HOW CAN PARLIAMENTARIANS, FAITH LEADERS, CIVIL SOCIETY LEADERS, YOUTH LEADERS NAP MANAGERS WORK TOGETHER TO END AIDS?

1. INTRODUCTION

The Pan Caribbean Partnership against HIV and AIDS (PANCAP) proposes to host a Regional Dialogue on the theme “How can Parliamentarians, Faith Leaders, Civil Society Leaders, Youth Leaders and NAP Managers work together to end AIDS?”  The Dialogue will be held in Port of Spain, Trinidad and Tobago on 24 and 25 April 2018.

2. CONTEXT

PANCAP was created by Caribbean Heads of Government in 2001 to facilitate a coordinated regional response to reduce the spread and mitigate the impact of HIV. The PANCAP strategic regional approach to HIV builds on a strong history of collaboration in public health and supports a deepening regional integration process of countries of varying population size, social and economic development, languages and culture. The collective efforts of the PANCAP membership seek to address common opportunities and challenges through action at the regional level to promote economies of scale and shared capacity. The success of the regional response is evident in significant achievements for the Caribbean:[1]

• Reduction in HIV incidence by 49% through 2014, and maintaining the annual number of new infections among adults at an estimated 17 000 [15 000–22 000] as reported in 2016.
• A decrease in new infections among children (aged 0–14 years) by 44% between 2010 and 2016, from an estimated 1800 [1500–2200] in 2010 to fewer than 1000 [<1000–1000] in 2016.
• A 55% reduction of AIDS-related deaths from 2000 to 2016, from an estimated 21 000 [16 000–26 000] in 2000 to an estimated 9400 [7300–12 000] in 2016.
• More than half (52%) of Caribbean people living with HIV were on treatment in 2016 up from 24% in 2010.
• At least three of four people on treatment achieving viral suppression in Barbados, Dominica, Guyana, Saint. Lucia, Suriname and Trinidad and Tobago (2016).
• In April 2015, Cuba became the first country in the world to achieve the target for elimination of mother-to-child transmission of HIV and congenital Syphilis, along with 6 additional countries (Anguilla, Antigua and Barbuda, Bermuda, Cayman Islands, Montserrat and Saint Kitts and Nevis, in 2017.

Despite these efforts and in spite of the overall gains towards epidemic control, throughout the Region, prevalence continues to be higher in key populations, including MSM, transgender, sex workers, youth, migrants and mobile populations, incarcerated persons and people who use drugs. The legal, social and cultural barriers that drive transmission and prevent key populations from accessing comprehensive and high-quality health services are deeply rooted in Caribbean societies. The need for law and policy reform is a challenge common to the vast majority of countries in the region, with 10 countries criminalizing consensual sex between adult men and many sharing laws against cross-dressing, constitutional bans on legal recognition of same-sex relationships and prohibition of entry for homosexuals. With the exception of Suriname, PANCAP member countries prohibit activities related to sex work and The Bahamas is the only CARICOM country where anti-discrimination provisions in the employment act make reference to HIV as a basis for non-discrimination. As the Region is faced with rapidly declining donor support to HIV programming, interventions targeted at key populations, including through community-based organizations (CSO), are likely to be most affected, especially as national programs are challenged to find the resources needed to scale-up treatment programs in line with Treat All. At a minimum, sustaining investment in prevention, treatment and care programs.

It is now, therefore, a strategic imperative to work in partnership and collaboration with each other, operating as a unified, coherent and cohesive whole (without prejudice to individual/respective organizations objectives) in order to achieve the overall goal of ending AIDS by 2030.

