Collaboration to Improve Transgender Medical Education

Researchers from the Faculty of Medical Sciences, The University of the West Indies, Cave Hill Campus, in collaboration with Butterfly Barbados (a local transgender civil society organisation), conducted a qualitative research project exploring the views and perceptions of medical educators regarding transgender health in March 2021.

The work was supported by the United Nations Development Programme (UNDP) Small Grants Programme and sought to identify ways to expand transgender health coverage in Caribbean medical curricula and improve transgender care delivery.

The findings will be used to inform curriculum planning and development at Cave Hill in the coming academic year. For further information, contact Dr Michael Campbell – Michael.Campbell@cavehill.uwi.edu

PANCAP supports National AIDS Programmes with digital communication for continuity of HIV services during COVID-19

To support the continuity of HIV prevention, treatment, care and support services during COVID-19, PANCAP provided five (5) National AIDS Programmes with Samsung Galaxy Internet-enabled tablets.  The National Programmes will utilize the devices for monitoring and evaluation, appointment bookings, virtual communication with clients and other activities critical to ensuring that programme implementation continues and the gains made in the HIV response are protected and maintained.

Support for the initiative was provided via the Global Fund Project – Sustainability of Services for Key Populations in the Caribbean and the Global Fund’s COVID-19 Response Mechanism (C19RM), which focuses on mitigating the effects of the pandemic on HIV programme implementation.

The beneficiary countries included Antigua and Barbuda, Belize, Guyana, Suriname and the Republic of Trinidad and Tobago. Each National Programme received two (2) tablets.

Dr Rosmond Adams, Director, PANCAP, underscored the importance of supporting National Programmes during COVID-19.  “Digital communication and virtual platforms are essential in facilitating continuity of programme implementation, especially in this time of physical distancing, minimizing in-person meetings and working from home,” stated the Director. He further pledged continued support to all National Programmes as the Region continues to navigate COVID-19.

SASOD Guyana Hosts Second 592 Virtual Pride due to COVID-19

Guyana’s Society Against Sexual Orientation Discrimination (SASOD Guyana) hosted the 592 Virtual Pride 2021 for a second year in succession due to COVID-19 restrictions.

The one-week virtual festival provided a safe, online space for LGBTQ+ people and allies to celebrate their successes and achievements while also providing an opportunity to reach out to the wider Guyanese community and diaspora to educate them about issues affecting sexual and gender minorities in Guyana and the Caribbean.

The event, which was held under the theme #LiveOutProud, commenced on June 7, marking SASOD Guyana’s 18th anniversary, and concluded on June 13.  Some of the highlights included the Live Launch on Instagram, Facebook, Twitter and on June 7, a health and wellness “Pride Yoga” event on YouTube on June 8, and a Facebook Live talk-show called “Global Guyanese Gyaffing” on June 10. SASOD Guyana hopes to return to in-person Pride events in 2022 if state regulations on COVID-19 allow.

Image: SASOD Guyana’s Joel Simpson (left) and David Clarke (centre) interviewing yoga instructor Shania Wilson (right) at the Live Launch on June 7, 2021

COVID-19 Vaccines and People Living with HIV

As countries in the Region commenced the roll-out of COVID-19 vaccines, the community of People Living with HIV (PLHIV) had concerns around the safety of the vaccines. Multiple concerns were related to their HIV status and possible interactions with Antiretroviral Therapy (ART) regimens which may lead to vaccine hesitancy in this population. The concerns were related to how the COVID-19 vaccine will impact their immune status, disease progression, and whether they were at higher risk for some of the adverse events reported in the media. To address these concerns, the Pan American Health Organization (PAHO) collaborated with PANCAP to host a webinar on COVID-19 vaccines for PLHIV on 8 June 2021.

PAHO experts Dr Karen Broome and Dr Margherita Ghiselli presented to over 100 HIV clinicians, healthcare workers and PLHIV from across the Caribbean Region.

Dr Broome highlighted the significant impact of the pandemic on individuals, families, communities and nations. She underscored how the COVAX facility is supporting the availability of vaccines in the Region.

