Dr Gomez was known universally as the patron saint of the National HIV response in the Bahamas. A pioneer in its most essential sense, he was the founder and sole Director of the National HIV Programme of the Bahamas and, as a complementary initiative, also founded the AIDS Clinical Services Programme at the Princess Margaret Hospital in Nassau.
Dr Gomez earned a medical degree from the University of the West Indies and immediately thereafter proceeded to Wayne State University where he specialized in Internal Medicine and Infectious Diseases. This preparation became his passport to a lifetime of selfless and unsurpassed public health service.
He published widely with his most celebrated work being his contribution to “Fourth Generation Enzyme linked to Immuno-Absorbent Assay for the Simultaneous Detection of HIV Antigen and Antibody”.
Fiercely committed to the cause of the Caribbean, Dr. Perry Gomez never plied his trade elsewhere. For more than three decades, he placed his renowned skills as an internist and infectious disease specialist at the complete disposal of the people of the Bahamas and, indeed, the wider Caribbean.
Under his calm but strong and compelling leadership, HIV transmission rates in the Bahamas declined by more than 30%, HIV transmission from mother-to-child had all but disappeared, 72% of all persons with advanced HIV received requisite treatment, while 100% of all persons with HIV and TB co-infection received full treatment for both conditions.
A true Caribbean patriot, Dr. Gomez lent his vast professional and leadership skills across the Caribbean. He was the Standing Chair of the Executive Council of the Caribbean HIV and AIDS Regional Training Initiative; served as Co-Chair of the regional initiative for the Elimination of Vertical Transmission of HIV and Syphilis and member of the Executive Board of the Pan Caribbean Partnership against HIV and AIDS (PANCAP).
For good measure, Dr. Gomez also served on various technical advisory bodies of PAHO/ WHO, UNAIDS and the Clinton Foundation.
Dr. Gomez was the recipient of several prestigious awards. • In 1998, he received the “Merit of Award of the Government of the Bahamas” for contribution to Medicine; • In 2003, he was admitted to the Most Excellent of the Order of the British Empire; • In 2005, he was named “Civil Society Person of the Year of the Bahamas”; • Again in 2005, he was recognized as “The Bahamas Journal Person of the Year”; and • In 2010, received the coveted “Sir Linden Pindling Award for Excellence”.
As the Bahamas Journal summed it up in its tribute of 2005, “the good doctor has been the epitome of what world class is all about and we have a responsibility to reward excellence”.
Because of his remarkable accomplishments, together with a lifetime of distinguished service to public health Dr. Michael Perry Gomez was conferred with the PANCAP Award for Excellence, in 2010.
To the family of the late Dr Michael Perry Gomez, we extend our deepest condolences.
PANCAP joins the Region in mourning the loss of HIV and public health adviser to the Caribbean, Dr. Michel de Groulard. Michel had more than 30 years of experience in International Public Health, with around 25 years dedicated to HIV.
Michel was a French citizen who made the Caribbean his home. He lived in the Republic of Trinidad and Tobago for several years until his passing.
A medical doctor by training, Michel worked on several public health projects for the French Ministry of Foreign Affairs and provided healthcare to remote desert villages in Mauritania and Cameroon. He also served as a Public Health Officer in the Grenada Health Ministry and an HIV Project Manager at the Caribbean Epidemiology Centre.
Michel joined UNAIDS in 2001 as a Senior Partnerships Adviser. He went on to serve the Caribbean region in several positions with UNAIDS, including Senior Program Adviser to the region for more than seven years. Last month, he concluded a two-year appointment as interim Country Director for the Guyana/Suriname office which he opened in Georgetown in 2005.
In his HIV work over the years, he continuously emphasised the role of civil society at all levels of the response to address risk and vulnerability, gender issues and barriers to access services. Michel provided technical support for creating the Caribbean Network of People living with HIV in 1996 and establishing the Caribbean Vulnerable Communities Coalition in 2005. For several years he was Vice Chair of Community Actions Resource, Trinidad and Tobago’s oldest organization serving people living with HIV.
