New Team Lead and Senior Advisor appointed to UNAIDS Caribbean Sub-Regional Office

The Partnership extends a warm welcome to Mr. James M. Guwani, recently appointed Team Lead and Senior Advisor at the UNAIDS Caribbean Sub-Regional Office, based in Kingston, Jamaica. He will be responsible for leading the Sub-regional Team and overseeing support for the implementation of the Sub-Regional Programmes and working closely with UNAIDS Country Offices in the Region to strengthen national and partner capacities for fast-tracking the AIDS response.

Mr. Guwani recently joined the Caribbean Sub-regional Team, effective 1 August 2018, from the UNAIDS Regional Support Team for Eastern and Southern Africa (UNAIDS RST ESA) based in Johannesburg, where he served as Regional Strategic Information Advisor and later Regional Programme Advisor.

He has been with UNAIDS since 2004 and has served as the Global Monitoring and Evaluation (M&E) Capacity Building Coordinator in Geneva, M&E Advisor in Uganda, Zambia, Guyana and Suriname, and the M&E Technical Advisor to Barbados. Prior to joining UNAIDS, James worked as a Monitoring and Evaluation Specialist at the Centres for Disease Control and Prevention (CDC) in the US. Before joining the CDC, he worked with the American Red Cross in Washington DC, as the Senior Program Evaluator for the Red Cross HIV and AIDS Education and Prevention Programs. He has a Doctorate in Medical Epidemiology from The Pennsylvania State University. Prior to attending Penn State, he received a joint MPH and International Development Studies Degree from Ohio University.

The Partnership anticipates a fruitful collaboration with Mr. Guwani at this critical stage of the Region’s HIV response. 

SCLAN receives grant funding for key initiatives 

The Spouses of CARICOM Leaders Action Network (SCLAN) received grant funding from Gilead Sciences Inc. for initiatives under the theme “Transforming Lives through Innovation: Implementation of high-impact prevention programs for adolescents, young men and women”.  The image depicts Mrs. Kim Simplis Barrow, First Lady of Belize and a representative of Gilead Sciences Inc during the presentation of the grant.

Faith leaders play a vital role in sustaining achievements of the health sector – Minister Karen Cummings, Guyana

Image: Hon. Dr Karen Cummings, Minister within the Ministry of Public Health, Guyana  

Participants of the Guyana National Faith Leaders Consultation in August, including faith leaders and leaders of key populations, were privileged to hear from Hon. Dr Karen Cummings, MP, Minister within the Ministry of Public Health, Guyana.

While Minister Cummings reflected on the progress made in the region’s HIV response, including the seven Caribbean territories being validated for the elimination of mother-to-child transmission of HIV and syphilis, she spoke of some “hard truths” regarding the challenges related to the response.

Minister Cummings warned that stigma and discrimination threaten the laudable gains made and can be considered a primary barrier to vulnerable populations accessing HIV prevention and other health care services.

“From fears of contagion to negative social judgment, many persons in society often unwittingly engage in and encourage varying degrees of stigma and discrimination against persons living with HIV,” stated the Minister.

Tackling stigma is key to HIV prevention

Minister Cummings further reflected on the early history of the epidemic when the late Jonathan Mann, former Head of the World Health Organization’s Global Programme on AIDS, had identified AIDS-related stigma and discrimination as a third epidemic following the accelerated spread of HIV infection and the visible rise in AIDS cases.

Minister posited that Mann recognized that stigma, discrimination, blame, and denial are potentially the most difficult aspects of HIV to address. However, she affirmed that tackling the factors that were outlined by Mann continues to be the key to preventing HIV transmission and mitigating the impact of the disease on individuals, families, and communities.

Minister Cummings noted that since its detection in 1983, HIV has been associated with aspects of religion such as “moral failings” and “sinful behaviour”. She underscored that this was a misguided view, stating, “We need to recognize, acknowledge and embrace all people, regardless of their beliefs, political persuasion, and sexual orientation.”

The Public Health Minister said that an essential part of the Fast Track Initiative to end AIDS is the inclusion of key populations who are being left behind in the HIV response. This mainly occurs, the Minister noted, because of stigma and discrimination, which severely impact negatively on vulnerable groups who hesitate to be tested because of fear.  These persons are ultimately left untreated.

