End-of-term evaluation
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- Adolescents
- Programme Design
- IEC versus BCC
Transgender People
The pervasive lack of understanding of transgender people fuels their vulnerability and according to the discussion summarises what could be described as the embryonic stages of HIV/STI programming in Barbados, as it relates to transgender people. One person said “…There is also a need for a better understanding of who Trans really are. Because the definition is very new, especially in the Caribbean, so there are a lot of areas that people want to focus on, but for me a definition [is required] for persons who don’t really understand who Trans are…” They went on to explain that there are significant differences in service needs for trans men and women. The man in the group said, ‘For me is like, we don’t really get as much pressure as trans women in Barbados… it’s not like if I were down in the mall …like some Bajan men would sit down and like kill batty man…there’s not much threatening in my life, [name of a trans women in group] now would be more at stake than me…” Therefore he did not feel that he had the need for any special services, but thought that services for other trans people are required. One woman said in terms of service needs, “…The trans agenda came to Barbados because of certain policies and programming and in that way…was dropped here…but education regarding trans in relation to key populations…as trans are four times more vulnerable to acquiring HIV than gay men…so you are the top there” [is required]. She went on to say that some progress has been made with regards to a series of sensitivity trainings with health care workers and the Barbados Defence Force staff. However she noted that the extent to which the information is embraced depends on people’s personal mores and “Christian values and hypocrisy”. The group discussed the common question asked by trainees, “Was it all worth it?” One woman said she responded by saying “…this is not a question of if it is worth it or not…this is not something that I can decide to do…this is just about how I felt about myself and I had to make the changes for my emotional wellbeing…so in that sense I would say it is worth it because I am better able to cope with the world”. The other woman said “And doing that in a world that is not supportive is even harder”. Both women spoke of problems in certain settings using female bathrooms and the notion that trans women should use the male bathrooms. The insensitivity and the considerable risk from homophobic males that this poses to the women, they explained is another example of how these kinds of experiences make transitioning so difficult. On the subject of HIV/STI services and experiences the group said that CEED is the only group really working with transgender people, among other key affected populations and there are no BCC programmes, although they acknowledged the considerable efforts of CHAA in beginning to address and include trans people in programming. However they felt that many transgender people are isolated and are not in contact with any services at all, so there has been minimal engagement in their opinion. The ‘right’ approach to transgender programming for the country was also noted as an area in need of examining as Latin American and Caribbean regional approach is one of a human rights based approach, compared to Barbados that has more on an HIV prevention approach. One woman said “There needs to be a shift in priorities”. On the question of S&D and how this is handled, the group said there is nothing in place to protect people if that are treated badly because they are transgender. As far as they know there have been no new policies, legislative changes or amendments over the past five years. One woman said “When you look at the discrimination policy…the act, it says on the grounds of race religion, it does not speak to sexual orientation or gender identity” Apart from some key individuals that are involved in advocacy [these group members], they said there is not a specific organization or movement supporting trans people in Barbados. The group felt that although some attempts at conducting needs assessment with KAP that included trans people have been done but there is a need for a discrete needs assessment for trans women to, better inform the development of a strategy for HIV/STI programming and that the NSP objectives do not adequately address the needs of transgender people. AdolescentsThis group of young people was very knowledgeable about HIV and gave most of the modes of transmission correctly and the heightened risk for certain groups and adolescent woman. They were also very knowledgeable about HIV prevention and signs and symptoms of STIs. The group said that they had learnt the information from the peer education classes that they attended, as the entire group said they were trained as volunteers. They were critical of the abstinence message for young people, one young woman said, “Everybody ain’t going do it now in this world today” and they thought the message should be about partner reduction as many young people have multiple sex partners. The young man said “Don’t’ go running around with each and every girl that you see” and another said “Know your partner, get tested and use condoms”. With regards to myths and misinformation among young people in general, the group said that there was still a lot of incorrect information about HIV that young people still believe, they said they think you can: “Catch AIDS by kissing” “Holding hands” “By hugging” “So they scorn people”
