Moving Forward despite the Challenges

HIV programmes in the Region faced numerous challenges. These include social issues confronting the disease and the lack of human resources. The ongoing COVID-19 Pandemic surely did add to these challenges by causing funding to be directed from disease areas such as HIV to the Pandemic response, disrupting care and treatment services and exacerbating stigma and discrimination, especially against Key Populations and other vulnerable groups.

Despite these challenges, National AIDS Programmes and Civil Society Organizations (CSOs) recognized very early that the Pandemic could derail progress and undo the gains that we have made over the years.

Through collaboration with PANCAP and other Key Partners, National Programmes implemented a strategic approach to ensure that any disruptions from the Pandemic would be minimized and HIV remained relevant during this period.

This strategic approach aims to ensure the continuity of services during the Pandemic. This included supporting National Programmes with Personal Protective Equipment (PPE) and other protective measures to safeguard both providers and users of the system to continue delivering services.

The strategy included placing Key Populations and vulnerable groups at the centre of the response. Many services offered during the Pandemic ensured that these services met the needs of key populations and most at-risk groups.

The strategy also ensured that the Region embraced new and innovative approaches to respond to the HIV epidemic. For example, HIV self-testing was piloted as an approach to fill testing gaps created because of the Pandemic. The Region has also experienced a scale-up of Pre-exposure prophylaxis (PrEP) in some countries.

Despite all of the challenges, National Programmes and CSOs have demonstrated resilience and will continue moving forward, keeping an eye on the goal of ending AIDS in the Region by 2030.

Mind the Gaps!

At the end of 2020, significant gaps remained in the HIV testing and treatment cascade for the Caribbean Region to achieve the UNAIDS 90-90-90 Targets. With the new 95-95-95 Targets, these gaps can become wider if the rate of filling them is not quickly realized.

With the ongoing COVID-19 pandemic that has damaged the Region’s economies, placing health systems under additional strain and driving many people into financial peril, significant challenges lie ahead of us on the road to filling these gaps and ending AIDS in the Region.

The pandemic has not only disrupted services in terms of access but has also reduced national funds available for testing, treatment, and care. Moreover, the widening inequality gap in the Region, brought on by the pandemic, disproportionately prevents vulnerable groups from accessing HIV and other essential services.

To protect the gains made over the last decade and for us to fill these gaps, quick and creative responses must be implemented immediately. These responses must be based on evidence and must be effective in ensuring that at-risk groups are protected. New HIV infections must be reduced, and those who are diagnosed must be linked and retained in care and become virally suppressed.

Countries must implement social protection strategies and policies that benefit vulnerable groups, especially People Living with HIV and key populations. Strategies to improve testing such as HIV self-testing must be scaled up, and other interventions to improve treatment and care and retention must also be quickly implemented and scaled up.

Director’s Message September – October 2021

The ongoing COVID-19 pandemic threatens to reverse years of progress across many Sustainable Development Goals (SDGs). While the virus has impacted everyone, it affects the world’s poorest and the most vulnerable people the most. The SDGs related to HIV and AIDS speak to ending AIDS and other communicable diseases by 2030. This is further reflected in the Caribbean Regional Strategic Framework on HIV (CRSF) 2019 – 2025 that serves as the guiding strategy for the Caribbean Region. However, actions to accelerate the CRSF have been significantly impacted by the disruptive nature of the pandemic. Health systems are struggling to mitigate the disruptions, which takes away the focus from the elimination agenda.

At the end of 2020, 82% of People Living with HIV in the region were diagnosed. Two thirds (67%) of all People living with HIV were on treatment, and 59% were virally suppressed. This highlights that there are still significant gaps to get to the 2030 agenda of ending AIDS in the Caribbean.

For us to get on track to end AIDS by 2030, Caribbean countries must step up the pace around prevention, testing, treatment, care and ending stigma and discrimination. This is going to necessitate a doubling up of efforts requiring us to ensure the continuity of services in a significantly disrupted environment while at the same time accelerating progress around the elimination goals.

Key Populations must be at the centre of the response to ensure that we strategize correctly to meet service delivery during the pandemic and respond to the elimination agenda. Key populations and their sexual partners accounted for more than 60% of new infections in 2020 and continue to be disproportionately affected by both the pandemic and the HIV epidemic.

Some strategies that must be adapted are decentralizing services to access points preferred by Key Populations to ensure uninterrupted access to HIV services and reducing contact with clinics. We would also need to scale up Multi-month Dispensing (MMD) and community refills of ART, PrEP and other medications. We will also need to maximize online service delivery options. However, while doing so, we must ensure that these services are assessable, affordable and Key Populations have the necessary infrastructure to access these services.