Dr Margherita Ghiselli placed the spotlight on COVID-19 vaccines for PLHIV. She emphasised that vaccines are critical for people with chronic conditions such as HIV. She also explained that the clinical trials included PLHIV, but safety data specific to this group is still limited. Her presentation also highlighted that there are no known interactions with ART medications and no adverse events associated with HIV status.

While there is no consensus on which CD4 count value should be used as a threshold (if any), people with weakened immune systems should be aware of the potential for reduced immune responses to the vaccine.

According to the WHO Strategic Advisory Groups of Experts (SAGE) for Immunisation, the groups prioritised for the COVID-19 vaccine do not include PLHIV with no aggravating risk factor that puts them at higher risk of COVID-19 infection and death. However, PLHIV with co-morbidities should be prioritised for early vaccination since their co-morbidities put them at higher risk of severe COVID-19 symptoms. These co-morbidities include COPD, asthma, diabetes, heart disease, kidney disease, liver disease, Parkinson’s disease, multiple sclerosis, motor neuron disease, severe obesity, among others.

PAHO and PANCAP will continue to highlight the efficacy and safety of COVID-19 vaccines for PLHIV through the joint webinar series.

PANCAP K4Health Project highlighted as Best Practice by Johns Hopkins Bloomberg School of Public Health

The Johns Hopkins Bloomberg School of Public Health, Center for Communication Programs (CCP) highlighted the PANCAP Knowledge for Health (K4Health) project as a best practice during its “Knowledge Management for Effective Global Health Programs” course in June.

The course was geared primarily toward professionals who work or aspire to work in international or domestic public health and Knowledge Management (KM) and Learning. It was facilitated by Dr Tara Sullivan, Project Director at Johns Hopkins Bloomberg School of Public Health and Ms Sara Mazursky, Deputy Project Director, Knowledge SUCCESS.

Dr Shanti Singh-Anthony, Coordinator, Knowledge Management and Mr Timothy Austin, Senior Project Officer, Communications, PANCAP Coordinating Unit, were invited to share success stories from the K4Health project.

Dr Singh-Anthony highlighted the project’s successful KM initiatives, including the use of Share Fairs and “peer assist” to foster effective and strategic collaboration between the Region’s National AIDS Programme (NAP) Managers and civil society organisation (CSO) representatives. She also spoke of the PANCAP Treat All Knowledge Suite and Roadmap, which provided the Region with essential information on the World Health Organization’s recommendation that all People Living with HIV (PLHIV) initiate antiretroviral treatment (ART), irrespective of CD4+ count or clinical stage.

Dr Singh-Anthony provided details on the project’s success in sharing best practices through South-South Knowledge Exchanges to Barbados, Dominica Republic and The Bahamas on Treat All, Pre-exposure prophylaxis (PrEP) and successful HIV testing strategies for key populations.

She shared PANCAP’s experience in applying the HIV knowledge management approaches to address the knowledge needs related to the COVID-19 pandemic and posited that these knowledge management approaches could be applied to other health and development issues.

Mr Austin illustrated how online engagement via the redesigned PANCAP website and social media platforms effectively established PANCAP as the knowledge hub for HIV in the Region with over 10 000 website users per month. He elaborated on the PANCAP Integrated Marketing and Communications (IMC) Strategy, which was utilised to elevate PANCAP’s visibility in the Region and effectively share updates on the Region’s HIV response with stakeholders, including CSOs, National AIDS Programmes, youth, policymakers, etc.

Mr Austin emphasised the importance of synthesising information to effectively communicate on complex public health topics using animated videos, infographics, podcasts and other KM and media products.

Dr Sullivan hailed the project as a best practice for effective use of KM for building collaboration and fostering knowledge sharing among distinct groups of people. She spoke of the value of the project in establishing common ground among NAP Managers and CSOs, which enabled increased cooperation in vital areas of HIV prevention, treatment and care.

The project’s success resulted in KM being a permanent part of the PANCAP Coordinating Unit’s operations and increased use of KM techniques in the Region for capacity building and learning for better health outcomes.

