“Communities must take an active role in response to public health threats like HIV and COVID-19” – World AIDS Day 2020 Message – Dr Nikkiah Forbes

World AIDS Day is commemorated on 1 December every year since its initial observance in 1988.  It is an opportunity for global unity to show support for People Living with and affected by HIV, to raise awareness about HIV and AIDS and to remember those who lost their lives to AIDS.

This year introduced us to a new virus called COVID-19 that emerged and caused a pandemic. We saw firsthand how pandemics affect health, lives and our way of life. COVID-19 highlighted the relationship between health, socialization and the economy. We saw how a pandemic could threaten access to healthcare, especially to vulnerable communities and those facing inequalities. We saw how global supply chains bringing medications and lifesaving commodities could be disrupted with shutdowns in global trade and travel. COVID-19 showed us and reminded us that we must be resilient, united and work together to see an effective response.  With this in mind, this year’s World AIDS Day theme is “Global solidarity, shared responsibility”.

Global solidarity, shared responsibility speaks to the importance of all communities actively taking a role in response to public health threats like HIV, AIDS and COVID-19.

We have learned valuable lessons over time in our work in HIV and AIDS. These lessons include working together to offer people-centred services, leaving no one behind and reaching persons where they are.  We have learned that we must fight stigma and discrimination and address health inequalities to achieve the best outcomes and best lives for People Living with HIV (PLHIV).  Those lessons and services centred around such fundamentals allowed resiliency and ongoing HIV care in the face of COVID-19.  These are some of the best practices that are the cornerstone of work in the Bahamas National HIV/AIDS Centre and Programme that have resulted in overall declines in new HIV infections and AIDS-related deaths.

Indeed our work in HIV and AIDS is a lesson in what we can do and accomplish when we all work together. For us to continue to make strides in our response, there needs to be a unified global response. The health response, including HIV and AIDS, must be fully funded and financed. All aspects must be strengthened, including the supply chain of antiretroviral therapy and access to innovative testing modalities. Health care workers providing care must be supported. Health systems require strengthening. Access to medicines and vaccines must be equitable and assured. Human rights for all must be respected. This requires committed and dedicated leadership. Every one of us plays a role as well.  Shared responsibility reminds us of the fact that what we all do matters and that we must make a collective effort along with the efforts of governments, civil society and others for the best response and the best possible outcomes.

Public Health Champion – Vishnu Singh, Medical Student, St. George’s University

Vishnu Singh is a medical student at St. George’s University, Grenada. In this edition of the PANCAP Newsletter, he discusses his experiences as a medical student during the pandemic.  

“In early January, I travelled to California to study for my medical examination. By mid-March, I was mentally exhausted from studying for long hours every day and was eager to take the exam and return home. On my scheduled date, I endured the gruelling 8-hour long test, all the while thinking it would be over soon and worth it once I got home to relax. However, life threw a curveball, and when my exam was done, I was informed that Guyana’s airport would be closed to all incoming flights on the following evening due to COVID-19. I panicked to search for flights that would arrive before the airport’s closure. When I realised that it was impossible to arrive in Guyana on time, I was deeply disappointed. I followed the news daily to learn of any plans for repatriation flights.

Considerable time was spent communicating with consulates, filling out the repatriation form and waiting for feedback and then making arrangements to take my PCR test. It was tough for me to deal with the uncertainties, and I felt as though I was slowly losing my mind while waiting for good news. I decided to use that period to achieve some of my personal goals that were long overdue and also to take up some new hobbies, like meditation.

Finally, in mid-June, I was informed of my placement on a repatriation flight to Guyana. The flight itself was difficult, especially having to wear my mask for the entire time, but I knew it was necessary to stay safe, and I made it home in one piece. Upon return, I spent the first week at home under self-quarantine. An official from the Ministry of Health called me daily to check on me. I spent the next month trying to balance virtual classes and assist with the family business.

In early August, I returned to the USA via another repatriation flight to begin my third year of medical school. I was hesitant to start my training at such an unprecedented time, but I realised that medical assistance is needed now more than ever, and I must play my part.

Although COVID-19 posed many challenges for me, I constantly remind myself that my life could be much worse, and I should be grateful for all that I have. We need to remind ourselves of the positives and focus on the good things. I want to encourage you all to do this, stay safe and keep playing your part in this fight against COVID-19”.