While the pandemic can be disruptive, it presents us with an opportunity to implement new strategies to mitigate its impact and ensure continuity of services. If these solutions are sustained beyond the pandemic, they may also modernize HIV and key population programming and position us towards the elimination agenda.

The Global Fund Continues to Support the Regional HIV Response

The Caribbean Region ranks among the top eight areas globally with the highest number of new HIV infections. Over the past decade, there have been significant strides in the Region in decreasing Mother-to-Child Transmission of HIV, decreasing deaths from AIDS, providing more Persons Living with HIV with life-saving Antiretroviral Drugs (ARVs), and supporting persons on medications in attaining viral suppression.  This has resulted in a reduction in HIV transmission and improved quality of life.

However, significant challenges remain. Although 77% of the estimated 330,000 Persons Living with HIV in the Caribbean overall have been tested and are aware of their status, and 81% of those diagnosed are on life-saving medications, with 80% of those on medications attaining viral suppression, progress has not been uniform across the Caribbean.

The Region has also not been able to stem the occurrence of new infections. These disproportionately affect socially marginalized key populations, including men who have sex with men, sex workers, adolescent girls, and young women.

The ongoing Coronavirus pandemic has disrupted several vital services essential for the control of HIV in the Region. For example, prevention services have seen a steep decline while testing services in many countries have fallen off, and community outreach has come to a halt.

Considering these disruptions and the potential that the pandemic can take us off track, the Global Fund to Fight AIDS, Tuberculosis and Malaria continues to support the Region to implement mitigation strategies to ensure continuity of services for HIV.

Through the support of the Global Fund, countries are implementing HIV self-testing initiatives to reach key populations and those who have difficulties accessing testing services. The Global Fund is also supporting community efforts and strengthening Civil Society Organisations’ capacity to reach communities most in need and offer the services they require, such as home delivery of ARVs and other commodities.

The Global Fund continues to be one of the most significant donor agencies supporting HIV work in the Caribbean.

PANCAP welcomes the Adoption of the 2021 Political Declaration on HIV and AIDS

The Pan Caribbean Partnership against HIV and AIDS (PANCAP) has been engaged over the past months with Member States and Civil Society Organizations (CSOs) to prepare for the United Nations High-level meeting on HIV.

This High-level Meeting is expected to be the springboard for a decade of action to reduce inequalities and root out the social determinants that fuel the HIV epidemic. All Member States were encouraged to participate in this meeting and to let their voices be heard. CSOs were especially encouraged to be part of country delegations since they play an important role in supporting the national and regional response.

The High-level Meeting is a call to action for Caribbean countries to recognize that despite the progress in the Region, there is still a lot of work to be done to fill the existing gaps. Countries must seize the opportunity to maintain their focus and commitment to ending AIDS as a public health threat as part of the 2030 Agenda for Sustainable Development.

PANCAP is pleased to see the progress represented by the new Political Declaration. Although we would have loved to see stronger language in some areas, and we are disappointed by some critical omissions and weaknesses in the Declaration, the Partnership pledges to continue working with all stakeholders in the Region to ensure that these are addressed as work towards ending AIDS continues.

There is much to welcome in the Political Declaration. PANCAP is pleased to see that key populations were named. This will ensure that the focus and response are placed where needed. Key populations have been at the heart of community-led responses to HIV for 40 years. Their continued leadership, along with the leadership of other vulnerable populations – women, adolescents and young people, Indigenous peoples, and people with disabilities – is essential and deserves greater recognition.

For this Political Declaration to mean something to the people affected and impacted by HIV, it must be supported at the highest level, and it must be backed with the financial and other needed resources.

Let us work together to ensure that this Declaration is not only words on paper but also means something to those crying out for our help.  Lets us all work together to END AIDS.

Gender-Based Violence – The Quiet pandemic holding back HIV Progress

The COVID-19 pandemic has exposed and exacerbated existing inequalities within countries and across the globe. Gender-based Violence (GBV), an expression of gender inequality and toxic masculinity, is another pandemic that exists in all societies at varying degrees of prevalence and severity.

GBV has been a significant problem before the COVID-19 pandemic and continues to occur, impacting the lives of many. Unfortunately, this situation has not received the type of attention that it should get, and, in some places, it goes on quietly.