“As healthcare providers responsible for the health and wellbeing of our fellow human beings, we cannot be blinded by prejudice and insular judgment. If we are truly committed and determined to take the fight to end AIDS, then we must demonstrate that resolve by working with persons with HIV, including the key population component,” Minister Cummings emphasized.

Faith leaders are integral to the response

Addressing the participants of the consultation, Minister Cummings highlighted that religious leaders play a vital role in helping to further the achievements of the health sector.  “Through your perspective, you have expanded programmes in partnership with the Ministry of Public Health. Further, you have support from international funding to help track the epidemic in a multi-sectoral, multi-level, multi-dimensional effort that simultaneously reduces stigma, shame, denial, discrimination, inaction, and misinformation still attached to HIV.”

Minister recommended that faith leaders intensify their efforts to support public health initiatives by promoting the SAVE model – Safe practices, available medicines, voluntary testing and empowerment through education – at the individual, family, local, community and national level.

She challenged Guyana’s faith community to work closer with the public health sector on removing barriers of stigma and discrimination and underscored that partnership and collaboration are integral to achieving the 2030 goal of ending AIDS.

Health Finance and Governance project helping to improve understanding of national funding and spending on health

Guyana has achieved significant progress in funding the national response to HIV but faces challenges related to scaling up of Treat All in an environment of declining donor funding. The USAID-funded Health Finance and Governance (HFG) project, in collaboration with PAHO/WHO, has supported a National Health Accounts (NHA) estimation exercise in Guyana to improve understanding of national funding and spending on health. A National Health Accounts dissemination meeting was held in Georgetown on 3 August, at which it was revealed that the Government’s share of HIV spending increased from 25 percent in 2015 to 64 percent in 2016, indicating increasing domestic resource mobilization for HIV.

Guyana’s Health Accounts will play an important role in the country’s health policy and future decision making for health expenditures. Ms. Julia Henn, Director of Health and HIV/AIDS Office, USAID/Eastern and Southern Caribbean, described the National Health Accounts as a “goldmine of information for policymakers.” One key recommendation is for Guyana to better leverage the private sector in order to diversify domestic funding sources for health and HIV. According to Mr. Tesfaye Dereje, Senior Health Finance Specialist of the HFG project, “Guyana is off to a great start.”

Faith leaders play a vital role in sustaining achievements of the health sector – Minister Karen Cummings, Guyana

Participants of the Guyana National Faith Leaders Consultation in August, including faith leaders and leaders of key populations, were privileged to hear from Hon. Dr Karen Cummings, MP, Minister within the Ministry of Public Health, Guyana.

While Minister Cummings reflected on the progress made in the region’s HIV response, including the seven Caribbean territories being validated for the elimination of mother-to-child transmission of HIV and syphilis, she spoke of some “hard truths” regarding the challenges related to the response.

Minister Cummings warned that stigma and discrimination threaten the laudable gains made and can be considered a primary barrier to vulnerable populations accessing HIV prevention and other health care services.

“From fears of contagion to negative social judgment, many persons in society often unwittingly engage in and encourage varying degrees of stigma and discrimination against persons living with HIV,” stated the Minister.

Tackling stigma is key to HIV prevention

Minister Cummings further reflected on the early history of the epidemic when the late Jonathan Mann, former Head of the World Health Organization’s Global Programme on AIDS, had identified AIDS-related stigma and discrimination as a third epidemic following the accelerated spread of HIV infection and the visible rise in AIDS cases.

Minister posited that Mann recognized that stigma, discrimination, blame, and denial are potentially the most difficult aspects of HIV to address. However, she affirmed that tackling the factors that were outlined by Mann continues to be the key to preventing HIV transmission and mitigating the impact of the disease on individuals, families, and communities.

Minister Cummings noted that since its detection in 1983, HIV has been associated with aspects of religion such as “moral failings” and “sinful behaviour”. She underscored that this was a misguided view, stating, “We need to recognize, acknowledge and embrace all people, regardless of their beliefs, political persuasion, and sexual orientation.”

