Message from Dr Rosmond Adams, Director, PANCAP – July 2020

The current Coronavirus pandemic has the potential to disrupt health services. An effective HIV response requires continuous service delivery in areas such as prevention, treatment and laboratory services. Moreover, HIV care and treatment services are dependent on community action to reach those at risk and to support those currently living with HIV to ensure that they are reached and linked to or are retained in care.

The Caribbean Regional Strategic Framework (CRSF) 2019 – 2025 provides essential guidelines that build on the already illustrious achievements of a Partnership deemed by UNAIDS to be an international best practice. Most appropriate, it’s a vision of a Caribbean free of AIDS and new HIV infections, in which all people are happier, healthier, productive, safe and respected.  It is complemented by a mission to stimulate the critical role of country programmes that empower Caribbean people to fulfil their potential and live happy, healthy, peaceful lives.

Disruptions from COVID-19 can delay or slow implementation of the CRSF as the blueprint for ending AIDS. However, COVID-19 presents us with an opportunity not to be missed. COVID-19 is highlighting critical areas for actions, especially issues such as inequalities, stigma and discrimination and the need to increase domestic funding for the HIV response.

The CRSF 2019 – 2025 highlights priority areas that go hand-in-hand with the COVID-19 response. These priority areas can be advanced during the pandemic. The response to COVID-19 and HIV require bold political and technical leadership to ensure that there is an effective response. Indeed, this is the first priority area of the CRSF 2019 – 2025. We need bold leadership now more than ever. While we are calling for such a response to get over the pandemic, it will be strategic to make a unified call for HIV and other health-related issues. Bold leadership requires taking action when and where needed and to ensure that the HIV response is fully supported.

HIV programmes require strengthening in many places. Prevention services have been weakened over the years. Other areas such as treatment and testing were set back due to the challenges of the pandemic. It is probably the ideal time for national programmes to integrate HIV into primary care so that services can be accessed more widely, making it accessible to clients.

Finally, as resources are mobilized to respond to COVID-19, it is critically important that we do not forget about HIV and that resources are also mobilized to support and sustain the HIV response.

While the CRSF was written before the COVID-19 pandemic, the priority areas are even more critical now. They serve as a guide for us to move forward and for us to examine the essential question: how do we advance the HIV response during COVID-19?

Remarks by Dr Rosmond Adams, Director, PANCAP on the occasion of the UNAIDS Global AIDS Report 2020 launch

It gives me great pleasure to present these brief remarks on next steps on behalf of the Pan Caribbean Partnership against HIV and AIDS (PANCAP) at this virtual launch of the UNAIDS Global AIDS Update 2020.

As COVID-19 rapidly spreads, the global HIV community is increasingly concerned about the potential impact of COVID-19 on the 37.9 million People Living with HIV globally. Indeed, the Caribbean Region is aware of the potential threat that COVID-19 will have on advancing progress towards ending AIDS in the region.

This report comes at an important time when we are faced with so many uncertainties in this very vulnerable corner of the globe. In addition to COVID-19, the region is faced by slow economic growth, which will present a challenge for financing and sustaining national and regional HIV/AIDS response. Additionally, other health sector challenges such as the rising burden of non-communicable diseases, the impact of climate change on health and the ever-looming threat from natural disasters are just a few examples.

The theme of this year’s report is, “Seizing the Moment: Tackling entrenched inequalities to end epidemics”. As we continue to maneuver the challenges of COVID-19, this theme is very fitting for us to look for the opportunities that the pandemic has presented and to seize the moment to accelerate action in filling gaps that exist in the regional response to ending the epidemic.

While the report highlighted that the Caribbean region has made progress in reducing new HIV infections and AIDS-related deaths and great strides have been made towards the Elimination of Mother-to-child HIV transmission, progress across the testing and treatment cascade has slowed. Awareness of HIV status is the first step in accessing care but is also a potential prevention tool and a way to normalise and destigmatise HIV. Therefore, any action on HIV must start with testing and awareness of one’s status.

Likewise, we have to focus on interventions aimed at improving linkage to and retention in HIV care to achieve the greatest reductions in HIV incidence especially among Key Populations as they are the drivers of the epidemic in the region accounting for 60% of new infections.