Caribbean Vulnerable Communities Coalition is the recipient of the Robert Carr Research Award

To be named as one of the 2020 winners of the prestigious Robert Carr Research Award is an incredible recognition of the work of the team at Caribbean Vulnerable Communities Coalition (CVC).

It demonstrates the critical role communities, and key populations can play in policy and research. It also validates the importance of collaboration between community groups and Academia. Such partnerships can only help to better serve the groups most affected by HIV and advance the regional HIV response.

The award is even more significant, given that it honours one of CVC’s founders, whose vision was for national programmes to have the relevant data to better understand the needs of our communities and design meaningful and targeted interventions.

The research, for which the award was presented will certainly provide important baseline data against which the success of any future interventions can be adequately measured.

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Editor’s note: PANCAP extends congratulations to the Caribbean Vulnerable Communities Coalition (CVC) for achieving this well-deserved honour.

The Robert Carr Research Award, presented every two years at the International AIDS conference, recognizes the collaboration between community organizations and academic researchers to improve outcomes for highly stigmatized and underserved populations. It is sponsored jointly by the International Council of AIDS Service Organizations, Human Rights Watch, the International AIDS Society and the Center for Public Health and Human Rights at the Johns Hopkins Bloomberg School of Public Health.

Key takeaways from the UNAIDS Global AIDS Update 2020 launch

Key takeaways from the UNAIDS Global AIDS Update 2020 launch

UNAIDS Caribbean

  • The Caribbean lags behind global averages for testing and viral suppression. To close the gaps the region must expand proven methods of active case-finding, linkage to care and retention in care, including through community-based programmes.
  • Year after year the data tell the story of men’s inadequate access to HIV services. It is time for a comprehensive strategy to meet men where they are, increase demand and adapt service delivery to meet their needs.
  • HIV resource availability from domestic sources increased by 38% from 2010 to 2019. It is critical that Caribbean governments guard these investments, even during COVID19.

CARPHA

  • HIV response gains were guided by evidence. National authorities should make regional COVID-19 data-sharing a priority to facilitate analysis and inform decision-making at the level of CARICOM.
  • Health authorities must avoid crises among people living with HIV and non-communicable diseases. Continuous monitoring and re-evaluation of considerations for vulnerable populations at risk to COVID-19 are critical.

PANCAP

  • Ending AIDS requires a coordinated multisectoral regional response as articulated in the 2019 – 2025 Caribbean Regional Strategic Framework (CRSF). The CRSF is our blueprint towards ending AIDS and it highlights policies and programmes to accelerate progress for achieving the UNAIDS 90-90-90 Targets to test, treat and defeat AIDS.
  • Addressing the needs of Key Populations is critically important. Access to care in most of our countries is hindered by several factors including criminalisation of same-sex relationships, hostile communities, homophobic discrimination and violence, external and internal stigma, and limited health education.

CRN+

  • Strategic information gaps must be closed for the region to truly understand and respond to its epidemics. Governments must increase investments in data collection and analysis and forge collaboration with civil society to achieve this.
  • In the context of COVID-19 community organizations must continue to increase collaboration with national and regional partners to understand the challenges and advocate for beneficiaries across the Caribbean.

SCLAN

  • During COVID-19 women and girls face a higher risk of contracting HIV
    due to the extended confinement measures as well as economic and social stresses. Decisive action is needed to address the risk of gender-based violence and sexual abuse.

One in three new HIV Infections in the Caribbean last year was among young people ages 15 – 24. Evidence-based strategies to increase youth access to education and sexual and reproductive health services are critical.

JASL increases support for clients during COVID-19 Pandemic

Jamaica AIDS Support for Life (JASL) remained open to serve its clients during the COVID-19 pandemic. The organisation modified its treatment, care and support programme to respond to the needs of their clients and received assistance through soliciting donations and writing proposals for small grants to mitigate the impact of the pandemic.