Above all Michel was a champion for the marginalized and excluded, especially people living with HIV and key populations. He ensured that communities’ concerns and voices were put at the centre of planning and advocacy. He is remembered by civil society for championing their critical importance in shaping public policy and delivering services.
Michel never truly retired. Always energetic and committed, he took on several challenges following his initial departure from UNAIDS in 2013. This included the role of Regional Manager for the USAID/PEPFAR LINKAGES programme for the Eastern and Southern Caribbean. He also volunteered with the Alliance Française in Port-of-Spain.
His interests in epidemiology and public health were enduring. Since the start of the COVID-19 pandemic, for example, he compiled and disseminated daily country and regional graphs tracking new infections and deaths in the Caribbean. His nightly WhatsApp messages to friends and colleagues continued until the night before his passing.
We extend our deepest condolences to his family, colleagues and friends. The Region has lost a dedicated champion for vulnerable populations.
The inequalities perpetuating the AIDS pandemic are not inevitable; we can tackle them. This World AIDS Day, 1 December, UNAIDS urges each of us to address the inequalities holding back progress in ending AIDS.
The “Equalize” slogan is a call to action. It prompts all of us to work for the proven practical actions needed to address inequalities and help end AIDS. These include:
Increase availability, quality and suitability of services for HIV treatment, testing and prevention so that everyone is well-served.
Reform laws, policies and practices to tackle the stigma and exclusion faced by people living with HIV and by key and marginalised populations so that everyone is shown respect and welcomed.
Ensure the sharing of technology enables equal access to the best HIV science between communities and the Global South and North.
Communities will be able to use and adapt the “Equalize” message to highlight the particular inequalities they face and to press for the actions needed to address them.
Data from UNAIDS on the global HIV response reveals that during the last two years of COVID-19 and other global crises, progress against the HIV pandemic has faltered, resources have shrunk, and millions of lives are at risk as a result.
Four decades into the HIV response, inequalities persist for the most basic services like testing, treatment, and condoms, and even more so for new technologies.
Young women in Africa remain disproportionately affected by HIV, while coverage of dedicated programmes for them remains too low. In 19 high-burden countries in Africa, dedicated combination prevention programmes for adolescent girls and young women are operating in only 40% of the high HIV incidence locations.
Only a third of people in key populations— including gay men and other men who have sex with men, transgender people, people who use drugs, sex workers, and prisoners—have regular prevention access. Key populations face major legal barriers, including criminalisation, discrimination and stigma.
We have only eight years left before the 2030 goal of ending AIDS as a global health threat. Economic, social, cultural and legal inequalities must be addressed as a matter of urgency. In a pandemic, inequalities exacerbate the dangers for everyone. Indeed, the end of AIDS can only be achieved if we tackle the inequalities which drive it. World leaders need to act with bold and accountable leadership. And all of us, everywhere, must do all we can to help tackle inequalities too.
Activities will build up to World AIDS Day in November. The World AIDS Day report will be released in late November.
On World AIDS Day (1 December) events will take place worldwide. These activities will be led not only by official bodies but also, most importantly, by communities. Through photos and videos shared by groups on social media and aggregated by UNAIDS, people can have a sense of the kaleidoscope of events taking place and be inspired by determination and hope.
“We can end AIDS – if we end the inequalities perpetuating it. This World AIDS Day, we need everyone to get involved in sharing the message that we will all benefit when we tackle inequalities,” says UNAIDS Executive Director Winnie Byanyima. “To keep everyone safe, to protect everyone’s health, we need to Equalize.”
Adaptable materials for World AIDS Day will be shared on the UNAIDS special World AIDS Day page beginning in October.
The Global AIDS Update 2022, released in July, shows that during the last two years of the Coronavirus (COVID-19) pandemic and other global crises, progress against the HIV pandemic has faltered, resources have shrunk, and millions of lives are at risk.
On average, the AIDS pandemic took a life every minute in 2021. There were 650 000 AIDS-related deaths last year despite the availability of effective HIV treatment and tools to prevent, detect, and treat opportunistic infections.