It is important to note that if we are to end AIDS and even eliminate a number of communicable diseases especially those referenced by the SDG-3, we must tackle the entrenched inequalities that stand in the way of progress. The HIV epidemic, as we know has been unusual in the extent to which discourse about its epidemiology has been linked to poverty and inequalities. This virus thrives on inequality.

Adolescents and young people, particularly girls and young women, must be the focus of any meaningful response. They are subjected to poor access to healthcare and education, limited empowerment, representation and opportunities to contribute to decision making with partners, family members and communities. Issues such as gender-based violence, harmful cultural norms, stigma and discrimination put them at increased risks.

Addressing the needs of Key Population is also critically important. Access to care in most of our countries is hindered by several factors including criminalisation of same-sex relationships, hostile communities, homophobic discrimination and violence, external and internal stigma, and limited health education.

We must also not forget men. There are many cultural and social norms that are proving to be obstacles to prevention and control among Caribbean men. Partially to blame is the “macho” culture that influences Caribbean men to suppress awareness of their bodies and not to show emotions or vulnerabilities. This puts them at increased risk and can result in not accessing care, not testing and loss to follow up.

We must continue our ongoing efforts to accelerate equitable HIV incidence decline.

Finally, I want to touch briefly on the 90-90-90 Targets. The region is lagging in these targets. According to the report, 77% of People Living with HIV (PLHIV) know their status, 81% of people who know their status are on treatment and 80% of PLHIV on treatment are virally suppressed with only 50% of all PLHIV are virally suppressed. These gaps must be filled. We must get these bars rising.

Another worrying challenge is that of data to guide strategic interventions. Significant data challenges exist in the region ranging from data quality and the timeliness of data. Go down to the granular level. 90-90-90 at the site level.

Supply chain management must be strengthened to ensure continued access to ARVs and other commodities.

Ending AIDS and addressing STIs requires a coordinated multisectoral regional response as articulated in the Caribbean Regional Strategic Framework (CRSF) – 2019-2025.  The CRSF is our blueprint towards ending AIDS, and it highlights policies and programmes to accelerate progress for achieving the UNAIDS 90-90-90 Targets to Test, Treat and Defeat AIDS, to which the region has committed.

We also hold strong to our Justice for All programme that was launched in 2015 to promote activities consistent with the UN Universal Declaration of Human Rights to which all countries are committed. It is intended to achieve one of the goals of the United Nations High-Level Meeting Political Declaration (2011) to eliminate stigma and discrimination against PLHIV by 2015 and to uphold the human rights and dignity of all.

PANCAP will continue to support the regional response by working with National Programmes, Key Partners and Civil Society Organizations, FBO etc.  We will address these challenges and work to break down the inequality barriers and other barriers that can hinder our move towards ending AIDS in the region.

Message from Dr Rosmond Adams, Director, PANCAP – June 2020

As the Caribbean Region continues to implement mitigation strategies to ensure the continuity of care for HIV during the COVID-19 pandemic significant challenges are still present and require a coordinated multisectoral response to stay on track if we are to end AIDS in the Region by 2030.

One of the most significant challenges faced by the region is financing healthcare, particularly financing and sustaining the National and Regional HIV response. COVID-19 has caused funds to be diverted to the pandemic response, which could result in a decrease in HIV funding. At the same time, external funders continue to withdraw from the region, reducing the availability of this level of funding, that is a significant contributor to many national programmes.

It is critically important for countries to sustain health gains and increase investments in the National HIV response.

How can countries commit to this in these challenging times?

Many of the countries in the region are tourism-dependent, and so COVID-19 will negatively impact these economies as this sector continues to take a beating.

As the pandemic continues to impact countries, additional resources are required to contain the spread of the virus and to provide health care to those affected.  The COVID-19 response will continue to demand more resources. Hence, the possibility of getting additional funds at the national levels for HIV is virtually impossible.

The Caribbean region, being mostly Small Island Developing States (SIDS), is very vulnerable to disasters. One common challenge is our vulnerability to natural disasters, especially the impact of hurricanes. With these adversities, the HIV response will not only be disrupted but there is the potential for economic challenges and implications for health budget allocation.

