Release Type: Speech

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.

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.

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.

As this is the last newsletter for 2019, I would like to reflect on our achievements in 2019 and highlight key remaining challenges. We had set ourselves an ambitious agenda for 2019 with a heavy focus on improving coordination and governance and supporting county efforts to implement innovative approaches for prevention, care and treatment.

Achievements

Following extensive consultations and dialogue, we have successfully elaborated the fourth iteration of the Caribbean Regional Strategic Framework on HIV and AIDS 2019-2025 and a Monitoring and Evaluation Framework with indicators and targets, and a two-year implementation plan. The CRSF 2019-2025 provides high-level guidance to ensure that resources are directed towards effective interventions that maximize the impact of regional efforts and provide good value for money and to respond to the remaining gaps in the response.

The capacity of National AIDS Programme Managers and Civil Society Partners has been increased to deliver a more effective response through the annual meeting of NAP Managers and Key Partners, Share Fairs, learning exchanges, series of webinars, documentation and sharing of information.

We successfully implemented the CARICOM-PANCAP Global Fund grant 2016-2019, PEPFAR-USAID Coordination and Knowledge Management programme activities 2018-2019, and the PANCAP component of the 10^th EDF grant.

We mobilised additional resources from the Global Fund for a Joint CARICOM/PANCAP-CVC-COIN Caribbean Multi-country grant and leveraged additional resources from PEPFAR-USAID by directing funding for the knowledge management programme to CARICOM thus increasing efficiencies obtained from savings on management fees to several conduits. These efficiencies are being applied to fill gaps in knowledge management.

The PANCAP Coordinating Unit (PCU) has strengthened collaboration with departments of the CARICOM Secretariat to advance the implementation of the CRSF.

The PCU, with support from the CARICOM Secretariat and Johns Hopkins University, facilitated its staff development in the area of project management and knowledge management to increase the PANCAP Secretariat capacity to fulfil its mandate.

The PCU facilitated CRN+’s organisational review and strategic planning for sustainability and improved governance and accountability.

We have increased opportunities for high-level youth advocacy for adolescents’ access to sexual and reproductive health services and comprehensive sexuality education.

Challenges

While we applaud Guyana for achieving the first 90 Target, Cuba, Haiti and Suriname for achieving the second 90 Target and Barbados and Suriname for achieving the Third 90 Target, the UNAIDS Global AIDS Monitoring Report 2018 reminded us that the region is not on track to achieving the 90-90-90 Targets by 2020. It also reminded us of the critical need for bold political and technical leadership to dismantle human rights barriers to health. These barriers present a challenge to finding, testing and retaining key populations in treatment and care and to achieving viral suppression.

While we have made some progress in building national capacity to accurately report on the CRSF and other indicators, significant gaps in capacity persist at the national and regional level. Significant gaps in laboratory quality and human resources and access to lab services also remain.

As the Partnership prepares to welcome a new Director in 2020, it is critical that we continue to strengthen existing and forge new partnerships to leverage both technical and human resources for sustaining the response at the national and regional level.

Following the successful Global Fund Sixth Replenishment that raised US14 Billion for the next three years, we anticipate additional funding for eligible countries and for another multi-country Caribbean grant, However, we must temper our expectations and be prepared to receive reduced allocations.  We await PEPFAR’s Regional Operational Planning schedule for the first quarter in 2020 to determine what resources will be available. However, we must be mindful that donors are reluctant to continue to invest resources in countries and regions that fail to address structural barriers to key populations access to prevention, treatment, care and support services, particularly when they continue to see no significant decline in mortality and reduction in new infections despite investments for over a decade.

Appreciation

I wish to thank the staff of the PCU for their unwavering commitment and significant investment of time that enabled the PCU to serve the Partnership efficiently.

Special thank you to all partners for their assistance, support, collaboration and continued confidence in the Partnership.

I extend my sincere gratitude to Chancellor Edward Greene for his guidance and support to me and his invaluable contribution to the Partnership.

On behalf of the PCU, I wish all partners a Merry Christmas and a very successful 2020.