The Public Health Minister said that an essential part of the Fast Track Initiative to end AIDS is the inclusion of key populations who are being left behind in the HIV response. This mainly occurs, the Minister noted, because of stigma and discrimination, which severely impact negatively on vulnerable groups who hesitate to be tested because of fear.  These persons are ultimately left untreated.

“As healthcare providers responsible for the health and wellbeing of our fellow human beings, we cannot be blinded by prejudice and insular judgment. If we are truly committed and determined to take the fight to end AIDS, then we must demonstrate that resolve by working with persons with HIV, including the key population component,” Minister Cummings emphasized.

Faith leaders are integral to the response

Addressing the participants of the consultation, Minister Cummings highlighted that religious leaders play a vital role in helping to further the achievements of the health sector.  “Through your perspective, you have expanded programmes in partnership with the Ministry of Public Health. Further, you have support from international funding to help track the epidemic in a multi-sectoral, multi-level, multi-dimensional effort that simultaneously reduces stigma, shame, denial, discrimination, inaction, and misinformation still attached to HIV.”

Minister recommended that faith leaders intensify their efforts to support public health initiatives by promoting the SAVE model – Safe practices, available medicines, voluntary testing and empowerment through education – at the individual, family, local, community and national level.

She challenged Guyana’s faith community to work closer with the public health sector on removing barriers of stigma and discrimination and underscored that partnership and collaboration are integral to achieving the 2030 goal of ending AIDS.

Caribbean Regional Network of People Living with HIV and AIDS (CRN+) convened 17th Bi-Annual General Meeting

Image: The New CRN+ Board of Directors 

The Caribbean Regional Network of People Living with HIV/AIDS (CRN+) convened its Bi-Annual General Meeting on 3 – 4 July 2018 in Port-of-Spain, Republic of Trinidad and Tobago; the first AGM held in four years. Thirty members from across 20 affiliate networks attended.  The meeting agreed on the membership of a new Board of Directors, which will serve from 3 July 2018 to 2 July 2020.

Mr Winfield Tannis-Abbott was elected Chair, Mr Tyrone Ellis, Vice Chair, Ms Tamara Felicien, Secretary, Mr Purnell Christian-Thomas, Treasurer, Ms Deneen Moore, Assistant Secretary-Treasurer, Ms Kerlin Charles, Board Member, and Ms Diana Weekes, Committee Member.

The goal of the AGM was to establish the strategic direction for the new CRN+ Board of Directors and affiliate networks of People Living with HIV (PLHIV).  The meeting also provided an update on the work plan implementation executed in the previous period and allowed members to reflect on progress in 2017 and the first half of 2018.

“Cross-dressing” Case Raises Deep Issues of Human Rights and Social Justice for Region

By Joel Simpson, Managing Director, SASOD 

On Thursday, June 28, 2018, a five-member panel of the Caribbean Court of Justice (CCJ), chaired by Justice Adrian Saunders, President, held a hearing in the appeal by Angel (Seon) Clarke, Gulliver (Quincy) McEwan, Peaches (Joseph) Fraser and Isabella (Seyon) Persaud, at the CCJ’s headquarters in Port of Spain, Republic of Trinidad and Tobago.

Click here for the audio recording of the hearing.

In February 2009, four transgender women were convicted for the offence of being “a man” appearing in female attire in a “public place” for an “improper purpose.” This offence falls under the 1893 Summary Jurisdiction (Offences) Act section 153(1) (xlvii) and, in its application, disproportionately targets Trans women. Labeling the law “hopelessly vague,” and constitutionally invalid, the litigants argued that the offence infringes on their rights to due process, freedom of expression and non-discrimination and equality. The litigants further argued that the law is not formulated with enough precision and clarity to allow the ordinary person to regulate their conduct.

It is important to note that “man” under this summary offence has been treated by state officials as including persons whose birth certificates describe them as “male” at birth and who identify as transgender persons or Trans women. However, there is growing acceptance and respectful treatment of persons whose gender identity does not correspond with the gender marker on their birth certificate.

It is a common and respectful practice to refer to a transgender person in a manner that is consistent with the gender that matches the individual’s identity, which in this case is female.