The Caribbean
Regarding the Caribbean, there were an estimated 330 000 people living with HIV last year. According to the report, from 2010 to 2021, AIDS-related deaths in the Region declined by 50 percent.
There were 5700 deaths last year, and new HIV infections decreased by 28 percent since 2010. An estimated 14 000 people contracted HIV during 2021, translating into 270 new HIV infections every week in the Caribbean.
“While the Caribbean has not had the increase in new infections experienced in other regions, the rate of decline is far too slow,” explained Luisa Cabal, UNAIDS Director of the Latin America and Caribbean Regional Support Team.
“Thousands of avoidable HIV infections every year are making it ever harder and more expensive to ensure People Living with HIV have access to lifesaving treatment and that the targets to end the AIDS pandemic by 2030 are reached,” Cabal added.
The report recommends that countries in the Region urgently prioritize combination HIV prevention. This includes behavioural interventions like comprehensive sexuality education as well as moving to large-scale implementation of prevention projects reaching vulnerable populations at elevated risk of HIV so that innovations such as HIV self-testing and pre-exposure prophylaxis or PrEP become more widely available.
PrEP is daily medicine taken by an HIV-negative person who is at substantial risk to prevent contracting the virus (View the PANCAP PrEP Knowledge Suite).
The data indicated that these prevention strategies are especially important for vulnerable groups like adolescent girls and young women as well as key populations such as gay men and other men who have sex with men, sex workers, transgender people and people who use drugs.
One-third or 34 percent of new HIV infections last year were among Caribbean young people aged 15 – 24. There were twice as many infections among young women (23 percent) as compared to their male peers (11 percent).
The report notes that during the disruptions of the last few years, key populations in the Region have been particularly affected.
As of the end of 2021, an estimated 84 percent of People Living with HIV in the Caribbean were aware of their status. Eighty-three percent of all diagnosed people were on treatment. Of these, 87 percent were virally suppressed last year. The target for 2025 is 95 percent for each of these result areas.
At present, the Caribbean is below the global averages for both HIV treatment coverage and viral suppression.
The report recommends that Caribbean countries implement policies that remove structural barriers to HIV services and repeal laws and policies that criminalize people living with and at risk of HIV.
Finally, deliberate action is required to ensure sufficient and sustainable funding for the Caribbean HIV response.
Image: Ms Luisa Cabal, UNAIDS Director Latin America and Caribbean Regional Support Team
The PANCAP Coordinating Unit and the Pan American Health Organisation (PAHO) have developed a Pre-exposure Prophylaxis (PrEP) knowledge suite available on the PANCAP website. The suite comprises digital posters for Social Media, Information, Education and Communication (IEC) materials, including digital brochures, clinical guidelines for PrEP and nPeP, PrEP registry, monitoring tools and capacity-building materials, including training videos.
The resource was developed to support countries in setting up services for PrEP and nPeP with emphasis on key populations. The package will allow for the standardisation of the services in the Region and data collection to support region-wide analysis for evidence-based decision-making.
Mr Timothy Austin, Senior Project Officer, Communications, PANCAP Coordinating Unit, explained that the IEC materials were developed based on input and feedback from a virtual focus group earlier this year. The focus group consisted of civil society representatives, key populations, technical staff from the National AIDS Programme Secretariat in Guyana, and technical staff from PANCAP and PAHO. He highlighted that the social media visuals and digital brochures contain essential PrEP information and detailed explanations on who should use PrEP, its effectiveness and its side effects.
Ms Sandra Jones, Advisor, HIV/STI, TB & Viral Hepatitis, PAHO/WHO – Subregional Program Coordination, Caribbean, emphasised that NAPS and CSOs can utilise the IEC materials to create demand for PrEP. She explained that the clinical guidelines and other tools would support the delivery of a comprehensive package of services that will facilitate a combination approach to HIV prevention.
Technical guidelines available in the suite also offer comprehensive information on procedures for initiating PrEP (first visit), a checklist for counselling clients and a list of medications that interact with PrEP, among others.
The PrEP Suite forms part of the initiatives under the current Global Fund project, with the technical guidance and support of PAHO. The overarching goal is to provide the necessary guidance and tools to support countries establishing and strengthening services for key populations.
