PANCAP and Government of Barbados host Parliamentarians Consultation

Wednesday, 29 May 2019 (PANCAP Coordinating Unit, CARICOM Secretariat): The Pan-Caribbean Partnership against HIV and AIDS (PANCAP), with funding from the CARIFORUM 10th European Development Fund (EDF) Programme of Support for Wider Caribbean Cooperation, collaborated with the Ministry of People Empowerment and Elder Affairs, Barbados and the Barbados National HIV/AIDS Commission to convene a consultation with parliamentarians in Barbados.  Dr Jacqueline Wiltshire, Deputy Permanent Secretary (ag), Ministry of People Empowerment and Elder Affairs chaired the meeting.

In delivering the Keynote address Hon Cynthia Forde, Minster of People Empowerment and Elder Affairs emphasized that leadership, as well as personal and political courage, were required to deal with the determinants that drive HIV. She reminded the meeting of the political leadership provided by the administration of former Prime Minister Owen Arthur who made HIV a priority by placing it within the Office of the Prime Minister.

Minister Forde challenged all parliamentarians to be involved in a system of governance that is grounded in the social protection of all groups. She stated that her Ministry and the National HIV/AIDS Commission take their mandate seriously and are working assiduously to transform the social landscape for all citizens and to ensure their right to fully participate in all spheres and contribute to social development and evidence-based policy.  The Minister emphasised that no one must be left behind and in this regard, her Ministry has taken its responsibility seriously. “Both government and parliamentarians have never made HIV a political issue but instead have funded a multi-sectoral response including services that are offered free of cost to all,” stated Minister Forde. She also observed that parliamentarians and faith leaders do not fathom the extent of their impact on citizens as they are in a privileged position to work collectively to eliminate the scourge of HIV. She called on all parliamentarians to recommit to an AIDS-free Barbados and Caribbean.

Ambassador Daniela Tramacere, Delegation of the European Union to Barbados, the Eastern Caribbean Countries, the OECS and CARICOM/CARIFORUM reminded the meeting that stigma and discrimination are still hampering efforts to reduce new HIV infections, increase the number of persons accessing anti-retroviral treatment and ensure that those who have contracted HIV can live full and productive lives. “The EU has invested approximately Euros 530,000 in PANCAP over two years from October 2017 to August 2019. We believe that our investment can also have a multiplier effect. Through sessions such as this, the message can be amplified to communities across the nation and the region,” stated the Ambassador. The EU Representative shared that through increased engagement and coordination, faith-based collaboration with health officials and political leaders can play a pivotal role in reducing the stigma and discrimination associated with HIV and AIDS. “Indeed, HIV/AIDS is not an individual issue but one that touches every part of society and our economy. This is our collective problem, and we need to come together to develop a collective solution,” stated Ambassador Tramacere.

Mr Dereck Springer, Director of PANCAP, provided an overview of PANCAP’s engagements with parliamentarians under its Justice for All programme that seeks to affirm human rights and reduce stigma and discrimination. The Director noted that both the Global Fund to Fight AIDS, Tuberculosis and Malaria and the CARIFORUM 10th European Development Fund are contributing to PANCAP’s work with parliamentarians geared towards creating a more enabling environment for people living with HIV and key population groups. He reminded the meeting of the crucial role that parliamentarians must play in response to HIV and acknowledged that parliamentarians come from families and society and regularly engage with their constituencies thus enabling them to understand the challenges faced by people living with and affected by HIV. He also highlighted the legislative, representational and oversight roles of parliamentarians.

Dr Anton Best, Senior Medical Officer, Ministry of Health, Barbados delivered a presentation that included an overview of the epidemiology of HIV in Barbados as well as the implementation of Treat All and Pre Exposure Prophylaxis (PrEP).

Dr Frank Anthony, PANCAP Consultant, provided a historical perspective of HIV, the advances being made in relation to the science, presented on the key actions required by parliamentarians in relation to their legislative, representational and oversight roles, and facilitated a discussion on key policy and legislative issues that require changes and which are within the control of parliamentarians.

During the plenary discussion led by Dr Frank Anthony, parliamentarians agreed to establish a Joint Parliamentary Committee to identify priorities for action.

The consultation was also attended by representatives of faith-based organisations, civil society organisations, and UN agencies representatives.

– ENDS –

Contact:

Timothy Austin
Communications Specialist
PANCAP Coordinating Unit
CARICOM Secretariat
Turkeyen, Greater Georgetown, Guyana
Email:      taustin.consultant@caricom.org
Tel:           (592) 222-0001-75, Ext. 3409
Website:  www.pancap.org

What is PANCAP?

PANCAP is a Caribbean regional partnership of governments, regional civil society organisations, regional institutions and organisations, bilateral and multilateral agencies and contributing donor partners which was established on 14 February 2001. PANCAP provides a structured and unified approach to the Caribbean’s response to the HIV epidemic, coordinates the response through the Caribbean Regional Strategic Framework on HIV and AIDS to maximise efficient use of resources and increase impact, mobilises resources and build the capacity of partners.

  • 10th European Development Fund (EDF) Programme of Support for Wider Caribbean Cooperation

Under the 10th (EDF) Programme of Support for Wider Caribbean Cooperation, PANCAP will strengthen coordination on human rights issues in keeping with the Justice For all Roadmap through the HIV and AIDS Thematic Task Force in CARIFORUM.

  • CARIFORUM

CARIFORUM refers to the Grouping of Caribbean States which are signatories of the Georgetown Agreement establishing the African, Caribbean and Pacific Group of States (ACP). The ACP grouping is composed of 79 African, Caribbean and Pacific states.

CARIFORUM is the recipient of and manages the implementation of Caribbean Regional Indicative Programmes financed by the EDF and Caribbean regional programmes financed by individual Member States of the European Union. It also provides technical assistance to agencies/institutions implementing projects under these programmes.

  • European Union

The Member States of the European Union have decided to link together their know-how, resources and destinies. Together, they have built a zone of stability, democracy and sustainable development while maintaining cultural diversity, tolerance and individual freedoms. The European Union is committed to sharing its achievements and its values with countries and peoples beyond its borders’.

Background to the PANCAP Justice for All (JFA) Roadmap

The PANCAP Justice for All (JFA) Programme was established in September 2013 as a regional response to the UN High-Level Political Declaration (June 2011) designed to reduce AIDS-related stigma and discrimination. The objectives of the JFA Roadmap are:

  • Enhancing family life and focusing on those in need
  • Increasing access to treatment and affordable medicines
  • Reducing gender inequality including violence against women, girls and adolescents
  • Promoting prevention with special reference to sexual and reproductive health and rights including age-appropriate sexual education
  • Implementing legislative reforms for modifying AIDS-related stigma and discrimination

Barbados Parliamentarians Sensitization Forum

Wednesday 29 May 2019 (PANCAP Coordinating Unit, CARICOM Secretariat): The Pan-Caribbean Partnership against HIV and AIDS (PANCAP), with funding from the CARIFORUM 10th European Development Fund (EDF) Programme of Support for Wider Caribbean Cooperation, hosted the Barbados Parliamentarians Sensitization Forum at the Radisson Aquatica Resort Barbados on 29 May 2019.    

The Forum formed part of a series of engagements with parliamentarians, which commenced in 2013 under the PANCAP Justice for All (JFA) programme. Parliamentarians were involved in defining their legislative, representational and oversight roles to address the barriers toward achieving the UNAIDS 90-90-90 Targets[1], eliminating stigma and discrimination and contributing to the end of AIDS. They discussed pursuing actions with specific timelines and made recommendations for the establishment of a National Parliamentarians Action Group to function as a coordinating mechanism to facilitate communications with and among National Parliamentary Committees.

Parliamentarians also utilised the forum to identify ways to collaborate with other stakeholders in the HIV response, including faith leaders, civil society, youth and Key Populations.

Featured speakers included Hon. Cynthia Y. Forde J.P., L.C.P. Minister of People Empowerment and Elder Affairs, Barbados, Hon. Gline A. Clarke, J.P., B.Sc., Dip. Ed., Deputy Speaker of the House of Assembly, Barbados, and Mr Dereck Springer, Director of PANCAP.

– ENDS –

What is PANCAP?

PANCAP is a Caribbean regional partnership of governments, regional civil society organisations, regional institutions and organisations, bilateral and multilateral agencies and contributing donor partners which was established on 14 February 2001. PANCAP provides a structured and unified approach to the Caribbean’s response to the HIV epidemic, coordinates the response through the Caribbean Regional Strategic Framework on HIV and AIDS to maximise efficient use of resources and increase impact, mobilizes resources and build capacity of partners.

  • 10th European Development Fund (EDF) Programme of Support for Wider Caribbean Cooperation

Under the 10th (EDF) Programme of Support for Wider Caribbean Cooperation, PANCAP will strengthen coordination on human rights issues in keeping with the Justice For all Roadmap through the HIV and AIDS Thematic Task Force in CARIFORUM.

  • CARIFORUM

CARIFORUM refers to the Grouping of Caribbean States which are signatories of the Georgetown Agreement establishing the African, Caribbean and Pacific Group of States (ACP). The ACP grouping is composed of 79 African, Caribbean and Pacific states.

