Author: Timothy Austin

The PANCAP South-South Learning Exchange promised to be an interesting event, and I cannot say that I was disappointed. HIV education and programming has been part of my work at GrenCHAP since 2018 and I have been especially interested in this and other sexually transmitted infections (STIs) for quite some time.

Though HIV is a big part of the work that I do the other STIs have always been of great interest to me. It is notable that because of increased HIV awareness the transmission of the virus has decreased across the globe. However, this focus has made education for other STIs less available and has resulted in an increase in the rates of these STIs.

Our trip to the Dominican Institute for Virological Studies (IDEV) was a fascinating experience, particularly regarding the information we received on Human Papillomavirus contraction in the anal cavity that can lead to cancers in that part of the body. HPV, though very common, is a less talked about infection but has that detrimental effect of causing cancer.  Witnessing how it is treated within the facility and how these services have been made available for individuals who experience these issues was one of the best things I have seen on this learning journey. The priority placed on other STIs allows for a better understanding of the risks associated with them and helps individuals be more proactive with protecting themselves.

Overall the experience was an enlightening one. Though I am not a clinician, I am excited to see what can be done in terms of anal health services within the OECS as we try to make other STIs a priority.

It was an intimate gathering on 24 February 2020, as staff of the PANCAP Coordinating Unit and a few members of the wider CARICOM Secretariat celebrated soon to be former Director, Mr Dereck Anthony Springer, at Parc Rayne, East Bank Demerara, Guyana.

The tributes were many.  In speeches and statements that were candid reflections of the man, his measure and message.  In songs and serenades by his staff led by Nickosha DeNobrega and later the great Mariah Carey, the lyrics so profound and beautiful that even the discordant chords, the contribution of the gathering, were not a distraction.

Tributes came from all levels of staff of the PCU and from the wider Secretariat with whom he has worked closely. They included the CARICOM Deputy Secretary-General, Dr Manorma Soeknandan and Dr Douglas Slater, Assistant Secretary-General.

They came also from those he continues to work with in a commitment to turn back the tide of the epidemic and to ensure it does not stay on shore. Among them, Dr Edward Greene, former Assistant Secretary-General for Human and Social Development, CARICOM Secretariat and UN Secretary-General Special Envoy for HIV and AIDS in the Caribbean.

All contributions highlighted who Dereck Springer was and is, in both professional and personal capacities They all proclaimed him an exemplary leader who led by example; a dedicated, disciplined and decisive leader; and “a man of the time, in the time and for the time” a fitting title of a booklet with glowing tributes from a wide cross-section of PANCAP partners that was presented to him.

A stunning portrait in the true likeness of Dereck was presented to him and it was fitting that the artist, Compton Babb, was a special guest, and witnessed the adulation for his work from Dereck and all those in attendance. It was indeed a wow! factor.   It preceded Dereck’s eloquently comprehensive “thank you” to every member of his staff and all those present.

This memorable event basked in an atmosphere consumed with appreciation, camaraderie, jolly banter, great cuisine and a joie de vivre. It was tinged with a bit of raw emotion, the reality that after all, this was a farewell. It was a beautiful morning. The photos attempt to tell part of the story; the whole story, forever hidden in the hearts of all who were a part.

I question numerous life decisions I make but attending this congress is not one of them. The entire experience was high energy, building momentum from day one. Sharing the same space with so many influential and dynamic young and “youngish” leaders across the Caribbean really made me more receptive to differences in ideas, opinions and circumstances.

The youth congress facilitated communication between the youth and the policymakers. The forum pioneered a new dynamic for discussions about youth health involving youth at every stage. It was a catalyst to drive the change in the Caribbean’s approach to youth and adolescent health issues. The congress was extremely productive with the creation of a roadmap for youth health, detailing its goals and objectives.

Being the first of its kind there were a few hiccups but the content, engagement and networking made up for it. The plenary sessions captured my attention the most since it was an early morning session, and my mind was still fresh. It allowed for a holistic discussion with all of the participants, and this invoked a sense of inclusivity at every level.

This congress was a great experience to not only share my ideas and learn from others but to ensure the information gathered would be disseminated to our respective peer groups and organisations.