Image: Dr Shanti Singh-Anthony, Coordinator, Knowledge Management, and Mr Timothy Austin, Senior Project Officer, Communications, PANCAP Coordinating Unit

CSO-Hub Secretariat with support from UNDP and the University of Belize hosts HIV Rapid Testing and Counselling Training in Belize City

The Civil Society Hub Organization (CSO-Hub) Secretariat, with technical support from the United Nations Development Programme (UNDP) and the University of Belize (UB), hosted an HIV Rapid Testing and Counselling Training for civil society stakeholders from 17 – 21 May 2021 in Belize City.  The training focused on building capacity to implement rapid HIV testing interventions with limited human resources.

The course was designed to provide guidelines and skill-building opportunities to potential HIV testers.  This involved training participants in identifying strategies to support clients in making behaviour changes that would reduce the risk of acquiring or transmitting HIV.

Participants were also involved in practical sessions on the six (6) steps of prevention counselling.

Capacity building was also provided on HIV counselling, the HIV rapid test algorithm, finger prick and blood collection, safety at the HIV testing site, record keeping, quality assurance of HIV rapid testing, quality control, proficiency testing and professional ethics.

The initiative forms part of Belize’s National AIDS Programme, which aims to significantly reduce HIV infections among the most vulnerable populations.

Image: Executive Director, National AIDS Commission (NAC) Belize, Enrique Romero, delivering opening remarks during the HIV Rapid Testing Workshop

Engaging Men and Boys to advance gender equality and help prevent GBV

Gender-based violence (GBV) is recognized as one of the most severe forms of human rights violations and public health challenges. It occurs at home, the workplace, schools, political circles, prisons, and health institutions, to name a few. Perpetrators can range from intimate partners, family members, employers, co-workers, and state officials[1].

In the Caribbean, societies are organized around hierarchical gender power relations with male domination, reducing women’s economic and emotional independence.

According to UN Women Caribbean, 1 in 3 women in the Caribbean experience domestic violence, and over one-third of the region’s women report intimate or sexual violence incidents[2].

While there have been numerous workshops, panel discussions, and calls to action on GBV and gender equality, men and boys’ engagement in the discourse has been limited. Men and boys need to become more visible as integral partners in tackling sexual/gender-based violence and gender inequality. There is the need to engage boys and men as agents of change in the prevention and response, not just perpetrators or bystanders.

One of the National Gender-based Violence Action Plan outcomes calls for men and boys’ increased understanding of the dynamics of gender and violence and their active involvement in reducing GBV in Belize.

As a result, the Spouses of CARICOM Leaders Action Network (SCLAN) and the National Women’s Commission of Belize, with support from the Spotlight Initiative, implemented the “Engaging Men and Boys” project.

The initiative included a “Training of trainers” programme, workplace training, a peer education toolkit, school training and a public awareness campaign.

The objectives of the project encompassed identifying strategies for men and boys to understand the dynamics of GBV and commit to helping to end all forms of violence utilizing the positive deviance approach; challenging views about masculinity using role modelling and the positive deviance approach to transform attitudes and beliefs which contribute to family violence.  The project also aimed to equip men and boys with tools and strategies to help prevent GBV in their personal lives and community.

SCLAN plans to expand the project regionally in 2022.

Image:

“Belmopan Active Youths” (Belize) participating in a workplace session implemented under the “Engaging Men and Boys” Project.

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[1] National Gender-Based Violence Action Plan: A Multisectoral Plan to Prevent and Respond to Gender-Based Violence in Belize 2017 – 2020; Ministry of Human Development, Social Transformation and Poverty Alleviation

[2] Violence Against Women in the Caribbean: A Critical Analysis

PANCAP hosts dialogue on COVID-19 vaccines with PLHIV in Guyana and Trinidad and Tobago

Image: From left: Dr Rosmond Adams, Director, PANCAP, Dr Shanti Singh-Anthony, Coordinator, Knowledge Management, PANCAP Coordinating Unit, Dr Tariq Jagnarine, National AIDS Programme Manager, Guyana and Dr Ayanna Sebro, Technical Director, National AIDS Coordinating Committee Secretariat (NACC), Republic of Trinidad and Tobago

PANCAP facilitated a virtual discussion with People Living with HIV (PLHIV) in Guyana and the Republic of Trinidad and Tobago to foster an improved understanding of the safety and efficacy of the COVID-19 vaccines.

