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.

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.