CARIFORUM is the recipient of and manages the implementation of Caribbean Regional Indicative Programmes financed by the EDF and Caribbean regional programmes financed by individual Member States of the European Union. It also provides technical assistance to agencies/institutions implementing projects under these programmes

  • European Union

The Member States of the European Union have decided to link together their know-how, resources and destinies. Together, they have built a zone of stability, democracy and sustainable development whilst maintaining cultural diversity, tolerance and individual freedoms. The European Union is committed to sharing its achievements and its values with countries and peoples beyond its borders’.

Background to the PANCAP Justice for All (JFA) Roadmap

The PANCAP Justice for All (JFA) Programme was established in September 2013 as a regional response to the UN High-Level Political Declaration (June 2011) designed to reduce AIDS-related stigma and discrimination. The objectives of the JFA Roadmap are:

  • Enhancing family life and focusing on those in need
  • Increasing access to treatment and affordable medicines
  • Reducing gender inequality including violence against women, girls and adolescents
  • Promoting prevention with special reference to sexual and reproductive health and rights including age-appropriate sexual education
  • Implementing legislative reforms for modifying AIDS-related stigma and discrimination

[1] By 2020, 90% of all people living with HIV will know their HIV status,

By 2020, 90% of all people with diagnosed HIV infection will receive sustained antiretroviral therapy and

By 2020, 90% of all people receiving antiretroviral therapy will have viral suppression.

PANCAP Learning Exchange promotes value of PrEP for prevention of HIV transmission

Image: (Front row, second from left) Ms Prenell King-Rolle, Acting Permanent Secretary, Ministry of Health, The Bahamas , Dr Pearl McMillan, Chief Medical Officer, Ministry of Health, The Bahamas, Dr Nikkiah Forbes,  Director of the National HIV/AIDS and Infectious Disease Programme, Ministry of Health, The Bahamas; (Front row, first from right) Dr Shanti Singh-Anthony, Knowledge Management Coordinator, PANCAP Knowledge for Health Project with participants of the PANCAP Learning Exchange and employees of the Ministry of Health, The Bahamas.

Friday, 17 May 2019 (PANCAP Coordinating Unit, CARICOM Secretariat): The Pan-Caribbean Partnership against HIV and AIDS (PANCAP), the mechanism that provides a structured and unified approach to the Caribbean’s response to the HIV epidemic, collaborated with The Bahamas Ministry of Health National AIDS Programme to coordinate a learning exchange that focused on The Bahamas’s experience in the implementation of Pre-exposure prophylaxis (PrEP). The capacity building initiative was held from 6 -10 May 2019 and also focused on “Treat All”, the transition to Dolutegravir, and laboratory support for viral suppression.

The initiative was led by Dr Shanti Singh-Anthony, PANCAP Knowledge Management Coordinator, who explained that the learning exchange was designed for participants to experience first-hand the process utilized by The Bahamas Ministry of Health National AIDS Programme to coordinate and collaborate with civil society organisations, the private sector, and other stakeholders to deliver comprehensive HIV services to communities, particularly key populations.

Dr Singh-Anthony also highlighted that participants were exposed to critical aspects of The Bahamas’ PrEP programme and benefitted from an explanation of how the country transitioned to the use of the highly effective antiretroviral therapy, Dolutegravir.

The countries participating in the learning exchange event included Guyana, Jamaica and the Republic of Trinidad and Tobago.

Multi-disciplinary country teams participated in the event.  The teams comprised of National AIDS Programme Managers, Clinical Care Coordinators, HIV clinicians and civil society organisation (CSO) representatives who work closely with the national programme in the implementation of PrEP and other aspects of the HIV response.  A total of seven persons from the three countries participated and interacted with representatives of the Ministry of Health The Bahamas, clinical and laboratory staff, and CSO representatives.

Dr Singh-Anthony explained that site visits were conducted to community clinics where participants interacted with key clinic staff in the areas of HIV testing, treatment, community outreach, documentation, and monitoring and reporting. This allowed participants to understand how services are organised and delivered, the number and skill set of the clinical team, and other resources available for supporting service delivery.

Participants also interacted with the beneficiaries of the clinics, particularly key populations and participated in community outreach activities led by the National AIDS Programme and CSO teams aimed at increasing access to services by key populations.

Dr Singh-Anthony believes that the Learning Exchange is critical to the implementation of PrEP in the Region.  “The Caribbean is on the cusp of fully embracing and implementing PrEP. Hence, it was crucial for PANCAP to lead this multidisciplinary team on a learning journey to expand their understanding of how PrEP can improve clinical management and outcomes for individuals at risk for HIV.  The overarching aim is for the Learning Exchange to act as an impetus for more expansion of knowledge on PrEP and its eventual implementation across the Region”.

The Learning Exchange forms part of the PANCAP Knowledge for Health Project with funding from the United States Agency for International Development (USAID).

Contact:

Timothy Austin

Communications Specialist

PANCAP Coordinating Unit

CARICOM Secretariat

Turkeyen, Greater Georgetown, Guyana

Email:      taustin.consultant@caricom.org

Tel:           (592) 222-0001-75, Ext. 3409

Website:  www.pancap.org

Helpful links:

PANCAP Knowledge for Health Project

https://pancap.org/pancap-work/applying-knowledge-management-to-strengthen-pancaps-coordination-role-for-the-regional-hivaids-response/

Video – HIV – Pre-exposure prophylaxis (PrEP) in the Bahamas

https://pancap.org/pancap-events/hiv-pre-exposure-prophylaxis-prep-in-the-bahamas/

What is PANCAP?

PANCAP is a Caribbean regional partnership of governments, regional civil society organisations, regional institutions and organisations, bilateral and multilateral agencies and contributing donor partners which was established on 14 February 2001. PANCAP provides a structured and unified approach to the Caribbean’s response to the HIV epidemic, coordinates the response through the Caribbean Regional Strategic Framework on HIV and AIDS to maximise efficient use of resources and increase impact, mobilises resources and build capacity of partners.

PANCAP Regional Meeting concludes with calls for holistic approach to providing migrant health services through an intersectoral strategy

Thursday, 11 April 2019 (PANCAP Coordinating Unit, CARICOM Secretariat): The Pan-Caribbean Partnership against HIV and AIDS (PANCAP), the mechanism that provides a structured and unified approach to the Caribbean’s response to the HIV epidemic, concluded the regional meeting to provide guidance on the implementation of the Regional Framework on Migrant Health and Rights on 11 April 2019 in Port-of-Spain, Republic of Trinidad and Tobago.

The purpose of the meeting was to facilitate input from regional stakeholders for finalising a guidance document on how to implement the Framework on Migrant Health and Rights within their country context.

The outcomes of the meeting included an agreement on a holistic approach to providing services for migrants including social services through an intersectoral strategy.

Participants emphasised that the health priorities of each territory must guide the implementation of the Migrant Framework at the country level as well as all policies governing access to migrants’ health.

Participants also agreed on the implementation of the Framework on Migrant Health and Rights at the country level in the interest of protecting and safeguarding public health throughout the region.

Participants were exposed to country presentations from Guyana and the Republic of Trinidad and Tobago, which provided details of the situation and response to Venezuelan migrants as well as experiences from Antigua and Barbuda, Belize, The Bahamas and the Organisation of Eastern Caribbean States (OECS).  These experiences illustrated the need for the implementation of the Framework to ensure consistent access to health by migrants.

There was also broad agreement on the need to implement the Framework at the country level from a Human Rights perspective.

Participants called for research into the financial and human resource capacity that is essential to provide holistic health services for migrants. The meeting noted the urgent need for strategic information for decision-making regarding the type of services necessary for migrants.  It was also recommended that countries research the requirements for a minimum package of services for migrants.

Participants also recommended research into sourcing a financial mechanism to mobilise funding for access to all healthcare by migrants.

Building strategic partnerships within the public health system to advance holistic treatment for migrants was proposed as a necessary step which would provide immediate results for improving access to services by migrants.  Participants also advocated for creating strategic alliances with social services to offer comprehensive care for migrants including sexual and reproductive health services, housing, nutrition, etc.

There were calls for an education, training and sensitisation programme for immigration and border patrol officers to provide guidance on the health, social and psychological requirements of migrants.

Educating the media on the positive impact of migration and highlighting the benefits of integrating migrants into society through public awareness communication campaigns was also recommended. Participants emphasised the need to utilise the regional media to highlight the positive aspects of migrants’ culture to reduce negative perceptions.

Mr Dereck Springer, Director of PANCAP, committed to PANCAP continuing high-level engagements with policymakers, including Ministers of Health and Finance and the CARICOM Secretariat to advocate for access to health by migrants as a public health priority.

The Director highlighted that PANCAP would follow up with countries on the implementation of the Migrant Framework through the PANCAP Justice for All Programme and the PANCAP Policy and Strategy Working Group on Stigma and Discrimination.

The PANCAP Director concluded the meeting with a challenge for participants to advocate at the country-level for an intersectoral holistic approach to providing services for migrants which would incorporate their social and psychological needs.  He noted that the draft guidance on the implementation of the framework proposed by participants is not prescriptive and can be adapted based on the requirements of each territory.

Participants included Port Health Medical Officers, Representatives of Ministries of National Security and Border Affairs, Legal officers and Protection Officers, International Development partners, Permanent Secretaries, Ministries of Health, Chief Medical Officers, National AIDS Programme Managers, Immigration Officers, Civil society partners that work with key populations, Youth Leaders, Private Sector, Academia, and the International Organization for Migration.

