Click the image below to open the photo story of the women of LINKAGES Nepal.
Transgender Day of Remembrance (TDOR) is an annual observance on November 20th that honors the memory of lives lost in acts of transphobic violence. On TDOR, LINKAGES is honored to feature the work and perspectives of one of our trans peer educators – Macarena Pérez. Macarena works with CEPROSH in the Dominican Republic to help trans women understand their right to live free of violence and access services if they experience violence. The interviewer, Betty Alvarez, is a LINKAGES consultant based in the Dominican Republic.
What does Transgender Day of Remembrance mean to you?
For me, this is a very important and significant day. Just as there is a day that commemorates the fight against violence suffered by cisgender women, we – the transgender community – deserve a day, too. It makes me proud that there is a day on which members of the global transgender community that have become victims of gender-based violence can be remembered, because we are also an important part of society.
How does your work as a peer educator help prevent violence against transgender people? How does it help ensure transgender people have access to services if they are victims of violence?
Being a peer educator has empowered me and helped me understand the importance of education and training. Being able to share my knowledge and life experiences with my peers has strengthened my own identity as a transgender individual and, in turn, helps my peers empower themselves and know their right to live free of violence.
I teach my peers about important gender-based violence information – including its links with HIV – provided to us by the LINKAGES project and CEPROSH. I explain “La Ruta” (route of available services) and give information about our rights and how to identify violence. The members of my community feel more confident in seeking health and gender-based violence services and demanding that their rights be upheld.
What kind of support is available to transgender people in your community if they become victims of violence? How is this different than the support that was available in the past?
Transgender people in my community have several services available to them if they become victims of gender-based violence. There are a number of clinical and psychological services provided by CEPROSH, the gender-based violence unit of the District Attorney’s Office, the local police, and peer educators like myself. These services have been strengthened and made more friendly to trans women with support from the LINKAGES project. We have more entry doors to free KP-friendly services than ever before.
What do you believe still needs to be done to end gender-based violence?
To end gender-based violence against trans women, we need to do a very big job. We need to create a new generation with a new way of thinking. We need to educate people from a young age to understand that being different is not a bad thing and that being different does not mean that we do not have the right to live free of stigma and discrimination. We have the right to live a dignified live.
How does gender-based violence against transgender people increase their risk of HIV and make it more difficult for them to access health services?
Many trans people are ignorant of their rights. We have been mistreated for so long that many of us are afraid to seek help because we are afraid of being rejected and discriminated against while seeking services. So, after being victims of violence, many transgender people do not go to services on time or do not go at all, increasing their risk of HIV and other physical and mental health complications.
Why is it important for HIV programs to offer violence services?
It is very important for HIV programs to talk about violence because when people go to a workshop or an educational session about violence in the community, they empower themselves and discover their value as a human being. Then they are more willing to seek services, including HIV services, when needed. As a trans woman, I have fought and will keep fighting so these kinds of programs continue to increase empowerment in the trans community and reduce the incidence of violence.
The participation of LINKAGES and partners and HIV clinics in offering gender-based violence services is fundamental for all key populations. Transgender people in Puerto Plata are now able to get stigma-free and cost-free clinical services, like post-exposure prophylaxis, and psychological counseling if they are victims of violence.
From peer educators to HIV testing counselors: how female sex workers are assisting their communities in Angola
Written by Celma Pedro, Technical Officer, Positive Living, Management Sciences for Health
Delfina da Costa worked eight years as a peer educator for female sex workers (FSWs) in her community in Angola, educating those at high risk for exposure to HIV. She frequented hot spots around town to share informative messages in a safe environment on how to stay healthy and prevent contracting or spreading HIV. She forged strong, trusting relationships with the women she helped, but Delfina wanted to do more. In October 2015, she was trained to be an HIV testing counselor.
“I always followed HIV testing on the side lines, watching carefully how it was performed on the women I referred. I always wanted to test. Now I can.”