At the opening ceremony of the Inaugural Caribbean Congress on Adolescent and Youth Health (CCAYH) held earlier this month Ambassador Irwin LaRocque, Secretary-General of the Caribbean Community (CARICOM) reminded us of the Conference of Heads of Government Nassau Declaration on Health 2001: “The Health of the Region is the Wealth of the Region”. Ambassador LaRocque proffered that ‘The Health and Youth of the Region are the Wealth of the Region”.

The Congress was held under the theme ‘Championing our wealth: promoting the health and well-being of adolescents and youth in the Caribbean and was attended by over 85 adolescents and youth, as well as healthcare professionals, and Regional and development partners, educational, communication and other professionals. Over three days, the Congress received presentations and convened group discussions and plenaries around four themes: 1. Mental Health, Substance Use, violence and injuries; 2. Sexual and Reproductive Health and Rights, HIV and STIs; 3. Nutrition, Physical Activity, Sports and Youth Development; and 4. Climate Change and Environment.

I have no doubt that this Congress stimulated and challenged the thinking of our adolescent and youth in our Region to reflect on their health and the critical role that they must play to maintain good health. They were buoyed with excitement to share and to learn from each other, as well as from the experiences of the “youngish” as they fondly referred to all of us who were not as young as they are. As was expected, the youth were creative in their interactive presentations and sought to energise and to balance serious issues with humour.  It was a joy to listen to their passion, perspectives, intellectual analysis and their relentless call for the “youngish” to move beyond planning and advocacy to action and change. In fact, it was Dr Clarissa Etienne, Director of the Pan American Health Organisation (PAHO), who began that call during her keynote address at the opening ceremony when she reminded youth of the many commitments that have been made by the “youngish” policymakers. In pre-empting the youth’s thoughts, Dr Etienne posited that they must be asking, “so what?”. She made a clarion call for decisive action by our policymakers.

The Congress participants agreed on a Roadmap toward Adolescent and Youth Health in the Caribbean and recommended that member states invest in adolescent and youth health and development to ensure that young people survive, thrive and are integrally involved in the transformation of the countries of the Region.  Key strategic areas that can promote significant returns on investment and realise triple dividends include investment in mental health, sexual and reproductive health, mitigating climate change, and healthy lifestyles.  It was also recommended that youth must also be facilitated to actively engage in processes. The Roadmap included several policy and programmatic recommendations under the four themes of the Congress.

Cognisant of the above recommendations, it is incumbent upon us the technical leaders to facilitate our young people’s engagement at the level of our Heads of Government to bring the recommendations in the Roadmap to their attention, call for bold action by them, and receive commitments which are followed by action to implement the recommendations of the Roadmap, albeit incrementally. This is the only way that we can truly convince our young people – our children – that they are the wealth of the Region and answer Dr Etienne’s question, “so what”?

It is indeed a distinct honour to stand before you as CARICOM Youth Ambassador of the Republic of Trinidad and Tobago on this incredible occasion.

I deliver these words out of my mouth but pouring out of the hearts of young people – youths and adolescents of the entire Region.

Today we witness, and we contribute towards history. History is more than the path left by the past. It influences the present, and it can shape the future.

Today history is being made as we inaugurate the First ever Caribbean Congress on Adolescent and Youth Health!

This congress is a safe space, rich in dialogue, where international partners and practitioners can highlight and address issues/challenges circumventing good health and wellbeing of a major subset of the population and a critical human resource: the youth and adolescents; Not forgetting adolescents and youths with disabilities.

It is a catalyst for policymakers to discuss how to improve as well as how to sustain investment in our health in a manner that is deliberate, impactful, measurable and sustainable – #Agenda2030!

This Congress, the first of its kind is for youth, by youth, with youth and supported by the young at heart- the “youngish”. It is bolstered by momentum. It is action-oriented and should have a decisive follow-up.  This is not a talk-shop. We must set the basis for no less.  Health and well-being are far and wide and must be met with ambitious, future-oriented, systemic regional responses.

When I think of regional responses, I think of the Caribbean Community – the CARICOM.  Collaboration, comradery and cohesive Caribbean integration!

The dream and ideology are meaningful as my sister would say when referring to the epiphany that birthed CARICOM when it was established in 1973.

Today, this audacious, integrative move is so that future generations would have benefitted from what we as young leaders would have advocated for and what we have worked so hard to achieve.

The young people are here in this room. They are present and ready. They are ignited by passion and purpose. We are ready to contribute to the conversations that impact us – which we have been excluded, ostracized and marginalized- or on a good day- tokenized.