  – ENDS –

Helpful links:

PANCAP Rights-Based Framework for Migrant Health and Rights 2018

https://pancap.org/pancap-documents/pancap-rights-based-framework-for-migrant-health-and-rights-2018/

Meeting to provide guidance to countries on how to operationalise the regional framework on migrant health and rights – Event page

https://pancap.org/pancap-events/regional-forum-on-migrants-and-mobile-populations-rights-and-health-2/

What is PANCAP?

PANCAP is a Caribbean regional partnership of governments, regional civil society organisations, regional institutions and organisations, bilateral and multilateral agencies and contributing donor partners which was established on 14 February 2001. PANCAP provides a structured and unified approach to the Caribbean’s response to the HIV epidemic, coordinates the response through the Caribbean Regional Strategic Framework on HIV and AIDS to maximise efficient use of resources and increase impact, mobilises resources and build capacity of partners. 

Editor’s Notes

Background to the Meeting to provide guidance to countries on how to operationalise the regional framework on migrant health and rights

CARICOM governments have signed on to the International Organization for Migration (IOM) and other relevant international conventions as evidence of their commitment to protect and promote the rights of migrants. The International Convention on the Protection of Migrant Workers and Members of Their Families 1990 is the most comprehensive instrument protecting the rights of migrants but only St Vincent and the Grenadines has ratified this convention.  With respect to migrant workers, some countries have ratified the following conventions: #97 Migration for Employment; #111  Concerning discrimination in respect of employment and occupation; and #138 Concerning minimum age for admission to employment.

Previous assessments/studies have found that in the majority of countries, the HIV-related needs of migrants and mobile populations are not integrated in the national HIV response and existing health care programmes. Little data is available on diverse mobile populations and there are no culturally and linguistically appropriate HIV intervention programmes targeting mobile populations, especially high-risk groups including sex workers and MSM.  Strict immigration policies adopted by some governments may drive sex workers underground, thereby making them and their clients more vulnerable to contracting HIV. Migrant workers in some countries are consistently listed among the most vulnerable populations owing to, among other factors; their legal status, lack of access to information and services, language barriers and poverty. However, to date no comprehensive strategies exist to address HIV prevention among this vulnerable population. There is limited understanding of the profile of the epidemic among migrant workers or the factors that increase this population’s vulnerability to HIV.

Given the challenges outlined above PANCAP, with funding from the Global Fund in June 2018, developed a regional rights-based framework to increase the access of migrants and mobile populations to HIV prevention, care, support and treatment.

The Framework sets out a roadmap for equitable and non-discriminatory access to health care services across the Caribbean for mobile and migrant populations regardless of age, race, colour, sex, language, religion, political or other opinion, national or social origin, sexual orientation, gender identity, property, birth or other status. The Framework responds to the findings of two multi-country studies conducted by PANCAP over the period 2011 – 2015 which highlighted the barriers to access HIV services by migrant and mobile populations. Following a participatory approach involving representation from Government, (Ministry of Health, Chief Medical Officers, National AIDS Programmes, Immigration Officers) Civil Society (Migrant groups and other key population groups) and international and regional organisations including, PANCAP, UWI, IOM, UNHCR and UNAIDS at a regional forum in Trinidad and Tobago from the 26-27 June 2018, the mandate was for the development of a more comprehensive roadmap for a Regional Rights-Based Framework to Increase the Access of Migrants and Mobile Populations to HIV Prevention, Care, Support and Treatment.

The Framework is rationalised with the vision of regionalism under the CSME and sets out guiding principles and recommended strategies for regional and national action. The Protocol on Contingent Rights was adopted and opened for signature at the 39th Regular Meeting of the Conference of Heads of Government of the Caribbean Community held in Montego Bay, Jamaica on 4-6 July 2018. It was signed by seven countries (Barbados, Grenada, Haiti, Jamaica, Saint Lucia, St Vincent and the Grenadines and Suriname) but is not yet in force. The Protocol grants rights to CARICOM nationals exercising the right of establishment, provision of services, movement of capital or free movement of skills. Spouses and immediate dependents are also entitled to enjoy these rights.

The Framework on Migrant Health and Rights was subsequently endorsed by the Priority Areas Coordinating Committee (technical committee of the PANCAP Executive Board), PANCAP Executive Board and the Council for Human and Social Development – Ministers of Health). The Priority Areas Coordinating Committee recommended that PANCAP should identify a model that can be used to guide countries in operationalising the Framework to their county context.

PANCAP Regional Meeting to Focus On Implementation of Migrant Health and Rights Framework

Tuesday, 2 April 2019 (PANCAP Coordinating Unit, CARICOM Secretariat): The Pan-Caribbean Partnership against HIV and AIDS (PANCAP), the mechanism that provides a structured and unified approach to the Caribbean’s response to the HIV epidemic, will host a regional meeting to provide guidance on the implementation of the Regional Framework on Migrant Health and Rights on 10 – 11 April 2019 in Port-of-Spain, Republic of Trinidad and Tobago.

The Framework was developed by stakeholders at the Regional Forum on Migrants’ and Mobile Populations’ Health and Rights in June 2018 with funding from the Global Fund to Fight AIDS, Tuberculosis and Malaria.

The purpose of the Framework is to increase the access of migrants and mobile populations to HIV prevention, care, support and treatment. The Framework provides a roadmap for equitable and non-discriminatory access to health care services across the Caribbean for mobile and migrant populations regardless of age, race, colour, sex, language, religion, political or other opinion, national or social origin, sexual orientation, gender identity, property, birth or other status.

The Framework was subsequently endorsed by the Priority Areas Coordinating Committee (PACC – the technical committee of the PANCAP Executive Board), PANCAP Executive Board and the Council for Human and Social Development – Ministers of Health (COHSOD). The PACC recommended that PANCAP identify a model to guide countries in operationalising the Framework within their country context.  This will be the focus of the upcoming regional meeting.

The meeting is occurring a few weeks after Hon. Terrence Deyalsingh, Minister of Health, Republic of Trinidad and Tobago announced that mi­grants will re­ceive the same free health care as na­tion­als, par­tic­u­lar­ly in re­la­tion to sex­u­al­ly trans­mit­ted dis­eases.

The Minister was speaking at the Seventh Meeting of National AIDS Programme Managers and Key Partners held on 11 – 13 March in Port-of-Spain.  The Minister further stated, “We have tak­en a de­ci­sion in Trinidad and To­ba­go, you know we have Venezue­lan mi­grants, to treat them as na­tion­als. Be­cause mi­grants do not live in iso­la­tion in the coun­tries they mi­grate to. They mix with the rest of the pop­u­la­tion; they in­te­grate them­selves with the en­vi­ron­ment.  So we have tak­en a pol­i­cy de­ci­sion at the Min­istry of Health to treat all mi­grants re­gard­less of their coun­try of ori­gin as cit­i­zens of Trinidad and To­ba­go when it comes to pub­lic health”.

PANCAP Director, Dereck Springer stated that the Minister’s announcement could not be more timely as a pivotal aspect of the upcoming meeting will be the input provided by participants for finalising a guidance document on how to implement the Framework on Migrant Health and Rights within their country context.

The Director further highlighted that the objectives of the meeting are to share the findings of a desk review on models/guidance for operationalising the Framework on Migrants Health and Rights and validate the findings of an assessment of the needs of countries’ health systems to provide services for migrants.

Participants will include Port Health Medical Officers, Representatives of Ministries of National Security and Border Affairs, Legal officers and Protection Officers, International Development partners, Permanent Secretaries, Ministries of Health, Chief Medical Officers, National AIDS Programme Managers, Immigration Officers, Civil society partners that work with key populations, Faith Leaders, Youth Leaders, Private Sector, Academia, the International Organization for Migration and the Office of the United Nations High Commissioner for Refugees  – The UN Refugee Agency.

– ENDS –

 

Helpful links:

PANCAP Rights-Based Framework for Migrant Health and Rights 2018

https://pancap.org/pancap-documents/pancap-rights-based-framework-for-migrant-health-and-rights-2018/

Meeting to provide guidance to countries on how to operationalise the regional framework on migrant health and rights – Event page

https://pancap.org/pancap-events/regional-forum-on-migrants-and-mobile-populations-rights-and-health-2/

What is PANCAP?

PANCAP is a Caribbean regional partnership of governments, regional civil society organisations, regional institutions and organisations, bilateral and multilateral agencies and contributing donor partners which was established on 14 February 2001. PANCAP provides a structured and unified approach to the Caribbean’s response to the HIV epidemic, coordinates the response through the Caribbean Regional Strategic Framework on HIV and AIDS to maximise efficient use of resources and increase impact, mobilises resources and build capacity of partners.

Editor’s Notes

Background to the Meeting to provide guidance to countries on how to operationalise the regional framework on migrant health and rights

CARICOM governments have signed on to the International Organization for Migration (IOM) and other relevant international conventions as evidence of their commitment to protect and promote the rights of migrants. The International Convention on the Protection of Migrant Workers and Members of Their Families 1990 is the most comprehensive instrument protecting the rights of migrants but only St Vincent and the Grenadines has ratified this convention.  With respect to migrant workers, some countries have ratified the following conventions: #97 Migration for Employment; #111  Concerning discrimination in respect of employment and occupation; and #138 Concerning minimum age for admission to employment.

