives whether we want it or not, I keep on getting out of bed to help bring it to zero.

The Second Regional Meeting of Youth Leaders: Sexual and Reproductive Health and HIV and AIDS,  showed me that as much as I thought I knew, the process of learning doesn’t stop. Each individual with their knowledge is one in billions. We must realize that our input as allies, community members, NGOs, government or whatsoever, brings us closer to the change we want to see no matter how small. This change can only be so if our intentions are real and honest.

With more appreciation for the little that I know, I’m more than ready to give it my all and play my part in leaving the world a better place than when I entered. For now, I’ll cheer to the little victories.

I’ve committed to the advocacy of CSE (Comprehensive Sexuality Education) in our education system and the access to high-quality health services. In doing so I’m taking home the following messages: there should be nothing for us, without us, make better use of opportunities given by CARICOM, and make more time to check up on one another. 

In this PANCAP Blog, Human Rights Activist Terry-Ann Roy reflects on the ruling in the Jason Jones Case.  

Photography: Christian Nixon and Maria Nunes  

On April 12th, 2018, the Republic of Trinidad and Tobago celebrated a landmark victory as the High Court of our country declared that sections 13 and 16 of the Sexual Offences Act, which criminalized sex between consenting adults of the same sex and anal intercourse, was unconstitutional as it infringed on the rights to family and private life of lesbian, gay, bisexual and transgender persons (LGBT).

As a young activist who has been involved in work with the LGBT community as well as a member of PANCAP’s youth arm, it served as an inspiration to continue the work which has been started by so many great leaders who have dedicated their lives to ensuring that LGBT persons are afforded their equal place in society.

From May 18^th to 19^th youth leaders from around the region gathered in the Republic of Trinidad and Tobago for the Second Regional Meeting of Youth Leaders on Sexual and Reproductive Health and HIV and AIDS.

As a youth leader myself, it was a wonderful meeting as I was able to exchange challenges and solutions with my regional counterparts. There were a number of important exchanges, for example, we learned from Kevin Mendez about the journey of Belize’s revised Health and Family Life Education (HFLE) curriculum. This essentially went from adoption in 2010, because the Government was on-board, to being removed from schools in 2012 because there was little public buy-in. Stories like that helped us in our Organisation of Eastern Caribbean States (OECS) group to really focus on the importance of key stakeholder consultation before we act on starting the conversation on our own HFLE syllabuses.

The meeting was made more interesting because it was planned and facilitated almost entirely by youth. This is something remarkable; it not only shows that youth can do important work but also shows that investing time and energy strategically in youth, can pay off not only in their own development but they, in turn, will help to develop their peers. These facilitators gave us articulate explanations on large complex documents such as the CARICOM Model Anti-Discrimination Bill  They helped us to navigate complex language used as jargon in international spaces.

As a CARICOM Youth Ambassador, there was another layer to the experience, I noticed. One of the presentations was done by Zuwena Perry of Barbados. She presented to the meeting about CARICOM’s structure and it generated lively discussion. Although this was just a small part of the meeting, it did make me particularly proud to see one of our own in action spreading the word about CARICOM and watching the uptake of the information by those present.

As I reflect on the last two days and the resulting work ahead, another key takeaway came from Nikolai Edwards, a young senator from Trinidad and Tobago who stated, “We don’t have to make it right, we just have to make it better”. This is something that I believe can help us stay focused as advocates, and in fact, help us reach goals in our everyday life.

On 31 March, the world observed International Trans Visibility Day. As a Human rights advocate, I have observed that the social context for trans persons living in the Caribbean is harsher.

There is a growing and thriving trans population in the Caribbean. Due to the high degree of stigma and discrimination, transgender people are subject to the conditions of inequality and exclusion in the economic, social and legal environment.  Often, they are prevented from accessing basic human rights such as healthcare.

The police reports are treated as jokes or go missing when transpersons report acts of violence towards them.  The records of crimes against transgender people emerge now from civil society, then they have the difficult task of reporting these acts of violence and sometimes killings.