On 15 October 2019, the first-ever Caribbean Council on Adolescence and Youth Health was held. It lasted for three days and was filled with individuals of various Caribbean countries and well-known organisations. It was a launch-pad where advocates, health and social workers, policy-makers, academia, clinicians and young people heeded the call for improved health and well-being of adolescents and young people for the future development of the Region.

Over the three days, I attended several sessions from different tracks and thematic focus. The sessions were excellent, the content was relevant and addressed issues affecting adolescents and young people in an honest, transparent and meaningful way. I particularly liked the smaller, more intimate sessions that ran concurrently and I wish that I could have attended them all. I was most interested in the session that dealt with mental health. As I listened to the presentations and experiences, the challenges of being an adolescent in a time where bullying is pervasive, academic competition is fierce, and support systems are lacking, resonated with me. As adolescents, we are indeed living in a time that requires careful navigation to protect our mental health.

All of the sessions were interactive, and I gained a lot of knowledge.

I am extremely grateful that I had the opportunity to attend such an important event, and I hope that I can participate in many more in the future.

I enjoyed the conference. It was my first, and I am incredibly grateful to the Pan- American Health Organisation (PAHO) for granting me this unique opportunity. I appreciated the idea of creating a conference that focused on adolescent health, and including adolescents in the decision-making when it comes to their health.

The Caribbean Congress on Adolescent and Youth Health (CCAYH) was a great initiative, as it was a different approach to resolving the issues affecting this demographic.  This was my first experience at such an event, and I was excited to be part of it.

The Congress was well organised, and a lot of pertinent information was presented. I liked the parallel sessions as these were smaller activities that allowed presenters to share more in-depth experiences, research and studies.

I enjoyed the sessions dealing with substance abuse and mental health. They were most interesting to me. The information remained with me, as the statistics put a lot into perspective in relation to what is really happening with young people and adolescents in the Caribbean. I was impressed with a presenter during the mental health session who was very courageous to speak about her struggles with mental health. I think this was an excellent way to educate and help us understand the complexity and hardships of mental health.

This congress gave me exposure and a wealth of knowledge. I am very thankful for the opportunity to experience and network with my Caribbean counterparts.

Arriving in Port-of-Spain on 14 October 2019, the air was abuzz with anticipation, excitement and curiosity from everyone attending the Caribbean Congress on Youth and Adolescent Health (CCAYH). This conference, which was the first of its kind, provided a unique opportunity for youth from all over the Caribbean to engage with experts in various fields regarding their own health, and a real chance for the voices of young people to be heard and taken into consideration. This was highlighted during the opening ceremony and was echoed throughout the conference: “Nothing for us, without us”.

The three days of the Congress, although hectic, were full of information sessions that were interesting, innovative, eye-opening and relevant, not just to the Caribbean, but in particular to Caribbean youth and adolescents. The participants were actively engaged in panel discussions, smaller focus group sessions, knowledge cafes, and social events- all of which served  to foster the exchange of information,  bring the participants closer together and create a sense of community working with a common purpose and for a common goal to improve health and development of the Region’s adolescent and youth. At the very onset of the Congress, participants connected and rallied around the different issues ranging from climate change and its impact on our health to the importance of achieving optimal mental health at a time when adolescents and young adults continue to grapple with bullying, societal acceptance and the need to succeed in a highly competitive environment. The networking opportunities and connections made were invaluable. We shared and appreciated the diversity in our opinions and experiences as we learned from each other.

We committed to staying in touch, to continue the advocacy for youth health and development and to build on the excellent momentum created by the Congress.

Of particular interest to me, was the fact that mental health in the Caribbean was prominently highlighted during the course of the Congress. As this was my interest area, and the area I presented on at the Congress, I was extremely happy to see Caribbean youth take such an interest and recognize the importance of promoting mental health awareness and mental health advocacy in the region. In addition to Mental Health and Substance Abuse, the other tracks presented on at the Congress were 1. Sexual and Reproductive Health and Rights 2. Nutrition, Physical Activity, Sports and Youth Development and 3. Climate Change and the environment. All of these areas are significant to adolescent and youth health, and I was happy to see that the organizers and participants recognized this and participated actively in all of the sessions.