The discussion was chaired by Dr Shanti Singh-Anthony, Coordinator, Knowledge Management, PANCAP Coordinating Unit, with support from Dr Tariq Jagnarine, National AIDS Programme Manager, Guyana and Dr Ayanna Sebro, Technical Director, National AIDS Coordinating Committee Secretariat (NACC), Trinidad and Tobago.

In opening remarks, Dr Singh-Anthony highlighted that despite the large volume of information available on COVID-19, it was important for PLHIV to hear experiences from their peers who received the vaccine.  She emphasized the importance of sharing first-hand experiences to increase the acceptance of the vaccine among PLHIV.

The Knowledge Coordinator referred to data provided by the World Health Organisation (WHO) that indicated that the COVID-19 vaccines approved by regulators are safe for everyone, including PLHIV and that there is no reason why PLHIV should not take the vaccines when offered.

Dr Singh-Anthony further explained that before vaccines are licensed for scale-up, national regulators review the data and ensure they are safe. No data have emerged to cause worry that PLHIV are at any greater risk from the COVID-19 vaccines than anyone else.  She further highlighted that the Region has surveillance systems in place to ensure that rare but serious adverse events are reported to the public health authorities and the manufacturers of the vaccines.

In remarks, Dr Rosmond Adams, Director, PANCAP, emphasized the importance of dialogue on the COVID-19 vaccine within the community of People Living with and affected by HIV, especially with regard to the harmful repercussions of “fake news” and misinformation about the vaccines. He referred to the current data from WHO, which underlined the safety and efficacy of the COVID-19 vaccines and urged PLHIV to continue to promote vaccination and other COVID-19 public health precautions.

The Guyana team shared their experiences with accessing the COVID-19 vaccines; participants shared their fears and how these were overcome by seeking advice from healthcare professionals.  They also highlighted the importance of following the science and WHO guidance on the safety of the COVID-19 vaccines.

The Guyana team also highlighted that there were no severe adverse effects from the vaccine among the group of PLHIV that shared their experiences.  Mild reactions reported included minor pain around the injection site and mild fever, which the WHO has listed as expected side-effects from the COVID-19 vaccine.

Members of the Trinidad Team shared their experiences, including a detailed description of the process involved in receiving the vaccines at health centres.  Participants from Trinidad also echoed the sentiments of Dr Adams, providing first-hand accounts of being exposed to large volumes of misinformation shared on social media and instant messaging platforms.  The team reiterated the importance of seeking information on the vaccines from trusted sources, including the Ministry of Health and PAHO/WHO.

Dr Sebro concluded the discussion by underscoring the importance of continued dialogue among PLHIV on the COVID-19 vaccines. She explained that the virtual dialogue is the first of many initiatives planned by NACC to increase the uptake of the COVID-19 vaccines among PLHIV in Trinidad and Tobago.

In addition, PANCAP will host a webinar, “COVID-19 Vaccines and PLHIV”, on Friday 18 June. A video series highlighting the safety and efficacy of the vaccines among PLHIV will also premiere on all PANCAP digital platforms.

COVID-19 and the impact on Vulnerable Populations

The coronavirus disease (COVID-19) pandemic is a global health emergency. With the indiscriminate spread of COVID-19 globally, many vulnerable populations are experiencing negative consequences such as job loss, food insecurity, and the inability to manage existing medical conditions and maintain preventive measures such as social distancing and personal preventative gear. Some of the most disadvantaged in the COVID-19 era are People Living with HIV (PLHIV) and other high-risk groups.

There is great concern about the impact of COVID-19 among the nearly 40 million PLHIV worldwide. HIV treatment centers and care delivery systems have been adversely impacted in several countries during the pandemic. But this has created an opportunity to apply alternative strategies like multi-month prescription, decentralizing HIV care in low-resource settings and introducing telemedicine in high-resource settings.  Other alternative methods include retention in care programmes and direct observation of treatment critical in mitigating shocks to healthcare systems in the future.