It is now evident that transgender persons are more visible in the Caribbean. There is a strong clear need for recognition and protection of their rights which have been violated historically. Self-perceived gender identity discrimination and violence are strong barriers to accessing healthcare, education, and employment. We must improve this with a clear implementation of decisive public policy to promote the human rights of this vulnerable population.

Because of the fear of discrimination, trans persons use healthcare facilities for critical situations only and often it is too late.  The education system has excluded them through discrimination, verbal and physical violence. Transgender persons have been denied access to work, even informal and badly paid jobs have been for most just a dream.

Gender Identity is real in the Caribbean.  To my trans persons in the Caribbean keep your faith in tack and continue to love who you are. I believe with education, and awareness, we can overcome our challenges.

Visibility is Empowerment.

After an hour and a half drive from Kingston, with scenic views of the valleys, peaks, and lush vegetation, we arrived at our destination: the St. Anns Bay chapter of Jamaica AIDS Support for Life (JASL). Excited for the opportunity to see the work this great civil society organization does, we all clamored out of our shuttle to a quaint unmarked building on a hill, with a stunning view of the bay. Met with warm smiles from the Chapter’s staff, and cute baby goats frolicking around a well-maintained yard, I marched up into the building and experienced something much different than I expected.

From hearing about the work of JASL regionally, and interacting with their well-informed and professional management team earlier in the week, I was expecting a state of the art facility with very formal, professionally-distant staff. Instead, I encountered a humble establishment with the friendliest, warmest and most inviting and passionate staff I have ever come across. I would be remiss to even call them mere staff as, from observation, they operated more as a tight knit family.

Throughout the day, there were several presentations and a tour of their facility, with a demonstration of processes, to showcase how they eagerly serve their community. The purpose of this learning exchange was to witness JASL’s service delivery, community engagement, and collaboration models. From the onset of the various presentations, of which many were very informative, it was clear that the team had an unwavering passion for the work that they do, and were very informed about their roles and how they aid in the fight against the HIV/AIDS epidemic.

However, the highlight of the chapter visit was the fishbowl exercise; where the JASL team invited a few of their clients so that we could experience their stories. Having never heard of a fishbowl exercise, I was very keen on seeing how it would work. For those who may not know what it is, it is where you have your clients, the ‘fish’, sit in a complete circle, the ‘bowl’, and everyone else, the ‘observers’, sit outside the circle. The goal was to replicate how one would observe fish in a fishbowl.

I was expecting the exercise to follow in the fashion of a support group. However, I was not prepared for the level of testimony these brave ‘fish’ put forth. They were courageous; it is not easy to stand before strangers and rehash your journey as an individual living with HIV. Hearing how instrumental JASL was in bringing them back from the depths of dark times in their lives, hearing how grateful they were to JASL for providing such a strong social support system, for re-empowering them, guiding them back to health, and to many of them, rekindling the sense of meaning and purpose, was an overwhelming experience that certainly left me, and others in the room, silent with emotion.

In the short 30 mins of the fish bowl exercise, it put in perspective how necessary it is for civil society organisations to not only provide direct services, but to foster an enabling environment where their community members are empowered to transform themselves and others that they know. As I prepared to make the journey back to Kingston, I felt a renewed passion setting in my bones. I looked up at the unmarked building overlooking the bay with a greater sense of appreciation and purpose.

Here it is, this family of professional and passionate individuals, with humble facilities, is guiding lost fish into their bowl of empowerment, and releasing courageous, thriving fish back into the tides of life.

In a short week, JASL has shown me how they form the bowl that transforms their fish. And now, I will go home to form the bowl that will transform our fish in the Bahamas.

HIV and AIDS continues to be a huge challenge in the Caribbean region 30 years into the epidemic. We’ve made great strides in reducing new infections and supporting people living with HIV (PLHIV) all across the continuum of care. To have an even greater impact and to reach the UN 90-90-90 goals, we have to strategize and strengthen our partnerships across the Caribbean region.