Previous assessments/studies have found that in the majority of countries, the HIV-related needs of migrants and mobile populations are not integrated in the national HIV response and existing health care programmes. Little data is available on diverse mobile populations and there are no culturally and linguistically appropriate HIV intervention programmes targeting mobile populations, especially high-risk groups including sex workers and MSM.  Strict immigration policies adopted by some governments may drive sex workers underground, thereby making them and their clients more vulnerable to contracting HIV. Migrant workers in some countries are consistently listed among the most vulnerable populations owing to, among other factors; their legal status, lack of access to information and services, language barriers and poverty. However, to date no comprehensive strategies exist to address HIV prevention among this vulnerable population. There is limited understanding of the profile of the epidemic among migrant workers or the factors that increase this population’s vulnerability to HIV.

Given the challenges outlined above PANCAP, with funding from the Global Fund in June 2018, developed a regional rights-based framework to increase the access of migrants and mobile populations to HIV prevention, care, support and treatment.

The Framework sets out a roadmap for equitable and non-discriminatory access to health care services across the Caribbean for mobile and migrant populations regardless of age, race, colour, sex, language, religion, political or other opinion, national or social origin, sexual orientation, gender identity, property, birth or other status. The Framework responds to the findings of two multi-country studies conducted by PANCAP over the period 2011 – 2015 which highlighted the barriers to access HIV services by migrant and mobile populations. Following a participatory approach involving representation from Government, (Ministry of Health, Chief Medical Officers, National AIDS Programmes, Immigration Officers) Civil Society (Migrant groups and other key population groups) and international and regional organisations including, PANCAP, UWI, IOM, UNHCR and UNAIDS at a regional forum in Trinidad and Tobago from the 26-27 June 2018, the mandate was for the development of a more comprehensive roadmap for a Regional Rights-Based Framework to Increase the Access of Migrants and Mobile Populations to HIV Prevention, Care, Support and Treatment.

The Framework is rationalised with the vision of regionalism under the CSME and sets out guiding principles and recommended strategies for regional and national action. The Protocol on Contingent Rights was adopted and opened for signature at the 39th Regular Meeting of the Conference of Heads of Government of the Caribbean Community held in Montego Bay, Jamaica on 4-6 July 2018. It was signed by seven countries (Barbados, Grenada, Haiti, Jamaica, Saint Lucia, St Vincent and the Grenadines and Suriname) but is not yet in force. The Protocol grants rights to CARICOM nationals exercising the right of establishment, provision of services, movement of capital or free movement of skills. Spouses and immediate dependents are also entitled to enjoy these rights.

The Framework on Migrant Health and Rights was subsequently endorsed by the Priority Areas Coordinating Committee (technical committee of the PANCAP Executive Board), PANCAP Executive Board and the Council for Human and Social Development – Ministers of Health). The Priority Areas Coordinating Committee recommended that PANCAP should identify a model that can be used to guide countries in operationalising the Framework to their county context.

National AIDS Programme Managers and Civil Society urged to collaborate on innovations to reach key populations with HIV prevention and to retain people on treatment and care

Tuesday, 12 March 2019 (PANCAP Coordinating Unit, CARICOM Secretariat): The Pan-Caribbean Partnership against HIV and AIDS (PANCAP), the mechanism that provides a structured and unified approach to the Caribbean’s response to the HIV epidemic, commenced the Seventh Meeting of National AIDS Programme (NAP) Managers and Key Partners in Port-of-Spain, Republic of Trinidad and Tobago on Monday 11 March 2019

The meeting was hosted 22 months ahead of the end of 2020 deadline for reaching the UNAIDS 90–90–90 Targets — 90% of people living with HIV diagnosed, 90% of diagnosed people on treatment and 90% of those on treatment virally suppressed.

In opening remarks, Director of PANCAP, Mr Dereck Springer highlighted that PANCAP recently evaluated the Caribbean Regional Strategic Framework on HIV and AIDS (CRSF) 2014-2018 and will be using the results to inform the development of the new CRSF 2019-2023. The evaluation found that the Region has made progress in responding to the epidemic but it also clearly illustrated that there is more to be done, particularly in relation to implementation of innovative activities to achieve prevention, retain people in treatment and care, reach key populations with services and create an enabling environment.

“Compared to 2013 when it felt as though we were in the midst of winter, we are now a much more united partnership. We are all PANCAP,” stated the Director, “the Partnership is much stronger and more resilient because of the work being done by everyone. We have demonstrated an indomitable will to overcome the many challenges including financial and human resources in our effort to serve the people of the Caribbean. PANCAP has restored its goodwill; the presence of over 135 partners here today is testimony of this goodwill and a recognition that the PANCAP brand is synonymous with good leadership, respect for partners, meaningful engagement and accountability. There is no other partnership for health like ours”.

The Director stated that there is renewed confidence in PANCAP and this has been achieved because the Partnership has placed people at the heart of the matter. “We have made them central to the Partnership, influencing policy and actively contributing to the decision-making process,” stated Mr Springer, “Our priority was to ensure that those of us within the leadership of the organisation did not become remote and disconnected from the views of the people whom we serve – the people who know best what their needs are and what needs to be done to meet them”.

He further stated that the Partnership is now more visible. “We are sharing our knowledge, we are improving coordination – both alignment and harmonisation,” stated Mr Springer, “We are demonstrating our added value to the Caribbean region. Our strategic regional approach to HIV builds on a strong history of collaboration in public health to overcome the challenges inherent to the unique geography, economy and culture of the Caribbean”.

The Director highlighted that a key objective of PANCAP is to achieve value for money by promoting economies of scale, as the region’s small developing states may provide limited capacity for developing the complex programmes needed for a comprehensive response to HIV.

The partnership marked 18 years of its existence on 14 February 2019. From its inception in 2001, there have been notable successes including the fact that HIV incidence and AIDS-related deaths have been reduced, and seven countries have been certified as having achieved the dual targets for the elimination of mother-to-child transmission of HIV and Syphilis.

Strengthened national programmes have improved capacity to implement prevention, treatment and care activities. “We have built the capacity of civil society and positioned them to access their own funding,” stated Mr Springer, “substantial investments have been made in strengthening health systems and in scaling-up services for increasing numbers of people who are living longer with HIV. Regional public goods and services have facilitated this by lowering costs and reducing inefficiencies inherent in building capacity in multiple countries”. He further stated that countries contribute to, and benefit from, more affordable access to medicines and the sharing of technical skills, operational capacity, information, advocacy and specialised services. PANCAP has supported the OECS Pharmaceutical Procurement System under the Global Fund Round 9 grant, which has now expanded. Technical support is sourced within the region and is implemented through peer-learning methodologies and virtual and face-to-face knowledge sharing events.

“We continue to respond to the needs of the region and we are actively mobilising resources from our development partners such as PEPFAR, the Global Fund and UN agencies, albeit in an environment of scarcity while leveraging the technical expertise of our development partners to support our national governments to increase domestic resources for HIV” stated the Director.

He urged participants to use the meeting to review progress, learn from each other, explore innovative approaches and commit to implementing and scaling them up. “Let us make our voices heard so that we can inform the priorities and strategies for our new CRSF, stated the Director, “Let us be bold. Let us not fear the future, instead let us identify and embrace the many opportunities that present themselves for us to renew, refresh, streamline and refocus. Let us find within ourselves, our invincible summer. I am confident that this Partnership will build upon this solid foundation over the next years and will provide the leadership required for achieving the vision of ending AIDS in the Caribbean region”.

Ms Aldora Robinson, Director of the Health Promotion and Advocacy Unit within the Ministry of Health, Agriculture and Human Services, Turks and Caicos Islands and the National AIDS Programme Managers Representative on the PANCAP Governance Bodies stated that in light of the challenge of reduced international funding the meeting could be a “game changer”.  “We cannot continue to do the same thing and expect different results,” stated Ms Robison, “we need to come together, NAP Managers and civil society, with purpose and innovation to accomplish results necessary to close the gap of the 90-90-90 Targets; building on the successes and gains already made”.

She advocated that National AIDS Programme Managers and civil society must work together in their individual countries where the context of the HIV response is often different.

“Each island must own their response,” Ms Robinson stated, “there is a critical need to increase access to HIV and STI Testing for key populations and we also need to pay attention to our 50-year olds and those who have retired.  We look forward to an exciting and informative week where purpose meets innovation. We must always remember that we are working towards the same goal of an AIDS-free Caribbean”.

In brief remarks, Mr Ivan Cruickshank, Executive Director, Caribbean Vulnerable Communities (CVC) Coalition, reminded participants of the 2020 deadline for ending AIDS and urged that all stakeholders commit to using the meeting to foster innovative solutions to fill the HIV gaps.  “We’re coming in on the heels of the recent UNAIDS report.  There is unfinished business, so whatever we do this week, we must connect the dots,” stated the Executive Director, “we’re a Caribbean nation of track and field and we know in track and field, especially in a 400 metres race, the last 10 metres are usually the hardest.  For many of us present here today, the last 10 metres are going to be critical. How we respond and how we achieve the targets depend on our collaborative spirit and ability to be innovative”.

Dr Lilian Pedrosa, Fund Portfolio Manager, Latin America and the Caribbean, the Global Fund, stated that it is a pivotal year for the The Global Fund to Fight AIDS, Tuberculosis and Malaria, which is approaching another replenishment period and attempting to secure additional funding to continue supporting the Global Fund grants. She reminded the meeting that the Global Fund has been supporting the Region since 2001, disbursing over US$800 Million specifically for the Caribbean Region.  She applauded the success of the Region in achieving the decline of deaths from AIDS, as well as the decline in new infections.  She also lauded the achievement of the validation of seven countries for the elimination of Mother-to-Child Transmission of HIV and Syphilis.

