Release Type: News Article

Editor’s note:

Large-scale implementation of Pre-Exposure Prophylaxis (PrEP) in the region continues to be a topic of much debate.  Below is a description of the implementation of a trial PrEP programme in the United Kingdom which offers a wealth of knowledge on how to gather evidence on PrEP implementation.  The editor of the PANCAP Newsletter wishes to thank Dr Jacqueline Wilthire-Gay, National AIDS Programme Manager, Barbados, for sharing this case study.

(United Kingdom) The National Health Service Commissioning Board (NHS England) announced in 2017 that pre-exposure prophylaxis (PrEP) will be available through the NHS as part of a three-year trial. This announcement came a year and a day after an historic win for NAT (National AIDS Trust) at the High Court that confirmed the NHS’s legal ability to fund the drug, which stops people from getting HIV.

The trial provided PrEP to a minimum of 10,000 participants. Eligible participants for the trial were able to access PrEP through sexual health clinics and included men, women, transgender people, and individuals with HIV positive partners whose viral load is not known to be controlled by HIV medication.

The medical effectiveness of the drug in preventing HIV infection is clear and well established. The NHS is using the trial to gather evidence on how to optimise uptake and implementation of a PrEP programme on a large scale.

Deborah Gold, chief executive at NAT (National AIDS Trust) said: “We already know that PrEP brings down rates of HIV infection, changing lives for those at risk and saving public money. We now need to work with NHS England, local authorities, and the sexual health sector to make sure the widest possible range of eligible people at high risk of HIV have access to the trial. We will continue to monitor the uptake of PrEP, aiming to learn as much as possible about how to get PrEP to all those who need it most.

“This is a pivotal moment in the fight against HIV. PrEP, if targeted properly at those in need and at high risk of HIV, offers the possibility of transforming the English HIV epidemic. From September, people at high risk of HIV will have access via the NHS in England to an empowering new tool that is truly individual controlled and not subject to negotiation with a partner, leading to the improvement of many, many lives. We warmly welcome this announcement.”

WHAT IS PREP?

Pre-Exposure Prophylaxis (PrEP) involves HIV negative people taking an antiretroviral drug to avoid getting HIV.
Multiple studies around the world have shown PrEP to be highly effective in reducing the risk of contracting HIV. The results of the PrOUD trial in England, released in 2015, prove that PrEP works and that concerns about it not working in a real-world setting were unfounded. Read more about the trial here: http://www.proud.mrc.ac.uk/

Most trials of PrEP and the US CDC Guidelines involve taking PrEP daily. A study in France, ANRS IPERGAY, has looked at the efficacy of PrEP when taken ‘on demand’, in other words not daily but only before and after sex. There was also significant preventive benefit shown in this trial.

Image: Advocacy Officer and spokesperson, JASL, Patrick Lalor

The Jamaica AIDS Support for Life (JASL) wants the Data Protection Act to make provisions to protect information on an individual’s sexual orientation and behaviour as well as sexual activities and attractions.

The group made the suggestion on Tuesday 27 March in its submission to the joint select committee of the Parliament of Jamaica reviewing the Data Protection Act.

The human rights organisation which has as its clients many of Jamaica’s vulnerable sexual groups, made five recommendations to the committee.

Among them, a deliberate effort in the wording of the Act to protect people’s health information, sexual orientation and HIV status.

Advocacy Officer and spokesperson for the group, Patrick Lalor said the Data Protection Act should protect information on people’s sexual orientation and HIV status.  He also wants the Bill to reflect prohibitions for insurance companies to require HIV tests to provide coverage, noting that it was easier for an individual who was hypertensive and had a pre-existing condition to get coverage, than for an HIV positive individual even as new medicines have emerged allowing people with the virus to live longer.

However, committee members Franklin Witter, Juliet Cuthbert Flynn and Julian Robinson disagreed with various aspects of the presentations.
Flynn said many individuals were denied policies with conditions other than HIV.

She said she was unable to get full coverage because of surgery done when she was 19 years old.

It was the view of most that insurance companies were driven by profits and were not keen on making payouts if it was determined that an individual’s pre-existing condition would cause early payout of massive sums.