The JASL study tour held in Jamaica August 8-11th was a fabulous example of a strong South to South Collaboration. We had an opportunity to visit the entire Jamaica AIDS Support for Life operations, benefit from presentations from the talented JASL team members and hear all about the way JASL has partnered with the Jamaican Ministry of Health and other civil society partners. JASL really supports PLHIV from the time of the first HIV test, linkage to care, nutritional support, navigating the health care system and obtaining psychosocial support. Quite a few clients shared with us that JASL enabled them to live healthy lives with HIV and overcome challenges and obstacles. The stories they shared with us were really touching and we even were treated to a poem about HIV, love and support.

We need more strong partnerships like this! Strong partnerships to end AIDS! Congratulations to JASL on the great work you are doing! Cheers and thank you for PANCAP/Knowledge for Health and USAID for supporting The Bahamas, Barbados and Guyana’s participation in this valuable exchange. There is definitely strength in unity! Here’s to our partnerships to end AIDS!

As I traveled to Jamaica for a South to South Learning Exchange, my head was full of all the numbers- HIV prevalence of 1.6%, 29,000 persons living with the disease, 81% of these know their HIV status, 43% of those on treatment and amongst those with 61% with viral suppression. I paid particular attention to the data on key populations and noted that Jamaica has one of the lowest HIV prevalence among the sex worker population in the region. In 2014, HIV prevalence among sex workers is 8.7% in Haiti, 5.5% in Guyana and comparatively low, 2.9% in Jamaica. Additionally, Jamaica’s data is suggesting that the prevalence among the population is declining, from 4.9% in 2008 to 2.9% in 2014. I was intrigued- what is different in Jamaica? What is contributing to this success? I had many questions and I was looking for some answers.

We spent the first two days of our four-day South to South Learning Exchange understanding the principles that guide Jamaica AIDS Support for Life (JASL) prevention programmes with a focus on key populations, defined as those having the highest risk of contracting and transmitting HIV. Having received a solid foundation and armed with the theoretical concepts, it was time to see their work in action. With much excitement, we “hit the road”. The teams coming from Guyana, Barbados and The Bahamas were eager to experience first-hand the uniqueness of JASL’s sex worker intervention and I was anxious to get some answers to my questions.

After a long journey, we arrived at “Back Road”. The long stretch of road was dark, with a constant flow of traffic both ways. Loud Jamaican music emanated from well-lit nearby bars. Numerous male patrons were seen hanging around with beer bottles in their hands, but only a few sex workers were standing along the roadside. The experienced JASL team quickly concluded that it was a “slow night” because it was mid-week. Nevertheless, we stopped at a point where there were a few commercial sex workers. JASLs team comprising of their peer navigator and HIV counselor/ tester approached them with ease and confidence. The sex workers willingly engaged the team and shared personal experiences on strategies they have used to protect themselves, including having the lights on. A lot of the discussion was on condom use, focusing on the size of the condoms and use of water based versus oil based lubricants. The peer educators were ready with their responses and once again I saw a condom blown as a balloon demystifying “small condoms”. We stayed for about an hour and a half, spoke with five-seven sex workers and tested four. As we concluded, it was clear to me that the sex workers were well educated on HIV and STI risk reduction and JASLs team has the expertise and experience for this type of work.

We departed “Back Road” at around 11 pm. It had been a long day for us and we were all tired. The bus was quiet – the music low and everyone deep in thought. I felt a renewed sense of commitment to serve the people who need our services most. I acknowledged the challenges of outreach work and had a greater appreciation and admiration for the work of civil society organisations. I applauded the field workers who spend many hours in the evenings combing the venues, seeking out persons to share techniques on the correct and consistent use of condoms, discuss HIV and STI risk reduction and test for HIV.

I drew from my experience as a former National AIDS Programme Manager and thought about a similar sex worker intervention in Guyana. I realized that there were as many commonalities as there were differences. I acknowledge that we are one Caribbean with similar cultures, but when it comes to HIV, the uniqueness of our specific context plays an important role in designing indigenous interventions that will change lives.

As I reflected on my questions, I realized that there is still more that I need to know. A little rest and I will be ready for the Day 3!