Never did she think that a job as Clinic Administrator would lead to a career that would change so many lives, but in 2007, Angelie Chotalal embarked on a path that would also change her life for good. Working at the Family Planning Association of Trinidad and Tobago (FPATT) in her late thirties, Angelie found joy in handling the administrative needs of the clinic, ensuring that the doctors and staff had all the resources to function at full capacity. She held that position for 3 years until she transferred into the vocation of Sessional Nurse, caring for the clients and clinic in a more hands-on role.  For the next 8 years, Angelie would devote her energy into education, becoming a Health and Family Life Education Master Trainer, as well as a Master Trainer in HIV Testing.  It was during this time that she also improved her bilingual skills; a decision that would prepare her for great success in the coming years.  “Hola! Como estás? Te ves bien,” she says as she greets a Venezuelan woman in the waiting area of the clinic. Her compassion is soothing and her smile is contagious. In her current role as Clinic Co-ordinator, Angelie has found herself having to be creative, innovative and still down-to-earth in the planning and execution of programmes for FPATT’s 4 static clinics across the country. The young migrant mothers of the clinic have come to know her as a matriarch, as she frequents the clinic floor always ready to attend to a new concern. “What makes them less than human?” Fleeing political oppression, lack of food and medicine and the downfall of the Venezuelan economy, over 40,000 Venezuelans have migrated to Trinidad to seek safer livelihoods. Many of them work to send most of their income home for the families they had to leave behind. “This here is my heartbeat. The work we do with the migrant community is dear to me because when I hear their stories, I know that there is so much more to be done. They are part of a population that has not received equal treatment. They’ve been put into a situation that they couldn’t expect and their only hope was to flee to this country where basic human rights are being withheld from them. What makes them less than human?” she asks, her visage pained with concern. Despite the influx of Venezuelans, Trinidad and Tobago’s migration policy has offered refugees very little access to healthcare and social services. However, FPATT’s mandate is to ensure that every person living within the borders of Trinidad and Tobago receive equal access to Sexual and Reproductive Healthcare (SRH) and Angelie’s personal mission is to ensure that they receive the best treatment when they come to her clinic.  “In 2018, we started offering healthcare specifically for the migrants. We had to ensure that our staff were compatible with our vision, and it was more than being bilingual; we each had to be genuinely empathetic toward the community we were seeking to serve. We worked to remove bias, xenophobia and other ill perceptions from even our own lives,” she noted. “The community is so close knit, that word of our services spread quickly and very soon our clinic for migrants was up and running. They would come in and see that it was a safe space to share their experiences and we took the time to listen, because they wouldn’t get this safety anywhere else.”  Before the FPATT clinic, migrants who needed SRH healthcare have had to book appointments with private doctors who often charge more than the migrants can afford.  “They work 12 hours a day, 7 days a week, get enough income to take care of their families here and those they’ve left behind. We’ve visited homes that house up to 10 migrant families, but it’s merely a shack with no running water or space to sleep. And then COVID hit,” she pauses pensively. “Incomes disappeared and so did options for housing; many of them were left homeless, so women who were already vulnerable were now being exploited. Imagine, your landlord asks you to pay for your rent with sex and a month later, brings his friends to cash in on the same favour, all because he knows you have nowhere else to live.”  Taking SRH Services online FPATT has offered all their regular healthcare services including gender-based violence counselling, birth control and emergency contraception to the migrant community. When Trinidad and Tobago entered a lockdown due to COVID protocols in 2020, FPATT approached the United Nations Population Fund for sponsorship to launch TeleHealth, an online medical consultation programme specifically for the migrant community. Through TeleHealth, clients are able to book 30-minute consultations with a clinical doctor and have their concerns addressed, ailments diagnosed and medicine prescribed, over WhatsApp video call.   In January 2021, FPATT also hosted a webinar series patterned after IPPF’s One Curriculum but tailored to the needs of the migrant community. The series featured FPATT’s team of clinical staff as well as experts in the fields of nutrition, self-defence and gender-based violence. “The response to both programmes is tremendous. The online access works well for our clients and we have developed such close relationships with them that we would love to expand our healthcare, but funding is often our major issue. We need sponsors to come on board, see how the programmes impact the people and help us continue to serve,” she states.  Ms. Chotalal looks forward to working with the Family Planning Association and helping communities that need their services the most.

Two clients of sexual and reproductive health counseling services agree that trust is one of the most valued aspects. Danitza Gonzales, the 28-year-old personal trainer, came to Inppares on the recommendation of a friend: “I felt great with the counseling. The same doctor gave me all the confidence to be able to tell her my issues and my doubts that are still taboo, she knew how to guide me”. Kiamara Meneses, 25, a sociologist, says that she found out about the institution through Facebook and when she arrived at counseling with her partner she felt confident: “We liked the way the explanation was provided and it was all very clear, so we kept coming back all of 2019, until 2020, because I was considering having a subdermal implant and I came to consult”, she commented. “What I liked the most about the counseling service was that there was no such luck of judging people, which had happened to me in other health facilities, where if I asked for a longer-lasting method, such as an implant or an IUD They put limitations on having children before or things like that. Here I understood that there are no restrictions to use a particular method and that seemed super important to me”, adds Kiamara. Among other aspects that the users highlight is the accessible price and the central location. “The cost seemed adequate to me, in addition to the treatment they gave me. So I stayed. When someone asks me where to go to seek contraceptive counseling or advice, I share the experience I have had, in addition to the fact that the place is very central and the price is very convenient,”says Danitza. “What I mainly like are the services Inppares has, in addition to counseling, the ease of accessing the methods, because they always have campaigns and also the HIV test; in addition to the Future Youth Center; so, it is a fairly comprehensive place and I would definitely recommend it. It contributes a lot to the lives of young people because information empowers. Young women can have a differentiated service that meets their needs, empowers them to make informed decisions about their bodies”, concludes Kiamara.  Danitza agrees that “Services like these have a great impact on the lives of women and men in order to make informed and responsible decisions; they should promote them more in schools and universities”.

