Trinidad and Tobago

The Trinidad and Tobago transgender activist and community leader Brandy Rodriguez has died.

Ms Rodriguez was a stalwart of national and regional efforts to advance the rights of lesbian, gay, bisexual and transgender people. She was the President of the Trinidad and Tobago Transgender Coalition (TTTC). Through her collaboration with the United Caribbean Trans Network (UCTRANS) and the Latin American and Caribbean Network of Transgender People, she contributed to the movement for increased visibility, advocacy and community organization around gender identity issues. She also contributed to policymaking and workplace engagement efforts, including as a member of the Pan Caribbean Partnership against HIV and AIDS.

But her impact went even deeper. As a peer navigator for many years at the Family Planning Association of Trinidad and Tobago (FPATT), Ms Rodriguez provided direct support to members of the transgender community, including street-based sex workers.

She also supported transgender people living with HIV to access testing, treatment and care services. Among Caribbean countries that have reported on HIV prevalence for transgender people, the median HIV prevalence is more than 27%, far higher than that among any other key population group. Ms Rodriguez worked to ensure that members of this community not only started treatment but stayed the course.

From the base of the TTTC in Tunapuna, Trinidad and Tobago, Ms Rodriguez worked to ensure that the most marginalized people in her community had access to food, health care and mental health support. During the COVID-19 pandemic, her organization coordinated relief for transgender people who had lost their means of generating income.

This May she was recognized by Queen Elizabeth II for her advocacy and service when she received the 180th Commonwealth Point of Light award.

“Brandy fought fearlessly against discrimination. And in this fight, she didn’t just ask for recognition or plead for equal access to quality health care, but she made the point that it was a right that must come without conditions. She was determined to settle for nothing less,” a release from FPATT said.

In 2018, she addressed journalists at a regional media sensitization hosted by the UNAIDS Caribbean Sub-Regional Office and the Caribbean Vulnerable Communities Coalition. For most of the reporters it was their first time speaking to a transgender person and hearing how stereotypes and prejudice in their reporting were harmful to the community.

“For 22 years it has been an uphill battle, especially in the Caribbean. My conviction to not be silenced and to help vulnerable people keeps me committed to my goal of a better, more inclusive future for all,” Ms Rodriguez said.

The Director of the UNAIDS Caribbean Sub-Regional Office, James Guwani, recognized Ms Rodriguez for her work as a voice for the voiceless.

“She shows why it is imperative that we support community organizations with the ability to connect to those who are hardest to reach. At a time that the global HIV response is focusing on ending inequalities and supporting community-led interventions, we draw inspiration from Ms Rodriguez’s life and work,” he noted.

“The mother of the LGBTI community of Trinidad and Tobago has gained her wings,” said Alexus D’Marco, UCTRANS’ Executive Director. “The work of Brandy Rodriguez will not be forgotten and we must ensure that it continues.”

Delores Robinson’s days are usually busy. She heads GROOTS Trinidad and Tobago, a civil society organization that provides psychosocial care for people living with HIV. It also manages a transition house that provides shelter and services for displaced members of key populations.

But since the first COVID-19 case in the country was confirmed, on 12 March, Ms Robinson’s workdays have become a whirlwind. The government’s containment measures—a stay-at-home order and a shutdown of all non-essential business—have thrust the most vulnerable people further into the margins.

GROOTS Trinidad and Tobago is an example of how civil society organizations can move quickly to identify and respond to the needs of the voiceless. Ms Robinson, a Jamaican, has lived in Trinidad and Tobago for the past 34 years. During conversation she alternates between wide, open smiles and a furrowed brow. These days there’s lots to worry about.

Every day she prepares meals for 30 families. She then personally delivers them. There is no structured funding for this effort—just money and other contributions from HIV response stakeholders.

There’s a unique story at each drop-off point. Today she manoeuvres through the narrow roads of Sea Lots, a low-income community in the shadow of the capital city, Port of Spain. The men on the block recognize her car. One offers to deliver her parcel. She laughs. Ms Robinson has come to visit the seven children of a single mother living with HIV who is currently hospitalized.