The four litigants, who were all present at the CCJ hearing on June 28, were represented by attorneys-at-law Douglas Mendes, S.C. (Republic of Trinidad and Tobago), lead counsel, C.A. Nigel Hughes (Guyana), Mishka Puran (Guyana), Clay Hackett (Trinidad and Tobago) and Isat Buchanan (Jamaica). Solicitor General Kim Kyte-Thomas, Kamal Ramkarran, and Selwyn Peiters represented the State.

In addition to the four litigants, over twenty representatives from civil society organizations and universities were present to observe the proceedings. Civil society organizations (CSOs) present included the Society Against Sexual Orientation Discrimination (SASOD), one of the original litigants in this case, Guyana Trans United (GTU), Guyana Rainbow Foundation (GuyBow), Promoting Empowerment Through Awareness For Les/Bi Women (PETAL) from Belize and the Alliance for Justice and Diversity (ADJ), which is a coalition of seven organisations in Trinidad and Tobago. The Faculty of Law The University of the West Indies Rights Advocacy Project (U-RAP) was also present.

Ifasina Efunyemi, an educator and representative from PETAL Belize, said, “Even though this was a case coming out of Guyana, it involves issues that are relevant to the LGBT community, and other social justice movements, throughout the region.” In a public forum held in the evening of 28 June at the City Hall in Port of Spain, hosted by Trinidad and Tobago’s AJD, on “Administrative Violence and Structural Inequality,” panellist David Abdulah, leader of the Movement for Social Justice, commented on the intersections of social justice claims.

The well-known labour rights leader said that “You cannot be fighting for workers’ rights and then discriminate between one worker and another.” Highlighting the need to recognize difference and diversity, the Very Reverend Shelley-Ann Tenia, Dean of the Holy Trinity Cathedral, also a panellist at the evening forum said, “There is space for us, even if we are different.”

One of the major hurdles for the appellants in their challenge to the 125-year-old law was the existence of a savings law clause in the Constitution that made it harder to use the Guyana Constitution to question laws in force before the 1980 Constitution. However, the ground-breaking decision of the CCJ on Wednesday 27 June, in the case of Nervais and Severin vs. AG of Barbados, provides an interpretation of savings law clauses that significantly limits their negative impact in cases challenging colonial laws. The CCJ declared that the mandatory death penalty in Barbados was unconstitutional and that the general savings law clause was not a barrier to that declaration.

Substantively, both sides appeared to agree that dress consistent with one’s gender identity, even if that identity is different from the gender assigned at birth, was wholly legal.

As a result, the focus of the hearing became the element of an “improper purpose.” Mendes SC in his presentation argued that criminalizing just thought—an “improper purpose”—was impermissible. He also highlighted that no offence was committed if a “man” was dressed in “male attire” for an “improper purpose;” likewise if a “woman” was dressed in “female attire” for an “improper purpose.”

At AJD’s public forum of 28 June, panellist and Managing Director of the Lloyd Best Institute of the West Indies, Sunity Maharaj, said that, “To one degree or another, people of the Caribbean have been living lives of improper purpose,” making reference to histories of resistance and struggle in response to colonial oppression.

Much of the discussion earlier that day between the CCJ judges and the attorneys focused on whether the term “improper purpose” was sufficiently certain to allow persons to know what was being prohibited. In his comments and questions, Justice Wit emphasized that the test must be based not on legal experts as the standard, but ordinary citizens and charges should stem from crimes and not one’s manner of dress.

Mendes SC strenuously argued that those applying the law specifically targeted the appellants as Trans women. The State suggested that any arbitrary and discriminatory enforcement of this law could be addressed through appeals and applications for judicial review. During the hearing, President Saunders commented that transgender persons who are not of great means or social influence might lack meaningful access to these procedures and thereby be at risk if the law is not sufficiently certain. Justice Wit gave the example of a rich person and a poor person, both of whom in principle could reserve a room at the Waldorf Astoria Hotel, but of course, in real terms, this hotel was entirely out-of-reach to the poor person because of lack of means.

It is important to recognize the experiences and efforts of the four transgender women leading this litigation over the past eight years.

