National Initiatives

Dudley Ferdinandus is the Counselor employed to FOKO in Curacao. His passion is that of working with men who have sex with men in that country, providing for them a service that champions the basic human rights of that population to health care services. The human rights approach to programming is at the very core of FOKO’s mandate.

But they take that a step further and have developed a strategy specific to young men who have sex with men. For Ferdinandus and his group, the issues faced by young persons are very unique, and must be given priority consideration. “Unless we listen to our youths, know their issues and help them through it, we will lose an entire generation:” says Ferdinandus. “These young gay men have a right to our services and we must give them our attention” said the Advocate and Counselor.

Dudley Ferdinandus (left) conducts a counseling session with one of his young clients. (Welsh photo)

If you take a look around the Caribbean region for a leader of people living with HIV, Surinamese Ethel Pengel, Chairperson of Double Positive Foundation would automatically come to the forefront. In the one-on-one counseling sessions with the women and girls living with HIV, she deals with issues ranging from partner notification to treatment adherence, from skills building to income earning. Pengel remarks that these sessions serve as a reality-check for her and directly inform her gendered perspective to HIV programming. Along with her four times per week support group meetings, the sessions form the base of her human rights advocacy platform.

So, when she speaks to the media about the issues that hamper access to HIV treatment for women and girls, Pengel really knows what she is talking about. She knows that they face stigma and discrimination from some healthcare workers; she knows that they face rejection and even abuse from their partners. She has seen failure in treatment regimes ending in the death of some women. She bears the pain of their children orphaned by AIDS. She screams at the injustice facing women because of her country’s criminalization of transmission and she is repulsed by its immigration laws that bar entry to HIV-positive women. She also knows and sees the attempts by these women to better their lives by learning new skills through advocacy, treatment adherence and income earning projects.

Ethel Pengel (r) presents a case to Human Rights Lawyer Veronica Cenac on the issue of criminalization facing some of the women she serves.

Free night clinics are the latest initiative by Jamaica AIDS Support for Life in its 18-year mission to respond holistically to the needs of vulnerable people in Jamaica. The new clinics are located in three strategic areas across the island, and will provide people like men who have sex with men and sex workers with access to the care of sensitive doctors and nurses. Services available at the clinics include personal counselling about HIV, testing for it, medicines for those who have the virus, activities to help them participate more actively in their medical care, and peer support groups.

The clinics are one of several programmes that JASL has designed and built over the years to improve access to services for the people it sees as most at risk. These programmes have included spiritual support, remedial education, career counselling, relationship skills, a safe space to gather, and leadership training.

Executive Director of JASL Stacy Ann Jarrett (right), explains the organization’s programmes to Patricia Atkinson (left) of the US Embassy’s Office of Public Affairs in Jamaica

“All our programmes are provided in a safe space designed to celebrate the humanity of all clients,” says Stacy Ann Jarrett. The JASL executive director is proud of the relationships her organization has built with people living with HIV and the “rights-based approach” JASL has taken to their work. “We need to have a strong voice in advocating for the essential needs of vulnerable people in Jamaica,” she adds. “JASL has become notorious for publicly advocating for our clients’ human rights and for legal and policy reforms for marginalized groups.” She includes in this category deaf people.

Jarrett believes JASL’s almost two decades of intimate relationships with the communities they serve has delivered a solid understanding of the issues that place people at risk, and given the organization the edge in its development and delivery of targeted programmes. Central to the JASL strategy, she notes, is to mobilize and empower people to become more active, more aware and more responsible. The agency does so by supporting the development within the communities it serves of structures that are managed by members of the communities themselves.

“We are mindful that the biomedical response to HIV is critical,” Jarrett argues. “But it certainly does not solve it all. Leave out the essential ingredient of what makes a person vulnerable to HIV in the first place and you immediately you compromise the development of truly effective interventions that make a real impact on the epidemic.”

The JASL Clinic which was donated by Food For the Poor.

Dr. Marcus Day of the Caribbean Harm Reduction Coalition insists that contrary to the popular belief of many HIV programmers, it is possible for HIV positive homeless substance users to receive anti-retroviral treatment and be as adherent as others living with the virus. Dr. Day’s approach is to enlist the support of volunteers, including community peer outreach officers, some of whom are drug users at various stages of use and non-use. On a daily basis, these officers hit the streets to find users and feed them. They administer anti-retroviral medication to them and observe them taking it. The outreach officers also bring these clients to the STI/HIV clinic for care and treatment. There they can take a shower and get a change of clothes. Nurse Pearl Theobalds complements the team by seeing and treating these drug users in the public clinic. For her, having a non-judgmental approach is key to dealing with this population and in helping them to get access to treatment. For Dr. Day, this collaborative approach is truly human rights in action!

Nurse Pearl Theobalds (left) and Dr. Marcus Day.

