In a country as diverse as Trinidad and Tobago, with 1.4 million varying hues and heritages, there still exists an arduous uphill climb for certain key populations. Conquering this apex of equality seems to be evasive as Government policy, general public perception and lack of education remain strong winds of opposition.  For persons like 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 LGBTQI 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 LGBTQI 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. That’s when FPATT asked Brandy to join their team in educating the LGBTQI community on the scope of healthcare that was available to them and guiding them to these resources within the public healthcare system. Since there was so much stigma surrounding the community, many of its members often stayed hidden under the shroud of comments that the gays and lesbians were the cause for the rise of HIV within Trinidad and Tobago. Even if a member of the LGBTQI community wanted to test for their HIV status, they would never dare to go into a public Health Centre, simply 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 the less undue 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.    Advocating for greater support Apart from a great lack of healthcare professionals that are willing to treat with the LGBTQI community non-judgementally, the community also lacks social support. Most of the members of the community face barriers in housing and employment, which means that they are easily swayed into earning their livelihood as sex workers. Over 95% of skilled and employable persons within the LGBTQI 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,” she states.  Brandy explains that being undetectable means that the client’s viral load is suppressed and they are living healthy lives. Since HIV infection has long been touted as a death sentence, the Educators work hard to ensure that 90% of persons who identify to be HIV Positive enrol in the FPATT Programme and 90% of those persons living with HIV (PLHIV) understand the importance of being adherent, through consistent treatment, healthy eating and rest. The Programme also offers sexual and reproductive health education on prevention against HIV re-infection and other STIs in the belief that SRHR interventions are preventative, cost effective, and would save lives and resources that would otherwise be spent on higher-level care. In addition, clients are navigated to medical practitioners and counsellors who can address issues of gender-based violence and mental health.  The Family Planning Association of Trinidad and Tobago has for many years advocated for sexual and reproductive rights of the LGBTQI 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, which is why every year, FPATT offers a total of 920 tests, 48 group sessions and additional one-on-one sessions accessible by all persons living within Trinidad and Tobago.  Following an assessment by PAHO, FPATT is poised to become a full service HIV treatment site, offering antiretroviral treatment (ART) as well as psychosocial services for persons affected by HIV. The Association’s goal is to stop discrimination and stigma against PLHIV and ultimately end the spread of HIV within Trinidad and Tobago by 2030.   

At her desk in the small, quiet office, sits an extraordinary Cuban physician and educator, whose accolades are second to none. Today, she is neither writing nor teaching on the advances in medical science, but rather, she is focused on her mobile phone. Engaged in a video call, she listens attentively to the person with whom she speaks. She shuffles in her chair, only for a brief moment, as if to make herself more comfortable and even more attentive. To Dr. Camejo, this is not just a job, this is her way of being present for a community that is in dire need of her help.   Four days a week, Dr. Mabel Camejo conducts TeleHealth, a telemedicine service initiated by the Family Planning Association of Trinidad and Tobago (FPATT) specifically for the Venezuelan and Cuban migrant communities. Her clients consider this service a god-send, as it allows them to book 30-minute consultations over WhatsApp video call. During the call, Dr. Camejo assesses and diagnoses her clients’ illnesses and prescribes medication if needed. If the client needs to be examined, she refers them to the FPATT clinic for hands- on assessment.    “My patients love it here. Many of them just don’t have the money or time to come in to the clinic for an appointment. If they have to take time off from work and that means no income for the day, but it’s easy when they can pick up the phone and send a message or take a call to get the same advice or treatment,” she notes.   Dr. Camejo recalls how technology has advanced since her practice in Cuba over 10 years ago. “In Cuba, the doctors go to the patient’s home so that we can chat with the whole family about how they can help the patient recover – whether it means reducing stress in the home, or cooking with less salt or sugar. There, we have to be the doctor for the entire family. Here, now in Trinidad, we get to do the same with TeleHealth. On the consultation call, we can address the whole family so that everyone understands the recovery path forward,” she said. “When people need help, you just have to help” With over 30 years of practicing medicine, Dr. Camejo specializes in gynecology, pediatrics and post-natal care but says that most of her migrant clients come in with a much wider range of ailments.  “Breast cancer is one I see very often. Then there is polycystic ovaries, diabetes, vaginal infections and even osteoarthritis. These women have been managing chronic illnesses that need constant and consistent treatment but because they cannot get medicine in Venezuela, they have to leave what they know as home to come here to Trinidad. It’s their only chance to survive,” she lamented.   Current policies in Trinidad and Tobago have prevented the migrants from accessing the public health care system unless they need pre-natal or emergency healthcare, so many of them with existing chronic illnesses have no other choice but to seek private care, which can be almost half of their weekly salary. However, FPATT’s mandate is to fight for equal Sexual and Reproductive Health Rights for all persons living within the nation’s borders and that includes the communities that need it the most.  In January 2020, FPATT launched an 8-module Zoom series for the migrant community that focused on the topics that were most critical to helping them integrate into their new home and culture. The structure was based on the IPPF’s One Curriculum, but designed to suit the needs of Trinidad and Tobago’s unique context. Dr. Camejo spoke from her expertise in Sexual and Reproductive Health, highlighting the use of contraceptives for planned pregnancies and the importance of regular pap smears to reduce the risk of cervical cancer.  “It’s information that they desperately need. They are in a new country, everything is different, including the systems, the culture and the food. They appreciate faces and voices that are familiar, sharing information that could save their lives,” she said. “This is what I love to do as a doctor. Since I was a little girl in Havana, I would watch my father speaking to his clients and he would be so careful with them and they would be so grateful that he came to see them. I feel the same way when I get to share and communicate with my clients. When people need help, you just have to help.” Dr. Mabel Camejo has been with FPATT for over 3 years and looks forward to serving the local Venezuelans and Cubans as long as she can. A migrant herself, she understands the intrinsic and changing needs of this community and continues to help FPATT tailor its services to ensure that equal opportunities in sexual and reproductive healthcare are afforded to all.          

Trigger warning: this story contains details about sexual assualt Monique* shared with IPPF her experience as a young, disabled woman with a child:  "I was constantly raped by my father. I got pregnant. People thought I shouldn’t and couldn’t raise my son, but now he’s going to one of the best public schools." "I’m a mother. I’m a woman. People seem to think there’s something strange about me wanting to have sex or enjoying it. People with disabilities are made invisible and silent. They need encouragement in gaining confidence and becoming as self sufficient as possible. This programme has given me confidence. I’ll make sure that what I learned I’ll teach to others." In Trinidad and Tobago, many young people face challenges when it comes to accessing sexual and reproductive health services, but young people with disabilities face additional barriers due to stigmatization and social prejudices.  Young people with disabilities are often isolated and lack knowledge about sexual and reproductive health and rights. As a result, they can be vulnerable to sexual abuse. Rates of unplanned pregnancies and sexually transmitted infections are high among young people with disabilities.  In Port of Spain and San Fernando, the Family Planning Association of Trinidad and Tobago (FPATT) set up 'Going Beyond the Walls' – a project to provide HIV testing and counselling to young people with disabilities. It offered a full range of other sexual and reproductive health services, from pap smears through to general counselling. They also organized seminars to sensitize young people to the issues faced by those with disabilities. Over 400 students attended educational sessions about people with disabilities and their sexual rights. Participants said their attitudes towards people with disabilities, and often towards themselves, had shifted significantly as a result of the project. They suggested that what they had learned should be communicated to everyone through campaigns, sensitization exercises and services. *Not her real name/image