Three million Venezuelans, fleeing a national crisis of economic depression and political oppression have found themselves seeking refuge in Latin America and the neighbouring islands of the Caribbean. About 40,000 of those have come to Trinidad and Tobago’s shores, with the hopes of finding a better life. Anything would be different from what they have left behind.  Neighbourhoods that once echoed the voices of playing children, were now riddled with the sounds of gunshots. Business places with broken store fronts, empty grocery and pharmacy shelves, elderly persons homeless and impoverished. Those with well-paying jobs could no longer make enough money to feed their families so walking the streets in your own neighbourhood put you at risk of kidnapping for menial ransoms.  This was the situation in Cumana Sucre that caused Marina Lopez to flee with her husband and two daughters in 2018. She was a preschool teacher and a good one at that. She loved the interaction she had with her students, seeing them grow in both knowledge and stature in their formative years, but it wasn’t enough to allay her fears of her own family’s survival.  As persons living with HIV, Marina and her teenaged daughter depended on constant access to medicine and healthcare, neither of which was still accessible. With daughters in tow, Marina and her husband braved the waters in search of new life in Trinidad.  About the same time, Ana Camacho, a young mother with dreams of migrating to Canada, said goodbye to her teary-eyed mother, sisters and 12-year-old daughter. She once held a good job as an administrator in Anaco, Venezuela, but when the company closed, she could no longer make the money needed to provide. A life in Canada seemed very promising and she and a friend decided that they would work for 3 months in Trinidad to gather the funds for the move up North. However, when she gained employment in Trinidad, her mother became ill and she was forced to postpone her plans and settle on the island in order to continue working.   “Everyone was so friendly and treated us like people” Both Marina and Ana can vividly recount the experiences that brought them to Trinidad 3 years ago. Today, they are both clients of the Family Planning Association of Trinidad and Tobago (FPATT) receiving care to meet their varying sexual and reproductive health needs.  “I was told about the Clinic from the UNHCR. They suggested that my daughter and I come here for treatment. When we got here everyone was so friendly and treated us like people. They understand us and that is so hard to find. They also referred us to the hospital in San Fernando for further treatment and it has been great since. We feel very comfortable here,” Marina disclosed. For 34-year-old Ana, her experience at FPATT is an interesting one. “When I first heard about the Clinic, I thought I would come in for a pap smear. I was in a new country, working and sending what I made back home for my family. I didn’t want to risk getting sick so I booked an appointment to get the test. When I came in, the nurses asked me if I was pregnant, and I said no, only to find out that I was. I was shocked, but I knew that the doctors and nurses at the clinic are good people and would take care of me during pregnancy. My son is now 14 months and now I come in for my contraceptive shot. I bring my son with me and everyone treats him like their own,” she says.  Ana was also a participant in the webinar series hosted by FPATT in January 2021. The 8-module Zoom series was based on IPPF’s One Curriculum, but designed to meet the specific needs of the migrant community. Although the series covered many topics including Nutrition, Gender-Based Violence and Sexual and Reproductive Health Rights, the one module that stood out for Ana was Self Defense.  “One day I was on my way to work in a taxi and I realized that the driver was not taking the route that other drivers do. I asked him where he was going and he wouldn’t answer me. I got very scared because I was in the taxi by myself. I started to shout at him and he still wouldn’t answer me until finally he stopped and I ran out of the taxi. I went to a police station and the officer asked me what I was doing alone in the taxi. I told him that I was trying to get to work. After that, I never worked again. It’s too risky. I wish I had seen that self-defense class before that evening,” she said.  Many migrants have had similar experiences to that of Ana’s. Incidences of sexual exploitation, gender-based violence, and xenophobia are rampant among the women in the community and so they are grateful for the refuge they find at FPATT. “In here, they genuinely look out for us,” Ana says, “and that’s different from how we are treated when we walk the street. They live up to their name as Family.”  