Like HIV and AIDS, COVID-19 has a more significant impact on people who are already marginalized. As a result, there is concern over the continued spread of COVID-19 in poorer countries and those with higher HIV rates. According to the Centres for Disease Control and Prevention (CDC), 16.7% of COVID-19 patients in intensive care are immunocompromised with underlying health conditions and their chances of recovery are much lower.

GROUPS MOST AT RISK

For COVID-19, failure to adhere to physical distancing or handwashing recommendations constitute behaviours that increase the risk for contracting COVID-19. People who are older or have pre-existing conditions such as chronic respiratory disease, cardiovascular disease, hypertension, cancer and diabetes are at greater risk of being infected with COVID-19. It is well established that HIV disproportionately affects groups already marginalized, including racial/ethnic and sexual or gender minorities and those living in poverty. It is quickly being recognized that COVID-19 also disproportionately affects minority groups, which is not surprising given existing health disparities and economic instability.

HEALTH DISPARITIES

As with HIV, the COVID-19 pandemic reveals the systemic inadequacies that produce health disparities. There is a disproportionate burden on already vulnerable populations experiencing poverty and other systemic stressors. The United Nations 2020’ report has indicated that increases in food costs and market stockpiling have had the most harmful impact on vulnerable communities, particularly those in low-income nations. Although vulnerable populations vary across countries, those with stigmatized or marginalized intersecting identities often experience the highest burden, including Men who have sex with Men (MSM), transgender women, people who inject drugs, commercial sex workers, young women, and youth (15–24), who account for a third of all new HIV infections. Furthermore, immigrants are at increased risk of infectious diseases, including both HIV and COVID-19, as are other people who are displaced.

Additionally, PLHIV in rural areas may experience additional barriers that inhibit access to care, such as the lack of adequate technology to support telemedicine, lack of finances for transportation to attend clinics, and other barriers to accessing care during the current pandemic.

BIOLOGICAL IMPACT OF COVID-19 ON HIV TREATMENT

PLHIV, whose disease is not well managed and whose condition is not virally suppressed, are placed at an increased risk for contracting and experiencing complications related to COVID-19, in addition to complications associated with HIV disease progression. Given the lifelong prognosis of HIV, it is imperative for PLHIV to visit their healthcare providers regularly and adhere to treatment.  PLHIV are also more likely to contract opportunistic infections such as pneumonia, Tuberculosis, Toxoplasmosis, etc., than those without compromised immune systems. They may experience delayed treatment due to COVID-19. This can occur due to overcrowding in an already taxed healthcare system. PLHIV who seek out urgent care may face an increased risk of contracting COVID-19 among other illnesses while in healthcare settings.

COVID-19 has taken a dramatic toll on HIV health care services. Lockdowns and associated changes have hampered the ability to deliver standard health care services, including testing, treatment, care, and dispensing of antiretroviral drugs (ARVs). Those associated changes include closing clinics, community health workers’ inability to visit PLHIV, the inability of support groups to meet, and the shortage of personal protective equipment (PPE) for health providers. Evidence already shows an overall decline in persons coming to facilities for HIV testing and clinical care and treatment.

PSYCHOLOGICAL IMPACT OF COVID-19 ON HIV TREATMENT

Given the unprecedented nature of COVID-19, an increase in anxiety has been prevalent worldwide. Furthermore, the CDC has noted that individuals with chronic health conditions, such as HIV, may develop a stronger stress response than the rest of the population. This strong stress response is due to an increased risk of contracting COVID-19 due to a compromised immune system. The compounded stigma associated with an HIV-positive status and COVID-19 may lead to an array of mental health issues and psychological disorders such as depression, sleep disorder, substance abuse, anxiety, schizophrenia, and personality disorders, which may trigger somatoform disorders which may lead to failure to seek care.

RECOMMENDATIONS

HIV services must continue to be made available for people living with and at risk of HIV. This includes ensuring the availability of condoms, lubricants, ARVs, sterile needles and syringes, harm reduction, pre-exposure prophylaxis (PrEP) and HIV testing.