“Ever since I can remember” says Nairobi the leader of the transgender group of COTRAVEDT in the Dominican Republic, “what I have between my legs has never matched what's between my ears”. This has been a great source of disappointment and shame for my family.” But trying to pretend to be something I am not ultimately failed to reconcile me with my mother. It proved unsustainable over time and came at tremendous personal cost, both in terms of my health and happiness. Thanks to the “Tal Cual” (As I am) health initiative of COIN, I no longer have to be apologetic and explain myself to a health care provider or resort to self-medicating”.

Nairobi (right) poses with Dr. Anita Radix (centre) and Transgender activist Vicky Sawyers (r)

The programme offers transgender specific healthcare within the context of primary care. “This is important”, explains Dr. John Waters who runs the clinic, “because transgender persons are often excluded from basic healthcare due to discrimination or lack of knowledge on transgender health issues. What little exists tend to focus exclusively on Sexually Transmitted Infection’s (STI’s) and HIV. This only serves to reinforce stigma and shame. Through the clinic’s transgender programme STI and HIV are integrated within a context of primary care that addresses specific transgender healthcare needs such as the use of hormones. We have seen how this builds trust and self-esteem and results in reduced risk taking behaviour and greater adherence with anti retroviral medication.”

Nairobi says that “Tal Cual is a safe and affirming place for the transgender community where they can access health services and get connected with supportive local resources”.

Nairobi Castillo (r) advocating for the rights of the transgender community.

How do you achieve an over 90% adherence to anti retrovirals? Talk to Nurse Madrill, who intimately knows the corridors of Belize prisons.
For her, each inmate has a basic human right to attention and health care. She ensures that they have nutritious meals, gives them their medication and watches them take it. As the nurse in charge of the Belize Central Prison, she insists on follow-up care as well as attendant tests such as CD4 and viral load counts, liver and kidney functions and chest x-rays. All of this is aimed at warding off opportunistic infections and helping infected prisoners to remain healthy. “Basically, I treat these clients in the same way that I would want to be treated. They are human beings and deserve love and attention” Madrill revealed.
She passes on this attitude to other staff members, asking them to maintain the same high standards in her absence.
What better example is there of combining a respect for human right with an insistence on access to treatment?

Nurse Madrilll advocates for the rights of prisoners at the CVC/PAHO Caribbean meeting

If ever there is regional heroine of sex workers it would undoubtedly be Juanita Altenberg, the Executive Director of Maxi Linder in Suriname.

Juanita Altenberg makes a presentation at a sex work consultation in the Dominican Republic.

Without any reservations Juanita has championed the rights of sex workers for over ten years and has become legendary for speaking publicly for the rights of this population on the national, regional and international arena. “Sex Work is the legitimate profession of these individuals and that should be respected by all. At Maxi Linder we treat all sex workers with respect and dignity” says Altenberg.

Juanita Altenberg(left) prepares Donna Da Costa De Martinez of Trinidad for interventions with sex workers.

As a result of her work with Maxi Linder, Juanita has been well sought after in the region where her expertise has been employed to build sex worker initiatives in countries such as Jamaica, Trinidad and Tobago, the Dominican Republic and St. Lucia. She is well known at the CARICOM/PANCAP levels where she has lobbied for the rights of this population for years. As a member of the Board of CVC, Altenberg has worked assiduously at the formation and development of the Caribbean Sex Work Coalition.

Regional Initiatives

As a CARIOCM Champion for Change, the Informative History Man takes his role very seriously. He uses his talent to encourage greater sensitivity to the issues faced by persons living with and or affected by HIV. To that end, he has performed on countless occasions for entities such as CARICOM, UNAIDS, the Civil Society Forum, Caribbean Drug and Alcohol Research Institute and Caribbean Vulnerable Communities Coalition.

His latest reggae hit insists that “...access to HIV treatment is for one and all” and is immortalized on as theme song of the CTAG /CVC documentary “Complex Problems: Simple Solutions” and its accompanying music video. For this Rastafarian advocate, all persons have the right to access care and support and no one should stigmatize or discriminate against them. “With antiretroviral medication available now-a-days, no-one should die of AIDS complications” he says.

But then he also introduces the prevention component to the picture. “This is because I and I do not want more of Jah’s people to become infected” he says. “So I have to big-up condom use” His lyrics are gender specific. To women, one song exhorts “have yu femidom in reserve” and to men the message is “You must strap-up, you must strap up”. He brings the three pronged strategy of care, treatment and prevention together in a creative way!!

The Informative History Man (2nd right) presents a copy of his hit single to international Actor Christopher Daly (left). Stacy Ann Jarrett (2nd left) Executve Director of JASL Nurses Daunette Wellington (centre) and Orchid Gowe (right) witness the ocassion.