Overall, the Caribbean Congress on Adolescent and Youth Health was a positive experience. At the end of the three days, a roadmap based on the discussions and recommendations from the various sessions was developed, and both the organizers and youth pledged to play an active role in implementing it. I look forward to seeing this roadmap implemented, and the positive changes it will bring. I also look forward to more events like this, as I think it was a great learning experience and of benefit not only to the individual participants but to youth development in the Caribbean region as well.

“Communities are supported to exercise their powers to choose, know and demand that governments accelerate their efforts to achieve HIV, health and development goals” –Winnie Byanyima, Executive Director UNAIDS.

 World AIDS Day provides the ideal occasion to join scientists, activists, practitioners and People Living with and affected by AIDS around the world in celebrating the successes that have been achieved. In the Caribbean  55 % of People Living with HIV (PLHIV) are on treatment compared with less than 5% in 2001, deaths from AIDS  are  one quarter of what it was in 2001 because of access to treatment, seven Caribbean countries out of 11 worldwide have achieved the elimination of mother to child transmission of HIV, and congenital Syphilis and four others are in close range of this achievement. There is even the  aspiration that AIDS, based on the 90-90-90 UNAIDS Targets  can be ended by 2030, if by next year, 90% of persons with HIV get tested, 90% that are tested positive are on treatment and 90% of those on treatment have viral suppression at a level  that does not transmit the disease.   Yet there are indications that at best only three Caribbean countries are on track to achieve these targets and the need for caution against complacency that will contribute to reversing these gains.

The Convergence of Community-Led Organizations and Community-Led Responses 

This year it is appropriate that World AIDS Day focuses on communities.  They make a difference.  Whether as Community-led organisations or as Community-led responses, they represent the voices of the marginalised. They champion the causes for inclusiveness and equality that are fundamentals of the 2030 Sustainable Development Goals.

Community-led organisations comprise identifiable groups or networks that are determined by and respond to the needs and aspirations of their constituents. Community-led responses provide strategies that seek to improve the health and human rights of constituencies.  In the context of World AIDS Day, “Community-led”, in principle, is an umbrella term that includes PLHIV, key populations, women, youth, and all self-organised groups.   In practice, it focuses on advocacy, campaigning and holding decision-makers to account; promoting service delivery, capacity building, and funding of community-led organisations, groups, and networks. These activities may take place at the global, regional, national, subnational, and grassroots levels.

For the Caribbean, making a difference at the community level has always been driven by the regional response from the inception of the Pan Caribbean Partnership against HIV and AIDS (PANCAP) in 2001.

The four (4) iterations of the Caribbean Regional Strategic Framework (CRSF): 2002-2007, 2008-2012, 2014-2018 and 2019-2025  have provided the blueprint for the Partnership that comprises governments, civil society, private sector representatives, development partners and a specific set of stakeholder groups. Chief among which are parliamentarians, faith leaders, key populations and youth.  The CRSF has consistently acted as guidelines for activities on the ground, which include national and community engagements and through broad-based consultations among its various stakeholders.

PANCAP was the first Regional entity to ever receive a grant from the Global Fund for AIDS, Tuberculosis and Malaria (GFATM) in 2004 while sub-regional partners such as the Organization of Eastern Caribbean States HIV Programme  and  the Caribbean Regional Network of People Living with HIV and AIDS (CRN+) were the first of their kind to also receive support for strengthening the reach of their programmes in the areas of prevention and treatment in 2004 and 2006 respectively. As the umbrella organization PANCAP’s modus operandum involves close engagements with the highest level regional decision making authorities: the Caribbean Heads of Government and the Council of Human and Social Development on which sits Ministers of Health, Education, Culture, Youth and Gender Affairs and which formulates policies that ensure implementation of  CRSF’s  priorities  at country level. With the reduction in donor funding for HIV to the Caribbean based on the classification of high and upper-income countries, PANCAP’s advocacy has contributed in no small measure to the agreement at the 18^th Meeting of the CARICOM Council of Ministers of Finance and Planning (July 2018) to make provision for funding the country integrated health priorities that contribute to SDG #3 including  ending AIDS by 2030.