Key submissions by Jamaica AIDS Support for Life for Data Protection Act:

*A more deliberate effort in the wording of the Act to protect people’s information
*Revisiting the definition of a minor
*A more equitable system of obligation placed on data controllers
*The inclusion of an oversight body for the Information Commissioner
*The broadening of the definition of consent to include informed consent (consenting based on
knowledge of what is required) and coerced consent (information given by coercion).

Image: Kandasi Levermore, Executive Director of the Jamaica AIDS Support for Life (JASL) 

Facing life in Jamaica in a harsh social context, transgender women have emerged as the group with the highest prevalence rate for HIV in the island.

A 2016 study found that just over four in every 10 transgender women in Jamaica, persons classified male at birth but who identify as female, have tested HIV-positive, and there are fears that the figure could be even higher as many are not regularly tested.

According to Kandasi Levermore, Executive Director of the Jamaica AIDS Support for Life (JASL), who contributed to the 2016 study, the HIV prevalence rate of more than 40 percent for transgender women is higher than the general population, sex workers, gay men and other men who have sex with men.

“It’s a matter that their risks are way higher. We look at the research that we have done and we found that women of trans experience are more likely to be infected with HIV than just a typical gay man,” said Levermore, who added:

“Their vulnerabilities are higher, the social context is harsher for these persons (but) you find that these persons are usually more educated, most of them finished secondary school. However, they do not get to transition into a job because they were born males they live as females, so it’s hard for them to get employment, and more than likely you find a number of them actively involved in sex work, so it complicates the vulnerability.”

Trans Population Growing

According to Levermore, the trans population in Jamaica is very present and growing in the sense that they are more visible, even though they are not living the way they would like.

“The truth is, based on what we are seeing, more of these subpopulation persons are not hiding. We are in the information age, things that used to be in the darkness are now coming out. It’s not something you can run from, it’s not a matter of if you are going to accept them, yes or no. They are here and they need their space.

“I can say that in the immediate stages when we were trying to put together the research we thought that, ‘Oh my God, we would not find 40 persons in Kingston, Montego Bay or St Ann to participate in this research,’ but we had over 150 persons who we were able to find as a sample for the population, so that suggests that there are persons within the country who identify (as trans),” said Levermore.

She argued that the trans women are less likely to seek medical attention because of the high levels of stigma and discrimination when they try to access services in the healthcare system, which further drives up the HIV rate in that group.

Levermore has urged health-care providers and the society at large not to forget the human element when dealing with transgender women.

This March, the PANCAP Knowledge for Health Project hosted a Share Fair on “Collaborating and Learning towards Treat All” in Port-of-Spain, Republic of Trinidad and Tobago with National AIDS programme (NAP) Managers and civil society representatives (CSOs) from 18 countries in the region. The share fair focused on key themes such as tackling adherence, testing, stigma and discrimination, linkage to care, integration, and CSO/NAP manager collaboration, within the context of how these topics contribute to achieving the 90-90-90 goals and getting countries to Treat All.  Several participatory knowledge exchange approaches were utilized to garner best practices in the region, including conversation cafés, panel conversations, storytelling talks, and human spectrum exercises, all with the intention of enhancing the sharing and learning among those in the room.

Image: Participant Martha Carrillo from Belize facilitates a fishbowl exercise on stigma and discrimination.

In addition, the PANCAP Knowledge for Health team engaged participants in three skills building sessions focused on utilizing the “Adobe Spark” Programme for improving report writing, creating effective charts, posters and graphics using “Piktochart” and utilizing the audience response system and virtual evaluation software, “Poll Everywhere” for accurate monitoring, evaluation, and audience surveys.

The Share Fair was particularly unique to the PANCAP-K4Health team because of the significant involvement of selected participants who took the lead in facilitating sessions. While they received prior coaching on how to implement knowledge management approaches, the facilitators embraced the challenge and successfully implemented their sessions. The success of this Share Fair was truly evident from the engagement and excitement from all of the participants and their sharing and learning together, all with a common goal of achieving the global 90-90-90 HIV targets and getting the region to Treat All by 2020.

View images of the Share Fair on the event web page here. 

