The following interview was conducted on May 20th, 2019, with Tania Kambel, Chief Executive Officer of New Beginnings | Chances for Life (CFL). CFL is a local civil society organization in Suriname that serves vulnerable and marginalized communities, including sex workers. CFL was an implementing partner under the USAID- and PEPFAR-supported LINKAGES project between 2016 and 2019.
When did LINKAGES first start providing support to CFL? Describe the partnership.
Our partnership with the LINKAGES project began in August 2016 and we have experienced it really as a mentorship relationship. LINKAGES introduced us to evidence-based approaches, but we were provided the freedom to adapt those approaches how we saw fit and define our own formula for success. Through our monthly monitoring meetings, it was actually a continuous conversation about our services, how we could improve our services, and the key populations we were reaching. We received continuous capacity strengthening in developing policies, in efficient finance management, how to report, and how to utilize data for strategy development. With LINKAGES’ support, we established a clinic and received support for our health navigation program. We got the opportunity to enhance our community engagement strategies.
What are some of the technical achievements CFL has been able to make with LINKAGES support?
Our community engagement strategy has evolved tremendously. When our partnership began with LINKAGES, we had a key population think tank to advise us on programming. Then, the think tank evolved into a Sex Workers Health and Advocacy Task Force (SWHAT) unit. This granted sex workers a voice in the decision-making process of our work and now it has transformed into sex workers leading programs. We have different engagement mechanisms. Our most successful model is the Latino sex workers who have organized themselves into a foundation which allows us to continue to do the supportive services we had under the LINKAGES project. But now they have so much ownership over the program that they now fundraise for things like health insurance.
Over the life of the project, CFL reached 2,820 sex workers. We tested 2,074 sex workers, and 117 of those were diagnosed HIV-positive. An additional sixty key population individuals living with HIV were referred to the CFL clinic for adherence support. CFL linked 173 people living with HIV to community care, and 147 were newly linked to clinical care. We initiated 128 individuals on antiretroviral therapy.
How has CFL’s capacity evolved through the partnership with LINKAGES?
CFL has succeeded in building an infrastructure that provides services through a network of support for key populations. This has worked well because we are not only providing services related to HIV, but also social services, access to food packages, and mental health services. Our network was established with support from LINKAGES and continues to exist because we got a clear idea of the needs of key populations. For example, if you do not know the size of your population, and you say ‘oh we reached 100’ but that 100 is in a population of 2,000, then you are actually not doing much. But with microplanning that we learned from LINKAGES we are very much aware of the populations that we serve, what are coverage is overall, and what coverage looks like in the districts. Recently, there was a survey conducted in Suriname for all key populations and CFL had the highest coverage of key populations reached. We wouldn’t have been able to do that were we not aware of their locations and particularly the hotspots where these at-risk communities are.
What are some of the greatest challenges CFL faces in its work in Suriname?
The national infrastructure for providing services beyond HIV services for key populations is something that remains a challenge. There is so much violence, especially towards transgender people and sex workersWithin our network of services, it works well. But, if for example there is a change in leadership at the police station or at the hospital, you have to start the sensitization process all over again. I think people do not understand. They do not relate to the reality of key populations and refuse to provide services to them because of their “behavior.” Transgender women – people still throw water on them, they come out of their house and throw hot water on them, they are still getting beaten every day, because the general population does not understand gender identity or simply refuses to have a conversation about gender identity.
Please share a story describing what you are proudest of when it comes to CFL’s work.
I am proud of the champions we have. We have watched as people who have come to us HIV-positive and homeless are now thriving. To us, it is an affirmation of the work we do. The program works because they were enrolled into care, they became undetectable, they became part of our health navigation program, and then they were reunited with their families and now have jobs. Some work at CFL now and some work elsewhere. Now, they can take care of their families. In some cases, we have helped ex-offenders. These individuals have successfully integrated back into society which is something that amazes me every day because I know their beginning, when they first came to CFL. That is something that the staff is proud of, but as the CEO I am very proud of. You can see the positive change and what amazes me actually is that the people that are successfully reintegrated often become our donors. In the month of March, when we looked at our results, we actually saw that the most donations that came in – like food and a chicken – things you see at the drop-in center, were actually from clients that graduated out of our care. I think that is amazing.
You said that you are reaching people that are HIV-positive and homeless. What supporting services beyond HIV services does CFL offer?
The supporting services that we provide ensures that every person that comes in to CFL is linked not only to services but to a support group that differs based on the population you belong to. So, if you are a substance user, or ex-offender, you have a support group of individuals that have had the same experiences as you and then you are enrolled into a work motivation program. We established this during our partnership with LINKAGES and we saw that poverty was a great influencing factor for whether people stayed adherent. During the week, people were either enrolled into agriculture activities within CFL or learned a craft or performed cleaning services, just for them to get the discipline to show up a couple of hours in the week and actually prepare them for the workforce again. When you graduate from the work motivation program, we link you to a job.
With LINKAGES closing soon in Suriname, what is next for CFL? How have LINKAGES investments in CFL positioned you for future success?
I feel confident. With what we have learned, CFL is now positioned as a place of learning. We have health workers, but we also have a university from Holland that approached us to learn how to work with key populations. So that is something and that is a permanent partnership, so we will get the opportunity to teach people to work with key populations, but we will also get the opportunity to learn from them. They will come in now on an ongoing basis working in our clinic, to improve our clinic methodologies, working on the infrastructure, and laws. Throughout the implementation of the LINKAGES project, our mindset was “we need to become the number one choice NGO serving sex workers” and that attitude made us ready for social contracting.
There is something else we are proud of that also is a result of the exposure we got through LINKAGES. When the Justice Department is sentencing young key populations – sex workers, MSM, transgender women – before they get to the sentencing, they allow these young key population individuals to work with us for three months and then we can advise the judge on how to proceed. That is something that never happened before, we can advocate based on what we know of the person, of the environment, their exposure. Then we provide a progress report and they come to the organization and look at how the young MSM has evolved since beginning the work motivation program. This month we learned that a 12-year sentence of a 15-year-old MSM will not be there anymore because he will be released in CFL care.
We were able to speak on his behalf because we know the environment. This is something that is going to be ongoing, because now we have been approached by another organization and a partner in Holland that wants to work with us to professionalize this system, so I think that getting the recognition and also the media if there is something in the newspaper that they think is a violation they will call us and say ‘well what do you think about that’, and ‘do you think that something needs to be done?’. So, I think the exposure positioned us in a way where the government of Suriname recognizes us as a partner, that we have something to say when it comes to key populations and their rights and their health.
That is something, I mean that was so exciting to speak on behalf of someone. Sometimes you have those moments when you just yell “Yes, yay!”
If you could share one key message from your experience with CFL to others working to address the HIV epidemic among sex workers and other key populations, what would you say?
I think it would be to work N.A.K.E.D! Never Assume, keep your Knowledge updated, and have an Eye for Detail. That is CFL’s work approach. You have to be open to learn. This does not happen without challenges. We had to make more services available and we were so enthusiastic about having an innovative frontline strategy and then the key populations came for the services and we were overwhelmed in the second year. There was a lot of learning and a lot of falling flat on our faces. I think everybody grew in the program and I think that is the richness of the project. We know our organization, we know our target population well, and we have great knowledge of their needs and continue to learn every day, the reward is great because you see them grow. They don’t just survive but thrive.
For more information on some of CFL’s work to ensure a sustainable response to HIV and AIDS, click here.