This is the context in which the vital role of the Caribbean Vulnerable Communities Coalition (CVC) in community engagement can best be appreciated

The Caribbean Vulnerable Communities Coalition (CVC) and Community  Engagement

The Caribbean Vulnerable Communities Coalition initially pioneered by the late Dr Robert Carr in 2005 was a spinoff from and supported by PANCAP. It has evolved into the Caribbean Vulnerable Community Coalition  (CVC) with headquarters in Jamaica and joint operation, El Centro Orientación e investigación Integral (COIN) in the Dominican Republic, comprises approximately 40 grassroots civil society groups that work with marginalised populations. These populations are especially vulnerable to HIV due to socioeconomic exclusion, punitive laws and policies,  high levels of violence against women and girls and stigma and discrimination across the Caribbean. CVC has developed a Shared Incident Database (SID) cataloguing human rights violations and providing pro bono legal assistance, community action and outreach in more than 2,668 cases. In addition, it’s training in HIV, Human Rights and Key Population Issues,  in collaboration with UNAIDS and the Caribbean Broadcasting Union,   has advanced the cause of human rights in more than 2000 cases. Among its most prominent roles in community education and media work are to advance human rights for key populations that in collaboration with The University of the West Indies Rights Advocacy Project (URAP) support activism, especially related to high profile cases in the courts of Belize, Guyana, Jamaica and the Republic of Trinidad and Tobago.

The CARICOM-PANCAP Global Fund grant 2011-2015, which included CVC and COIN and other sub and sub-sub recipients,Global Fund proposal placed emphasis on delivery of health care, especially in the implementation of primary health, including strong community participation. Community involvement in the Caribbean over the years has transitioned from family and community-led financial, social, and psychological support to the establishment of formal community-based HIV support organisations and networks.  It now focuses on testing, education and health promotion at the local level and linkages to health services. Community systems strengthening in the CRSF focuses on supporting critical populations networks, facilitating national programming and outreach specifically to these populations and conducting specific monitoring and evaluation and research.

Convergence: PANCAP and CVC-COIN

What is important to note that in the collaborative PANCAP and CVC-COIN Global Fund grants 2016-2019  they maintained complementarity in the thrust for PANCAP’s engagement with high-level policymakers and CVC and COIN with their focus on community engagements.   However, in the implementation of their respective mandates,  it is clear that the overlap in the visions and missions is reflected in the PANCAP Justice for All programme and Roadmap, supported by CVC-COIN.

 There are no better illustrations of the value of this approach than in PANCAP’s consultations with parliamentarians, faith leaders, youth, key populations, NAP managers and civil society with the support of CVC. The presentation by CVC’s partner, Jamaica Network of Seropositoves, to the PANCAP Parliamentary Forum in Jamaica in February 2019, strongly advocated against the criminalisation of wilful transmission of HIV. CVC interventions in other PANCAP fora have helped to shape the policies for inclusion of access of migrant communities to medicines and services as well as funding more specifically on the policies to reduce the spread of HIV among prisoners through prevention measures and highlighting the evidence of violence against the LGBTI population and the need for equitable policies for sex workers.

What has emerged as the next steps of the PANCAP-CVC-COIN nexus is a project titled, Sustainability of services for key populations in the Caribbean. The grant programme seeks to address the following key challenges in the regional response:

• Stagnating number of new infections in the region with increasing new infections evident in Belize, Suriname and Guyana, and among men.

• Inadequate progress linking and maintaining PLHIV on treatment and achieving viral suppression.
• Declining funding for HIV, including from donors, with the potential to jeopardize the work of CSOs providing services to KPs.

• Countries have committed to scale up treatment programmes per WHO guidelines to “Treat All”, even as they face rapid declines in donor funding.