These challenges are real and continue to be compounded by the pandemic. It is crucial that as we sail these turbulent waters, we build capacity to govern and sustain the national and regional HIV response. There is the need to invest in health financing systems to ensure that the limited resources are managed wisely. Despite these challenges, we have to continue to push for increased domestic funding. Additionally, data continues to be a challenge; we have to look for ways for improving data use for planning, resource allocation and efficient service delivery models that can withstand COVID-19 and other emerging challenges.

Director’s message – May 2020

HIV in the Caribbean Regional Health Security Agenda

The COVID-19 pandemic has underscored the importance for the region to focus on and to strengthen Regional Health Security. Health security is not a new topic but has recently taken on a new urgency for policymakers and public health specialists.

The emergence of communicable diseases in the region such as Zika, Chikungunya and now COVID-19, along with natural disasters especially hurricanes and the potential future challenges from Climate Change are all examples of why a Regional Health Security framework is needed to ensure that the region can prepare and mitigate against the impact of these threats.

Regional Health Security consists of the activities required, both proactive and reactive, to minimise the danger and impact of acute public health events that endanger people’s health across the region and international boundaries. It must be noted that Regional Health Security is not only a public health issue but requires multisectoral support, collaboration and action.

HIV continues to be a global public health threat

As the region’s focus is turned towards containing COVID-19, let us remember that HIV continues to be a major global public health issue, having claimed more than 32 million lives so far. The Caribbean has the highest incidence rate of reported AIDS cases in the Americas.  The Caribbean is the second most-affected region in the world after Africa, with an HIV prevalence of 1.6%.

Many challenges continue to complicate HIV control efforts in the Caribbean. Many People Living with HIV or at risk for HIV infection do not have access to prevention, treatment, and care, and there is still no cure. HIV primarily affects those in their most productive years, and it not only affects the health of individuals, but also impacts households, communities, and the development and economic growth of nations.

“We must not lose the gains made in the HIV response”  

The region is already faced with severe challenges due to other infectious diseases, natural disasters, and additional global health and development problems. However, if we are to ensure that the region is safe and secure, HIV must be part of the health security agenda. The regional HIV response must be scaled up. It must provide the highest level of commitment to ensure that costed, inclusive, sustainable, credible and evidence-based national HIV and AIDS plans are funded and implemented with transparency, accountability and effectiveness to safeguard the sustainability of the national response.

The HIV epidemic in the region is far from over. We cannot ignore HIV or otherwise, we can regress and lose control of the epidemic and the gains made over the years.  

Director’s Message – April 2020

PANCAP highlights Next Steps for Continuity of Care during the COVID-19 Pandemic

This week I had the pleasure of speaking virtually with the National AIDS Programme (NAP) Managers and Key Partners on how the COVID-19 pandemic is affecting the continuity of care for HIV and AIDS in the Caribbean Region.

As countries implement containment measures to control the spread of the virus, the continuity of care is crucial for People Living with HIV (PLHIV) to ensure that they receive the care that they need.  It is also equally important to ensure that those at risk of contracting HIV and other Sexually Transmitted Infections (STIs) are offered the necessary preventative services to protect them from contracting these diseases.

Our NAP Managers and Civil Society Organizations (CSOs) work very hard to deliver preventative services, offer counselling services, ensure that persons adhere to treatment and that clinics conduct regular follow-ups. However, because of the implementation of COVID-19 measures, they are facing disruptions. In some countries, curfews, social distancing, and stay-at-home orders have reduced the operating hours for HIV care centres and the number of persons who can access care daily.

The potential impact on countries which may have lower-capacity health systems and large vulnerable populations, is still unknown and so appropriate precautions and mitigation strategies must be developed and implemented across all sectors to prevent potentially devastating outcomes.

The meeting urged National Authorities inclusive of CSOs and other partners working in HIV and AIDS to conduct a thorough gap analysis of the existing gaps and to identify potential threats that can impact the continuity of care during the COVID-19 pandemic.

Countries are further encouraged to develop a plan for the continuity of care during the pandemic. These plans should address how care will be delivered during the next six months in the first instance and then identify medium to long-term mitigation strategies as we do not know how long containment measures will be in place.