The Youth Advocacy Movement (YAM) of St. Lucia Planned Parenthood Association (SLPPA) was recently recognised by the St. Lucia Government - Ministry of Youth Development and Sport, they received an award for Outstanding Youth Organization, which is given to an outstanding organization/group which has for the past 2 years achieved community, national or regional recognition in promoting youth development through its programmes and or policies. Currently, the organization is conducting exciting grassroots initiatives in Saint Lucia, such as youth training programmes within under-served communities island-wide and tackling a wide range of issues such as parenting, self-awareness, and gender-based violence. Now more than ever we support and encourage our young leaders as they educate and innovate in their communities, making sexual and reproductive education and health more accessible.  Follow them at www.instagram.com/yam_slu SLPPA aims to promote family welfare and reduce the incidence of unwanted pregnancies, particularly among adolescents, through a strengthened family life education programme and quality sexual and reproductive health (SRH) care services that complement government provision.

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.   

A passionate advocate for comprehensive sexuality education, Jonathan is Famia Planea Aruba’s (FPA) IEC coordinator and manages the scheduling, guiding, and delivery of school projects. As part of this role, he works closely with students to help support and shape their projects.  “We are approached almost on a daily bases, throughout the school year, by students needing appointments for their school projects. These projects can vary from information about sexual and reproductive health and rights to the internal structure of FPA as an organization. That is why it is very important to first ask what kind of project the student has been tasked with. Questions such as school, grade level, course name, number of students, project goal and due date are among just a few of the primary questions that must be asked when scheduling a school project”, Jonathan says. FPA has developed information packages that are topic-ready for most of the general projects. These are used as an information base, while the presentation and appointment are tailored to each individual student.  “We will sometimes receive multiple students or groups for the same project, this is bound to happen when an entire class receives the same project, it is then up to me to make each appointment different while providing the same information. Digital presentation is usually my tool of choice. This provides me the possibility to incorporate all the necessary information, but I can always make a few tweaks to personalize each presentation”, says Jonathan.  During project weeks at most of the schools, the FPA office can be busy with visiting students.  “After the start of the COVID-19 pandemic most of the school project appointments became digital meetings. Removing the human contact can sometime provide new challenges for both the students and us. This demands that the student be more prepared than before with sharper questions, since the traditional conversation that usually leads to more questions is different when using digital methods, but we will do our best to help the student in every way possible”, Jonathan mentions.  

Famia Planea Aruba (FPA) is proud to be able to serve over 7,000 clients and celebrated its 50th anniversary in November 2020. FPA strives to live up to the motto, ‘Improving your quality of life’, by ensuring its healthcare provision is accessible to everyone.  One regular client is Christopher, an account manager at a local marketing agency. “I am truly a big fan of FPA, they are really good at being inclusive to men as well as women. The entire staff is very client orientated, I have never felt judged or discriminated against while using any of their services, or while at their office. They are always ready to answer any questions I may have or ease any concern.” FPA has built a strong bond of trust and communication with its clients by sharing regular updates on their work and projects.  “I try as much as possible to stay up-to-date with FPA, I have followed all of their projects so far and have really enjoyed them. I can still remember when I was younger and had my first girlfriend, FPA was my go-to for information, guidance, tips and tricks. They are very good at adapting to each situation, whether it is personal, local or even global”.  FPA places great emphasis on listening to the community it supports to better understand their needs. This enables the team to provide their clients with carefully researched and targeted healthcare.  “Over the years, FPA has gone above and beyond to provide both myself and my partner with information and contraceptives. Over the last few years, in addition to visiting their office, I can follow-up my consultation by asking them additional questions through their social media counseling or even the delivery service”, says Christopher.  

During the 1970’s Aruba’s population was rapidly growing; yet one-third of all pregnancies were unplanned. With the arrival of Famia Planea Aruba (FPA), local communities were able to access health and contraceptive care. For more than 50 years FPA has evolved and adapted its healthcare provision to meet the needs of the growing and changing community. Access to contraception continues to be FPA’s most in demand healthcare provision.  “As a recently graduated Social Worker, I feel it is very important to provide both, men and women, with information and products regarding sexual and reproductive health and rights. We hear far too often that preventing an unwanted pregnancy should be the woman’s responsibility, especially from our male counterparts”, says Lisen, one of the Information, Education, and Communication Support Staff at FPA. During a one-on-one consultation at the FPA office, everyone is provided with information individual to their own needs as well as that of their partner. This information is provided by a trained IEC member of the team.  “I believe in the values of FPA, and that information is the key to health and a prosperous future. When counseling an individual, I try to take time to get to know the person the best I can in what is usually a short period. By building a trust relationship with each client they are more inclined to open up and ask the questions they truly need help with. What for one person might seem a small issue might be something huge for another one when as a counselor you are able to assess each individual, you can achieve so much”, Lisen says. What sets FPA apart from a pharmacy is the integrated care provision. This includes guidance provided with the contraceptives, the individually tailored care for each client, and working in close partnership with family practitioners, midwives and the local general health insurance provider. “There are some clients that you see so often that they almost become like family in a way, as soon as you see them you can already anticipate their needs. I am just 25 years old which means that some of the clients are my age, some older, some younger. Seeing someone you helped out in public and having them greet you or tell you that you did a great job helping them is such a wonderful feeling, I don’t know if I will ever get used to it”, Lisen says.