Dr Pedrosa emphasized that the Region should also be commended for the increase of domestic contributions for HIV.  “When the Global Fund started as a partner in 2001, together with other partners, we were funding most of the response”, stated Dr Pedrosa, “What we have seen in the last few years is a new momentum where countries are really stepping up the plate and increasing their financial commitment to sustain the gains made in the fight against AIDS”.

She noted that despite the successes and increased domestic financing, there is the challenge of reaching the right key populations and increasing testing.  She also noted there are some countries where the bulk of the epidemic is concentrated in key populations and national programmes continue to be challenged with retaining people in care. She emphasized however, that the most significant challenge faced by the response is stigma and discrimination.

She challenged the participants to utilize the meeting to reflect on the lessons learned from national programmes and to build on the unique partnership created by PANCAP. She also urged participants to use the resources and expertise within the Partnership to advocate within their countries for an end to stigma and discrimination.  “We need to reach the finish line for ending AIDS together, as one Caribbean”, stated Dr Pedrosa.

Dr James Guwani, Team Leader, UNAIDS Caribbean Office, highlighted that the Caribbean joined the community of nations in a commitment to end the AIDS epidemic by 2030 as part of the Sustainable Development Goal agenda. Next year, 2020, the Region will reach a key benchmark to determine whether it is on course to realize the vision of a world without AIDS. He emphasized that every country will ask how close they are to diagnosing 90% of people living with HIV, to starting 90% of diagnosed people on antiretroviral therapy and to achieving viral suppression among 90% of those on treatment.

“While it is urgent and important that we press forward, I urge all of us as partners in the Caribbean AIDS response to first look back,” stated Dr Guwani.  He shared that in 2004 and 2005 the region experienced an estimated 18,000 AIDS-related deaths. In 2017, that number had fallen by more than 40%.  From 1997 to 2000, there were an estimated 30,000 new infections annually in the Caribbean. By the end of 2017, that number was reduced by half.  In 2015, 45% of all people living with HIV in this region were on treatment. Two years later that number had increased to 57 percent—well over half of the HIV positive population.

Dr Guwani further stated that the numbers tell the story of a region that has gotten many things right including widespread access to treatment, increased testing availability and some traction with respect to prevention. “These strides are in large part thanks to the people and partnerships in this very room,” stated Dr Guwani, “As we redirect our attention to the uphill battle before us, let us remind ourselves of our capacity to mobilize leaders and communities, to inform and sensitize citizens and to treat and care for those living with HIV. We have what it takes to end this epidemic. We must now ask how we can harness our expertise, resources and passion to reach those who have not benefitted from the services on offer”.

He emphasized that the big picture is that in 2017, 73% of Caribbean people living with HIV knew their status, 79% of diagnosed people were on treatment and 70% of those on treatment were virally suppressed.

Dr Guwani challenged the meeting to answer the following questions: why are quarter of those testing positive in the Caribbean diagnosed late, why do so many people not stay the course having started treatment, and why aren’t prevention efforts reaching enough of the young people who now account for almost one-third of new infections in the region.

He urged the participants to combine evidence, analysis and insights to determine what the Region should do differently in order to reach the youth, men, women and members of key and vulnerable communities who continue to be left behind.  

Ms Victoria Nibarger, PEPFAR Coordinator, Caribbean Regional Program, Office of the Global AIDS Coordinator and Health Diplomacy (S/GAC), Jamaica highlighted the recent case of a man living with HIV in London who had been “functionally cured” of HIV, following a bone marrow transplant from an HIV-resistant donor.  She noted that more than 18 months have passed since the man last took ARVs, and there remains no trace of HIV in his blood.  She shared that Anton Pozniak, President of the International AIDS Society, called it a “critical moment” in terms of the fight against HIV, but emphasized that at present it does not offer a large-scale strategy for a cure.

“I have no doubt that we are all united in our hope for a scalable cure,” stated the PEPFAR Coordinator, “but even in the meantime we have a historic opportunity to make what once seemed impossible possible – controlling and ultimately ending HIV as a public health threat around the world”.

She highlighted that when the United States government launched PEPFAR in 2003, HIV was a death sentence in many parts of the world.  Thanks to the lifesaving efforts of PEPFAR and its partners, the world is a more secure place.  Ms Nibarger explained that with strong bipartisan support across three U.S. Presidents and nine U.S. Congresses and working with our many partners around the globe, PEPFAR has invested more than 80 billion U.S. dollars in the global HIV response.  The results have been incredible:  more than 17 million lives saved, prevented millions of new HIV infections, and created the roadmap to controlling the pandemic.

The PEPFAR Coordinator emphasized that the region cannot achieve epidemic control so long as any one country is lagging behind.  She stated, “This Seventh Annual Meeting is an invaluable opportunity for those of us working throughout the Caribbean to come together, to learn from one another, to strategize and to strengthen our joint resolve to combat HIV.  This meeting can serve as a troubleshooting forum.  I am confident that the collective wisdom on all fronts – health, culture, and politics – is sufficient to overcome challenges that are being faced”.

She challenged participants to devote significant attention to the 90-90-90 Targets, for a progress check as 2020 approaches.  The cascade for the collective region is approximately 73-57-40 of all people living with HIV.

Ms Nibarger applauded the Region for being well on its way to achieving the First 90.  “We need to review testing strategies to ensure they are maximally efficient and that we are not over-testing certain populations, stated the PEPFAR Coordinator, “PEPFAR firmly believes that index testing and partner notification services are essential to ensuring that at least 90 percent of individuals know their status.  We are confident that this is possible to do across the Caribbean, despite challenges related to stigma, discrimination and violence”.

She further stated that despite the great strides in implementation of Treat All, the percentage of those diagnosed who are on treatment remains low – around 57 percent of all PLHIV for the region. She urged the participants to work together to rapidly expand treatment coverage with the goal of every individual who is diagnosed with HIV rapidly initiating ART.  She emphasized that there is overwhelming evidence that this policy results in better patient outcomes, stronger adherence and higher viral suppression rates.

“We believe the adoption of TLD (fixed-dose combination of tenofovir 300mg /lamivudine 300mg /dolutegravir 50mg (TLD), as a first-line regimen is essential to ensure better adherence and clinical outcomes.  Differentiated service-delivery models, such as 6-month scripting, are more convenient for patients and can help to ease crowding at treatment facilities and pharmacies,” stated Ms Nibarger.

She further stated that the final 90 – viral suppression – has the farthest to go, with the current regional figure at about 40 percent.  “We support the scale-up of viral load testing, which will help to ensure optimal clinical outcomes”.

On the issue of sustainability, the PEPFAR Coordinator explained that the PEPFAR budget for the Caribbean Regional Programme will be reduced for the next fiscal year, “We will closeout our bilateral programming in Suriname this Fall, followed by a planned closeout in Guyana and Barbados in Fall 2020.  At this time, we do not have planned closeout dates in Jamaica or Trinidad and Tobago.  As donor resources decline, host governments are taking on more of the financing – and this is commendable.  We believe it is critical that governments continue to learn from one another about how to successfully mobilize domestic resources to strengthen sustainability and prepare for donor transition.  As such, we look forward to the roadmap for sustainability that is an expected outcome of this meeting”.

She further stated “Treat All, index testing, multi-month scripting, viral load scale-up, increasing government resources are some of the minimum requirements for our 2019 PEPFAR Regional Operational Plan.  They are WHO-supported policies and practices that PEPFAR is requesting to be in place ahead of our new fiscal year.  There is strong evidence that they are necessary for efficient and effective programmes, which enable the reduction of HIV transmission and, eventually, epidemic control”

Ms Nibarger highlighted that despite the changes, she can confirm that PEPFAR remains fully committed to the sustainability of the Partnership, “It is these partnerships that make progress, and our joint goal of reaching the 90-90-90 targets, possible.  We have heard you, our partners; we will not reach our goals if we focus only on services for members of key populations who are comfortable disclosing their status.  Not everyone is willing or able to disclose.  Therefore, we are proposing new strategies – including men’s health clinics – to broaden our reach and ensure that our PEPFAR dollars are finding those who need help.

We are looking at ways to support integrated service-delivery models that will better provide for the holistic needs of patients.  We want to increase knowledge of private practitioners and their contributions to the HIV response as well as to link them to our clinical-mentoring activities.  We aim to strengthen direct partnerships with local non-governmental organizations who are integral to the response”.

The PEPFAR Coordinator emphasized that PEPFAR worldwide will continue to prioritize strategic information, as decisions must be data-driven.  She explained that it is through strong strategic information systems that the most accurate picture of the epidemic can be seen as well as the identification of areas where interventions are working, outstanding gaps, and efficient use of collective resources.

“This time together presents a great opportunity.  I am hopeful that we will come away from this meeting with new ideas about how to accelerate progress toward 90-90-90.  I hope that we will further strengthen the commitment to international best practices and figure out how we can adapt them to fit the context of the Caribbean region as well as individual countries.  Just like with the news of the patient in London being “functionally cured,” progress is happening, and we have reason to be optimistic.  Together, we can – and we will – end the HIV pandemic in the Caribbean,” stated Ms Nibarger.