Countries are encouraged to explore innovative strategies for HIV prevention and testing, including but not limited to measures such as self-testing and the utilisation of already existing virtual platforms to reach individuals and groups who need care.

PANCAP and its partners will continue to support countries as these plans are developed, and strategic approaches are explored.

We recognise that operating in this environment can be difficult, but as a Partnership, our collective efforts will go a long way in getting us through these difficult times.

Director’s Message – March 2020

As the COVID-19 pandemic spreads around the world, it is becoming clear that persons with underlying conditions, and also the elderly, are at higher risk of becoming severely ill. People Living with HIV (PLHIV) could prove more vulnerable to this new virus, given that their immune system is already compromised.

This is indeed a challenging time for us in the region. Our health systems are already faced with numerous challenges, such as the availability of resources and the lack of human resource capacity. However, almost all countries in the region have reported imported cases and some level of local transmission. Countries have put measures in place to prevent widespread transmission and contain the spread. We can only hope for the best.

“COVID-19 will undoubtedly change how we do things over the coming months.”

As we look towards the 90-90-90 Targets, as well as other national and regional targets, we must recognise that this pandemic could knock us off track and severely impede the realisation of these goals. COVID-19 will undoubtedly change how we do things over the coming months, and we must recognise the impact which this could have on PLHIV.

Continuation of HIV services

With measures such as social distancing and the closure and suspension of services, HIV prevention and care services can be disrupted. There can be disruption to the available testing and counselling services. How we offer these services must be revisited and should be considered, particularly within the context of social distancing. We must be able to find practical ways to ensure that persons are still tested and that they are still offered the required standard of care.  Persons may encounter reduced access to preventative care, and even more troubling, those persons who are already linked to care may experience a disruption in getting to their care facilities to obtain their medication and to access laboratory testing. Laboratories may also begin to prioritise COVID-19 testing, and this could lead to delayed HIV testing, which can impact the care of PLHIV. These can impede our move towards the 90-90-90 Targets.

Applying lessons learnt from the HIV response

Notwithstanding these uncertainties, the HIV and AIDS response has given us valuable lessons which we can apply to the COVID-19 pandemic.  We remember the early years of HIV and AIDS, when there was widespread fear about the virus, and also the move to social isolation for those who were infected and most at risk. Today, we are witnessing the same level of fear with COVID-19 and the issues surrounding isolation and social distancing. In their response to HIV, healthcare providers have had significant experience dealing with specific social issues, such as stigma and discrimination, and so successful strategies which have been used in the HIV response can be applied to diminish the fear, stigma and discrimination around COVID-19.

PANCAP pledges to continue to work with our partners to do everything within our capacity to raise our voices for the rights of PLHIV and to share information, guidance and good practices to protect each other.

I, therefore, ask that we all stay safe and that we take all the necessary measures to protect ourselves and those around us.

International Women’s Day 2020 – “I am Generation Equality: Realizing Women’s Rights”

Recognising the Role of Women in our society: Let us all be equal.

International Women’s Day (IWD) is celebrated annually on 8 March. This year, the theme is: “I am Generation Equality: Realizing Women’s Rights”. The theme is aligned with the United Nations’ Women’s new multigenerational campaign, Generation Equality, which marks the 25th anniversary of the Beijing Declaration and Platform for Action.

International Women’s Day is a day set aside to celebrate the social, economic, cultural and political achievements of women. The day also marks a call to action for accelerating women’s equality.
In the Caribbean, women play an important role in community building, nurturing families, national and regional development, inter alia.

Women live very progressive lives in some parts of the world. Their lives have, however, not been without certain struggles. In other parts of the world, they continue to struggle for equality and remain oppressed, and face specific issues, such as domestic abuse, gender-based violence, and the lack of access to education, jobs and health care.

Women account for more than half the number of People Living with HIV worldwide. Young women (10-24 years old) are twice as likely to acquire HIV as young men of the same age. HIV disproportionately affects women and adolescent girls because of the vulnerabilities created by unequal cultural, social and economic status.

As we celebrate IWD let us, therefore, reflect on the women in our lives: our teachers, our doctors, our nurses, our grandmothers, our mothers, our wives, our sisters, our aunts, our daughters, our nieces, our friends, and recognise the important role that they have been playing to make the world a better place for all of us.