The Government of Trinidad and Tobago has provided a range of COVID-19 relief options. These include salary relief, rental assistance grants and nutrition support. Sometimes, Ms Robinson’s role is to help clients navigate government systems. For example, one illiterate mother living with HIV lost her food card and needs help getting it replaced.

“The forms are complicated for many people, plus they don’t have an Internet service,” Ms Robinson explained. “Now that we are all being encouraged to conduct business online, many have no access.”

Since the stay-at-home orders went into effect, she’s been asked by the police to accommodate women and children at the transitional home. The combination of income loss and constant contact has exacerbated abusive situations, leading to a spike in reports of domestic violence.

Ms Robinson reports that her clients living with HIV have so far had no problem accessing their treatment. Before COVID-19, it was standard practice for Trinidad and Tobago clinics to dispense two- to three-month supplies of HIV medicines at a time. HIV treatment facilities and sexually transmitted infection clinics remain open, although they have altered hours.

“They have their meds,” she said. “What they need most now is nutritional support to be able to stay healthy and take their treatment.” And they need masks.

UNAIDS Caribbean is advocating for governments in the region to ensure that community organizations like GROOTS are included in decision-making and planning around meeting the needs of vulnerable populations during the COVID-19 crisis. They are an essential service, ensuring that people’s most basic needs are met. These organizations should be included in contingency plans for connecting people living with HIV to services. And they should be resourced.

“We think we’re all in this together, but there are many people who don’t have the things we take for granted—a safe home, healthy food and the ability to speak out. It’s tiring work but it’s needed now more than ever,” Ms Robinson said.

Caribbean faith leaders met in Port of Spain, Trinidad and Tobago, on 1 and 2 February to determine how they can support the Sustainable Development Goal agenda to end AIDS. The 55 faith leaders from 14 Caribbean countries representing the Bahá'í, Christian, Hindu, Muslim and Voodoo faiths were joined by regional and international development partners, including UNAIDS Deputy Executive Director Luiz Loures.

The faith leaders agreed on a set of recommendations, including offering leadership in support of achieving the 90–90–90 targets—whereby 90% of people living with HIV know their HIV status, 90% of people who know their HIV-positive status are accessing treatment and 90% of people on treatment have suppressed viral loads—and addressing violence against women and girls. Other recommendations include engagement between representatives of religious organizations and key populations, including men who have sex with men, sex workers and people who use drugs.

While religious organizations have long contributed to the Caribbean AIDS response, the consultation aimed to increase knowledge and coordination, while rallying the region around the goal of ending the AIDS epidemic. However, the meeting heard that challenges surrounding stigma, discrimination, prevention and access to services remain.

The consultation, which was organized by a regional Faith Leader Planning Committee with support from the Pan Caribbean Partnership against HIV and AIDS, culminated with an endorsement of the United Nations Political Declaration on Ending AIDS and a road map to deepen their partnerships and capacity.

(L to R): UNAIDS Deputy Executive Director, Management and External Relations, Ms Jan Beagle; Hon Rodger Samuel, Minister in the Office of the Prime Minister responsible for HIV; Dr Ernest Massiah, Director, UNAIDS Caribbean; Mr Sam Condor, Deputy Prime Minister and Minister of Foreign Affairs of St Kitts and Nevis; Mr Ainsley Reid, GIPA, Jamaica; Ms Angelica Hunt, Ag UN Resident Coordinator; and Ms Izola Garcia, UNAIDS Coordinator for Trinidad and Tobago.

Representatives from government, civil society, people living with HIV, UN agencies and development partners from across the Caribbean met in Port of Spain, Trinidad and Tobago, to review progress made towards achieving universal access to HIV prevention, treatment, care and support targets. The two-day meeting held from 23-24 March was convened by UNAIDS in collaboration with partners in the lead up to the UN High Level Meeting on AIDS, which will take place in June 2011.

“This is a unique opportunity for everyone who is part of the AIDS response day after day to reflect and take stock of where we are on our shared journey,” said UNAIDS Deputy Executive Director, Management and External Relations, Jan Beagle.

Political leaders were candid about the challenges and underscored the need to engage young leaders and do things differently as the AIDS response enters a new era and moves towards reaching zero new infections, zero discrimination, and zero AIDS-related deaths.