Image: Health Minister, John Boyce, greeting Deputy Chief of Mission, US Embassy, Laura Griesmer. At left is Health Office Director, USAID Eastern and Southern Caribbean, Julia Henn (Photo credit: The Barbados Government Information Service – BGIS)

As external aid for HIV programmes decreases across the Caribbean, an increased mobilisation of domestic resources is necessary to ensure sustainability and continued access to programmes in affected countries.

This declaration came from Minister of Health, Barbados, John Boyce as he addressed the opening of a two-day workshop on Domestic Resource Mobilisation for HIV in the Caribbean at the Courtyard by Marriott.

The meeting has brought together technocrats from Ministries of Finance and Health in Barbados, Guyana, Suriname and Trinidad and Tobago.

The primary objectives are to discuss the most urgent priorities for problem-solving and funding HIV and to develop a country-specific action plan to ensure countries are able to respond with their own resources in the face of the expected decline in external financing.

Mr. Boyce maintained that the “huge mobilisation of resources” for the global HIV response over the course of the epidemic had been unprecedented in the history of public health.

In the last decade, he disclosed, tremendous progress had been made in the prevention, care, and treatment of HIV. He noted the massive rollout of antiretroviral treatment, adding that because of dedicated programmes within countries and increased funding, HIV-related health outcomes had improved and HIV incidence had stabilised and even declined in some countries.

However, he stated, the shift towards domestic funding was now necessary as external aid declined, with the United States, which remained the largest contributor to the global HIV response, proposing cuts of almost 20 per cent amidst competing demands for donor budgets.

The Health Minister told the audience: “I therefore encourage you to support your own programmes and strategies for mobilising domestic resources and take responsibility for your own needs. As Health Ministers, we are often the most aware of the challenges the health sector faces in regard to ineffective or insufficient spending. Thus, we can play an important role in creating advocacy messages that put health at the top of our governments’ agendas.”

Mr. Boyce submitted: “Shifting the funding paradigm towards domestic funding is challenging, but it has the advantages of fostering ownership and accountability in the implementation of the national HIV response and increasing its sustainability.”

From the Desk of the Director, Pan Caribbean Partnership against HIV and AIDS (PANCAP): 

Dear Partners,

Please join me in welcoming our new PEPFAR Coordinator, Ms Victoria Nibarger who is based in Kingston, Jamaica. Victoria is a U.S. Foreign Service Officer. She arrived in Kingston in January 2018 and will oversee the United States’ assistance to combat HIV and AIDS in Jamaica, Barbados, Guyana, Suriname, and the Republic of Trinidad and Tobago.

I had the opportunity to speak with Victoria and I would like to assure you that she is eager to provide the leadership required for advancing PEPFAR’s support and to serve the region.

Best regards,

Dereck.

Biography

Victoria Nibarger
PEPFAR Coordinator
U.S. Embassy Kingston

U.S. Foreign Service Officer Victoria Nibarger arrived in Kingston in January 2018 to assume the role of Coordinator for the President’s Emergency Plan for AIDS Relief (PEPFAR).  In her capacity, she will oversee U.S. assistance to combat HIV/AIDS in Jamaica, Barbados, Guyana, Suriname, and Trinidad and Tobago.

This assignment marks a return to Kingston for Victoria, who previously served in the Consular Section of Embassy Kingston.  During that tour, she led the Embassy’s efforts to evacuate American citizens from Haiti following the tragic January 2010 earthquake.  Victoria then moved to Belgrade, Serbia, where she served as an Economic Officer responsible for reporting on developments in the country’s macroeconomic situation, including the aviation, agriculture, environment, and health sectors, as well as on women’s entrepreneurship and labor relations.  Her most recent overseas assignment was at the U.S. Embassy in Kyiv, Ukraine, where she served as a Political Officer focusing on humanitarian issues – and the related U.S. policy response – resulting from the ongoing armed conflict in the Donbas region of eastern Ukraine.

Prior to joining the Foreign Service, Victoria worked in the non-profit sector, first in government relations for the American Cancer Society and then in international research for the Campaign for Tobacco-Free Kids.  She also taught English to university students in Wuhan, China.  Victoria graduated cum laude with B.S. degrees in biology and political science and a minor in leadership studies from Kansas State University.  She completed her M.A. at Kansas State in the field of political science, for which she earned summa cum laude honors; her master’s thesis explored the relationship between HIV/AIDS and democracy in sub-Saharan Africa.  Victoria studied in the Czech Republic and Turkey, and she speaks Russian.