Delfina administers HIV rapid tests at hot spots, screens FSWs for sexually transmitted infections, and consults with health care professionals about the specific needs of her clients. She also links HIV-positive FSWs to peer navigators and care support services. If a FSW does not want to meet with a peer navigator, Delfina supports the patient herself from the onset of treatment.
Delfina’s transition from peer educator to HIV testing counselor marked the beginning of professional development and advancement for peer educators working with key populations (KPs) in Angola. Her experience is unique, as members of KPs have not typically held positions of leadership or authority in the past, and KP-led HIV organizations are scarce. Until recently, giving KP peer educators the opportunity to train as HIV counselors was frowned upon by many civil society organizations (CSOs) in the country.
Since 2015, LINKAGES has partnered with Associação de Solidariedade Cristã Ajuda Mútua (ASCAM), a local nonprofit CSO in Luanda, Angola, and the first in country with an entirely KP-led management team. ASCAM began as an emergency support service during wartime; today, the organization works almost exclusively in HIV education. Together, LINKAGES and ASCAM recruit individuals from KP communities—primarily FSWs—to be peer educators. After serving in this position for at least one year, peer educators can train to become HIV testing counselors within their local communities. HIV testing counselor training is a two-week course with theoretical and health facility practicum requirements, conducted in partnership with the Angolan government.
Professional development for KP individuals in HIV prevention, care, and treatment services has come a long way in recent years. “When we started working in Angola in 2015, the only CSO that had key population peer educators was ASCAM,” says Ana Diaz, LINKAGES Angola program manager, “but the HIV testing counselors were not key population members. KP members had never been given the opportunity to train as counselors, but now they can.”
Establishing more prominent roles for KP community leaders in the HIV prevention, testing, care, and treatment of individuals like themselves builds trust between health provider and patient, and strengthens referral uptake of KPs to HIV service providers.
The success of these trainings in reaching previously unidentified KP individuals has made other partner organizations aware of the benefits in providing opportunities for KP peer educators. LINKAGES has trained 23 KP HIV testing counselors to date, 16 of whom are FSWs. Becoming a counselor is a big step in establishing a career in health care. Having a training certificate from the government can open many doors to other projects that may even go beyond HIV prevention, care, and treatment services.
For Delfina and other HIV educators in Luanda, empowering FSWs within CSOs is an ongoing effort to promote more accurately representative leadership.
Fatima Zua, a FSW peer educator with ASCAM, says: “When we work to empower women [key population members], everyone wins. I feel they understand our needs because they were in our position before.”
Written by Christio Wijnhard, Project Coordinator for the LINKAGES Project at Foundation He+HIV, Suriname
Even though Clarence suspected that he might HIV-positive, the 24-year-old was shocked when he first learned his status. “I cried and I cried. I wanted to commit suicide. I thought it was the end for me.”
When Clarence first accepted his sexuality, he just began experimenting and never thought about practicing safe sex. But he lived in a small village where news traveled fast. When people started talking about two of his former sexual partners being HIV-positive, he realized the risks involved.
The young Surinamese man met a health navigator working for Foundation He+Hiv (FHH), a LINKAGES implementing partner. They had met before on social media, but the health navigator invited him for a one-on-one conversation at FHH. The health navigator then determined that Clarence had been risky in his behavior and advised HIV testing. “At first I was reluctant to go for an HIV test. But, after thinking about it, I agreed.” Clarence’s health navigator motivated him to not be afraid and pointed out the importance of knowing his status for sure. Finally, on November 7, 2016, the health navigator accompanied him to a health care facility.
The outcome was devastating at first. “I have two dogs, Bruce and Chulo, and I could see their chain in front of me because that was what I wanted to use to kill myself.” Clarence was embraced by his health navigator, who shared with him some surprising information that changed the way he would view his HIV-positive status.
“He told me he was also infected with the virus. At first I would not believe it because he was a normal-looking man on the outside.” Looking back, Clarence can honestly say that this moment changed his life. “Hearing and seeing someone that was also infected, but looked very healthy, took away the feeling of being alone and lonely. It took away my fear of dying.”