Ms Sandra Jones, Technical Advisor HIV/STI, TB and Viral Hepatitis PAHO/WHO – Sub-regional Program Coordination, Caribbean highlighted that over the last 3-5 years the region has made progress towards reversing the HIV epidemic, achieving a reduction in the number of new HIV infections by 18% and deaths by 23%.  “However, as demonstrated by the evaluation of the CRSF 2014-2018, there are gaps and challenges, resulting in uneven progress in the region”, stated Ms. Jones, “while there has been progress in placing more people living with HIV on treatment, much more needs to be done to increase the numbers and to retain people on treatment. In fact, significant effort is required for the Caribbean to achieve the UNAIDS 90-90-90 targets”.

She stated that the region has a unique opportunity to address the challenges, accelerate actions and close the gaps with specific indicators for HIV, the Sustainable Health Agenda for the Americas, the HIV fast-track targets and evidence-based interventions.  She also stated that Regional Frameworks such as the CRSF, the Caribbean Cooperation in Health coupled with a strong primary care system in each of the Member States, and committed partners can assist the region in achieving the 90-90-90 targets.

Ms Jones emphasized that paramount to achieving the 2030 goal of ending AIDS is a paradigm shift.  She stated, “The time to be innovative is now, given the overwhelming evidence for HIV prevention and treatment that are currently available. The rapid implementation of different innovations and evidence-based interventions for HIV prevention, care and treatment which include Pre-exposure prophylaxis (PrEP), Post Exposure Prophylaxis-PEP, self-testing, Treat All, as well as sexually transmitted infection (STI) prevention and Control, with emphasis on key populations and migrants, should be delivered in a more cohesive, integrated manner, focusing  on universal access and coverage for everyone. The delivery of an integrated service for HIV and STI must continue to include civil society organizations. Providing linkage to care will ensure that “the unreached is reached, leaving no one behind”.

She further stated, “One of the achievements that the region is proud of is the Elimination of Mother-to-child Transmission of HIV and Syphilis (EMTCT). The Caribbean is a leader in EMTCT. Besides the validation of Cuba and six other Caribbean Countries in 2015 and 2017, seven of the nine countries validated are from the Caribbean.  This achievement is possible due to the primary health care focus and the integration of HIV and Syphilis primary prevention and treatment services into national maternal and child health programme”.

Ms Jones explained that as a result, the estimated coverage of HIV testing among pregnant women increased from 58% in 2010 to 73% in 2017, while ART coverage for HIV+ mothers increased from 50% in 2010 to 75% in 2017. All these have resulted in a 27% reduction of new infections among infants from 2010 to 2017, with an estimated 5,800 new HIV cases averted.

She stated, “let us all remember that the elimination of the mother-to-child transmission, which we thought was not possible, is a tangible commitment to universal health and brings us closer to ending AIDS and other STIs as a public health problem in the Caribbean.

Ms Jones reaffirmed PAHO’s commitment to work hand-in-hand with Member States and with all partners including civil society organizations to provide the necessary policy advice, technical support and capacity building so that the Region can collectively reverse the HIV epidemic, ending AIDS and priority STIs as public health problems in the Caribbean.

Hon. Terrence Deyalsingh, Minister of Health, Republic of Trinidad and Tobago and Chair, PANCAP Executive Board highlighted that the HIV programmatic interventions by necessity also require political will, strategic leadership, good governance and an overall unrelenting bravery. He emphasized the need to analyse evidence in a sovereign way that is cognizant of the unique country socio-cultural and economic context for executive decision-making.

He stated that winning and losing battles among programmes, policies and legislative agendas must not daunt the focus on the war against the HIV epidemic, and improved quality of life for those living with and affected by HIV.

 He shared that in 2015 Trinidad and Tobago had an uncertain future for the National AIDS Coordinating Committee (NACC) that became a loose amalgam to the health-based HIV and AIDS Coordinating Unit (HACU). There was staff attrition, minimal spending of US funds from the PEPFAR programme from 2010 to 2015 and the characteristic of the epidemic was still ill-defined in an embryonic case-based surveillance system and further stymied by these governance battles.  “As a country, we were still quoting cases ever diagnosed as over 20,000 cases to characterize our evidence base for advocacy and decision-making without knowledge of all deaths, including those related to AIDS. The country was beginning to slowly recognize that the Spectrum UNAIDS estimates were congruous with the truer reality of 11,000 persons being alive and living with HIV.

 The Minister explained that in 2015 and 2016 there was a reintegration of the NACC into the Office of the Prime Minister to oversee HIV Prevention activities particularly in spheres of community engagement through social and NGO support services, addressing childhood sexual, age and gender appropriate education as well as, child abuse and domestic violence. This brought back purpose to the health-based HIV Unit to contribute to the national HIV programme as overseen by the NACC through preserving the traditional gains in HIV testing expansion and HIV treatment and unravelling and tackling the case-based surveillance and adopting the 90-90-90 cascade histogram to guide national decision making.

“This refocus was synergistic with the 2016 UNAIDS global resolutions and with the local arm of PEPFAR’s strategic realignment of their prevention and strategic information goals to increase persons on Antiretroviral (ART) and strengthen case-based surveillance,” stated Minister Deyalsingh, “The deliberate re-engagement of PEPFAR saw a then fledgling expenditure up to 2015, increase greatly in the 2016 and 2017 fiscal years. This has assisted Trinidad and Tobago to move closer to the desired 2020 Fast Track Targets from a HACU reported 2015 baseline 90-90-90 achievements of 83-74-42, to an overall target of 79-78-87 in 2017”.

Minister Deyalsingh emphasized that Trinidad and Tobago’s roadmap offers the words and phrases of steadfast, evidence-driven, organizational and political will, and willingness to change and innovate. “A reiterated call to get technical support for country case-based surveillance systems, opt-out testing as an accelerated strategy at select health care facilities that address STI, TB, mental health, substance abuse and hospital ward admissions and mental health focus on treatment adherence are key” stated the Minister.

The Minister further stated that the HIV epidemic has been better understood and managed more aggressively in the last three years with a trajectory to further improve. “The AIDS epidemic can be ended on, or before 2030,” stated Minister Deyalsingh, “We need to be honest and look hard at what the national evidence and national socio-economic situation are sometimes screaming at us to do. There is an overdue need to collaborate in an atmosphere of mutual respect beginning with countries recognizing the global comparator of apples with apples with regional partners.  However regional and multilateral agencies must also accept that despite all the recommended plethora of actions that a sovereign country’s self-determined narrow critical path for success should be fully supported”.

Minister Deyalsingh challenged the participants to use the forum to highlight country positions, programmes and policy initiatives to provide not the “typical problem tree decorated with obstacles, but the solution tree decorated with the Caribbean resolve, as led by PANCAP to permanently root out these obstacles that must be perceived as only short-term programme gaps”.

The Minister commended the exceptional and creative leadership of the Director of PANCAP. He noted that the Region will owe him a debt of gratitude when it achieves the UNAIDS 90-90-90 targets. He acknowledged the presence of the youth – CARICOM Youth Ambassadors and key population leaders – to whom he urged that the baton be passed to lead the response in the future.

– ENDS –

 Helpful links:

Seventh Meeting of the National AIDS Programme Managers and Key Partners Event web page

https://pancap.org/pancap-events/7th-meeting-of-the-national-aids-programme-managers-and-key-partners/

Global AIDS Update 2018 – Miles to Go

https://pancap.org/pancap-documents/global-aids-update-2018-miles-to-go/

Caribbean Regional Strategic Framework on HIV and AIDS

https://pancap.org/pancap-documents/caribbean-regional-strategic-framework-on-hiv-and-aids-2008-2012/

What is PANCAP?

PANCAP is a Caribbean regional partnership of governments, regional civil society organisations, regional institutions and organisations, bilateral and multilateral agencies and contributing donor partners which was established on 14 February 2001. PANCAP provides a structured and unified approach to the Caribbean’s response to the HIV epidemic, coordinates the response through the Caribbean Regional Strategic Framework on HIV and AIDS to maximise efficient use of resources and increase impact, mobilises resources and build capacity of partners.

Editor’s Notes

What are the Joint United Nations Programme on HIV and AIDS (UNAIDS) 90-90-90 Targets?

  • By 2020, 90% of all people living with HIV will know their HIV status.
  • By 2020, 90% of all people with diagnosed HIV infection will receive sustained antiretroviral therapy.
  • By 2020, 90% of all people receiving antiretroviral therapy will have viral suppression.

Background to the National AIDS Programme Managers and Key Partners Meeting

The Caribbean Regional Strategic Framework (CRSF) 2014-2018 articulates the vision and collective priorities of Caribbean states through their membership in the Pan Caribbean Partnership against HIV and AIDS (PANCAP). The core premise is that stemming the HIV epidemic in the Caribbean rests on the commitment, capacity and leadership of national authorities and effective response. The primary goal of regional collaborative efforts is to support country responses by addressing common challenges in the areas of evidence-based policy formulation, and innovative responses  to  addressing legislative gaps, resource mobilisation, coordination and technical assistance., An effective regional response, guided by the CRSF 2014-2018, therefore  requires that the links and interfaces between country programmes  and regional support programmes be defined and agreed to by country partners. This is critical for strengthening country ownership of the PANCAP response and a shared responsibility to strategically align efforts to end HIV as a public health problem in the Caribbean.