Famia Planea Aruba’s (FPA) contraceptive delivery service is an added personal touch to its online store. The site is accessible to both members and non-members who can shop in privacy for their contraceptives and schedule a delivery. Orders are delivered by FPA staff with clients having the option to pay cash or debit upon delivery. To ensure a clients’ privacy and confidentiality orders are delivered discreetly. Ghislaine Koeiman, Head of Information, Education, and Communication Support at FPA has been managing the delivery service since it started in August 2018. “Since the start of the delivery service in 2018, our clients were enthusiastic however, the usage started slow. I believe this was due to the unfamiliarity, and people were still in the transition phase to online services. Moreover, clients believed that the delivery transportation would have been in a car completely covered in images of condoms, sperm cells and pills, which made them skeptical of using the service due to embarrassment”, says Ghislaine.  As with any new service comes challenges as well as opportunities. “Some of the challenges we face are the overload of deliveries on one day.” Even though Aruba is a small island and there are traffic jams only at specific hours in the day. “Sometimes I get stuck in traffic and try to rush myself to deliver the products in the time slot and at times I find myself in places that I barely recognize and discover new locations.” “The part I enjoy is the communication with the clients. Building a relationship with the client and vice versa provides a smoother transition of service but also provides the comfort and safe feeling for the client”. Ghislaine says the service often calls for more than the delivery of contraceptive orders, as clients may have questions or need support about their health. FPA’s bespoke healthcare delivery has seen successful growth since it started, with an increase of 115% during 2019 and 170% in 2020. “There has been an immense increase in the service in 2020 due to the pandemic. We already had the service in place, so we just had to fill in the gaps; for example, providing more hours and dates for clients to make use of the service.” <img src="https://tracker.metricool.com/c3po.jpg?hash=8b2b54e62fc802a9ae3ee7903a883415"/>

“One day, when I returned from work, Ms. Glenda and Mr. Martin from ADS Pro-Familia were at my house, I heard what the volunteering was about, regarding the education of the men in the community, how to teach, how to stop machismo, to be less violent, how to give the talks and visit the clients; they also talked about the contraceptive methods, medicines and many things that would change people's lives, the proposal seemed important to me and I accepted since I like to work for my people”, recalls José. Since 2008, male participation in sexual and reproductive healthcare in rural communities has been an integral component of the Community-Based Program (PBC), addressing issues of masculinity, behavior, and access to healthcare. "When I gave the talks on masculinity, they questioned me: 'Why can't you scream at home, if you're the man?' Or 'Who you think you are to say those things?', questions that I also asked myself once", says José. “Thanks to the training I have had and the support of the Pro-Familia staff, I have managed to learn and clarify my doubts. During the process I have had a personal change, I no longer respond if someone seeks me to fight and now, I don’t carry my knife everywhere as I used to, I take care of my own health, I share the responsibilities at home, I take care of my two-year-old son; before volunteering, I thought it was a woman’s job, I didn't do that”, reflects José. Educational activities on sexual and reproductive healthcare remain a challenge. Yet, health promoters can help break down some barriers through counseling for couples and the provision of contractive supplies - especially condoms - and medicines. “I like the communication I have with the Pro-Familia staff and the training reinforcements, they should keep it that way, because it's the way to learn and do things better in the community,” he says. “The change begins with oneself and then transmits it to others. I gather men in talks, make visits to their homes, give guidance on prevention of sexually transmitted infections, family planning and not to be violent”, says José. "Older adult men are more difficult to change." Changing attitudes to contraception  José has seen a change in the attitudes of men in his local community and those small achievements encourage him to keep going. “When men ask me about violence and condom use, I feel encouraged. For example, a co-worker uses a condom and confidently tells me that he does it because he learned from the talks he received, that motivates me to continue guiding towards new masculinities." For male clients who are referred by their local health promoter for a voluntary surgical contraception (VSC) procedure, the care is free of charge thanks to the Community-Based Program’s special fund. José is aware that there is still work to be done; "the issue of vasectomy is difficult with men in the community, the challenges continue." “In the community, young people ‘get to live together at an early age (marital union), maybe I cannot change that, but I can help them to be better people, to respect each other. Just as I changed, so can other men,” says José.  