Being a part of an extremely marginalized community, they have faced significant barriers to legal representation and accessing justice due to various contributing factors such as poverty and discrimination. While they were successful in accessing partnerships and resources to help further their challenge of the law, the larger community of Transgender persons still face many of these barriers. This litigation is an important step towards a more progressive and accepting society but we should remain cognizant of the everyday realities of those who are still marginalized due to their identities.

The CCJ has reserved judgment in this appeal. If the CCJ finds for the appellants, it can declare that the summary offence in section 153(1) (xlii) is inconsistent with the Constitution and therefore null and void. Alternatively, the CCJ may seek to modify the offence to bring it in conformity with the Guyana Constitution. The written decision in the McEwan appeal could be delivered during the remainder of 2018 or the first half of 2019, based on CCJ’s practice in other cases.

HFG project supporting 3 Caribbean countries to produce first-ever Health Accounts

Image: Health Accounts technical team members trained in Guyana, June 2017.

The USAID-funded Health Finance and Governance (HFG) project has been supporting three countries in the Caribbean region to produce their first ever Health Accounts. This support will enable the Republic of Trinidad and Tobago, Guyana and Suriname to understand how the health sector is financed, to plan for future financing needs and to benchmark their health financing performance with peer countries. In addition, health spending for specific diseases such as HIV will be analyzed. This will help the governments to plan for domestic financing for HIV in the context of decreasing donor funding and to ensure more efficient allocation of those funds.

The Health Accounts are being produced using the internationally-recognized framework of the System of Health Accounts 2011 and will provide analysis on the sources of health spending, as well as how health spending is distributed to different health providers, goods and services and diseases or conditions. All three Health Accounts are expected to be completed by the end of September 2018. HFG is also supporting Barbados to update their 2012/13 Health Accounts for an updated analysis of spending for fiscal year 2016/17, using a new approach to analyze health spending in a quick and cost-effective way to respond to health ministries’ needs.

HFG is working with multiple partners to institutionalize Health Accounts in these countries, including UNDP in Trinidad and Tobago and PAHO in Guyana and Suriname, as well as co-producing the Health Accounts in Trinidad and Tobago with The University of West Indies’ Health Economics Unit. HFG’s support will help ensure that the University can be a source of technical support for Health Accounts for the region in the future. Health Accounts results have already been used by countries in the Caribbean to increase government allocation to health (e.g. in Saint Kitts and Nevis) and to introduce taxes on sugary foods and drinks (e.g. in Barbados and Dominica). HFG-supported Health Accounts analysis with partner countries is one component of USAID’s programs designed to strengthen the sustainability of the HIV response in the region, including targeted prevention, care, and support for key populations and the achievement of countries’ commitment to 90-90-90 goals.

SCLAN creates alliances for health initiatives

Image:  (R-L) Spouse of the Prime Minister of Belize and Chair of SCLAN, Mrs. Kim Simplis Barrow, First Lady of Guyana and Vice Chair of SCLAN, H.E. Mrs. Sandra Granger,  Dr. David Walcott (Jamaica), Mrs. Elizabeth Murray (Gilead Sciences), Dr. Edward Greene (PANCAP) and Mr. Ramon Zertuce (Gilead)

Since the Launch of the Spouses of CARICOM Leaders Action Network (SCLAN) in Belize in September 2017 emphasis has been placed on establishing partnerships to advance the objectives of the Network. On June 26, 2018, a Dialogue between the Business Centre for International Understanding (BCIU) and Spouses of CARICOM Leaders Action Network (SCLAN) was held in the Grand Ballroom, Inter-Continental Barclay Hotel, New York. SCLAN was represented by Her Excellency Mrs. Kim Simplis Barrow, Spouse of the Prime Minister of Belize (Chair) and Her Excellency Mrs. Sandra Granger, First Lady of Guyana (Vice Chair). BCIU was represented by its President and CEO Mr Jirair Tichansky who chaired the Dialogue.

Also in attendance were members of Gilead Sciences Inc., including Mrs. Elizabeth Murray, Director of Latin America Access and Emerging Markets. Since the Network’s Inception in 2017, Gilead Sciences Inc. has committed to assist the First Ladies in building stronger collaborations to maximize synergies across the regions. Through their access programs, the company assists developing countries to address high incidences of HIV, including the elimination of mother-to-child transmission by offering HIV medications at substantially reduced prices.