The National AIDS Programme Managers and Key Partners Meeting provides an opportunity for joint decision-making in setting programmatic priorities and identifying partner contributions in order to strategically align efforts in the fight against HIV. The Meeting Agenda is intended to allow for in-depth analysis and discussion on the relevant aspects of the UN Post 2015 Agenda, and the overall advancements of the Caribbean Region in implementing new initiatives for HIV. It is within this context that opportunities and challenges for the Region and individual countries to expand the national responses will be discussed. PANCAP acknowledges the need for greater attention to intercountry linkages and greater collaboration with regional partners. This will serve to maximise synergies and provide a mechanism for making regional public goods available to national programmes to enhance their delivery and impact.

PANCAP Knowledge Management Share Fair to focus on improving access to HIV prevention, treatment, care and support by men and boys

Thursday, 7 March 2019 (PANCAP Coordinating Unit, CARICOM Secretariat): The Pan-Caribbean Partnership against HIV and AIDS (PANCAP), the mechanism that provides a structured and unified approach to the Caribbean’s response to the HIV epidemic, will host a Knowledge Management Share Fair in Port-of-Spain, Republic of Trinidad and Tobago on 14 March 2019.  Participants will include over 80 National AIDS Programme (NAP) Managers and Implementing Partners such as civil society organizations that work with people living with HIV and key population groups (including youth).  The Share Fair is an initiative of the PANCAP Knowledge for Health project, which aims to enhance knowledge generation, sharing, and learning among HIV programme implementers and civil society around the implementation of Treat All[1] and the 90-90-90 Targets[2].

The Share Fair will expand on the capacity building initiatives implemented by the Project.  These include the Knowledge Synthesis and Best Practices Workshop (2016), South-to-South Learning Exchanges to the Dominican Republic and Jamaica (2017-2018), Treat All Message Design Workshop (2017), “Collaborating and Learning towards Treat All” Share Fair (2018), PANCAP webinars, and other ongoing regional knowledge management efforts around 90-90-90 and Treat All.

It will provide a space for NAP managers and Civil Society Organization (CSO) representatives to showcase best practices from implementation experiences, discuss critical challenges, and provide recommendations for increasing access to services for men, including men who have sex with men and other key populations in achieving 90-90-90.  Access to services by men will be a key issue during the Share Fair as the UNAIDS Global AIDS Update 2018 shows that gay men and other men who have sex with men accounted for nearly a quarter of new infections in 2017.  The report also highlighted that efforts to reach men and boys, and particularly gay men and other men who have sex with men, are constrained by health services insufficiently tailored to their needs and limited community-based services.

To build capacity in the area of improving access to health by men, the Share Fair will include a Knowledge Café, which will highlight successful Men’s Health programmes.  According to PANCAP Knowledge Coordinator, Dr Shanti Singh-Anthony, the intention is to highlight innovations from country programmes that have achieved positive results in relation to increasing access to prevention, treatment, care and support services by men and boys.  Implementers of programmes who are challenged to reach men with health services can use the innovative practices to increase men’s access to quality health services.

“Previous Share Fairs were successful in forging stronger partnerships and collaboration between NAP Managers and CSOs and sharing of best practices,” stated Dr Singh-Anthony “we intend to build on these successes.  We cannot afford to leave our men and young boys behind at this critical stage of the HIV response.  The Share Fair will provide an ideal opportunity for the two groups to utilize the lessons learned from the region to enhance services for men.  The overarching objective is to increase the number of men and boys who are accessing HIV prevention, treatment, care and support services”.

Participants will also share implementation experiences in relation to the provision of Pre-exposure Prophylaxis (PrEP), innovations for reaching and testing key populations, and strategies for sustaining the HIV response.

       – ENDS –

Contact:

Timothy Austin

Communications Specialist

PANCAP Coordinating Unit

CARICOM Secretariat

Tel: (592) 222-0001-75| Email: taustin.consultant@caricom.org

Fax: (592) 222-0203 | www.pancap.org

 Helpful links:

What is the PANCAP Knowledge for Health Project?

https://pancap.org/pancap-work/applying-knowledge-management-to-strengthen-pancaps-coordination-role-for-the-regional-hivaids-response/

 Global AIDS Update 2018 – Miles to Go

https://pancap.org/pancap-documents/global-aids-update-2018-miles-to-go/

 What is PANCAP?

PANCAP is a Caribbean regional partnership of governments, regional civil society organisations, regional institutions and organisations, bilateral and multilateral agencies and contributing donor partners which was established on 14 February 2001. PANCAP provides a structured and unified approach to the Caribbean’s response to the HIV epidemic, coordinates the response through the Caribbean Regional Strategic Framework on HIV and AIDS to maximise efficient use of resources and increase impact, mobilises resources and build capacity of partners.

Editor’s Notes

What are the Joint United Nations Programme on HIV and AIDS (UNAIDS) 90-90-90 Targets?

  • By 2020, 90% of all people living with HIV will know their HIV status.
  • By 2020, 90% of all people with diagnosed HIV infection will receive sustained antiretroviral therapy.
  • By 2020, 90% of all people receiving antiretroviral therapy will have viral suppression.

[1] In September 2015, the World Health Organization (WHO) issued a new policy, which stated that anyone infected with HIV should begin antiretroviral treatment as soon after diagnosis as possible. With its “Treat-all” recommendation, WHO removed all limitations on eligibility for antiretroviral therapy (ART) among people living with HIV; all populations and age groups are now eligible for treatment.

[2] Joint United Nations Programme on HIV and AIDS (UNAIDS) 90-90-90 Targets:

  • By 2020, 90% of all people living with HIV will know their HIV status.
  • By 2020, 90% of all people with diagnosed HIV infection will receive sustained antiretroviral therapy.
  • By 2020, 90% of all people receiving antiretroviral therapy will have viral suppression.

UNAIDS is greatly encouraged by news of a possible cure of an HIV-positive man

SEATTLE/GENEVA, 5 March 2019—UNAIDS is greatly encouraged by the news that an HIV-positive man has been functionally cured of HIV. The man was treated by specialists at University College London and Imperial College London for advanced Hodgkin’s lymphoma in 2016 using stem cell transplants from a donor who carried a rare genetic mutation. Researchers report that HIV has been undetectable in the man since he stopped taking antiretroviral medicine 18 months ago.

“To find a cure for HIV is the ultimate dream,” said Michel Sidibé, Executive Director of UNAIDS. “Although this breakthrough is complicated and much more work is needed, it gives us great hope for the future that we could potentially end AIDS with science, through a vaccine or a cure. However, it also shows how far away we are from that point and of the absolute importance of continuing to focus HIV prevention and treatment efforts.”

Stem cell transplants are highly complex, intensive and costly procedures with substantial side-effects and are not a viable way of treating large numbers of people living with HIV. However, the results do offer a greater insight for researchers working on HIV cure strategies and highlight the continuing importance of investing in scientific research and innovation.

The result, reported at the Conference on Retroviruses and Opportunistic Infections in Seattle, United States of America, is one of only two cases of reported functional cures for HIV. The first was the case of the Berlin patient, Timothy Ray Brown, who received similar treatment for cancer in 2007.

There is currently no cure for HIV. UNAIDS is working to ensure that all people living with and affected by HIV have access to life-saving HIV prevention, treatment, care and support services. In 2017, there were 36.9 million people living with HIV and 1.8 million people became newly infected with the virus. In the same year, almost 1 million people died of AIDS-related illnesses and 21.7 million people had access to treatment.

UNAIDS

The Joint United Nations Programme on HIV/AIDS (UNAIDS) leads and inspires the world to achieve its shared vision of zero new HIV infections, zero discrimination and zero AIDS-related deaths. UNAIDS unites the efforts of 11 UN organizations—UNHCR, UNICEF, WFP, UNDP, UNFPA, UNODC, UN Women, ILO, UNESCO, WHO and the World Bank—and works closely with global and national partners towards ending the AIDS epidemic by 2030 as part of the Sustainable Development Goals. Learn more at unaids.org and connect with us on Facebook, Twitter, Instagram and YouTube.

Innovative ways to address gaps identified in UNAIDS 2018 GAM Report for discussion at Seventh Meeting of National AIDS Programme Managers and Key Partners

Friday, 1 March 2019 (PANCAP Coordinating Unit, CARICOM Secretariat): The Pan-Caribbean Partnership against HIV and AIDS (PANCAP), the mechanism that provides a structured and unified approach to the Caribbean’s response to the HIV epidemic, will host the Seventh Meeting of National AIDS Programme (NAP) Managers and Key Partners in Port-of-Spain, Republic of Trinidad and Tobago from 11 – 13 March 2019.  Participants will include over 130 National AIDS Programme (NAP) Managers, Chief Medical Officers, Permanent Secretaries, Development and Regional Partners, Implementing Partners such as civil society organizations that work with people living with HIV and key population groups (including youth).

The meeting is being hosted 22 months ahead of the end of 2020 deadline for reaching the UNAIDS 90–90–90 Targets —90% of people living with HIV diagnosed, 90% of diagnosed people on treatment and 90% of those on treatment virally suppressed.

The purpose of the meeting is to update programme managers and all stakeholders involved in the HIV response on national and regional commitments, progress on current global strategies, identify innovative ways to address gaps identified in the UNAIDS 2018 Global AIDS Monitoring (GAM) Report and to strengthen the Caribbean regional HIV response. The Meeting will facilitate information and best practice sharing; peer learning and technical cooperation among countries to strengthen ownership; improve harmonisation and sustainability of the Region’s HIV response.