Jamaica Family Planning Association (JFPA), is the brainchild of May Farquharson and Amy Bailey. Both women established what became the Caribbean and Jamaica’s first contraceptive initiative, The Jamaica Birth Control League, - in Kingston, which later became the Jamaica Family Planning League. By the 1950s, Dr Lenworth Jacobs and his wife Beth noticed the need for basic sex education within St Ann and would eventually offer their office space for a family planning clinic. In 1956, the organization was renamed the FAMPLAN and became the seventh member of the International Planned Parenthood Federation. The clinic faced resistance from religious groups in the midst of political tensions in Jamaica. Regardless, Dr and Mrs Jacobs with the help of funders, medical personnel, public health nurses and community health aides, persisted and ensured the development and continuity of the organization. But it is the recollection of registered midwife Dorothy Boyd-Brown, of the early days of FAMPLAN, which will leave you hanging on to every word as she tells the story about the glory days of family planning in Jamaica. “I came on to FAMPLAN in 1973 as a volunteer. I was the nurse in charge of maternal and child health at the St Ann’s Bay Health Centre. I got very interested because at the time they had a vibrant youth programme where you would go to schools, churches, other organisations and encourage persons to use contraceptives and other services that we offer like tubal ligation, vasectomy and other things. I wanted to know what this organization was about, so I served as a volunteer until 1977,” Boyd-Brown said. Boyd-Brown is proud to see FAMPLAN develop and grow to provide access to healthcare to over 100 rural communities and hard to reach populations in and around St Ann. “It’s how you were able as a nurse to help others. You had a mobile unit and trust me I enjoyed the mobile unit, going up into the hills,” she said. “They always seem to upgrade the services they offer and have effective communication around the populace in the surrounding communities.” Boyd-Brown lamented on the Community-based Distributors (CBD) Programme, which was huge in the 1970s. The CBDs responsibility was spreading the message of family planning through contraceptive demonstrations, condom distribution, and community-based talks to increase awareness. The impact of the work led to long-term contraception methods like tubal ligation and vasectomy being offered through a special clinic, in addition to hormonal contraception methods. While women were open to the various contraceptives available, there was still a lot of reluctance from men towards family planning. In response, Dr Stewart McKoy pursued the introduction of vasectomy as an alternative contraceptive method. This was, however, met with strong opposition from the Rastafarian community and men who believed in having as many children as possible. “When I came back to St Ann, I was introduced to the Beth Jacobs Clinic. I came and had a whole lot to do here…I was also trained in laparoscopic tubal ligations and when Professor Hugh Wynter heard I was down here he gave me a laparoscope and said start. Therein began the laparoscopic tubal ligation. There were times we did one in 15 minutes. We got so proficient,” Dr McKoy said, pointing out that the fostering of patient-doctor relationships served to bridge the gap between residents and FAMPLAN and led to greater reception of the services. Overtime the work within the community grew and partnerships with other organizations resulted in increased screening for cervical, breast, and prostate cancers, as well as testing for sexually transmitted infections. “You’re able to help a lot of people, even people who don’t come here. I am able to present the information to my schools, to my churches. They are still getting the information and they know what to do,” Boyd Brown said. The team remains committed to spreading the message of contraceptive care and health and wellbeing. “I feel good to get up in the mornings and I look forward to coming here as I know people are depending on the services offered, and they are depending on me,” Nurse Boyd-Brown said. Dr McKoy added: “When I drive in here my thoughts are that I’m home, after all these years it’s good to be back, see familiar faces like Boyd-Brown and continue the work.”