GBV requires the same effort and attention that governments globally have given to COVID-19. With many countries under lockdown due to governments’ response to COVID-19, GBV has increased significantly. This increase is a reminder of the need to have a contingent mitigating mechanism to protect the marginalized, women and girls, against a co-existing pandemic.

In the Caribbean, nearly half of Caribbean women surveyed in five Caribbean countries face at least one form of violence; physical, sexual, economic, or emotional. This is way above the global average of one in three women who suffered physical and/or sexual violence by an intimate partner in their lifetime. This is unacceptable and should motivate all of us working and living in the Caribbean into action to end this violence.

Gender inequality links GBV and HIV as one of two indirect pathways that have a more significant impact on HIV transmission than the direct pathways. In societies where patriarchy and unequal gender norms are deeply entrenched, men are more likely to perpetrate sexual violence, pay for sex, and are less likely to use condoms.

Intimate partner violence is also an indirect risk factor for HIV acquisition. Women who experience intimate partner violence have more mental health issues, including depression and anxiety, higher use of alcohol and less control over their sexual decisions. Experiences of intimate partner violence increase the likelihood that a woman will acquire HIV by up to 55%.

If we are to end AIDS in the Caribbean Region, we must tackle this silent pandemic immediately. GBV is a significant contributor to the HIV epidemic. There is growing evidence that GBV is not only a human rights violation but also a barrier to HIV prevention, treatment, and care.

Director’s Message – March 2021

Due to the global spread of the COVID-19 virus, many populations are experiencing negative consequences such as job loss, food insecurity, and the inability to manage existing medical conditions and maintain preventive measures to control the spread of the virus, such as social distancing and personal protective equipment (PPE).

Some of the most disadvantaged in the COVID-19 era are People Living with HIV (PLHIV) and other vulnerable groups.

As the number of new HIV infections decreases globally, there are still subpopulations that remain at higher risk of infection in the Caribbean and have limited or no access to prevention, care, and treatment.

The populations that are the hardest hit are those that also lack power and experience high levels of food insecurity, poverty, drug abuse, incarceration among men, and those suffering from other infectious and chronic diseases.

As we struggle to ensure continuity of services for PLHIV during the pandemic, we need to consider how we can better support them to ease the added burden of the pandemic.

We can support PLHIV by ensuring food and other social protection services, including temporary shelters for key populations, People Living with HIV, and other vulnerable groups.

There is also the possibility to explore opportunities to provide cash transfers and other support to PLHIV who have lost their jobs or are in vulnerable conditions, especially among key populations. Also, there is a need to provide services to support populations most affected by violence, especially among women, transgender women, girls, and migrant populations.

Let us use our collective skills and collaborate to support the most vulnerable during COVID-19.

International Women’s Day 2021 – “Women in leadership: Achieving an equal future in a COVID-19 world”

“This International Women’s Day challenges us to reflect on women who have taken up extraordinary leadership roles during the
COVID-19 Pandemic. From the outstanding leadership of Mia Amor Mottley, Prime Minister of Barbados, who has been a pillar of the Region’s response to the Pandemic, to the single mother who has lost her job because of COVID-19. Women have persevered in the face of the Pandemic’s challenges.

Women living with and affected by HIV have experienced particular hardships with the loss of income and reduced access to HIV prevention, treatment and care due to COVID-19 restrictions. The Region’s National AIDS programmes and Civil Society Organisations are to be applauded as they stepped up to ensure continuity of care. The Region has also noted an increase in gender-based violence due to lockdowns. I challenge our members and partners to support creating an enabling environment in which ALL women and girls are protected, valued and respected”. – Dr Rosmond Adams,  Director, Pan Caribbean Partnership against HIV and AIDS (PANCAP)

#IWD2021 theme: “Women in leadership: Achieving an equal future in a COVID-19 world”

Women of the world want and deserve an equal future free from stigma, stereotypes and violence; a future that’s sustainable, peaceful, with equal rights and opportunities for all. To get us there, the world needs women at every table where decisions are being made.

This year, the theme for International Women’s Day (8 March), “Women in leadership: Achieving an equal future in a COVID-19 world,” celebrates the tremendous efforts by women and girls around the world in shaping a more equal future and recovery from the COVID-19 pandemic and highlights the gaps that remain.

Women’s full and effective participation and leadership in of all areas of life drives progress for everyone. Yet, women are still underrepresented in public life and decision-making, as revealed in the UN Secretary-General’s recent report. Women are Heads of State or Government in 22 countries, and only 24.9 per cent of national parliamentarians are women. At the current rate of progress, gender equality among Heads of Government will take another 130 years.