To prevent persons not having an adequate supply of medicine and to reduce the need to access the health system, countries should move to the full implementation of multi-month dispensing of three months or more of HIV treatment.  This can be further enhanced with telemedicine, virtual support groups, food hamper delivery and increased mobile testing. There must be access to COVID-19 services for vulnerable people, including a targeted approach to reach those most left behind and removing financial barriers.

ADVICE FOR PEOPLE LIVING WITH HIV

  • People with a CD4 count of over 200 who are taking HIV treatment and have an undetectable viral load are considered at no greater risk than the general population. They should follow general advice to observe the curfew hours and maintain social distancing.
  • People with a CD4 count below 200, or who are not taking HIV treatment, or who have a detectable viral load may be at higher risk of severe illness. Nonetheless, they should still follow the same general advice.
  • People with a very low CD4 count below 50 or who have had an opportunistic illness in the last six months should follow the Ministry of Health guidelines – wear a mask, wash hands regularly and avoid crowded spaces with social distancing practices.

COVID-19 is serious, and PLHIV should take all recommended preventive measures to minimize exposure and prevent infection. As in the general population, older people living with HIV or PLHIV with heart or lung problems may be at a higher risk of becoming infected with the virus and suffering more severe symptoms.

All PLHIV should reach out to their healthcare providers to ensure that they have adequate supplies of essential medicine. Until more is known, PLHIV —especially those with advanced or poorly controlled HIV disease — should be cautious and pay attention to the prevention measures and recommendations by the Ministry of health.

National AIDS Programme (Guyana) and CRN+ discuss Alternative Models of Interventions for PLHIV

To address HIV service provision gaps and barriers to prevention, care and treatment due to COVID-19, the National AIDS Programme Secretariat (NAPS) Guyana, with support from the Caribbean Regional Network of People Living with HIV (CRN+), facilitated a government and civil society stakeholder forum on 30 March 2021.

The Forum focused on innovative ways through which civil society organisations (CSOs) in Guyana can meet these urgent needs. With thirteen (13) representatives from government and civil society, the session provided an opportunity for the NAPS to explore alternative models of interventions for supporting People Living with HIV (PLHIV) during COVID-19. Participants described specific information on structuring monthly support groups in smaller numbers, piloting a reservation platform for PLHIV to make appointments and seeking ways to connect PLHIV with social protection schemes.

The facilitator, Dr Minerva Pinelo of Right Insights, shared examples of alternative models of interventions rolled out in Belize and drew from case studies from Zambia and New Guinea. The session’s format was instructional, allowing participants to learn more about alternative models such as adherence clubs, community antiretroviral therapy distribution points, community antiretroviral therapy groups, appointment spacing and fast-tracking for antiretroviral therapy refills.

The session allowed for discussion on various specific examples of interventions that have supported PLHIV’s adherence and quality of life. Questions, queries, and comments shared indicated a mutual interest in addressing the prevalence of HIV in Guyana and the commitment to scaling up alternative models of interventions for PLHIV to address service provision gaps exacerbated by the pandemic.

CSOs reported innovative ways to garner support for PLHIV and overcome present challenges. For example, Ms Desiree Edghill, Executive Director of Artiste In Direct Support (AIDS), reported that their peer support group was reduced to two persons to comply with COVID-19 safety recommendations for avoiding large groups. In addition, the CSO, along with another organisation, piloted the use of “Quick Res” for booking appointments for consultations or accessing sexual health services. By booking appointments, PLHIV are less exposed to waiting in crowded lobbies for HIV testing services, STI testing services, medication refills or other sexual reproductive health services.

There was significant enthusiasm from Dr Tariq Jagnarine, National AIDS Programme Manager – Guyana and at least two CSOs that reported opportunities for scaling up existing alternative models of interventions as a country. It was clear that while challenges such as stigma and discrimination and socio-economic hardships have deterred PLHIV from remaining adherent during the pandemic, CSOs must continue to address service provision gaps.

Participants were receptive to drawing from best practices and emerging trends presented during the Forum, including integrating technology, where possible to achieve a wider reach of PLHIV throughout all regions in Guyana.