COVID-19 resulted in clients losing their jobs and not being able to provide for themselves and their families. These clients needed money including a travel stipend to attend the clinic, nutritional support and care packages including sanitisation items. Loss of employment, lack of basic living support and depleting nutritional supplies are the main issues that undermined clients’ adherence to medication. To play its part and ensure that the gains made with adherence and viral suppression of its clients were not eroded, JASL quickly sprang into action and launched an initiative geared towards “Helping us to help People Living with HIV (PLHIV) during this time of crisis.” Specifically, it tried to assist clients by providing financial assistance, nutritional support and care packages.

JASL called local organisations and submitted proposals to international donor agencies to provide financial and other support. Executive Director of JASL, Kandasi Levermore expressed that “we cannot negate the importance of nutritional support in maintenance of optimal care and as such, JASL seeks to ensure that each of our clients is provided with holistic “love, action and support.” Many of these clients were not able to access the benefits from the Government of Jamaica’s CARE Programme.

Assisting JASL’s clients, including PLHIV has helped to address some of the clients’ socioeconomic challenges so that they were not distracted from continuing their ARV regime. PLHIV who are adherent to their ARVs will optimise their immune system and improve their chances to fight against the symptoms of COVID-19.

During the pandemic, JASL also engaged in other COVID-19 response efforts. The organisation developed its Infection Prevention and Control Protocol which was implemented to protect its staff and clients from COVID-19 and other infectious agents. Employees were adequately equipped with the requisite personal protective equipment (PPE) to protect themselves from contracting COVID-19 and clients were provided with masks, temperature checks and sprayed with hand sanitisers upon entering the treatment sites.

The organisation also suspended all community interventions and amplified one-on-one peer testing by appointments only at the organisation’s offices or at locations convenient to people who want to be tested.

JASL’s treatment, care and support programme remains grounded in the organisation’s strategic objective to improve the health outcomes of over 800 clients accessing services at three treatment sites in Kingston, St. Ann and Montego Bay.

JASL continues to provide relevant services for clients while the pandemic unfolds as the organisation is committed to improving their health outcomes.

The organisation is encouraging individuals and companies to support their work and the cause by calling its head office on 876-925-0021 or donating at NCB Knutsford Branch 351813768.

COVID-19 and its effect on vulnerable groups especially women and girls

The COVID-19 pandemic has disrupted lives globally, causing a significant struggle for vulnerable populations, particularly our women and girls.

This impact on our vulnerable groups only reinforces the inequity that exists, which we addressed during our United Nations General Assembly (UNGA) side event in September 2019. The inequalities were always present, COVID- 19 is only exposing them even more so now. Regardless of the situation, “women and girls are negatively and disproportionately impacted by disasters and conflict” (UNFPA and UN Women).

Moreover, COVID-19 has put the most vulnerable populations at higher risk due to the confinement measures and economic stresses that tend to reinforce abusive behaviour. According to UN Women, emerging data shows that since the outbreak of COVID-19, physical and sexual violence against women and girls (VAWG) has intensified.

Fortunately, despite challenges, there are immense opportunities: my experience as Belize’s Special Envoy for Women and Children and Chair of SCLAN has cemented my belief in the power of collaboration.

COVID-19 has shown us that there is still an urgent need for innovative targeted tools and comprehensive strategies to accelerate progress for our vulnerable populations. As we see positive efforts to fight COVID-19 in our region, we must use this dynamism to seek sustainable financing and reinforced partnerships that strengthen actions to protect women and girls.

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Over 10 000 persons benefit from PANCAP – PAHO Webinars

Since the beginning of the COVID-19 pandemic, the PAHO/WHO Sub-regional Office for the Caribbean collaborated with the Pan Caribbean Partnership against HIV and AIDS (PANCAP) on a series of webinars which aimed to provide effective, timely and relevant information to the Caribbean on a wide range of topics relating to COVID-19 and HIV. The webinars were aimed at diverse audiences and served to provide updates on new scientific evidence and to share evidence-based frameworks and strategies as well as successful and innovative implementation experiences for the prevention and management of COVID-19.

PANCAP and PAHO have been intentional in combining presenters who are experts in technical areas with regional presenters on successful Caribbean implementation experiences. This approach provided an understanding of evidence-based frameworks and how these can be applied to the local context.