Through its MSM/HIV community awards program, amfAR – The Foundation for AIDS Research - has been making strides with the Caribbean Vulnerable Communities Coalition (CVC), working with already existing groups in countries such as Trinidad and Tobago, St. Lucia, Grenada, Guyana, and Dominica.

Whereas the role out of related activities differs in each country, all have the common theme of been used to heighten awareness faced by sexual minorities. For example, through AMFAR:

In Dominica, CHAP has been able to advance their Human Rights advocacy agenda by exploring and implementing creative, non-confrontational and effective methods of dealing with stigma and discrimination in Dominica. As a direct spin-off, they are now arranging for radio and television panel discussions on the topic 'Recognizing Discrimination'. Efforts will continue to educate the public on the prevention and spread of HIV/AIDS especially within the MSM community - this is done mainly by preparing low literate brochures with the relevant information using a local lingua thereby making it more interesting. These are included in a safe sex kit. All of this is done with the view of the LGBT community living healthy and fulfilling lives.

Daryl Phillip (right) of Dominica CHAP extends a warm welcome to Dr. Paul Skyers.

In St Lucia, United and Strong facilitated regular consultation with members of the LGBT community examining among other things the Legal Reform; human rights advocacy, safer sex practices and HIV care and treatment issues.

Kenita Placid of St. Lucia’s United and Strong was among those who made presentation to the Constitutional Reform Commission on behalf of that county’s GLBT community.

Additionally, they took the brave step of making and submitting a Written and Oral presentation to the Constitutional Reform Commission for the removal of the buggery and gross indecency law, the inclusion of sexual orientation and gender identity in the expansion of the non discrimination laws.

Participants celebrate after one of their innovative sessions.

In Trinidad and Tobago, Friends for Life was able to among other things conduct safer sex and HIV sensitization sessions for members of the MSM community in the sister island, Tobago. The Tobago chatrooms which were a recent undertaking, had previously suffered from a lack of resources, both physical and human. This initiative provide a boost. MSM in Tobago, were highly motivated by the group work process in the chatroom setting. They expressed a need for such meetings and a satisfaction that they had finally started.

The project also challenged the organisation to explore non-traditional ways of mobilizing its constituents. The popular use of mobile phones to access social networking gay chat-rooms proved vital in the rural areas where the internet was less prevalent.

Members of Friends for Life caught in an intense discussion in their Tobago interventions.

GrenCHAP followed suit by launching their version of the “Would Jesus Discriminate” campaign that sought to challenge faith based communities in taking a stance against institutionalized homophobia.

Left alone to amfAR’s Kent Klindera, MSM Initiative Program Manager, “We are mindful of powerful forces working against human rights in the region– specifically the rights of sexual minorities. Simply informing people of HIV risks is not enough! We must address structural issues, promoting human rights – including health access – for all. He went on to say, “More can and will be done to address these issues in the region and amfAR will do all it can to assist.” Recently, amfAR launched a “request for proposals” (RFP) for another round of funding of MSM/HIV programs in the Caribbean; with awards expected by March 2010. See www.amfar.org/msm for more information.

The Caribbean Treatment Access Group (CTAG) has taken the matter a step further where treatment advocacy in the region is concerned. They use the mechanism of a small grants programme for civil society organizations to help ensure that access to treatment is heightened in the region.

CTAG’s Mario Kleinmoedig (right) and SEROvie’s Steeve Lagueer engage the media at the Launch of Access to Treatment Day 2009 in Haiti.

Since its inception in 2004, CTAG has distributed a total of 30 grants to 15 different organizations throughout the Caribbean. Some activities have included care and support centres for persons living with HIV, advocacy for homeless sex workers, skills building and income generating for most at risk population and the production of audio visual material to be used for policy level advocacy. One such example is the grant awarded to Casa Joven del Caribe in Puerto Rico. This allows that group to take food, clean syringes and medication to substance users in the rural town of Altos de Cuba, Vega Baja Puerto Rico by a dedicated team of staff and volunteers. Twice per week they can be seen working with this clients to ensure that they are clean, well fed and take their medication. That group’s CEO Alice Ayala says, “We do this without Government help because we realize that substance use is a major epidemic that is affecting our country. Each of these persons is a human being deserve to be treated with dignity and respect.”

In addition to that the group has launched an Annual Access to Treatment Day during which focus is brought on the issues faced by different groups in accessing care and treatment in the region. According to the ITPC/ Collaborative Fund CTAG’s Program Manager, Dr. Moisés Agosto, “The availability of ARVs is not enough for successful treatment. It is known that there are other factors that affect patient’s capacity to completely benefit from the medications. For example, proper nutrition, health care workers disposition at ARV distribution sites, treatment and adherence literacy and other social barriers. They all need to be addressed and dealt with.”

Media Launch of Access to Treatment Day in Guyana.

Media Launch of Access to Treatment Day in Jamaica.