Critical issues highlighted by the GAM report, which will form the basis of discussion, include the fact that there is an estimated 310,000 people living with HIV in the Caribbean at the end of 2017.  The gap to achieving the First 90 of the 90-90-90 Targets in 2017 was 54,800 people living with HIV who do not know their status.  The gap to achieving the Second 90 in 2017 is 74, 400 people living with HIV who are not on treatment.  The gap to achieving the Third 90 in 2017 was attaining viral suppression of an additional 103,000 people living with HIV.

Participants will be engaged in discussions on strategies for addressing these gaps as well as exploring what sustainability means for individual countries in the context of their existing economic realities and creating a roadmap for integration as a key strategy for sustainability.

Stakeholders will also receive updates on the achievements and synergies of the PANCAP, Caribbean Vulnerable Communities Coalition (CVC-COIN) and the Organisation of Eastern Caribbean States (OECS) Global Fund grants and the transfer of regional public goods developed under these grants.  Development and regional partners will also provide updates on programmes and activities that are contributing to the achievements of the goals and targets of the Caribbean Regional Strategic Framework on HIV (CRSF).

Ms Aldora Robinson, National AIDS Programme Coordinator, Turks and Caicos Islands and the National AIDS Programme Managers Representative on the PANCAP Governance Bodies, believes that the meeting could be a “game changer” at this critical point in the region’s HIV response.  “In an environment of reduced international funding for HIV, calls for country ownership, and the global vision of an AIDS-Free Generation, NAP Managers and CSOs must work together to establish innovative ways to address the gaps in the response as highlighted in the GAM report,” stated Robinson.

She further highlighted that the critical issues for discussion include increasing access to HIV and STI testing for key populations, including transgender and youth, and scaling-up Sexually Transmitted Infections (STI) testing within the HIV combination prevention approach.  Countries will also commit to implementing innovative strategies for reaching, testing and retaining persons on treatment and for preventing HIV among key populations and reporting on progress.

The meeting is expected to culminate with an agreement by all stakeholders on strategies for addressing gaps in achieving the 90-90-90 Targets, a critical element of PANCAP’s vision for an AIDS-free Caribbean.

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Helpful links:

Seventh Meeting of the National AIDS Programme Managers and Key Partners Event web page

https://pancap.org/pancap-events/7th-meeting-of-the-national-aids-programme-managers-and-key-partners/

Global AIDS Update 2018 – Miles to Go

https://pancap.org/pancap-documents/global-aids-update-2018-miles-to-go/

What is PANCAP?

PANCAP is a Caribbean regional partnership of governments, regional civil society organisations, regional institutions and organisations, bilateral and multilateral agencies and contributing donor partners which was established on 14 February 2001. PANCAP provides a structured and unified approach to the Caribbean’s response to the HIV epidemic, coordinates the response through the Caribbean Regional Strategic Framework on HIV and AIDS to maximise efficient use of resources and increase impact, mobilises resources and build capacity of partners.

Editor’s Notes

What are the Joint United Nations Programme on HIV and AIDS (UNAIDS) 90-90-90 Targets?

  • By 2020, 90% of all people living with HIV will know their HIV status.
  • By 2020, 90% of all people with diagnosed HIV infection will receive sustained antiretroviral therapy.
  • By 2020, 90% of all people receiving antiretroviral therapy will have viral suppression.

Background to the National AIDS Programme Managers and Key Partners Meeting

The Caribbean Regional Strategic Framework (CRSF) 2014-2018 articulates the vision and collective priorities of Caribbean states through their membership in the Pan Caribbean Partnership against HIV and AIDS (PANCAP). The core premise is that stemming the HIV epidemic in the Caribbean rests on the commitment, capacity and leadership of national authorities and effective response. The primary goal of regional collaborative efforts is to support country responses by addressing common challenges in the areas of evidence-based policy formulation, and innovative responses  to  addressing legislative gaps, resource mobilisation, coordination and technical assistance., An effective regional response, guided by the CRSF 2014-2018, therefore  requires that the links and interfaces between country programmes  and regional support programmes be defined and agreed to by country partners. This is critical for strengthening country ownership of the PANCAP response and a shared responsibility to strategically align efforts to end HIV as a public health problem in the Caribbean.

The NAP (National AIDS Program) Managers and Key Partners Meeting provides an opportunity for joint decision-making in setting programmatic priorities and identifying partner contributions in order to strategically align efforts in the fight against HIV. The Meeting Agenda is intended to allow for in-depth analysis and discussion on the relevant aspects of the UN Post 2015 Agenda, and the overall advancements of the Caribbean Region in implementing new initiatives for HIV. It is within this context that opportunities and challenges for the Region and individual countries to expand the national responses will be discussed. PANCAP acknowledges the need for greater attention to intercountry linkages and greater collaboration with regional partners. This will serve to maximise synergies and provide a mechanism for making regional public goods available to national programmes to enhance their delivery and impact.

PANCAP to host Parliamentarians Sensitization Forum in Jamaica

Wednesday 27 February 2019 (PANCAP Coordinating Unit, CARICOM Secretariat): The Pan-Caribbean Partnership against HIV and AIDS (PANCAP), with funding from the CARIFORUM 10th European Development Fund (EDF) Programme of Support for Wider Caribbean Cooperation, will host a Parliamentarians Sensitization Forum in Kingston Jamaica on Thursday 28 February 2019.

The Forum forms part of a series of engagements with parliamentarians, which commenced in 2013 under the PANCAP Justice for All (JFA) programme.  The objectives of the Forum are to outline the challenges to the Jamaica HIV response including stigma and discrimination that serve as barriers to achieving the UNAIDS 90-90-90 Targets and ending the AIDS epidemic, define parliamentarians’ legislative, representational and oversight roles toward addressing the challenges to ending the AIDS epidemic and pursue actions with specific timelines aligned with parliamentarians’ legislative, representational and oversight roles.

Participants will be engaged in making specific recommendations for the establishment of a National Parliamentarian Action Group to function as a coordinating mechanism to facilitate communication with and among National Parliamentary Committees, with specific reference to the 2030 Sustainable Development Goal (SDG) #3: ensuring healthy lives and promoting well-being for all at all ages, with a specific target that by 2030 to end the epidemics of AIDS, Tuberculosis, Malaria and neglected tropical diseases and combat Hepatitis, waterborne diseases and other communicable diseases.

The Forum will also seek to identify ways to collaborate with other stakeholders including faith leaders, civil society, youth, and Key Populations to respond to HIV.

Featured speakers include Hon. Delroy Chuck, Minister of Justice, Jamaica, Hon. Pearnel Charles, Sr., Speaker of the House of Representatives, Jamaica, Dr Peter Phillips, Leader of the Opposition, Mr. Fredrik Ekfeldt, Deputy Head of Mission, Minister-Counsellor at the European Union Delegation to Jamaica, Belize, The Bahamas, Cayman Islands and Turks and Caicos and Dr Edward Greene, Special Advisor to PANCAP. Representatives of the Ministry of Health, UN agencies and civil society organizations will also be attending. Mr. Dereck Springer, Director of PANCAP, will preside over the meeting.

The objectives of the Forum are aligned with the JFA Programme and PANCAP’s regional response to the UN High-Level Political Declaration (June 2011) designed to reduce AIDS-related stigma and discrimination.

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What is PANCAP?

PANCAP is a Caribbean regional partnership of governments, regional civil society organisations, regional institutions and organisations, bilateral and multilateral agencies and contributing donor partners which was established on 14 February 2001. PANCAP provides a structured and unified approach to the Caribbean’s response to the HIV epidemic, coordinates the response through the Caribbean Regional Strategic Framework on HIV and AIDS to maximise efficient use of resources and increase impact, mobilizes resources and build capacity of partners.

  • 10th European Development Fund (EDF) Programme of Support for Wider Caribbean Cooperation

Under the 10th (EDF) Programme of Support for Wider Caribbean Cooperation, PANCAP will strengthen coordination on human rights issues in keeping with the Justice For all Roadmap through the HIV and AIDS Thematic Task Force in CARIFORUM.

  • CARIFORUM

CARIFORUM refers to the Grouping of Caribbean States which are signatories of the Georgetown Agreement establishing the African, Caribbean and Pacific Group of States (ACP). The ACP grouping is composed of 79 African, Caribbean and Pacific states.

CARIFORUM is the recipient of and manages the implementation of Caribbean Regional Indicative Programmes financed by the EDF and Caribbean regional programmes financed by individual Member States of the European Union. It also provides technical assistance to agencies/institutions implementing projects under these programmes.

  • European Union

The Member States of the European Union have decided to combine their expertise, resources and destinies. Together, they have built a zone of stability, democracy and sustainable development whilst maintaining cultural diversity, tolerance and individual freedoms. The European Union is committed to sharing its achievements and its values with countries and peoples beyond its borders’.

Background to the PANCAP Justice for All (JFA) Roadmap

The PANCAP Justice for All (JFA) Programme was established in September 2013 as a regional response to the UN High-Level Political Declaration (June 2011) designed to reduce AIDS-related stigma and discrimination. The objectives of the JFA Roadmap are:

  • Enhancing family life and focusing on those in need
  • Increasing access to treatment and affordable medicines
  • Reducing gender inequality including violence against women, girls and adolescents
  • Promoting prevention with special reference to sexual and reproductive health and rights including age-appropriate sexual education
  • Implementing legislative reforms for modifying AIDS-related stigma and discrimination