3. OBJECTIVES

The objectives of the Dialogue are to:

• Review the recommendations/commitments made at the respective stakeholder consultations of parliamentarians, Religious leaders, civil society leaders, youth leaders and National AIDS Programme Managers for ending AIDS during the 2017-2018 engagements;
• Lay the foundations for increased partnership/collaboration between and among Stakeholder groups to achieve the organizational, national, regional and international agreed targets for ending AIDS by 2030;
• Discuss, develop and agree on strategic initiatives and activities that actions the PANCAP Justice for All programme, including the adoption of CARICOM Model Anti-Discrimination Legislation 2012, with particular reference and relevance to the national and organizations agenda;
• Discuss and agree on mechanisms/strategies for effecting harmonized and sustainable partnerships and collaborations between all stakeholder groups, that is, organizations, national, regional and international partners, for ending AIDS.

4. BUILDING ON THE STAKEHOLDER GROUPS ENGAGEMENT 2017-2018

The Dialogue will build on the Regional Consultations of Faith Leaders held in February 2017, Youth, April 2017, and Parliamentarian, May 2017; the Joint Forum of Faith Leaders and Key Population Leaders in February 2018; and the PANCAP national level consultations with each of these stakeholder groups convened under the Justice for All Programme. The Dialogue will also take into consideration the targets established in (a) the United Nations High-Level Meeting Political Declaration June 2016 on ending the AIDS epidemic by 2030; (b) the 2030 Sustainable Development Goals (SDG) approved by 192 nations at the United Nations (UN) in September 2015, and the commitments made by each stakeholder group for ending AIDS. Special attention will be given to SDG 3: Ensure healthy lives and promote well-being for all ages and SDG 16:  Promote peaceful and inclusive societies for sustainable development, provide access to justice for all and build effective, accountable and inclusive institutions at all levels.

Based on the groundwork between 2012 and 2015 and the lessons learned from operations on the ground, special attention in 2016 was given to working with stakeholder groups, individually, to identify what each could contribute to ending AIDS in the Caribbean. The results have been heartening. They have been demonstrated in the recommendations from Regional Consultations coordinated by PANCAP in partnership principally with UNAIDS, UNDP and PAHO/WHO and in which the UN Secretary-General Special Envoy for HIV in the Caribbean and the Director of the PANCAP Coordinating Unit played lead advocacy roles. The outcomes from these stakeholder fora identified a series of recommendations whereby their respective collectives may contribute to ending AIDS.

Faith Leaders agreed on a Declaration with ten (10) actionable recommendations with a Regional Consultative Committee as coordinating mechanism to harmonize the implementation programmes. It was also agreed to include a representative of the LGBTI sector to advance the discussion on reducing stigma and discrimination. The follow up also included the establishment of National Faith Leaders Networks linked by the PANCAP information and communication system designed to facilitate on-time sharing and dissemination of information.  Based on a mapping of attitudes and values of faith leaders by the Jamaica network, a number of strategic interfaith interventions have emerged for consideration by all national networks in charting the way forward.

The recommendations from the Parliamentarians’ Forum focused on legislative, operational and oversight arrangements which include the adoption and implementation of the PANCAP Model Anti-Discrimination Legislation and broadening the discussions on fast-tracking the AIDS response It is intended to catalyse discussions in National Parliamentary Fora, starting in September 2017. A PANCAP Information and communications link will be the basis of information sharing among the national parliamentary groups.

Similarly, the Youth Forum with a core group of CARICOM Youth Ambassadors and key population youth leaders has established a regional youth network with emphasis on HIV prevention to be driven by national peer group counseling, utilizing social media and mobile technology to reach underserved communities.  Youth leaders agreed to advocate for increasing adolescents’ access to sexual and reproductive health care services; comprehensive sexuality education to be implemented in schools across the Caribbean, where it is not a usual phenomenon; and gender-neutral laws that protect all victims of sexual assault.

A follow-up PANCAP Workshop to Strengthen Advocacy Skills of Youth Leaders (January 2018) established targets for advocacy including rights-based approaches, priorities for strategic engagements, evidence to inform policy and use of governmental executive, parliamentary and judicial branches to enforce rights. It was recommended that there is the need for a systematic approach to targeting young people belonging to key population who are more difficult to reach utilization the leadership platform comprising the CARICOM Youth Ambassadors Programme in collaboration with CVC and COIN.