“Fear, denial, ignorance, stigma and discrimination are still very prominent in the region. It is a barrier to condom use, even accessing HIV treatment and care,” said Rodger Samuel, Minister in the Office of the Prime Minister, Trinidad and Tobago. “The old approaches do not seem to be working, especially with the new generation. If we do not get our youth involved, ‘getting to zero’ will be an immensely hard task.”

There are an estimated 260 000 people living with HIV in the Caribbean. Close to half of people in need of antiretroviral treatment are receiving it. Overall, HIV now affects more women than men in the region. However, there is considerable variation between countries. For example, 60% of people living with HIV in the Bahamas are women. But in Cuba and Suriname, 69% of people living with HIV are men. AIDS remains the leading cause of death in people aged 20-59 years old.

Participants acknowledged important progress in the region to date, including a 43% reduction in AIDS-related mortality between 2001 and 2008, and an 18% reduction in new HIV infections among children during the same time period. There has been significant expansion of programmes to prevent mother-to-child HIV transmission of HIV, with four countries that reaching 95% coverage.

But stigma and discrimination, homophobia and a punitive legal environment continue to undermine efforts to reach universal access goals towards HIV prevention, treatment, care and support across the Caribbean. There are 11 countries in the region that criminalize sex between people of the same sex, and 13 that criminalize sex work. Five countries, territories and areas continue to impose restrictions on the entry, stay and residence of people living with HIV.

“The HIV response shines a spotlight on inequality and violations of human rights, and compels us to act,” said Ms Beagle. “We must remove punitive laws that are blocking access to critical HIV services. The law should work for the HIV response, not against it.”

Participants also discussed the need to increase investment in stigma and discrimination reduction programmes to secure the rights of people living with HIV. Ainsley Reid, Coordinator for the Greater Involvement of People Living with HIV, Jamaica, underscored this by highlighting that “people living with HIV need more than medicines.” 

“I know people who have died with the medicines in their hands. What we really need is social protection, including food, employment, housing, etc. This is what it takes to move beyond ‘victim mode’ and have empowerment and meaningful involvement,” he added. 

Participants during the universal access consultation that took place in Port of Spain, Trinidad and Tobago. 23-24 March 2011

Civil society reported on the outcomes and conclusions of a one-day meeting which they held prior to the universal access consultation. Representatives called for the removal of punitive laws that block HIV responses and violate human rights. The need for intensified political and community action to take on the continued taboo around issues related sexuality was also stated. Civil society also emphasized the need to train healthcare workers on ethics and confidentiality. A call was made for regional negotiations to drive down the price of medicines.

Changes in the development environment, including signs of reductions in funding flows, was a backdrop to the discussions during the two days. During the last decade the Caribbean region received more than US$ 1.3 billion in external funding for HIV. While some countries already fund their national HIV programmes entirely from domestic resources, others will be under increasing pressure to reduce programme delivery costs and secure new resources as current sources of funding decline.

“It will be imperative to clearly identify where we can make efficiencies in the region, and be ruthlessly honest about dropping what doesn’t yield us results,” said Ernest Massiah, Director of the UNAIDS Regional Support Team for the Caribbean in his remarks during the opening ceremony.

A version of this story was first published at UNICEF.org

With the picturesque backdrop of Speyside, northern Tobago, in the distance, Kalifa Martin and her colleague Kerlan conduct a UNICEF-supported 'Kicking Aids Out' workshop. Credit: UNICEF Trinidad and Tobago/2009

A UNICEF-supported programme called 'Kicking AIDS Out' (KAO) has recently begun in Speyside, northern Tobago, by the Trinidad and Tobago Alliance for Sport and Physical Education (TTASPE). The new programme uses sports and games to teach young people and adolescents about HIV. Speyside is a small community that is best known as a destination for fishermen and divers. In 2007, UNICEF and TTASPE, along with the Red Cross of Trinidad and Tobago, teamed up to conduct a youth-led Vulnerable Community Assessment. Based on this assessment, Speyside was selected as the first area to initiate 'Kicking AIDS Out'.

Training for adolescents

Soon after the assessment, UNICEF and TTASPE began conducting workshops to train adolescents to become KAO peer facilitators. Kalifa Martin, 15, is one these young trainees.