The webinars conducted from March to May 2020 have reached over 10,000 persons.  Participants have the option of joining the live sessions or viewing the recording on the PANCAP and PAHO Facebook pages as well as the PANCAP website and YouTube Channel.  Participants’ engagement with the webinars has been high. Organisers have received positive feedback on the relevance of the knowledge shared and the expertise of the presenters. A recent post-webinar survey revealed that 98.5% of participants gained new knowledge, while 100% indicated that the information presented was useful to their work.  In addition, 95% of participants stated that they would utilise the new knowledge in the execution of their work programmes.

The two entities will continue this successful collaboration with the overarching aim of providing critical knowledge for the Region’s response to COVID-19.

The Caribbean’s Remarkable Response to COVID-19

The Caribbean has been commended globally by the World Health Organisation (WHO), CNN and BBC for its outstanding handling of the COVID-19 pandemic. How did the Caribbean do it? As with everything, it begins with leadership. At the helm was a woman who led with distinction.  The Hon. Mia Amor Mottley, Chair of the Caribbean Community (CARICOM) and the Prime Minister of Barbados, was proactive and impressive in her harnessing of the region’s technical expertise and resources to the region’s benefit as well as Barbados. This resulted in effective and timely communication buttressed by carefully crafted messages from reliable sources to the populations of the region.

The region’s containment of this unrelenting virus is due in large measure to the effective teamwork of our agencies and their expert staff. CARICOM, PANCAP, PAHO, CARPHA, CMLF all executed an excellent containment strategy. Their sterling efforts, combined with a poised approach by all of these tireless teams is nothing short of exemplary. Kudos to ALL concerned for sharing the critical information responsibly to save many lives and so avoid overwhelming our health care systems that proved to be more efficient and organised to cope with this pandemic than many larger more powerful nations.

This is not new to the region. The Caribbean and its resilient people have a track record of leading the world in their response to epidemics and pandemics: The Caribbean was the first area of the world to eliminate polio and measles; Cuba became the first country in the world to achieve the elimination of Mother-to-child Transmission of HIV and Syphilis and on World AIDS Day 1 December 2017, six Caribbean territories and states joined Cuba in that achievement.

Our leaders, medical professionals at all levels, labs and all frontline workers, have acted decisively, worked unselfishly and helped keep us safe across the Caribbean.

We salute you and thank you!

COVID-19 and Laboratories

An opportunity for strengthening laboratories and health systems in the region.

Diagnostics and Laboratory capacity are essential but often ignored pillars of both a responsive health system and effective global health security.

The Coronavirus pandemic has, more starkly than ever before, highlighted the critical importance of accurate, reliable and timely laboratory testing for diagnosis, patient care and management and understanding the scope of viral transmission, thereby protecting national, regional and global health security. For those of us that live in the Caribbean, as we watched the COVID-19 pandemic sweep through Asia, Europe and the United States, on its way to our shores, many lessons have been highlighted – the DOs and DON’Ts of how to manage this pandemic emerged and are emerging day by day!

Read the full article.

Fear of stigma and discrimination, a hindrance to HIV care

When we speak about HIV today, there still exists some element of fear and uncertainty by many individuals towards People Living with HIV (PLHIV). Even with the vast wealth of information and education, some persons continue to stigmatise and discriminate against PLHIV.  This poses a significant challenge for navigating and retaining persons in HIV care and treatment programmes.

How do we help PLHIV to deal with stigma and discrimination? We simply continue the fight with counselling, continuous education, and equipping persons with the correct tools such as information on civil society organisations that provide specific help and guidance on how to deal with discrimination.

From the beginning of the process, this fear of stigma poses a challenge to get persons to participate in free HIV testing. They fear being identified and discussed. For persons who have tested positive, the problem becomes more significant. They fear being identified with the HIV clinic, and the thought of family, friends and coworkers being made aware of their diagnosis can affect their enrolment in treatment. Because of this reality and their need for privacy coupled with their self-guilt and shame, we face high rates of non-adherence to treatment, dropouts and loss to follow-up.

We must understand the impact this situation has not only on the individual but on society. Only then can we fully grasp the extent of the damage that is created as a result of stigma and discrimination against PLHIV.

The fear of being stigmatised and discriminated against is real; we, therefore, have to continue to empower PLHIV to deal with it, and to know that there is hope and help beyond that situation hence equipping them to be physically and mentally healthy.