The Joint Faith Leaders and Key Population Leaders Consultation recommended that emphasis be placed on:

• Creating ‘spaces of hospitality’ within the faith community designed to “welcome the strangers” and “the others in their otherness” based on respect for human rights and for “community evangelism” such as the practice among some denominations in the Dominican Republic”
• Establishing the basis for places of worship to give parents and guardians tools on sexuality and incorporate holistic sexuality education into their programmes, including those for youth.
• Making every effort to reach marginalized populations, including advocating for and/or reasonable legislative changes, and seeking to cooperate in this venture.
• Fostering a spirit of appreciation on the part of key populations for the differences among religious leaders and denominations in movement toward respectful engagement to advance policies and programmes designed to reduce stigma and discrimination.
• Establishing a national mechanism to address social and psychological approaches for dealing with the challenges affecting key populations.
• Designing collaborative approaches whereby Faith Leaders and Key Populations will focus on resolving differences to achieve agreement on the following:
• common issues and shared priorities at national and regional levels;
• mechanisms for sustaining joint implementation of programmes;
• joint national level policy formulation and activities for advancing the short, medium and long-term goals of PANCAP Justice for All Roadmap;
• the way forward including improving communications and harmonizing policies between FBOs and Key Populations;

National AIDS Programme Managers requested support for operationalize their programmes. Specifically, they recommended:

• New strategies to overcome HIV-related stigma and discrimination;
• Addressing the social determinants affecting HIV transmission;
• Behavior Change Modification strategies and interventions;
• Continued dialogue and efforts towards the removal of legal, regulatory and other structural barriers that affect access to services;
• Development of policies with regards to extended Post Exposure Prophylaxis (PEP) and Pre Exposure Prophylaxis (PrEP);
• Strengthening and creating more collaborations and partnerships inclusive of key populations;
• Effective responses to data requirements, supporting strengthening of health information systems and making use of research and monitoring and evaluation tools;
• Greater support for and involvement of CSOs in National responses;
• Prioritizing of finances in local governments for effective national responses; and
• Enhanced communications modalities with cognizance to messaging.

5. RESOLVING SPECIAL ISSUES RELATED TO INCLUSION

Several issues revolving around the need for inclusion emerged during the various discussions that require collective action 

1. People Living with HIV (PLHIV)

• Recognize the voice and importance of PLHIV spearheaded by in-country CRN+ networks
• Incorporate PLHIV and CRN+ in the national and regional decision-making process and the strategies for ending AIDS
• Create the environment – mainly through reducing stigma and discrimination – that would facilitate PLHIV feeling free to declare their status and to have access to public health and the services of the Church

1. Sex Work

• Reconstruct the definition of Sex Work and advocate for Governments to legalize it which will require recognizing Sex Workers performing a service as their human rights to earn a living.
• Transgender
• Acknowledge the place of Transgender within the construct of social relations and the faith community

1. Gender equity

• Identify the issues related to enhancing the health and welfare of women and girls as critical to the goals of ending AIDS. In this regard PANCAP pays particular attention to the priorities established by the ‘Every Caribbean Woman Every Caribbean Child’ (CARIWAC) Initiative, co-chaired by the CARICOM Secretariat and UNFPA;
• The priorities focus on reducing violence against women girls and adolescents, adolescent pregnancies and cervical cancers and making the Caribbean the first region to eliminate mother to child transmission of HIV and congenital syphilis;
• Find the formula to include men and boys as part of the solution.

 Target audience

Selected parliamentarians representing Government and opposition, Members of the Regional Faith Leaders Steering Committee and other selected faith leaders, selected regional civil society leaders, members of the PANCAP Youth Advocacy Steering Committee and National AIDS Programme Managers.

[1] 2017 Global AIDS Update, pp. 140 – 148 http://www.unaids.org/sites/default/files/media_asset/Global_AIDS_update_2017_en.pdf