Author: Timothy Austin

The National AIDS Commission (NAC), Belize, in partnership with the Caribbean Regional Network of People Living with HIV/AIDS (CRN+), hosted a virtual Public-Private Partnership (PPP) Forum with the participation of fifty (50) members of various sectors of society, including members of the public, private, and government sectors.

The Forum was facilitated by local consultant Dr Minerva Pinelo from “Rights Insights”. Presenters included Ms Eva Burgos, Executive Director, Gojoven Belize and CSO Hub, Mr Enrique Romero, Executive Director, NAC Belize, and Mr Jason Shepperd, Senior Programme Officer, CRN+.

The event, which was open to the public, provided the platform for participants to learn more about Belize’s HIV response.  The event also focused on the Caribbean’s HIV experience and, more significantly, the revised HIV workplace policy. The primary goal was to fuel engagement around the acceptance, development, and implementation of workplace-specific HIV policies.

The Primary objectives of having businesses and organizations formulate their own HIV workplace policy include but are not limited to creating an environment that is conducive to openness and acceptance among employees, ensuring confidentiality and non-discrimination, promoting awareness and prevention training programmes to reduce the possibility of contracting HIV and improve care, treatment, and support services.

Other objectives include promoting access to treatment and reducing new infections, limiting the impact of HIV and AIDS in the workplace at the individual level for employees, their families, and communities and ensuring a healthy workforce and long-term production sustainability.

The Forum also provided an opportunity for participants to engage in interactive discussions through a question-and-answer session and receive clarification on areas of interest related to HIV and AIDS.  The topics discussed included stigma and discrimination, the effects of COVID-19 on People Living with HIV (PLHIV) and the overall economy.  Participants also discussed ways to ensure mutually beneficial partnerships for progress, the need for increased technical support from the private sector to Civil Society Organizations (CSOs) and increased outreach support from the CSOs to the private sector.

Participants were provided with a brochure that included a roadmap in preparation for the development and design of an HIV workplace policy. The brochure can be accessed via the NAC’s website (www.nacbelize.org).

Dr Ruth Ramos Gonzalez-Ram is a Cuban born, Guyanese-trained physician who has made significant contributions in HIV medicine, patient care and services provided in Guyana. On the occasion of her retirement, I sat with her to find out a little more about her journey and her experiences over the years.

Dr Ramos graduated from the University of Guyana School of Medicine in 2000 and started to work at Georgetown Public Hospital Corporation (GPHC). In her days at the Internal Medicine department, Dr Ramos recalls that she was always attracted to what was referred to as the “back cubicle”- where all the AIDS patients were placed. At that time, knowledge of HIV and AIDS was minimal, there were no antiretroviral drugs available, and there was little one could do to help these patients.

Fast forward a few years, and in 2002, she was asked to be a substitute doctor at the Genito-Urinary Medicine (GUM) Clinic at a time when they anticipated they were going to be short of staff. She worked at the GUM clinic initially for two months, but her interest was solidified in working with infectious diseases and HIV medicine during this time. Upon her return to GPHC, she requested to be permanently transferred over to the GUM Clinic.

Dr Ramos recalls that there were many challenges in the early days: delayed HIV results, unavailability and limitations with regards to treatment options and lack of knowledge on HIV management. She said there were many times when improvisation was necessary, especially when treating children, but that they always worked to make the most of what they had in every situation to do the best for patients.

Dr Ramos says there have been many improvements and she has been a first-hand witness to these as they have happened over the years. Presently, HIV testing is available across the country, care and treatment have been de-centralized, and people can access both antiretrovirals and treatment for opportunistic infections at many locations. She says human resources have significantly increased. More doctors, counsellors, outreach workers, and nurses have been properly trained and equipped to manage HIV. Literature has become widely available, and the country has developed its guidelines and protocols for HIV management. Dr Ramos is proud to have witnessed this transformative period and to have played a role in making it happen.

When asked to share some of the key things she has learnt over the years, Dr Ramos says that working with HIV patients, at the time when she did, introduced her to a virgin field in medicine in Guyana. She enjoyed growing and learning with the development in the field; discovering new diagnostic methods, new therapies, understanding management of opportunistic infections. However, above all, she says that the most important thing she learnt was to “be less of a doctor and more of a human”. She said some of the most important things she learned were to be a better listener, more patient, less judgmental, more compassionate, and overall, her experiences have made her a better person.

Dr Ramos’s most significant achievement over the years has been having the privilege of motivating and supporting patients in some of the darkest moments of their lives, giving them hope and reassuring them. This has given her great joy, to see many of her patients lead productive lives and have undetectable viral loads. She said, “To see little children, now grown up, having healthy children of their own, that gives me great satisfaction, and I call it success!”.

Dr Ramos hopes that HIV can be integrated into healthcare as just another chronic disease in the future. She hopes that stigma and discrimination will be eliminated from both the medical community and society at large. She hopes that there will be better treatment options developed and that maybe one day, we will even have a vaccine to prevent HIV infection and relegate HIV to the history books.

Dr Ramos says to young doctors thinking about entering the field of HIV medicine, “If you want to be challenged every day, to keep exercising your brain and never be bored, go for it!”. She says that because HIV and infectious diseases are continuously evolving, it is imperative to keep updated.

Dr Ramos stresses the importance of staying humble as no one person will live long enough to understand all the mysteries of the human body and the diseases that can affect us. She says that she has had a most rewarding career and “I could never regret the day I decided to become an HIV physician!”

Youth in the Caribbean will benefit from Comprehensive Sexuality Education (CSE) activities launched by the UNFPA in a virtual webinar in February. CSE programmes enable young people to protect their health, wellbeing and dignity and are a strategic vehicle for promoting gender equality and human rights. The activities will be conducted under the Spotlight Regional Programme for the Caribbean which is part of the wider Spotlight Initiative (SI), a global, multi-year partnership between the European Union and the United Nations to eliminate all forms of violence against women and girls by 2030.