PANCAP, with technical support from the Jamaica AIDS Support for Life (JASL), will facilitate a “Training of Trainers on the use of Oral Pre-exposure Prophylaxis (PrEP) for the prevention of HIV, 16 – 18 August 2022 in the Republic of Trinidad and Tobago.
The capacity-building activity is designed for health care providers working at the community and facility level to equip them with knowledge about PrEP as an additional tool for prevention. The course will sharpen their skills in negotiating tailored prevention plans for their respective beneficiaries.
In addition, the training activity will provide basic PrEP information and employ participatory activities to allow participants to effectively promote/support PrEP as another prevention strategy for some of their clients. For medical practitioners, the training will provide guidance on how to administer, monitor and manage PrEP.
The training is supported by the United States Agency for International Development (USAID) and facilitated by JASL trainers with capacities across clinical aspects of PrEP services and administration, understanding referrals and linkages approach to PrEP, communication, messaging, monitoring and evaluation.
The capacity building is happening several weeks after the launch of the PANCAP PrEP Knowledge Suite, developed with technical support from PAHO for use by National AIDS Programmes, civil society organisations, and other stakeholders involved in HIV programme implementation for capacity building and community health promotion activities on PrEP.
On 17 May 2022, the World Bank released a White Paper with a proposal to create a Financial Intermediary Fund (FIF) for Pandemic Prevention, Preparedness, and Response. For some, the idea of creating a new global fund for pandemics was only a matter of time, not unexpected and even anticipated given that the world has lost trillions of dollars due to the COVID-19 pandemic and no-one would want to go through a similar situation in the near or intermediate future.
The pandemic is not over. While the world’s predominant Omicron variant and its different sublineages do not seem to be as devastating in terms of deaths, it continues to cause tens of thousands of infections almost daily around the world. This raises the burden of disease and causes labor disabilities, flight delays or cancellations, supply chain interruptions, and other serious disruptions to society. Furthermore, the high inflation that is currently being experienced worldwide and the risk of a global recession have not only been exacerbated by the Russian invasion of Ukraine but are symptomatic of economic phenomena already being driven by the impact of the pandemic.
The Global Fund was too slow to act
Last year, when the Global Fund Board discussed its new 2023-2028 Strategy, several of us sent letters to Board members and made our position known: that the Global Fund should expand its mandate beyond the three diseases so it could explicitly incorporate prevention, preparedness and response to COVID-19 and other potential pandemics. Given that we saw the risk that a new type of Global Fund would have to be created for that purpose, we advocated for these functions to be incorporated into the work that is already being successfully performed by the Global Fund.
Unfortunately, the expansion of the mandate was not explicitly authorized.
Yet if nothing else, COVID-19 has shown us that the world was ill-prepared to deal with a global pandemic of this nature and that existing modalities were not fit for purpose and would need to be severely overhauled to deal with any such future threats.
At that time, and to some extent still remaining, there was a lot of controversy regarding the placement of pandemic preparedness and response (PPR) within the new Global Fund Strategy, with many fearing that its inclusion would detract from attention to HIV, TB and malaria. This has undoubtedly impacted on the decision not to given PPR the same weight as the three diseases and health system strengthening in the new Global Fund Strategy 2023-2028.
It is hardly surprising, therefore, that someone else has stepped in to take up the challenge of addressing global prevention, preparedness and response to future pandemics.
Upping the competition for scarce financial resources
The World Bank’s new proposal to create the FIF has started to compete for the same international resources for global health. However, while the Global Fund model is inspired by a bottom-up approach to develop and create responses through partnerships, the World Bank model appears to adopt a top-down approach, in that a group of intellectuals have generated a model whereby donors define the flow of resources with decision-makers at the top deciding how to help poor people at the base. This is best described as a paternalistic or colonialist model and is a step backwards.
The model proposed by the World Bank seems to be inspired by organizational models from the last century. In this model, only the member states have a voice and a vote: the donors are at the top of the pyramid and the countries, which are called beneficiaries, are at the bottom. Under the proposed FIF, the implementers would be the World Bank itself, WHO, other United Nations (UN) agencies, the Regional Development Banks (RDBs), and a potential space for others defined as “etcetera” in the original White Paper.