"I heard there was an HIV workshop at the community centre and decided to go and learn more about HIV, because I knew it was important to get the right information," Kalifa says. "What I wasn't expecting was that I would learn about it through games and fun activities. I liked this and invited my sisters to attend and we are now all involved in the programme."

Growing up in Speyside, Kalifa saw firsthand how AIDS can have a ripple effect.

"When something happens to one person, it affects the whole community," she says. "I want more people to get tested and start making wise choices. I would like Speyside to be an example to other communities."

Increasing the level of knowledge of HIV among young people in Trinidad and Tobago is an important step. According to a recent UNAIDS/WHO/UNICEF country report, in 2007 56% of young people aged 15-24 had correct knowledge of, and rejected myths about, sexual transmission of the virus. A significant minority, 12%, in this group had also had sex before the age of 15. The same report suggests that the situation is especially serious for young women as they are over three times more likely than their male counterparts to be living with the virus (0.3% of boys compared to 1% of girls aged 15-24).

'I want to help people'

Since her training, Kalifa has conducted many ‘Kicking AIDS Out’ workshops – where lectures are replaced by educational games that resonate with young people. One such game is similar to dodgeball, except that in the KAO version, being hit with the ball symbolizes being exposed to HIV. The message is that anyone who doesn’t protect themselves is vulnerable to infection.

"It is through projects such as KAO that UNICEF hopes to empower young persons such as Kalifa to actively re-create their communities as places where young persons make informed choices," explains UNICEF Trinidad and Tobago HIV Officer Marlon Thompson.

There are currently about 20 peer educators like Kalifa in the KAO programme. And she knows that the initiative is having positive results. She has seen her peers in Speyside become more knowledgeable about AIDS and then readily share their knowledge with their family members and friends.

The programme has also changed Kalifa, who now dreams of becoming a doctor. "I want to help people living with HIV and even find a cure for it," she says.

Dr Jean Ramjohn-Richards, wife of President George Maxwell Richards, presents Brent Benjamin, winner of the Caribbean Coalition on Women, Girls and Aids (CCWA) regional  Logo Competition, with a cheque of US $500 at the launch of CCWA launch on 4 March 2009, Port-of-Spain.
Credit: UNAIDS

Violence against women is increasing women and girls’ vulnerability to HIV in the Caribbean region. This is the stark message which emerged from the launch of the Caribbean Coalition on Women, Girls and AIDS (CCWA) hosted on 4 March by the UNAIDS Caribbean Regional Support Team at the National Library, in Port of Spain, Trinidad.

Sexual violence against women and girls in the Caribbean is pervasive. According to a regional study, 47% of adolescent girls’ first sexual experience was “forced” or “somewhat forced” (Halcon, L. Beuhring T and Blum, R.: 2000). Violence or the threat of violence increases women’s vulnerability to HIV by making it difficult or impossible to negotiate safer sex and condom use. It also affects women’s expectations in relationships and can also stop women from accessing HIV prevention, care and treatment services.

The CCWA, a broad coalition of women from a diversity of backgrounds pledged to vigorously challenge not just violence against women but all aspects of female vulnerability to HIV. The First Lady of the Republic of Trinidad and Tobago, Her Excellency, Dr. Jean Ramjohn-Richards, who is a member of the CCWA, was in attendance as well as Yolanda Simon, Director of Caribbean Regional Network of People Living with HIV/AIDS (CRN+), founding member and advocate of the CCWA.

According to Roberta Clarke, Regional Programme Director of UNIFEM, much more needs to be done to transform unequal and harmful gender relations between women, men, boys and girls; as this culture of inequality is a root cause of women’s vulnerability to HIV.

“We know that the Caribbean is an unsafe space for women. Several Caribbean countries have amongst the highest homicide rates and all have higher than global averages of sexual violence, with three countries having amongst the top ten highest rates,” said Ms Clarke.

The CCWA therefore has a role to play in drawing attention to the persistence of inequality and violence and in advocating societal transformations which are consistent with the full respect for human rights.

The launch event also saw the unveiling of a new logo for the Coalition. Young Trinidadian, Brent Benjamin, was the winner of the competition to design the logo and he was presented with his prize by her Excellency, Dr. Jean Ramjohn-Richards.