The webinar provided an outline of the CSE activities to be implemented, and participants were allowed to provide inputs in accelerating the planned efforts. The effects of COVID-19 in the education sector that might also put at risk the continuity of the CSE delivery through Health and Family Life Education (HFLE) were also discussed.

Director and Representative for the UNFPA Sub-Regional Office of the Caribbean, Alison Drayton, who welcomed participants to the launch, highlighted that Caribbean youth’s growth and development continued to be undermined by what she called “new manifestations of age-old threats”. She identified several CSE challenges being faced by Caribbean youth. She expressed that vulnerability to all forms of violence, particularly bullying, sexual violence, abuse and exploitation and adolescent pregnancy rates remained very high.

Highlighting the role of the CSE initiatives in addressing these issues, the Director explained that strengthening regional capacities to advocate for and deliver quality CSE for in and out of school youth in the Caribbean was at the heart of the Regional Spotlight Programme. “The Comprehensive Sexuality Education interventions, through the Spotlight Initiative, are informed by robust evidence and aim to contribute to the collaborative efforts in preventing violence against women and girls in the Caribbean,” she said.

The CARICOM Secretariat is one of the organisations that has partnered with the UNFPA on this initiative and is playing a significant role in implementing the Spotlight Regional Programme for the Caribbean.

Helen Royer, Director, Human Development, CARICOM Secretariat, said the implementation of a regional HFLE curriculum, the creation of resources and toolkits, training of teachers to communicate the curriculum, and improved coordination among all the agencies at the regional and national levels are among the outcomes of CARICOM’s efforts at strengthening HFLE. Despite those investments, she was concerned that the key messages of HFLE were still not being converted into measurable behaviour change.

Against that backdrop, Ms Royer said CARICOM welcomed the Spotlight Initiative to enhance regional capacities to advocate and deliver quality Comprehensive Sexual Education.

“The interventions are aligned with the hopes for healthy and contributing Caribbean citizens, as outlined in the CARICOM Human Resource Development 2030 Strategy and are also in support of the recently launched Road map by PAHO for promoting the health and wellbeing of adolescents and youth in the Caribbean which received CARICOM’s support and endorsement,” Ms Royer stated.

UNFPA works with governments, civil society and other partners to implement CSE. UNFA also promotes policies for and investments in comprehensive sexuality education programmes that meet internationally agreed standards. This initiative is financed through funding from the European Union and UN agencies through the Spotlight Initiative.

The COVID-19 Pandemic has resulted in a surge in cases of violence against girls and women in the Region.  In response,  the Centro de Orientación e Investigación Integral (COIN) with support from the U.S. Department of State’s Bureau of Western Hemisphere Affairs has launched “Caribbean United against Gender-based Violence – GBV”.

The goal of the project is to address the root causes of GBV in the Caribbean and to contribute to the end of violence against women and promote equitable environments.

Santo Rosario, Executive Director, COIN expressed that “One of the biggest problems in the international framework has its roots in the cultural and educational processes of our societies, which place women in a situation of vulnerability compared to men. Gender inequality is a structural problem that requires that all the structures of the state and civil society recognize the implicit bias as well as the explicit discrimination that exists and promote laws and mechanisms that transform the way women are seen and treated. We must do segmented politics, as GBV is reflected in each one of the segments: at work, in politics, and relationships, as women are vulnerable in all these spheres. Policies, mechanisms and sanctions must be developed that accompany a new educational perspective that places women in a position of equality.”

The project will support the creation of an enabling environment through a series of community-level small grants that will include four types of interventions:

• Change social norms: baseline surveys, training for men and boys that address socio-cultural attitudes that lead to GBV and social-emotional learning programmes.
• Build institutional capacity and alliances: training with civil society organizations as well as with government entities, the establishment of multi-stakeholder discussion spaces and participation in networks.
• Empower youth: empowerment and leadership training and direct involvement in local project activities as advocates against GBV.
• Improve availability and access to services: mapping of existing services, securing MOUs among project sub-recipients and service providers, the establishment of a referral system and multi-stakeholder case management system.

In particular, these interventions aim to strengthen the capacity of local actors to provide GBV prevention and response services to survivors of abuse, improve available data on the services that are already put in place and reduce socio-cultural attitudes that lead to GBV.  The project also aims to strengthen civil society and local governments’ abilities to improve access to GBV services and address GBV issues that result from the COVID-19 Pandemic.

The project will be implemented through small grants to local organizations in twelve Caribbean countries, namely:  Antigua and Barbuda, The Bahamas, Barbados, Dominican Republic, Dominica, Grenada, Haiti, Jamaica, Saint Kitts and Nevis, Saint Vincent and the Grenadines, Saint Lucia, and the Republic of Trinidad and Tobago.

Editor’s notes:

In the Caribbean, available data shows a troubling panorama: three of the top ten recorded rape rates in the world occur in the Caribbean^[1] , and in nine Caribbean countries, 48% of adolescent girls’ sexual initiation was forced or “somewhat forced”^[2]. Some examples include the Dominican Republic and Haiti, which, according to the UNDP, are among the four countries with the most significant gender inequality in the Region. Kay Fanm, a Haitian women’s rights organization, has estimated that 72% of Haitian girls have been raped. In the Dominican Republic, there is an average of 177 femicides (killing of a woman or girl, in particular by a man and on account of her gender) per year since 2005.

[1] 2007 report by the United Nations Office on Drugs and Crime and the LAC region

[2] According to a survey that was pointed to in the 2007 report aforementioned.