How do the two models differ?
We can see the main components of both models below.
Table 1. A comparison of the Global Fund and World Bank implementing models
Global Fund
Financial Intermediary Fund
Model at Inception
Bottom-up
Top-down
Decision-making
Through partnerships
Pyramidal decision making,top to bottom
Country defined as
Country Coordinating Mechanisms (CCM) comprising governments plus relevant stakeholders
Member-States (governments)
Implementers
Eligible developing countries
RDBs, UN Agencies, World Bank, and WHO
Beneficiaries
People and communities from eligible countries
All developing countries
Civil society, communities, private sector and private foundations
Role as partners from CCMs to the Board levels
Civil society is considered to be an observer and participate as such, while the private sector is still undefined
Allocations
Grants to eligible countries
Grants and potentially loans and/or bonds to all interested developing countries
Funding
Replenishment cycles every three years
Replenishment processes are being considered
Disease focus
HIV, TB, malaria, health system strengthening, and human rights barriers associated with the three diseases, plus COVID-19 -related responses
COVID-19 and other future pandemic prevention, preparedness, and response
Governance and accountability issues
Of course, the elements listed in this table are not the only components that can be compared, there are other elements that should also be considered. For example, the track record in transparency: the mechanisms for allocating Global Fund grants are explicit and based on epidemiology and the capacity to pay indicators of each country and the country proposal is prepared and endorsed not only by the government but also by all non-governmental entities represented on the country’s CCM. In the case of the World Bank, as is the case with almost all multilateral organizations created after World War II (e.g., the World Bank, the International Monetary Fund and other Bretton Woods institutions, WHO and most UN agencies), its mandate is to negotiate only with member states. And the results of those negotiations are only made public once they are completed and the agreement has been signed. Transparency was not exactly one of the most cherished values of the last century, as it is in the current 21st century.
From another perspective, the Global Fund itself is a financial intermediary fund which temporarily receives resources from donors that are finally assigned to implementers in eligible countries. Creating a new FIF would be an unnecessary bureaucratic duplication that is based on a model that is less inclusive and potentially less impactful for countries and communities.
The reaction from stakeholders
Following the publication of the White Paper, interested parties were offered the opportunity to respond with written feedback to be received by 1 June 2022. Many of these comments from interested stakeholders – including civil society, academics, and other non-government representatives or entities – expressed concern that the Global Fund was not included in the proposed process. As a reaction to these comments, the newspaper Politico has reported that the Coalition for Epidemic Preparedness Innovations (CEPI), Gavi, the Vaccine Alliance, and the Global Fund have now been included as potential FIF fund recipients.
Communities, civil society and non-state actors are excluded
But is this the solution? That the Global Fund becomes a FIF recipient? Competing for FIF resources with the World Bank itself, not to mention against RDBs, other UN agencies, and WHO? Perhaps the World Bank is still not very clear about how it wants to operate the FIF: it has called on civil society and non-state actors to listen to their ideas and potentially invite them as observers, but not to sit down at the table together to make decisions jointly, at the same level as member states. This is because – according to the top-down model – they are not equal and there are hierarchies to be observed.
The fact that the World Bank is still unclear on exactly how to operate the FIF, and assuming that its creation is inevitable and will possibly be endorsed by the majority of the G20 countries, does not mean that we cannot continue to question its existence. The RDBs, UN agencies, World Bank and WHO cannot and should not be implementers, as set out in the FIF White Paper. The implementers must be the countries themselves, whether it be through governments, the private sector, civil society, and/or communities based in those countries. The role of WHO and other agencies in the UN system should be one of technical collaboration and technical partnership, but not as implementers or financial intermediaries; on the other hand, both the RDBs and the World Bank have been and must continue to be financial intermediaries.
The implications for the Global Fund
While the World Bank clearly defines exactly how the FIF will operate, one thing is obvious and must happen. The Global Fund Board, its respective Committees’ members and the Secretariat need to continue the discussion on how the Global Fund should prepare and adapt/reform itself to continue to be the most relevant actor in the global financing of prevention, preparedness and response to future and existing pandemics.