The aim of the dialogue in New York City was to form alliances with the Business Centre in support of the four main pillars of the “Every Caribbean Woman Every Caribbean Child” Initiative for which SCLAN advocates. These include reducing adolescent pregnancies, violence against women and girls, cervical cancer and eliminating mother-to-child transmission of HIV. These pillars fall within the priorities of the PANCAP JFA Roadmap.

Other participants at the Dialogue also expressed support for SCLAN’s Programme. Among them were representatives from Chevron Corporation, Hess Corporation, AB INBEV Ltd, IHG, ORBIS, Henry Schein Inc., Rabin Martin, UNAIDS, PANCAP and a number of NGOs including AIDS for Life, Infiniti Partnership, Global Coalition of the Ageing, Thirty Steve East, Mount Sinai Medical System, UNIDOS EN RED and Physicians for Human Rights.

Dr Tedros Adhanom Ghebreyesus, WHO Director-General and his Team, also responded positively to the initiative and agreed to foster links with  SCLAN in the context of WHO’s 5-year Development Plan which includes the goals of achieving Universal Health Coverage and responding to the health challenges of climate change especially among the SIDS in the Caribbean and the Pacific.

Mrs Barrow in thanking the participants, said ‘this dialogue has opened the doors for worthwhile partnerships that would contribute to the viability of SCLAN in its efforts to make a difference in the lives of women, girls, and adolescents in the Caribbean.”

Caribbean voices from AIDS 2018

Laboratory and Quality Systems Specialist at the Caribbean Med Labs Foundation (CMLF), Ms. Wendy Kitson-Piggott attended the 22nd International AIDS Conference, 23 – 27 July, as a self-sponsored delegate.  The Trinidad-based microbiologist has participated in several of the International AIDS Conferences since 1992 after assuming the regional laboratory advisory function for the Special Programme on Sexually Transmitted Infections (SPSTI) at the Caribbean Epidemiology Centre (CAREC).  

Speaking to the editor of the PANCAP Newsletter, Wendy shared that her consistent attendance has been quite rewarding.  She highlighted that the discussions, decisions and advocacy shared at the global event have resulted in significant actions and responses in the Caribbean aimed at the prevention and control of the HIV epidemic. These have ranged from innovations in lab diagnostic technology, which improved timeliness and reliability to significant cost reductions and access to antiretroviral medication (ARVs).

Wendy believes that it is important for Caribbean professionals in related STI and HIV professions engaged in the response to make a personal effort to continue to participate and influence the ongoing debates about effective and relevant approaches to HIV control and prevention.

AIDS 2018 provided a vast landscape of activities, panel discussions and presentations on innovations in the Global HIV response.  However, it was important for Wendy to secure her spot at events that provided a wealth of knowledge on the continuum of care for the 90-90-90 Targets.  She attended sessions that presented new knowledge on innovative and cost-effective approaches to scaling up HIV testing including experiences with and effectiveness of self-testing across the globe, the future of CD4 and viral load testing and the continuing importance of timely testing and diagnosis of Opportunistic Infections (OIs) and Sexually Transmitted Infections (STIs).  She was also exposed to sessions on the acceptability and feasibility of ‘Treat all’ as well as Pre-exposure prophylaxis (PrEP) in resource-limited environments.

Wendy was also grateful for the experience since it provided critical updates for the role of laboratories in the HIV response.  There were sessions that provided critical data that can aid the Caribbean region’s ability to apply global experiences and evidence to review and improve current lab approaches, programmes and services that support the achievement of treatment cascade targets.

At the culmination of AIDS 2018, Wendy does not regret her investment in attending, she stated, “I look forward to the application of innovative, relevant and cost-effective strategies to expand and improve testing support across the region for every step in the treatment cascade. I hope that professionals from all of the relevant disciplines who attended this conference – lab, clinical, behavioural, economic etc. – return and aggressively and collectively advocate for the region to take ultimate responsibility for the sustainability of efforts and capacities if we are to end AIDS by 2030”.

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