PANCAP recognises the importance of women in our society and their struggle for an equal world.  We support their development and will work to ensure that the rights of women are addressed and advanced, particularly in areas related to HIV and AIDS, sexual and reproductive health and gender-based violence.

PANCAP, therefore, salutes all women on this their very special day.

Helpful links:

UN Women’s International Women’s Day 2020 web page:
https://www.unwomen.org/en/news/in-focus/international-womens-day

International Women’s Day 2020 theme— “I am Generation Equality: Realizing Women’s Rights”
https://www.unwomen.org/en/news/stories/2019/12/announcer-international-womens-day-2020-theme

Director’s message – February 2020

Today I say goodbye to the Partnership. It was indeed a privilege to serve this dynamic Partnership over the last nine years, six and a half as Director. My wish when I took the reins as Director was that I would leave the Partnership better than I found it. Your many tributes over the last six months suggest that I have done so. Together we are now stronger and more resilient.

I am deeply grateful to my dedicated staff for their unwavering support to me and the Partnership. The staff believe in our mission, and although few, every day they demonstrate an unrivalled passion and commitment to serve the people of the Caribbean.  No task is ever too great for the staff of the PANCAP Coordinating Unit. They gave me the strength to embrace each day with gratitude, enthusiasm and humility. I owe our success to them.

I thank the Secretary-General of CARICOM for affording me the opportunity to serve the community and the wider Caribbean.  I extend a special thank you to the Deputy Secretary-General for helping me to navigate many minefields and her willingness to always give me an audience, to listen and provide guidance and support.  I thank my supervisor, Dr Douglas Slater for his confidence and for giving me the freedom to provide the leadership required for fulfilling our mandate and advancing the Partnership. A special thank you to the heads of departments and staff of the CARICOM Secretariat for their guidance and support.

I was inspired by Chancellor John Edward Greene, who mentored and supported me while modelling bold leadership and finesse while engaging with the political leadership in the Caribbean. I sincerely thank him.

Professor Peter Figueroa was unwavering in his support to me and the Partnership. I thank him for being a source of strength and encouragement.

I express sincere gratitude to our International Development Partners; The Global Fund and PEPFAR-USAID-CDC, PAHO, UNAIDS, UNFPA, UNDP, UNICEF and others and the key players in the Partnership, including the Lead Head for Human Resource, Health and HIV, Board and PACC members, regional partners, Ministers, National AIDS Programme Managers, Chief Medical Officers, Permanent Secretaries, youth, civil society, key populations leaders, faith leaders, parliamentarians, academia, media and others, for investing in PANCAP and for your overwhelming support over the last six and a half years.

I wish you all success and look forward to a stronger Partnership under the leadership of our new Director, Dr Rosmond Adams.

Director’s Message – January 2020

Despite the substantial resources invested in the Caribbean region, we continue to be challenged by inadequate and unreliable data to help us to describe our epidemic accurately and inform programming. While significant progress has been made, the region is behind in achieving the 90-90-90 Targets by the end of 2020. The Caribbean Regional Strategic Framework on HIV and AIDS (CRSF) 2019-2025 acknowledges that insufficient data-driven programming limits efforts to efficiently target activities to the geographic locations and populations in greatest need. The CRSF therefore, recognises that there is an urgent need to define a regional HIV research agenda that aligns with the priorities outlined in the CRSF, and which is anchored in the established academic institutions of the region.

Over the last three years, the Caribbean Public Health Agency (CARPHA) has expanded a regional data repository to facilitate reporting on the CRSF indicators, thus providing an opportunity to simplify reporting by enabling country reporting to be streamlined and shared with other organisations as needed (CRSF 2019-2025). However, data gaps persist, as data were available for only 13 of the 28 indicators for the CRSF 2014-2018, largely because of limited site-level data management and slow reporting to national levels. While key population size estimates have improved, data collection from civil society organisations remains a gap. CARPHA has been working with countries to develop strategic information action plans to improve reporting.