I say let’s do this together: inter-state, inter-organisational and inter-generational!

May God Bless you and May God Bless your nations. 

As always it is a pleasure for me to be here in Trinidad and Tobago but even more so this evening given that it is an event dedicated to our Region’s Youth.

I must congratulate Dr. Pemberton and her Planning Committee for having the vision to organise this first Caribbean Congress on Adolescent and Youth Health.

In 2001 at Nassau, our Heads of Government declared that “The Health of the Region is the Wealth of the Region”. This evening I take the liberty to amend it slightly to state that The Health and Youth of the Region are the Wealth of the Region.

I welcome the representation from across the Caribbean and I am pleased that some CARICOM Youth Ambassadors are participating in this event.

The voices and concerns of our youth must be heard and addressed as we seek to define the world in which we live today and tomorrow. Fora such as these present a suitable opportunity for discourse on issues which have a significant impact on our lives.

The World Health Organization (WHO) defines health as ‘a state of complete physical, mental and social well-being, and not merely the absence of disease or infirmity’.

This definition speaks to a holistic approach which I believe is well captured in the programme for the next three days.

A similar approach has been adopted by the CARICOM Secretariat, over the years, with respect to the development of programmes targeting our youth. These are being conducted through a multi-sectoral institutional framework for national policy, integrated planning, and action, through the CARICOM Youth Development Action Plan (CYDAP). This Plan is a product of the CARICOM Commission on Youth Development (CCYD) in which the youthfully participated.

The Plan focuses on six priority areas with Health and Well-being as an important goal to be achieved. It emphasises “youth access to youth-friendly, gender-sensitive and culturally appropriate health information to maintain their physical, mental, social and emotional well-being”.

A key aspect of achieving and maintaining health and well-being is our lifestyle and the choices we make. The prevalence of lifestyle diseases, such as hypertension and diabetes so concerned our Heads of Government that they held the historic first-ever Summit on Non-Communicable Diseases (NCDs) right here in Port of Spain in 2007. They have held several special sessions subsequently on this topic with the latest in 2017.

It was recognised that NCDs have implications not only for our health; it also has serious social and economic repercussions. Caribbean countries are among the worst affected by NCDs in the Americas. A recent study in one of our Member States showed that the cost of dealing with NCDs is as high as five percent of GDP.

We must all be aware of the four acknowledged risk factors for NCDs. These are unhealthy diet, physical inactivity, tobacco use, and harmful use of alcohol. That awareness must guide us towards behavior that minimises the risks.

Unhealthy diet and physical inactivity, in particular, are areas of significant concern with regard to childhood obesity. In the medium-term, obesity in children represents the greatest threat to the health of future generations.
In many CARICOM Member States, the level of overweight and obesity is more than 30% in both primary and secondary school populations.

Recognising the danger posed by this phenomenon, Heads of Government have endorsed policies geared towards arresting this worrying trend. These include tax measures on beverages and other manufactured food aimed at reducing fats, sugar and salt content. Proposals have also been put forward with respect to front of package labelling.

They have also urged the promotion of physical exercise in school-age children and greater emphasis on public education programmes encouraging healthy lifestyles.

A Caribbean Public Health Agency (CARPHA) 2016 survey of chronic disease risk factors in CARICOM Member States report substantial levels of tobacco use and harmful use of alcohol.

A 2013 Report on Student Drug Use in 13 Caribbean Countries, released by the Inter-American Drug Abuse Control Commission (CICAD), showed a marked increase in the overall average prevalence of drug use when compared to 2010.

The Caribbean Community has, for several years, been addressing the harmful use of drugs within the context of the Regional Drug Demand Reduction Strategy.

Among the notable initiatives undertaken which have either involved youth themselves or have targeted youth as a vulnerable group are:

 adolescent treatment and prevention training to build the capacity of drug demand reduction practitioners working with adolescents and youth; and

 capacity-building among youth in the use of edutainment as a means of communicating information on drug use prevention and treatment.

Another health issue that is gaining increasing attention among our young people is that of mental health. Last year in Jamaica at my annual interaction with the youth of the region this issue was specifically put forward by the youth.