Uniqueness of the Caribbean Experience

These are mainly sketches of a vibrant Pan Caribbean Partnership in which CVC plays a critical, even defining its role in community-led responses, protecting the civic space for the vulnerable and marginalised and promoting the growing importance of innovation in the HIV response designed to end the AIDS epidemic.  CVC’s collaboration with and supporting of PANCAP’s Knowledge for Health Programme,  has enhanced the capacity of the Partnership to produce baseline information, treatment and adherence goals policies to prevent or reduce secondary transmission through grassroots programmes that explore the unique history and reality of the marginalised and vulnerable groups.

This uniqueness has the potential of making community engagement and empowerment in the Caribbean a win-win scenario.  In so many ways the Caribbean experience is fully responsive to the clarion call by the new UNAIDS Executive Director, Winnie Byanyima.  During the launch of her first UNAIDS report, “Power to the People” she called on UNAIDS to take significant steps in a new direction,  “the first step is to address inequality and injustices that fuel the HIV epidemic.  We have to address inequality. It cannot be right that some people get treatment and live long lives while others cannot access health care and die.  We need to provide more services — education,  health, social protection.  That is how we will end AIDS”.

The Caribbean Congress on Adolescent and Youth Health (CCAYH) was described by participants as a transformative experience.  In this PANCAP Blog, participant Matthew Simon reflects on his amazing experience.

“In October, I was presented with the opportunity to attend the first “Caribbean Congress on Adolescent and Youth Health” (CCAYH), held in beautiful Port-of-Spain, Republic of Trinidad and Tobago. This was the first time that I’ve witnessed mental health being properly addressed as a public health issue.

While technology is my first love, I am also interested in the mysteries of the human mind, in particular, its patterns. Hence, I intended to use the CCAYH to gather more knowledge on this specific topic. The presentations on meticulous research by the presenters were more than fulfilling. Each touched on various issues of mental health, with some addressing trends, others dealing with causes and treatment for mental illnesses.

One positive aspect that I noticed was the higher ratio of youth to older people, which was something that I had never seen before. I am proud that the young participants were given opportunities to provide input in matters which concern them.

Using the information gathered from this congress, as well as inspiration from fellow attendees and presenters, I plan on conducting a study of my own into Caribbean youth’s mental health and behavioural patterns”.

This blog is being written as the first Caribbean Congress on Adolescent and Youth Health (CCAYH) in Port-of-Spain, Republic of Trinidad and Tobago ‪on 15 – 17 October 2019 is in session. The theme of the Congress is “Championing our wealth: promoting the health and well-being of adolescents and youth in the Caribbean”.  The event has attracted approximately 150 youth from across the Region.

Ms Terez Lord, CARICOM Youth Ambassador provided a fundamental challenge to the Congress in her remarks at the opening session  “This Congress, the first of its kind is for youth, by youth, with youth and supported by many agencies.  It is bolstered by the momentum of our time. It is action-oriented and should have decisive follow up. This is not a talk-shop. We must set the basis for no less. Health and well-being are far and wide in reach and impact and must be met with ambitious, future-oriented, systemic regional responses”.

This landmark Congress is being held under the patronage of Mrs Sharon Rowley, Spouse of the Prime Minister of Trinidad and Tobago with the support of several partners including PAHO, UNFPA, UNAIDS, Caribbean Development Bank, PANCAP and the Spouses of Caribbean Leaders Action Network (SCLAN), among others.  We, therefore, await the outcomes of the Congress identified as “regional commitments”, a “vision and core principles” to address the health needs of adolescents and youth, empowering champions and developing “action plans” based on current and emerging priorities. This event promises to lead to a rebranding of Youth Affairs in the Caribbean; a phrase borrowed from the vision of the Hon. Terrence Deyalsingh, Minister of Health who stated that Trinidad and Tobago is rebranding its approach to mental health.

Rebranding here is applied to the broader range of issues at the CCAYH and should be closely aligned to recent international events, especially those which occurred during the UN General Assembly (UNGA) in September. I have provided a sample of programmes and policies at the global level, referred to by many of the speakers at the opening ceremony. These provide useful lessons.

Some Lessons to be learned from recent International Engagements  

The four illustrations are by no means exhaustive but provide some useful signposts for action.