When the time came to start medication, Clarence had some difficulties. The side effects were too much to handle, and he even stopped taking his medication because of them. His health navigator and the specialist at the Academic Hospital had serious talks with him. The doctor even told him bluntly: “If you don’t take your medication, you will die. Is that what you want?” Finally, the health navigator decided to bring Clarence for a talk with the project coordinator.
The project coordinator asked Clarence about his dreams and his goals. Clarence shared that he was worried about his cousin. “She is my favorite cousin. I love her very much but she is risky in her behavior, like I was.” Then, they started talking about the possibility of her being HIV-positive as well. When the project coordinator asked Clarence what he would do if his cousin was infected and did not take her medicine, Clarence replied, “I would tell her not to be stupid and take her medication of course!”
Clarence paused for a moment, before saying, “Okay, I get it!”
Today, Clarence is still working on accepting his status. Twice a month he attends MSM support group sessions, which focus on self-empowerment. He meets up once every few weeks with his health navigator. He also uses the psychosocial care services at FHH, and he joined the group for the annual retreat of key population members who are living with HIV.
“I feel super fantastic! Because of the coaching, I was able to define what I liked. I am very interested in photography and I would like to take dance classes, and I might pursue a career as a male model someday.” Clarence also told his health navigator that he no longer wanted to be accompanied by him when he needs to visit the health care facility. “I feel empowered enough to visit health care facilities on my own.” Clarence also started writing about his feelings in a dairy.
“I feel great, really. And I want to work on improving myself because I want to be a good example for other people dealing with acceptance of their HIV status. I want them to know that it is not easy but if I can make these changes and be happy and work towards a good life living with HIV, so can they! I want to be their inspiration.”
Written by Beyonce Karungi, Executive Director, Transgender Equality Uganda
The Commission on the Status of Women (CSW) is the largest international gathering of governments and civil society dedicated to developing an agenda that promotes progress for women and girls. Each year, the UN brings together women and girls from all over the world to discuss issues that affect women from all spheres of life. Despite the sense of total inclusion, transgender women and girls are often underrepresented in this crucial space. Consequently, the transgender community faces a challenge in raising and addressing the issues specific to them.
The CSW recently emphasized inclusion of transgender people in its sustainable development goals. The discussion surrounding trans inclusion was unprecedented and a major credit to the UN organizers. Hopefully, this discussion continues to provide an ongoing dialogue that will work toward the improvement of the status of all women – including trans women – around the world.
I was one of the few transgender women present at the latest CSW. While there, I participated in many forums including development of the UN Women’s Strategic Plan development (2018-2021) at the UN headquarters. We lobbied UN women to include the transgender community in the strategic plan by connecting us with country offices and registering us to participate not only in trans-specific events but also in the main CSW discussions that typically include all women and girls.
At CSW, I also participated in a sex worker session focused on the conditions faced by this key population. Internationally, policy discourse has shifted in many ways to defend sex work as real work. Still, efforts to criminalize clients are unaligned with what sex workers need in order to be able to thrive as workers.
I was also involved in the Lesbian Bisexual Transgender Intersex (LBTI) women’s session. LBTI women are not explicitly mentioned as a vulnerable group in many spaces. This cultural stance and attitude is in large part internalized by LBTI people, which creates a strong obstacle to self-identification. The stigma surrounding LBTI women makes them a socially invisible community within general society. The result is that, with a few exceptions, the most vocal leadership of LBTI women’s rights has traditionally been men.
CSW participants discussed many issues, including peace and security for women and human rights defenders, sexual and reproductive health and rights, maternal health, gender-based violence, and family planning. Transgender women and girls continue to be excluded from the economic, political, and social sectors, which limits their access to education, health services, and employment.
While one of the main goals of the CSW is to empower all women and girls, transgender women remain unfairly marginalized.
The CSW needs to ensure that transgender people are represented and that data collection is supported so we can begin to advance the livelihood and well-being of transgender women everywhere. It is within the power of the CSW to include all women in discussions on women’s status in the world, and doing so will increase the awareness and importance of transgender inclusion, health, and rights.