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.

Remarks by Dr Rosmond Adams, Director, PANCAP at the World AIDS Day 2020 Caribbean Virtual Panel Discussion and launch of the In Your Hands HIV Self-Testing Advocacy Campaign

Good Morning Everyone

Let me say thanks to the organizers for having PANCAP as part of this important discussion. Indeed, this is a demonstration of the type of solidarity that is needed at this critical time to confront global public health issues and to respond to the HIV/AIDS epidemic.

It is also a testimony of the shared responsibility that all must support whether individually of by our organizations doing our part in the response.

As we commemorate World AIDS Day 2020, the COVID-19 pandemic has further challenged our efforts to reach global targets on the road to ending AIDS.

Nonetheless, it has presented us with opportunities for us to look at the way we are doing things and to explore new and innovative approaches that are results-oriented. The epidemic is changing and so must our response also.

We cannot sit and continue to debate how can we increase testing and increase the number of people who know their HIV status without seizing the opportunity to explore and implement initiatives such as HIV self-testing.

HIV self-testing is safe, effective and simple to use. It empowers individuals and it puts the responsibility right into our own hands. It also will increase uptake of HIV testing services, especially for populations with low access to testing and those at higher risk that would otherwise not get tested.

There is still fear and stigma associated with the traditional HIV test. There is the fear of needles, the fear around confidentiality, etc. HIV self-testing can help to overcome some of these fears.

There are concerns in the health sector that persons may do the tests and may not be linked to care if they are tested positive. I am certain that with good support systems in place, individuals requiring care can be linked to care and we can get the data needed to monitor and evaluate programme effectiveness. Also, when individuals do the tests and they are aware of their status they will be empowered to be more responsible.

We at PANCAP fully endorse and support the push for HIV self-testing in our Region and we stand ready to support countries in implementing Combination HIV Prevention Programs with an aim to reaching everyone and ensuring that no one is left behind.

Message from Dr Rosmond Adams, Director, PANCAP on the occasion of World AIDS Day 2020

Message from Dr Rosmond Adams, Director, PANCAP on the occasion of World AIDS Day 2020

Each year, December 1 is commemorated as World AIDS Day, an international day dedicated to raising awareness of the AIDS pandemic caused by the spread of HIV infection, to recognise those who continue to work to end AIDS and to pause and remember those who have left us because of this disease.

The theme for World AIDS Day 2020 is, “Global solidarity, shared responsibility”. The Pan Caribbean Partnership against HIV and AIDS (PANCAP) endorses this theme as it effectively captures the phenomenal efforts of our public health champions in responding to the COVID-19 Pandemic while working to maintain the gains made in the HIV response.

Health care providers working in HIV have also been called to the battlefield to respond to COVID-19 a clear demonstration of the type of solidarity in health that is needed for us to live in a safe and healthy Caribbean.

The Coronavirus pandemic has disrupted 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 retained in care.

National AIDS Programmes and Civil Society across the Region continue to be challenged especially in the area of HIV testing as lockdowns, and other COVID-19 protocols have prevented persons from accessing services.  However, as the Region has proven in the past, rising to any challenge with collaboration and innovation is a hallmark of Caribbean people.

Public health practitioners across the Region have utilised strategic collaborations to respond to COVID-19 and protect the gains made in the HIV response.

In Belize, Enrique Romero, Executive Director, National AIDS Commission (NAC) used his alliances with social workers, adherence counsellors from the Ministry of Health (Belize), Peer Navigators, NAC District Committees and Civil Society Organizations (CSOs) to conduct a Needs Assessment of People Living with HIV.

The assessment revealed that many People Living with HIV were desperately in need of food items to remain adherent to their medication.  Enrique jumped into action, and within a few days, he worked tirelessly with the Ministry of Human Development, Social Transformation and Poverty Alleviation (Belize) to expedite assistance to these individuals through the Government of Belize’s “Food Assistance Programme”.

Loss of employment, lack of essential living support and depleting nutritional supplies are some of the main issues that undermine adherence to HIV medication.  COVID-19 has exacerbated these circumstances.