One of our young health professionals presented a paper at that forum which pointed to a WHO/PAHO (2016) report that indicated that 4% of the regional population were treated for mental illnesses across the region in 2015. The most prevalent mental disorders were schizophrenia and depression with the highest diagnosis rate in the 18-30 age category.

She identified suicide as a possible outcome of mental illness with a mortality rate of 7.3 per 100,000 in the Region.

She referred to the pressure placed on youths to succeed in examinations, the phenomenon of bullying and peer pressure which all have an adverse effect on the mental health of adolescents and youth.

This issue has been, of late, receiving a lot of attention through sensitization and realisation of the seriousness of the matter. Last Thursday, World Mental Health Day, was used by our Member States to highlight initiatives being taken to combat the problem with emphasis on the youth.

One of the multiple risk factors for mental illness is posed by the traumatic psychological effects of natural disasters. As climate change continues to increase the intensity and frequency of these disasters in our Region, the toll on the mental health of our people is also a matter of real concern.

In the aftermath of the devastating storms, such as we saw in 2017 with Hurricanes Irma and Maria, and this year with Hurricane Dorian, serious health risks will arise, both physical and mental. Vulnerable groups bear the brunt of much of the damage, destruction and despair. PAHO has been very active working with our Member States to address the challenges. The Caribbean Development Bank (CDB) is funding a project since 2018 on mitigating post-disaster mental challenges in CARICOM Member States.

This is one of the issues that demands that we increase our drive to create greater resilience to withstand the economic, physical and social effects of the climate phenomenon. You the youth must become involved, in helping to build our resilience as a Region.

CARICOM is also committed to improving the sexual and reproductive health of adolescents and youth.

This is clearly articulated in the Integrated Strategic Framework for the Reduction of Adolescent Pregnancy in the Caribbean, produced by CARICOM and the United Nations Population Fund (UNFPA). There is also the Regional Plan of Action for Women, Children and Adolescent Health, which was approved by CARICOM Ministers of Health in September 2018 and the Caribbean Woman, Caribbean Child Initiative.

The work done by the Pan Caribbean Partnership against HIV and AIDS (PANCAP) also addresses the sexual and reproductive health needs of adolescents and youth.

While the Caribbean has seen a reduction in estimated adolescent fertility rates moving from 91.6 in 1980-1985 to 60.2 in 2010-2015, some of our countries have the highest estimated adolescent fertility rates. In 2018, 13 percent of all births in the Region were attributed to adolescent mothers (10-19 years of age).

I have taken note of the expectation that this Congress will strive to arrive at core principles to address the health needs of adolescents and youth in the Caribbean. I therefore look forward to receiving your recommendations.

You can be assured of my commitment to continue engaging with our adolescents and youth to address the issues related to health and well-being and to ensure your continued valuable contribution to the achievement of a viable and prosperous Caribbean Community.

I thank you.

National AIDS Programme (NAP) Managers and Civil Society Organisation (CSO) Leaders sharpened skills for advocacy and media engagement at the recent PANCAP Communication Training. PANCAP recognises that engagement in advocacy and policy dialogue with national, regional and global partners is crucial for both NAP Managers and CSO Leaders if we are to fill the gaps articulated in the Caribbean Regional Strategic Framework on HIV and AIDS (CRSF) 2019-2025. PANCAP also recognises that our current pool of advocates in both national AIDS programmes and civil society organisations require training to strengthen their capacity to effectively engage with policymakers and the media.

Strategic Priority Area 1 of the CRSF 2019 – 2025 calls upon national technical managers and experts to become more sophisticated in their advocacy with policymakers and to take advantage of mass and social media as powerful tools for advocacy which cuts across all seven strategic priority areas. Our national managers and experts must provide the technical leadership required for bold and innovative action. Such action is crucial for effecting change in policy and legislation and increasing domestic resources for sustaining the HIV response.

UNAIDS reminds us that advocacy has sparked action in the face of denialism and indifference, mobilised unprecedented financial resources and enabled communities to participate in designing health services that meet their needs. UNAIDS emphasises that advocacy is a defining feature of the response to the AIDS epidemic, and it is a crucial factor in the levels of investment and political commitment dedicated to responding to AIDS.