A native of Kansas, Victoria is married to Daniel Nibarger, also a Foreign Service Officer with the U.S. Department of State.  They have three children.

The Caribbean Regional Network of People Living with HIV and AIDS (CRN+), successfully completed a HIV Environmental Scan Dissemination Meeting in Paramaribo, Suriname on the 20th February. Participants included representatives from the “Double Positive Foundation”, HE+HIV Foundation, National AIDS Programme, Ministry of Health, Civil Society Organizations and CCM. The meeting was facilitated by Mr. Jason Shepherd, Senior Programme Officer, CRN+.

Pivotal to the discussion were calls from participants with disabilities on ways in which HIV prevention and care services can be designed to include them. These included creating HIV education materials with the use of Braille, the tactile writing and sign language systems used by people who are visually impaired. Other ideas included the use of a picture board or touch screen that uses pictures or symbols to communicate methods of HIV prevention and care.

CRN+ Interim Chair, Mr. Winfield Tannis-Abbot commended the involvement of persons with disabilities and stated that it was crucial for CSOs and National AIDS Programmes to provide HIV prevention and care services in a manner that is suited for this audience. “There is no excuse for the lack of access to knowledge on prevention and health care services”, stated the Interim Chair, “more innovation is needed to ensure that persons with disabilities can fully participate in our HIV prevention and care efforts”.

“Along with innovation, there needs to be a willingness from all parties to fully involve persons with disabilities in HIV prevention,” stated the CRN+ Senior Programme Officer.

The meeting formed part of a series of activities by CRN+ which included similar dissemination meetings and capacity building activities for CRN+ networks and CSOs in Belize, Dominican Republic, Haiti and Jamaica in January and February 2018.

Image: Dr. Minerva Pinelo, Communications Specialist, facilitator of the capacity building training for CSOs in Belize  

The National AIDS Commission (NAC) Belize engaged Civil Society Organizations (CSO) in a one-day capacity building and development session intended to promote and improve the quality of key CSO participation while enhancing and operationalizing each organization’s program profile. The session was held at the University of the West Indies Conference Room in January.

The one-day session focused on enhancing the country’s multi-sector approach to the HIV epidemic, and developing the CSO’s ability to create targeted, program-centric impact in achieving the 90-90-90 Goals (by 2020, 90% of all people living with HIV will know their HIV status, 90% of all people with diagnosed HIV infection will receive sustained antiretroviral therapy, 90% of all people receiving antiretroviral therapy will have viral suppression).

The sessions built the capacity of each organization to recognize and assess their relevance and role within the national response to HIV and how that translates into positive targeted action that will create change. Participants were asked to assess themselves based on their mandates, visions, and missions as well as identify their specific target audience in relation to the national agenda and goals. This fostered inter-agency collaboration within the CSO community of Belize and allowed each organization to identify their specific niche within the national response to HIV.

The sessions were facilitated by Dr. Minerva Pinelo, Communications Specialist and coordinated by the NAC Secretariat.  The NAC will continue to assist CSOs in their individual and collective work with the overarching aim of elevating the national HIV response.

Dr. Allyson Leacock, Executive Director, LIVE UP: The Caribbean Media Alliance spoke with the editor of the PANCAP Newsletter about the amazing career of Kent Jordan, Technical Director of LIVE UP.  Kent sadly passed away on January 28 but he is fondly remembered by his colleague and friend.  Dr. Leacock’s reflections on this veteran of the HIV response is below:

“Lights, camera, action! Tape rolling… Kent lived for that moment…..that was Kent Jordan.

My words seem woefully inadequate. Kent has been my colleague and friend, since my early days in broadcasting until the morning of January 28.  We were colleagues for four decades. Throughout that time, he remained the same authentic human being, with impeccable character and integrity.

From our days at “Barbados Rediffusion” that morphed into “Voice of Barbados 790AM” (VOB), to the “Caribbean Broadcasting Corporation (CBC)”, when as General Manager, I asked him if he would join my team.  We also worked closely at the “Caribbean Broadcast Media Partnership (CBMP)” and remained colleagues at “LIVE UP: The Caribbean Media Alliance”. During this time, Kent remained the same astute, committed, compassionate professional, who knew far more than most.