In Jamaica, Kandasi Levermore, Executive Director of the Jamaica AIDS Support for Life (JASL), responded to the needs of her clients by soliciting donations and writing proposals for small grants to provide clients with nutritional support, care packages, sanitisation items and financial support for transportation to attend clinic visits.  Such action in the face of so many adversities may have saved many lives and protected the gains made in the Region’s HIV response.

In Barbados, Dr Nastassia Rambarran and her team from Equals Barbados arranged for delivery of multi-month medication supplies, provided care via telemedicine and donated food hampers sourced from donations and an external grant.

These are just a few examples of our Caribbean Public Health Champions recognising their shared responsibility and taking decisive action to ensure the continuity of HIV services during COVID-19.

COVID-19 has thrown our National HIV Programmes and Civil Society into circumstances that demanded their best.  I am humbled and inspired by the response of our Public Health Practitioners and Civil Society leaders.  I have only highlighted a few of the best practices that have emerged from the Region, but there are many more success stories to share.

This World AIDS Day, I urge our Partners to share their stories and celebrate the success of maintaining the Region’s HIV response in the face of COVID-19.  Our Region has responded to the global Pandemic with cooperation, unity and innovation, which ensured the continuity of HIV services and better health outcomes for People Living with HIV.

Our Governments, National Programmes, community mobilisers and the private sector stepped up to provide the needed services so that People Living with HIV can remain on their medication.  Time will reveal how many lives were saved because our Region acted promptly and effectively.

I do believe that despite the challenges of 2020, our Region can amplify the HIV response and fulfil the mandate of the Caribbean Regional Strategic Framework on HIV and AIDS (CRSF) of a Caribbean free of AIDS and new HIV infections, in which all people are happier, healthier, productive, safe and respected.

We have demonstrated our ability to be innovative during this crisis. COVID-19 has disrupted the way we do things, but it has provided us with the opportunity to embrace change and innovation. Countries in the Region are now embracing innovations such as HIV self-testing, multi-month dispensing of ARVs and the use of digital technology to offer services virtually.

The Partnership remains committed to supporting this momentum, and we stand in solidarity with everyone as each of us does our part in ending AIDS in the Region.

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COVID-19 reshaping HIV services in the Caribbean

National AIDS Programmes continue to be challenged by the ongoing COVID-19 pandemic. Despite these challenges, they continue to deliver services to ensure the continuity of care. The delivery of services at this critical time requires reshaping the way that services are traditionally delivered. COVID-19 presents an opportunity to explore innovative solutions and new methods for service delivery.

Amongst the services significantly impacted by the pandemic disruptions is HIV testing. Persons requiring testing must access care at a health facility. Countries are now exploring the possibility of implementing HIV self-testing. HIV self-testing has the potential to rapidly increase uptake of HIV testing services, especially for populations with low access and those at higher risk that would otherwise not get tested. In areas where COVID-19 disruptions are high, self-testing is an ideal alternative to scale-up testing.

The pandemic has also opened up new avenues for the care of those who are stable and require fewer clinical interactions. By doing so, stable patients do not need to visit clinics as frequently as they did for medication and routine follow-up. Many programmes have implemented multi-month drug dispensing of antiretroviral therapy or ART for about three to six months. This has allowed care providers to devote more time to those with more urgent needs. It has also reduced the frequency that clients visit pharmacies to fill their prescriptions.

Many HIV programmes have also been embracing the use of digital technology. In some cases, clients are now able to book appointments online to avoid overcrowding in waiting rooms, especially in small clinics where physical distancing may not be possible. Also, some services, such as counselling and patient follow-up, are being conducted virtually.

Despite the disruptions from the pandemic, these new approaches are reshaping the way services are delivered. Most of these interventions still require close monitoring and evaluation to know if they are effective. Notwithstanding this, these interventions have the potential to reach more people and to deliver services in a quick, efficient and safe manner. They can change the way that care is provided beyond COVID-19.

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.