The communication training enabled participants to increase their skills in advocacy for funding and policy change and to engage through the mass and social media from an evidence-informed position. Having sharpened their skills, technical national partners must now utilise the PANCAP Regional Advocacy Strategy 2017 to increase their strategic advocacy and media engagement.

This overarching regional strategy seeks to harmonise advocacy efforts and amplify the voice of PANCAP partners (including expanding the coverage of priority issues by mass media), to present a unified front with consistent messaging across constituencies and sectors, to extend reach into regional high-level political fora and national political processes and mechanisms, and to strengthen connections to the communities most affected by structural barriers.

It provides a framework for harnessing and building on the comparative strengths of partners in a way that increases the likelihood of success to create a broad-based coalition in which more established partners, such as the Caribbean Vulnerable Communities Coalition (CVC), provide the capacity building and access needed for key population communities to be the drivers of advocacy action.

UNAIDS also reminds us that advocacy remains crucial to driving sufficient resources, addressing the needs of the people most affected, and holding governments accountable for the concrete results that will lead to ending AIDS as a public health threat. I call upon the participants of the training and other stakeholders to be bold in their advocacy while recognising that it takes practice to develop its full strength and potential. Johann Wolfgang von Goethe wrote, “Boldness has genius and power and magic in it.”

The Tenth International AIDS Society (IAS) Conference on HIV Science which was held in Mexico City on the 21-24 July 2019 provided a space for researchers to showcase advances in HIV Science. As expected presentations, panel discussions, and posters on HIV prevention initiatives, PrEP, Treat All, stigma and discrimination and sustainability dominated the conference. However, for me, the key takeaway message was that ending AIDS as a public health threat requires bold political action to address policy and legislative changes for eliminating stigma and discrimination and increasing and maintaining national investment in HIV.

Stigma and discrimination continue to impede access to prevention, treatment and care services particularly among key populations, inter alia men who have sex with men, transgender persons, sex workers, persons who use drugs, people with disabilities, women and girls and indigenous people. Stigma remains a structural barrier to ending AIDS and a key component of the response. The conference brought this into sharper focus by providing a preponderance of evidence that people who experience stigma are at an increased risk of HIV. One presenter stated that stigma is a fundamental determinant of health, and health equity and suggested that stigma undermines three key determinants of health: access to resources; access to social support; and access to psychological and behavioural responses through exclusion. In relation to HIV stigma, one moderator queried whether it is different from other types of stigma. Indeed, it is, and there is a fundamental difference. The way that HIV stigma is felt is based on moral judgment. It is unique as it is associated with sexual, drug use and racial biases which people see as ‘the other’. It is also seen as contagious.

From my more than two decades of work and research on HIV stigma, I am convinced that real change can only come about through interpersonal engagement with people who stigmatise. Individuals can only begin the process of change if they can internalise how their stigmatising attitude perpetuates stigma and how this impacts the lives of people who experience stigma. One of my mentors, Bonita Harris, a Guyanese educator, has held the view that stigma work is hard work. It is where the rubber hits the road. Such work must facilitate self-awareness, which allows people to reflect on how they felt when they were seen or treated as ‘the other’. It is only then that they can begin the process of seeing themselves in the experiences of others and to move from intolerance to genuine acceptance of the other irrespective of who he or she is or his or her values.

Stigma is complex, however, if we focus on its complexity, we will fail to act. To act, we must first hold ourselves accountable by our language and how we describe language as cultural. One presenter focused his presentation on policy as a structural determinant of HIV risk in the context of persons who use drugs. He cited the confiscation of syringes from persons who use drugs and how this increases their risk and vulnerability to HIV when they feel forced to share syringes. He also cited police confiscation of condoms from sex workers and its corresponding risk to those women and men. He argued that policy and criminal justice reform is an HIV prevention imperative and that punitive legislation distances people from testing and treatment as it criminalises while having no positive impact on preventing HIV infection. Punitive and non-protective laws are associated with HIV infection. He advocated for evidenced-based and human rights affirming policies to be fully part of the HIV response and emphasised that policy commitment is required for sustainability of key populations model of prevention, treatment, care and support services.