Through experience gained over the past twenty years, the Global Fund has amply demonstrated how to respond to pandemics: not only what works best but how countries can be motivated to co-invest with domestic resources so that the best possible results can be obtained. Its partnership model includes not just three diseases of pandemic dimensions, but also health and community systems strengthening within the context of a human rights and gender framework. Additionally, during these past two years the Global Fund has also shown how to respond swiftly and decisively to a fourth pandemic, allocating more than $4 billion to help developing countries fight COVID-19 through the COVID-19 Response Mechanism (C19RM) ¾ see Article 4 in this issue of the GFO, on the Office of the Inspector General‘s Audit of C19RM.
The Global Fund has shown flexibility in the past and demonstrated its ability to be nimble, and if its internal decisions impose barriers to be more effective, in doing so it reforms itself and adapts to new realities. This is reflected in differentiated funding modalities, policies for countries facing challenging operating environments or for ineligible countries in crisis, etc. In 2010, faced with a critical situation for the successful continuation of the financing of the Global Fund, its Board approved the creation of a comprehensive reform working group, whose proposed and subsequently approved plan allowed the Global Fund to quickly adapt to a new financial reality and continue developing what it knew how to do best: invest to save millions of lives.
*Jorge Saavedra is a medical doctor from Mexico, with masters’ degrees in Public Health and Health Policy & Management. He has been the Director General of Mexico’s National HIV Program and is currently President of the AIDS Healthcare Foundation (AHF) Mexico and Executive Director of the AHF Global Public Health Institute at the University of Miami. Has been a member of the Global Fund’s Latin American and Caribbean Constituency and is still a member of the Developing Country NGO Constituency on the Board.
He would like to thank Guilherme Ferrari Faviero for his edits and suggestions.
Under the Multi-country Global Fund (GF) Grant Project for the Caribbean, three (3) additional countries, Antigua and Barbuda, Belize and Guyana, have advanced with the implementation of Pre-exposure Prophylaxis (PrEP). Technical support for the advancement of these countries to implement this high impact prevention service was provided by the Pan American Health Organisation (PAHO) and PANCAP. Barbados, a recipient under the grant, has provided support to the three (3) countries by transferring knowledge and experience over the years. Approximately seven (7) countries in the Caribbean are currently implementing PrEP as opposed to two (Barbados and Bahamas) in 2019, all at different levels of implementation.
Under the current Global Fund project, with the technical guidance and support of PAHO, a comprehensive PrEP guidance package was developed to support countries in initiating PrEP services. The purpose of the package is to facilitate the standardization of the services, data collection, and monitoring across the Region. In addition, the package includes generic clinical guidelines (based on recommendations from World Health Organisation – WHO guidelines) for PrEP and nPeP for key populations, clinical intake forms, social media products, brochures, PrEP registration, monitoring and training tools.
To further strengthen PrEP implementation in the Region and with the technical support of PAHO, PANCAP is collaborating with Callen-Lorde, a Global leader in Key Population health care in the United States. The partnership will support in-country capacity building to generate demand for PrEP and skills critical to providing quality PrEP services to key populations.
Due to the pandemic, onsite, in-person capacity building in New York was not possible. However, the collaboration will move forward with country visits by experts from Callen -Lorde to strengthen the national services based on the specific needs and concerns of the Member States mentioned above.
In May, a virtual planning session was held with the team from Callen-Lorde, PAHO, PANCAP and national teams from the individual countries to determine the level of implementation and technical expertise critical to strengthening PrEP services.
Mr Collin Kirton, Officer-in-Charge, PANCAP, lauded the collaboration, “This initiative with Callen-Lorde is building on ongoing work which commenced with the support of PAHO in 2018. Callen-Lorde brings many years of programme implementation and clinical experience to this initiative and our Region. I am pleased that Callen-Lorde will support your technical assistance needs and urge you to clearly define these so that the technical assistance is intentional, targeted and will be most useful in advancing PrEP programmes in our Region”.