Leny de la Mata Aquino has been working at Inppares since 2003, after working in public health establishments in the highlands of Peru and moving to the capital. “I came to Inppares invited by a colleague and I liked that we were working on rights; it was an awakening in sexual health. Because, although it is true, I am an obstetrician, I had not been trained in sexual and reproductive health and rights. And I learned a lot,” she recalls. “I also liked the camaraderie and working in a small institution, we treated each other like family. I had many perspectives in the sense of knowing a different environment because I had worked in the provinces for a long time and the realities are completely different”, says Leny. From her work experience at Inppares, Leny de la Mata highly values ​​the bond that is developed with the people who come to the services, which contributes a lot to an informed decision and a strengthening of self-care. “When you are close to people, you contribute a lot. As obstetricians, we dedicate ourselves to patients, we feel the many needs of users who come to the service, with many doubts regarding their sexual and reproductive health, with much ignorance of sexually transmitted diseases. Many people protect themselves from pregnancy, but not from STIs,” she says. As a counselor in sexual and reproductive health, Leny is aware of the importance that the empowerment of a women has on her body. “We also seek to empower women so they can recognize they have rights, which are above the decision of their partner. Before, couples had to consent to the choice of voluntary surgical intervention, but now it is not necessary and women have to make their own decisions. So far, we have users who ask their partners to determine a method of contraception, but we insist that the decision be made by her, we ask her: "What would you like?" It is important to empower them because sometimes the partner wants one thing and the woman wants another,” she says. In the day-to-day of counseling, Leny must also provide attention to cases surrounded by gender-based violence, which represents a very great challenge: “Machismo is cultivated since childhood.  That, in some way, is making it difficult to correct some things so far, because it’s part of the culture transmitted from generation to generation”, she reflects. “Inppares services are comprehensive; in other places, the counseling focuses only on contraceptive methods because they only see it as family planning, but here the counseling is comprehensive; from the moment the patient is admitted, he or she comes as a whole person. If I find a problem that I cannot solve, we have other professionals who can provide care, that helps us to provide the care people need”, Leny concludes.

Famia Planea Aruba (FPA) saw a gap in the market and developed its online store to better reach clients like Hilyann, a journalist, with an active lifestyle and work schedule.  FPA’s online store is open to members and non-members where they shop for their favorite FPA product in a worry- and hassle-free environment from the comfort of their own home, office, school or even on the go. Being able to order products online saves time and also supports those clients with limited access to transport.  “As a young professional, one of the challenges I often face is balancing my profession with my active lifestyle and practicing self-care. This is why I couldn’t be happier with FPA’s online store”, Hilyann says. The visually appealing online store is available in the local Aruban language, Papiamento. The site has been designed to provide quick access to various contraceptive methods, with supporting information to help clients make choices based on their needs. “It is so convenient and allows me to manage my time more efficiently, making it so much easier to be conscious of the necessary efforts with regards to my reproductive health. Above all, it allows me to focus on my personal goals, all while making the right choices when it comes to family planning”, she adds. Clients can browse a range of products and add their selections to the cart. At the check-out clients fill in their preferred time, date, and location for delivery. A confirmation email will be sent to the client while FPA starts to prepare the order for delivery.  “Shopping on the FPA online store makes me feel very in control and empowered. I hope that more people of all ages take advantage of this service. I hear far too often that people say they don’t have time, nobody has actually, but FPA is there for you. Take control of your sexual and reproductive health, empower yourself, be the boss of your time and your body”.

During the course of their studies, most students are required to develop projects and presentations about sexual and reproductive health. In the latter years of study, students start to prepare for more career-oriented studies and they are keen to learn more about how an organization like Famia Planea Aruba (FPA) operates.  As an NGO, FPA is a great source of support where students can learn more about the nature of social work including counseling, management, and get hands-on experience. The FPA team also support students to learn about its mission and vision, as well as management and structure nationally and internationally. It is an opportunity for them to learn that FPA is a of the International Planned Parenthood Federation (IPPF).  Students, Zavannah and Xian, are currently studying social work as one of their majors at the EPI vocational school. “FPA is one of our favorite organizations to work with, they are very accommodating to our deadlines and provide tailored information. We have already done various projects with them and we still choose FPA every chance we get”, Zavannah says. FPA offers internship opportunities for both vocational and university students. This experience can have a huge impact on a student, and some often go on to become part of the team.  “When we do school projects with FPA we can really get a view of what our futures as social workers can look like. We always receive answers to all our questions, they have always have their mission and vision statements at hand which for our projects are very important”, Zavannah adds. “We can always count on FPA to provide visual materials as well. We sometimes have to finalize our projects with different presentations and we can always ask for pictures, videos and graphs to make our project wonderful”, Xian comments. FPA places great value on its ability to inspire and support young people with their studies and future careers such as social work where they, in the future, can help and support others.

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.