The CCWA has been supported by the UNAIDS Caribbean Regional Support Team, along with UNIFEM and regional civil society organizations including CRN+, Caribbean Association for Feminist Research and Action (CAFRA) and the Centre for Gender and Development Studies (CGDS) for 15 months leading up to the official launch. This support will continue in 2009 during which time the Coalition will be hosted by UNIFEM with continued assistance from UNAIDS.

(from left) Michele Moloney-Kitts, Assistant Global AIDS Coordinator, US Department of State: Dr Roy Austin, US Ambassador to Trinidad and Tobago; Dr Karen Sealey, Director, UNAIDS Caribbean Regional Support Team. Credit: Shirley Bahadur

Despite successes in the Caribbean AIDS response, every day in the region 38 people lose their lives to AIDS and 55 become infected with HIV. This was the sobering message delivered by Dr Karen Sealey, UNAIDS Director of the Caribbean Regional Support Team, at the opening of the 7th Annual US Chiefs of Mission Conference on HIV/AIDS in the Caribbean held in Port of Spain, Trinidad and Tobago.

The annual high-level gathering which ran from October 22-23 was organized by the US Embassy in Trinidad and Tobago, in collaboration with USAID and Centers for Disease Control. Ambassadors from the Bahamas, Barbados, Belize, the Dominican Republic, Guyana, Jamaica, Suriname and Trinidad and Tobago attended. Haiti was also represented.

There were myriad challenges to draw their focus. In the region the epidemic is increasingly affecting young women. Disproportionately affected too are people who practice certain behaviours including men who have sex with men, people who buy and sell sex, crack cocaine users and prisoners. Stigma is rife throughout the small island nations of the region and discrimination based on differences in sexual orientation is fuelling the epidemic. Following the recent decriminalization of homosexuality in Panama, the seven countries in the Americas where homosexuality is still effectively a crime are all in the Caribbean.

HIV treatment and prevention

(from left) Patrick Manning, Prime Minister of Trinidad and Tobago; Dr Roy Austin, US Ambassador to Trinidad and Tobago; Michele Moloney-Kitts, Assistant Global AIDS Coordinator, US Department of State; Dr Karen Sealey, Director, UNAIDS Caribbean Regional Support Team. Credit: Trinidad Express

There has, however, been significant momentum in several areas including treatment. In 2003 4000 people were receiving antiretroviral therapy, by the end of 2007 that figure had increased to 30,000.

According to Patrick Manning, the Prime Minister of Trinidad and Tobago who addressed the conference, his country shares in this notable success: “There has been a 50% reduction in reported deaths. Some people have been able to return to relatively normal lives due to treatment from antiretroviral drugs.” He also stressed that complacency remained a clear danger.

Treatment success however has not been matched by prevention success across the region. For every 50 people put on antiretroviral therapy in 2007, there were 100 new infections.

US President’s Emergency Plan for AIDS Relief

One of the main areas for discussion was the second phase of the US President’s Emergency Plan for AIDS Relief (PEPFAR) and how the Caribbean could spearhead implementation. In July President Bush signed the reauthorization of PEPFAR to the tune of US$ 39 billion for AIDS and the Global Fund over the next five years. Haiti and Guyana have been recipients to date however other countries in the Caribbean are set to receive support from this new PEPFAR allocation. Although details of how the region will benefit have not been decided, UNAIDS is committed to helping ensure that this is maximized by working hand in hand with partners in Washington DC and in the region, such as the Pan Caribbean Partnership against HIV/AIDS (PANCAP).

The conference expanded the knowledge base of the US Ambassadors in the Caribbean and encouraged them to use their leadership role to highlight the epidemic and better support their host country’s challenge to it. In the past this gathering has helped to give the Ambassadors a powerful advocacy voice in the region.

Keeping HIV high on the agenda

Looking ahead to 2009, UNAIDS Regional Director Dr Sealey called for AIDS to be kept on the highest political agenda. The Government of Trinidad and Tobago will host three significant gatherings in the coming year; the Summit of the Americas, the First Caribbean Games and the Commonwealth Heads of Government Meeting which present potential opportunities to create new regional momentum in the challenge to HIV.