Women are also at the forefront of the battle against COVID-19, as front-line and health sector workers, as scientists, doctors and caregivers, yet they get paid 11 per cent less globally than their male counterparts. An analysis of COVID-19 task teams from 87 countries found only 3.5 per cent of them had gender parity.

When women lead, we see positive results. Some of the most efficient and exemplary responses to the COVID-19 pandemic were led by women. And women, especially young women, are at the forefront of diverse and inclusive movements online and on the streets for social justice, climate change and equality in all parts of the world. Yet, women under 30 are less than 1 per cent of parliamentarians worldwide.

This is why, this year’s International Women’s Day is a rallying cry for Generation Equality, to act for an equal future for all. The Generation Equality Forum, the most important convening for gender equality investment and actions, kicks off in Mexico City from 29 – 31 March and culminates in Paris in June 2021. It will draw leaders, visionaries, and activists from around the world, safely on a virtual platform, to push for transformative and lasting change for generations to come. – UN Women

PANCAP Director calls for a harmonized relationship between Governments and Civil Society Organisations through social contracting to further advance the End AIDS Strategy for the Region

Dr Rosmond Adams, Director, PANCAP, speaking at the PANCAP Toolkit for Social Contracting launch, called on governments and Civil Society Organizations (CSOs) to work together harmoniously to advance the Caribbean’s efforts towards ending AIDS by 2030.

Dr Adams highlighted that COVID-19 has further exacerbated the challenges faced by national and regional programmes. “If we are to maintain the gains and sustain the response, we will have to ensure that all hands are on board moving forward”, stated the Director.

PANCAP launched its toolkit on Social Contracting last week. The toolkit presents a step-by-step approach to guide decision-makers in the implementation of Social Contracting. The toolkit is built on the principles of commitment, meaningful participation of all partners, transparency, fairness and equity, accountability and independence.

The toolkit will allow countries to assess where they are along the process and provide guidance to move to the next steps. For countries that are in the initial stages or are just discussing social contracting, the toolkit will provide advice on the critical areas for consideration, such as the legal and regulatory framework, costing and the standardized contractual mechanism that must be put in place.

Dr Adams noted that effective rollout of social contracting would require planning, ongoing advocacy, and collaboration between government and CSOs as they build partnerships to deliver HIV services. This partnership must be grounded in trust, transparency, accountability, and efficiency geared toward assisting government in implementing policies and supporting national goals as outlined in their National Strategic Plans.

The Director urged Governments to continue working with CSOs to develop, finalize, and approve country roadmaps for social contracting and commit to implementing activities outlined in the roadmaps.  These include revisions of current legislative and normative documents and to set aside funding to support social contracting for CSO services for key populations.

He called on donors to support government and CSOs to implement social contracting and provide technical assistance for implementation.

He also encouraged CSOs to advocate for funding for government social contracting and highlighted the importance of cooperation with the government to implement and ensure accountability.

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

PANCAP joined the global community as we observed World AIDS Day on 1 December. Several activities were held across the Region to bring awareness to HIV, recognize the work that has been done and to strategize on how we can sustain the HIV response in the future.

We recognize the work at all levels, especially that of our global partners such as the Joint United Nations Programme on HIV and AIDS (UNAIDS), World Health Organisation (WHO), Pan American Health Organisation (PAHO), President’s Emergency Plan for AIDS Relief (PEPFAR) and others. Governments, National Programmes, Civil Society Organizations, People Living with HIV (PLHIV), Faith-Based Organizations, Communities and individuals have also played a central role in getting us to where we are today and have always been supportive to the PANCAP partnership.

Over the years, we have seen a record number of PLHIV receiving antiretroviral treatment.  We have also seen progress with “Undetectable = Untransmittable” (U=U), meaning that people who adhered to treatment and achieved an undetectable viral load cannot pass the virus on to others. New Infections and AIDS-related deaths in our Region have also decreased, and there have been bold actions to address issues such as stigma and discrimination around the disease.

Indeed, we have come a long way. When HIV was first recognized four decades ago, fear and death were the keywords that defined this disease as the world faced a new and unknown virus. Today, scientific advances, such as the development of antiretroviral drugs, have enabled people to access treatment to live long and healthy lives.

As we reflect on the 2020 theme for World AIDS Day, “Global Solidarity, Shared Responsibility”, it is essential to view it as a call to action for all of us to work together to end AIDS and to support our brothers and sisters living with HIV.

The road ahead is long, but once we work together, I am confident that we can end AIDS.