One young woman said “The Guidance Counsellor should actually be talking about it…they not doing that, because I find a lot of parents be saying you shouldn’t teach sexual education to children in schools…so at the age of fourteen and fifteen a lot of children are having sex, but they [parents] are still in denial…” They also thought that part of the problem why young people are not interested in HIV/STI information is the way in which it is being taught. They said it is very boring and that the approach needs to be tailored more to suit young people. They said that it is usually taught by older people too and young people don’t want to discuss these things with people who are not in the same age group. “They pretty it up too much” was another view from the group. By this they explained that the language they use is outdated and they skirt around the sensitive information. They want plain talking in young people’s lingo using methods like drama and music and social media and make it more exciting. They said in its current state it was totally unappealing to young people. When the discussion came to young people and access to SRH services and accessing condoms, they spoke very highly of what they described as “Sir Winston Scott” (they said some people know it as Ladymeade) one young woman said: “You can tested and it is free…they treat young people very well and everything is confidential” Another member said “They have charts and everything, they explain everything to you”. They also spoke of being able to go the Family planning clinic. One young woman said “I was scared to go there, but when I went everything was fine” Some of groups said that the nurses at some polyclinics are “very unmannerly”. “If you’re young and you pregnant you get treated really rough, nurses does tell you all kinds of things” The group was not aware of any empowerment programmes to further their education, gain access to training or job opportunities, with the exception of the Peer Education classes that they received. Neither had any been involved in any BCC or gender programmes and said that generally there are little provisions such as youth clubs and spaces for adolescents to go to in Barbados. When they were asked about what the churches do for young people the group laughed and one member said “They does talk about god and tell you how to dress” On questioned as to whether or not the peer education that they received had a impact on their own sexual behaviour, they also laughed and most said that they practice safe sex some times. One young woman said in reference to how young people operate sexually said “People who want tief a piece-aint got time for all ah dat” [Referring to condom use and the hurried and furtive nature of teenage sex]. DiscussionWith the exception of the SWs the findings should be seen as the views of ‘enlightened beneficiaries’, as most of the participants were trained agents of HIV/STI programmes in peer and advocacy capacities. This raises some questions about the extent of ‘real active and ongoing engagement’ with KAPs in the HIV response, especially when most of the participants were involved in delivering these aspects of HIV/STI programming but felt that their reach to the wider audience of their peers was very limited. All of the groups talked about unmet needs among key affected groups. In fact there were several prominent cross cutting themes that emerged that are in need of highlighting in relation to how well the NSP objectives were met according to key affected populations. Programme DesignThe first appears to the lack of coherent strategies and methods to engage KAP. With the exception of the sex workers, despite probing, participants were not able to provide any in-depth information that told the story of how Barbados has been going about engaging and intervening with its key affected populations. Whilst aspects of evidence based programming were seen with Life with a Purpose (BCC) CEED (empowerment) and CHAA (outreach and testing) audience specific strategies for KAP appear to be in need of reviewing, especially in relation to meaningful and structured inclusion of trained peers in delivering programmes. Perhaps a greater emphasis should be placed on not only understanding the needs of KAP, but also ensuring that programmes are designed to respond to the expressed needs. An example of this was seen with PWD when the attitudes of able bodied persons and communication challenges are their greatest barrier to accessing sexual and reproductive health care, yet HIV programming is focused mostly on providing HIV information to PWD. Similarly the stark lack of knowledge and focus on STIs also needs to be enhanced and maximized, particularly for young people as they become sexual beings and at a time when they are enthusiastic about the topic of sex, providing of course that programmes are age-appropriate and youth friendly. IEC versus BCCThe feedback from the sex workers about the Life with a Purpose programme and CHAA outreach provides encouraging evidence that there has been shift from IEC to BCC with promising results for sex workers. All the women spoke of an ongoing relationship where they have been coached, mentored and counselled over time. This has resulted in self-reported behaviour change to varying degrees, as expected with a programme of this nature and with a highly vulnerable group and shows clearly the effectiveness of BCC. In contrast most of the other groups did not know of or had ever participated in anything like this and therefore they could not attribute any changes in their behaviour to BCC programmes. Therefore it is worthwhile examining this model more closely to see how aspects of this programme can be adapted and broadened for BCC with other KAP. Also noteworthy for the future designing of interventions was that PLHIV, Transgender people and Sex workers spoke of a single person in most cases with the right attitude and approach as having had the greatest impact on them. This demonstrates not only the importance of peer involvement, but the critical need to involve and employ people with the right attitudes to work effectively with KAP, regardless of whether they are peers or not. An example of this was seen with the MSM group who felt that interventions that target them would be more successful if the younger MSM felt less judged by older MSM involved in delivering programmes. Also the outreach services to SW were considered highly valuable and effective and this should be scaled up to all KAP as this is the most efficient way of engaging persons that are ‘hard-to-reach’. Download 0.92 Mb. Share with your friends:
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