Political commitment is required for key populations provision and access to services. Strong leadership of ministries of health and policymakers were cited as game changers in Thailand that ensured key populations model of care. The Caribbean Regional Strategic Framework on HIV and AIDS (CRSF) 2019-2025 includes a Strategic Priority Area (SPA) – Critical programmes and social enablers for creating an enabling environment. It outlines several strategies, including design and implementation focused strategies to target identified loci of stigma and discrimination directed towards key populations, People living with HIV (PLHIV) and youth. This SPA also responds to the evidence that a multipronged approach is required for achieving an enabling environment. Another strategy is to design, resource, evaluate and scale-up cross-sectoral approaches to pilot comprehensive sexuality education programmes in schools in recognition that our adolescents are growing up without the correct information and skills to reduce their risk and vulnerability to HIV and other social ills.

Under this SPA, the CRSF calls upon countries to intensify and institutionalise cross-sectoral collaboration to implement social protection programmes to address socio-economic drivers of HIV, with emphasis on gender-based violence and vulnerability associated with migration and population movement.

The SPA also recognises the critical need to advocate for sustained domestic resourcing for HIV, health and social protection programmes that deliver comprehensive, differentiated, non-discriminatory services that reach key populations, including the increasing number of migrants in the region.

If the Caribbean is to achieve the goal of the CRSF, that is, to reduce new HIV infections, address health disparities and social inequities, and contribute to the achievement of sustainable health and development, the region requires bold political action for increased investment to address stigma. This would enable us to accrue significant gains across the prevention and the treatment cascade.

UNAIDS 2019 HIV Global Report informed us that the Caribbean is required to have another 106,000 persons on treatment and achieving viral suppression if the Region is to attain the 90-90-90 Targets by the end of 2020. Countries must therefore focus resources to implement strategies to target identified loci of stigma and discrimination directed towards key populations.  This can only be done through bold political, as well as technical leadership and innovative action.

I bring you greetings on behalf of Dr The Honourable Timothy Harris, Prime Minister of St. Kitts and Nevis and Lead Head with responsibility for Human Resources, Health and HIV and Ambassador Irwin LaRocque, Secretary-General of the Caribbean Community.

I wish to congratulate UNFPA for convening this follow-up meeting to the 2018 High-Level Dialogue on Comprehensive Sexuality Education (CSE) in Health and Family Life Education (HFLE) and to acknowledge the support of other partners.

A recent evaluation of the Caribbean Regional Strategic Framework on HIV and AIDS, 2014 to 2018, found that Age-appropriate, gender-sensitive, evidence-informed programmes that provide comprehensive sexual and reproductive health education,  being delivered throughout the education sector and in community settings, had not been met during the period under review.  The evaluation found that there was inadequate provision of HIV life skills based on sexuality education, and implementation of the HFLE curriculum is uneven across Caribbean countries, ranging from no implementation to limited implementation at three levels (primary, secondary and teachers training institutions). This finding was supported by the analysis of the PANCAP Partners’ Survey which revealed that capacity was limited in the delivery of age-appropriate, gender sensitive, evidence-informed programmes that provide CSE throughout the education sector and the community and in providing technical guidance and support to establish and maintain high-quality standards for prevention programmes.

It was therefore not surprising that UNAIDS data on adolescents suggest that they are highly vulnerable because of early and forced initiation of sex; high pregnancy rates; and low level of knowledge about HIV prevention.  Key population youth remain at particularly high-risk with reports of estimated HIV prevalence among gay and bisexual adolescent boys as high as 14% to 27%, and 27% in transgender adolescents.

The same evaluation recommended that governments should support the revision and strengthening of the HFLE curriculum to include more relevant age-appropriate information on stigma and discrimination with reference to youth and adolescents, and especially information on sexuality, sexual and reproductive health including HIV and AIDS and other STIs.

Given the serious concerns regarding the findings of the CRSF 2014-2018 evaluation in relation to the inadequate impact of the prevention response in the Region, the PANCAP Executive Board called upon national governments to take note that while tens of thousands of cases of HIV infections have been prevented, we need to significantly reduce new infections.  This requires us to promote age-appropriate sexual education and skills and extend sexual reproductive health services to all youth and key populations and to advocate for the introduction of innovative prevention approaches and improve the quality of prevention services to ensure greater impact in reducing new HIV infections.