The Caribbean Regional Network of People Living with HIV/AIDS (CRN+) facilitated a virtual election for new directors to serve on its board. The election was held on 28 January 2022.
Mr William Moultrie III was elected the new Chair, Mr Ricky Pascoe, Vice-Chair; Ms Renatta Langlais, Secretary, Ms Christel Charles, Treasurer, Mr Marten Colom, Assistant Secretary, Mr Kenny White, Assistant Treasurer and Ms Diana Weekes, Board Member.
With the installation of a new Board of Directors, CRN+ plans to focus on advocacy for People Living with HIV (PLHIV) across the Region. The mandate of the new board includes increasing representation for PLHIV and further establishing CRN+ as “the authentic voice” for and on behalf of PLHIV.
Mr Moultrie III expressed his satisfaction with the new board, stating, “now is the time to change how we operate. We need to act more, and we need to be inclusive; we need to unite PLHIV. These are the critical keys for our success.”
Several Caribbean countries have graduated to middle-income status over the past ten (10) years, and more are transitioning out of eligibility for external funding from traditional donors. This has increased the burden on countries to fund and manage their priority health programmes without external support. Further, the economic impact of COVID-19 has put increased burden on countries where the expertise of HIV programmes has been leveraged but without budgetary increases.
Civil Society Organisations (CSOs) and Community-Based Organisations (CBOs) have been critical players in their national HIV responses, providing expertise for efficient service delivery and deeper penetration into general, key and vulnerable populations. External donors have traditionally supported these non-government entities; hence CSOs will be significantly impacted by the decrease in funding. This risk of losing the gains made over the past decades would further isolate the key and vulnerable communities.
Social contracting has been proposed for several years as a viable option to sustain the critical work by CSOs and CBOs in their country’s HIV response.
In early 2021 the CARICOM Secretariat, via PANCAP, advanced this mechanism by developing a tool kit to guide countries on the process should they consider social contracting a viable option. Later in 2021, PANCAP examined seven (7) countries to determine if they already had a funding mechanism to support non-government players or were interested in establishing or strengthening social contracting as a financing option. The latter would be a mechanism by which governments would finance programmes, interventions and other activities implemented by CSOs to respond to HIV and AIDS through a public tender.
Barbados, Guyana and Jamaica have already commenced implementation or have decided to pilot social contracting. However, other countries were identified as being near ready to advance should 1) the appropriate advocacy be provided and 2) domestic funding be identified. Antigua and Barbuda was one such country.
The AIDS Secretariat, Antigua and Barbuda, convened a workshop in March with critical CSOs to increase their understanding of social contracting and its benefits. This was followed by individual in-person organisation meetings to explore their capacity and interest in receiving public resources. Sessions were then held with senior government gatekeepers, including the Ministry of Health Wellness and Environment and the Ministry of Finance, to identify procurement processes, a potential package of services, and gaps in targets.
Weeks of hard work culminated on 31 March 2022, when discussions were held between CARICOM-PANCAP and the Ministry of Health, Wellness and the Environment in Antigua and Barbuda on social contracting. Honourable Molwyn Morgorson Joseph, Minister of Health, Wellness and the Environment, indicated his strong support for the tremendous work of the National AIDS Secretariat and the work of CSOs in reaching key populations. He also expressed his confidence in social contracting being a valuable tool to support Antigua and Barbuda’s national response.
Minister Joseph intends to meet with CSO partners to recognise their work and has reached out to CARICOM for additional support in developing the critical programme documents and government submissions to start a pilot in the next fiscal year, 2023-2024. Antigua and Barbuda would be the first country in the Organisation of Eastern Caribbean States (OECS) to implement social contracting.
Image:Office of the Minister of Health, Wellness and the Environment, Antigua and Barbuda (left to right): Ms Ena Henry, Permanent Secretary, Ms Sandra McLeish PANCAP Consultant; Honourable Molwyn Morgorson Joseph, Minister of Health, Wellness and the Environment; Dr Rhonda Sealy-Thomas, Chief Medical Officer and Ms Delcora Williams, AIDS Programme Manager.