Given our current reality, defining the regional HIV research agenda is high on PANCAP’s list of priorities for 2020.  In this regard, the Priority Areas Coordinating Committee (PACC) has provided guidance to the Regional Monitoring and Evaluation Technical Working Group on Health on the process for determining the research agenda as well as the monitoring and evaluation needs which will be costed subsequently. This process is crucial for guiding research efforts and site-level available resources. The agenda would include among others, research, testing, treatment, adherence, retention, service delivery, and stigma and discrimination, that would inform regional policy change and improve outcomes for People living with and affected by HIV and key populations.

Implementation of the research agenda requires a paradigm shift, from thinking about data for reporting to thinking about data for use throughout programming. We must be cognizant of the need to also invest in data systems that inform programming. Successful implementation of the research agenda specifically requires the support of our universities that possess the skills to conduct such research, donor support and commitment from our national partners to facilitate the collection of data. Given the urgency, let us all commit to supporting the Regional Monitoring and Evaluation Technical Working Group on Health to define a regional HIV research agenda.

World AIDS Day 2019: PANCAP Director pays tribute to the stellar contributions of Communities

This year’s World AIDS Day theme is “Communities make the difference”. According to UNAIDS, the observance of World AIDS Day is an important opportunity for stakeholders to recognize the essential role that communities have played and continue to play in the AIDS response at the international, national and local levels.

I believe that this theme shines a spotlight on the phenomenal work that is being done by communities. It allows us to pay tribute to the passion, advocacy, resourcefulness and relevance of communities and to honour and celebrate their stellar contributions to the HIV response. Communities include peer educators, networks of People living with or affected by HIV, such as gay men and other men who have sex with men, people who use drugs,  sex workers, women and young people, counsellors, community health workers, door-to-door service providers, civil society organizations and grass-roots activists. Since 1993 I have witnessed firsthand how communities have come together to do extraordinary things in their response to the needs of our brothers and sisters who were and continue to be challenged as People living with or affected by HIV.

As someone whose response was grounded at the grassroots level, I have seen communities give birth to groups and organisations to respond to HIV and the needs of key populations, speak up, inspire, and embrace our common humanity. I have seen communities stand alone against the self-righteous groups that see communities of men who have sex with men and transgender persons as a threat to the status quo and their authority over our so-called ‘” ordered societies”’. Communities have been an easy target for vilification and ridicule.

Communities have stood against the oppressors that seek to relegate them to second class citizenship. Communities have responded with compassion, enthusiasm, courage and practical solutions to effect positive change and to transform their lives.

It is the overwhelming response of communities that set us on this journey of resilience and has now given us hope that we can end AIDS. It is the advocacy and bold leadership of communities that forced the world to mount an unprecedented response to a public health threat such as we have never seen before. I am reminded of the words of Dr Jonathan Mann on the Tenth Anniversary of AIDS in August 1994. Quote – “We witnessed the birth of an authentic impulse of solidarity, our credo was tolerance; the scope and span of our communication were breathtaking. We helped open a new era in history and as we stormed the gates of the status quo, we knew we would prevail. Just as we learn about life by living, so we have learned about HIV and AIDS through real experience, hard work, joy and pain. There is nothing peripheral or superficial about what we have done. People around the world, facing specific immediate problems with prevention and care, or struggling against exclusion and discrimination, responded with creativity and courage which has no historical precedent, and which the world had no right to expect”. End of quote.

Communities were deeply affected and instead of crumbling in the midst of winter they rose up and found within themselves an invincible summer. It is their advocacy that saw the establishment of PANCAP, the first United Nations General Assembly Special Session on HIV and AIDS and global financing institutions such as the Global Fund to Fight AIDS, Tuberculosis and Malaria. It is communities that have strategically engaged with international development partners to ensure responsible transition and sustainability.

We must recognize communities as a coveted asset to the HIV response.  We must see communities as the glue that holds us together. We must see communities as the backbone of the HIV response. Communities can bring evidence of what is happening in their respective groups to inform advocacy.  We must see communities as worthy of investment. Therefore, as donor resources diminish, our governments and private sector must continue to invest in communities. When we invest in communities we are investing in our and our children’s future. We are investing in the vehicle to ending AIDS since communities are better placed to reach individuals that are underserved and who experience structural barriers, including stigma and discrimination, to access to prevention, treatment, care and support services. When we invest in communities, we are ensuring that we leave no one behind. Therefore, let us all commit to investing in communities for ending AIDS.