1. UNGA’s first Summit on the Sustainable Development Goals (SDGs) since they were adopted in 2016. The political declaration, entitled, “Gearing up for a decade of action and delivery for sustainable development,” proclaimed: “We stand firm in our determination to implement the 2030 Agenda as a plan of action for people, planet, prosperity, peace, and partnership – a plan to free humanity from the tyranny of poverty and heal and secure our planet for future generations.” Many of the speakers, especially Her Excellency Paula-Mae Weekes ORTT, President of the Republic of Trinidad and Tobago and the Hon. Terrence Deyalsingh underscored the importance of SDG #3 on Health and wellness referring in particular to the need for the Congress to address Noncommunicable diseases (NCDs), Mental Health, suicide among young people and violence against women and girls.

1. UN General Assembly Political Declaration themed “Universal Health Coverage: Moving Together to build a Healthier World” – This was highlighted in the address by Dr. Carissa F. Etienne, Directorof the Pan American Health Organization (PAHO), who underscored that PAHO is striving toward significant achievements over the next decade by  (a) tackling communicable diseases, including HIV and AIDS, Tuberculosis and Malaria, while addressing non-communicable disease and the growing threat of antimicrobial resistance through robust and resilient primary healthcare systems; (b) ensuring  universal access to sexual and reproductive health-care services and reproductive rights; (c) protecting  the wellbeing and dignity of women and girls; (d)  changing  the financing paradigm by stepping  up the pace of investment towards Universal Health Care (UHC); and (e) the importance of bold leadership.

3. Global Strategy for Women’s, Children’s and Adolescents’ HealthForemost among the leadership of this strategy is the UNFPA whose Regional Director, Ms Alyson Drayton amplified how sexual and reproductive health and rights are highlighted in the global programme of the organisation. The Chair of the Spouses of CARICOM Leaders Action Network (SCLAN), Mrs Kim Simplis Barrow also underscored that CARICOM First Ladies place emphasis on these issues and in particular on engaging men and boys in reducing violence against women and girls.

4. The Lancet journal published “HIV, Health, and Wellness” which is a first of its kind review and meta-analysis that found that HIV continues to disproportionately affect gay, bisexual, and other Men who have sex with men (MSM) throughout Africa. This general conclusion may equally apply to the Caribbean as a whole. The authors evaluated 75 independent studies conducted across 28 countries. They found that HIV awareness, ART coverage, and viral suppression remain too low to reach the UNAIDS 90-90-90 Targets by 2020. Additionally, levels of testing were significantly lower in countries with severe anti-LGBT legislation.

Making Rebranding a Reality: “The Health and Youth of the Region are the Wealth of the Region”    

This conclusion is influenced by an event at the Annual IMF- World Bank Meeting in Washington on October 15, 2019, titled “IMF inspired Generation Z: Finding its Voice”. The leading voice at that session was Natasha Wang Mwansa an 18-year-old dynamo from Zambia. Her pedigree is fully illustrated in the following video: 

It is also a reflection on the aspirational goal advocated by Ambassador Irwin Larocque CARICOM Secretary-General who gave the keynote address at CCAYH. He called for amending the 2000 Nassau Declaration of CARICOM Heads of Government from “the Health of the Region is the Wealth of the Region”  to that of “the Health and Youth of the Region are the Wealth of the Region”.

I could not help thinking that the Secretary-General has provided a fitting way to mark the  10th Anniversary of the presentation to CARICOM Heads of Government in Suriname in  January 2010 where the seminal report of The CARICOM Commission of Youth Development, The Eye on the Future: Investing in Youth Now for Tomorrow’s Community was presented.  The Commission was co-chaired by Hon. Yldiz Pollock Beighle, now Foreign Minister Suriname, and a former CARICOM Youth Ambassador with the late Professor Barry Chevannes.  I, therefore, pose the question: How about making this 10^th Anniversary celebration in January or February 2020 an exercise in visioning the rebranding of Youth leadership at CARICOM?  Perhaps at CARICOM’s intercessional meeting of Heads of Government?  How about aligning its mission around the theme: the Health and Youth of the Region are the Wealth of the Region?

Dr Edward Greene

PANCAP Advisor