Talking to Kent was like watching the “Discovery Channel” (where some of his work was shown), “National Geographic” and Sci-fi channels all in one. He was a walking encyclopedia, sharing minutiae and explaining how everything worked, especially equipment and why it worked that way. His work for Caribbean tourism with his “Holiday Channel” and his work for the “United Nations Environment Programme” on climate change are testimony to his yeoman’s service, not only to Barbados but also to the Caribbean.

Unassuming and amiable, he could work with anyone from the most arrogant to the most ignorant, demonstrating a rare and admirable ability to move past ego and achieve efficiency never taking his eye off the goal. He remained in the background but was the wind beneath many wings.

There are so many outstanding highlights of his phenomenal work on projects in partnership with others, that it’s hard to choose, but for CBMP and LIVE UP some standouts are his herculean efforts producing and directing:

1. CBMP Annual Executive Meetings in Cuba, Belize, Jamaica, Curacao, and Antigua
2. LIVE UP: The Show Series for 8 years
3. Anti-stigma Messages – St. Lucia, British Virgin Islands and Jamaica, and his voice will live on in all of our Live up Public Service Announcements (PSAs).
4. Producing and directing the CBMP 5TH Anniversary Media Leaders’ Summit with over 100 Caribbean media executives
5. International AIDS Conferences in Vienna, Mexico, and Washington—when he ensured every journalist filmed, edited and filed their stories back to the Caribbean every day.
6. PANCAP@10 IN ST.MAARTEN, where Kent and the Dream Team played a critical role in the technical logistics of this milestone event! And finally,
7. Regional Testing Day – RU+UR-?… (Are you positive you are negative?) that catchy jingle and the concept for its filming in the Frank Collymore Hall was entirely Kent’s and it became a hit that had to be used over and over for four years. Kent toiled in customizing and distributing those PSAs for 21 countries every year. Last year was the swansong and grand finale at its 10th anniversary and I’m so happy he was able to be part of it, recording the 33 citations for the awards ceremony and directing the televised broadcast across the region.

Kent Jordan is nothing short of exceptional. In all the decades I’ve known Kent, I’ve never heard him complain. Kent has been our rock through thick and thin despite his health challenges, he has always selflessly given us 100 percent of his expertise, so dedicated was he to his craft and to LIVE UP.

The impressive body of work created by Kent is the embodiment of passion and professionalism. We honour Kent for his gentle spirit and unmatched loyalty and support of LIVE UP to his death.

On behalf of the Chairman and the Board, we thank his family for your gracious gesture of support and send you love and light.

“Kentus”, I miss you already.

Well done! You were good and faithful to the end. You were the personification of LIVE UP: we shall love, protect, and respect you always and forever.

And that’s a wrap!”

The collective power of people to transform the social and political structures that govern their lives 
is the true heart of development. Social and Behavior Change Communication (SBCC) engages and supports people to shift norms, change behaviors, and amplify the voices needed to address the persistent development challenges the world faces today: extreme poverty, gender inequities, public health emergencies, acute and chronic diseases, climate change, and democracy and governance among others.

The 2018 International Social and Behavior Change Communication (SBCC) Summit featuring Entertainment Education is organized to better understand what works in shifting social norms, changing behaviors and in amplifying the voice of those who have most at stake in the success of development efforts. It is designed to wrestle with the profound issues of social justice and agenda setting that affect these decisions. Who decides, for example, what behaviors need changing or which norms should be shifted? How can people’s realities and voices be put at the center of such change? How much emphasis should be placed on shifting norms and behaviors when power structures, policy environments or lack of services may constitute problems that overwhelm the capacity of individuals or communities to act?

Where And When Will The Summit Be Held?
Nusa Dua, Indonesia from April 16-20, 2018

Who Should Participate?
The Summit is open to a wide range of participation from government, regional entities, academics, NGOs, CSOs, global agencies and the private sector working on development and health issues.

Who Is Organizing The Summit?
The 2018 SBCC Summit will be hosted by a consortium of international and local partners including the Johns Hopkins Center for Communication Programs, The Communication Initiative, Soul City Institute, UNICEF and BBC Media Action.