In 2017, PANCAP developed a Caribbean Regional Youth Advocacy Framework on Sexual and Reproductive Health and Rights.  It identified the need to address the dissonance between the age of consent for sex (16 in most territories and the age at which adolescents can access SRH services (18 years); comprehensive sexuality education to be implemented in schools across the Caribbean, where it is not a usual phenomenon; and advocacy towards gender-inclusive policies and laws. To advance these priorities, a Regional Youth Steering Committee, comprised of CARICOM Youth Ambassadors and Key Population Youth Leaders, was established in July 2017 to oversee the implementation of the Framework.  To effectively do this, youth leaders were trained to advocate for substantive policy changes across the region in support of reducing their vulnerability to HIV infection by improving access to HIV combination prevention, care, treatment and support services, in recognition of their sexual and reproductive health and rights.  In May 2018, the Second Regional Meeting of Youth Leaders on SRH and Rights was convened and over 40 youths from CARICOM Youth Ambassadors, youth leaders from Key Populations agreed to advance the priorities of the Caribbean Regional Youth Advocacy Framework.[1] Youth representatives have been engaged in high-level advocacy with Ministers of Education and Health at the 2018 High-Level Dialogue on CSE in HFLE, and 2018 COHSOD–Ministers of Health on the priority issues mentioned earlier. They have also been positioned to represent Caribbean youth on the PAHO EMTCT TWG and the recently established PAHO Youth Advocacy Group. In relation to the latter, two of these youth recently attended its inaugural meeting which was held in Washington D.C. and actively participated in a workshop on School Health Programming. One of them is present with us here today – Dennis Glasgow, who is also the youth representative on the PAHO EMTCT TWG.

To facilitate a greater understanding of CSE, PANCAP synthesised the UNESCO International technical guidance on Sexuality Education: An evidence-informed approach, into nine infographics that contain key messages on the different aspects of sexuality education. The infographics are on: Health and Wellbeing; Relationships; Sexuality and Sexual Behaviours; Skills for Health and Wellbeing; The Human Body and Development; Understanding Gender; Values, Rights, Culture and Sexuality and Violence and Staying Safe. These were developed primarily for faith leaders and other PANCAP stakeholders, to demystify comprehensive sexuality education, facilitate their buy-in and reduce opposition to the rollout of the curriculum in schools.  We are awaiting feedback from the Regional Consultative Committee of Faith Leaders.

The Partnership is currently developing a CRSF 2019-2023 which acknowledges that young people face persistent challenges to realising their sexual and reproductive rights, including the gap between the age of sexual consent (16) and the age (18) at which they can independently access health services, for example, HIV testing. Cognisant of these lessons, the draft CRSF 2019-2023 clearly articulates as a strategy – the need to design, resource,  pilot,  evaluate, and scale-up regional cross-sectoral initiatives, to implement comprehensive sexuality education in schools with high levels of risky behaviour.

I believe that we all hold the view that the delivery of CSE in schools must receive buy-in from parents and guardians, religious leaders and community gatekeepers for its successful implementation in the school system.  My own experience as a science teacher, designer and facilitator of youth peer education and as a consultant, who in 2008 was tasked with evaluating Guyana’s implementation of HFLE has helped me to better understand the critical importance of engaging parents, faith leaders, community gatekeepers. It is essential to help them to understand what we mean by CSE and clearly articulating its benefits to obtain their buy-in.  We must advocate for the inclusion of CSE in the curriculum of teacher training institutions to enable every graduate teacher to enter the school system with the knowledge and skills, and level of comfort to deliver CSE in HFLE.  CSE cannot, and must not be delivered as an academic subject. This may require revitalising the creative thinking of some of our teachers to enable them to include CSE in HFLE.

Our young people continue to call upon us to engage them in the design of such programmes to reduce their risk and vulnerability. Only recently, Dennis Glasgow made that call at the “Women Deliver Conference” in  Vancouver, Canada. Let us, therefore, answer that call and ensure meaningful engagement and involvement of our young people so programmes can be adapted/developed to meet their needs.  As parents, we all have a responsibility to ensure that our children, including those who are adolescents and young adults, are given the tools to develop life skills that would enable them to make choices that will reduce their vulnerability, and most importantly allow them to survive in today’s complex and fast-moving world. A world in which many of them are growing up without extended family and community support. A world in which they now have easy access to information through the many digital platforms.  A world in which they often feel alone and unsupported. I, therefore, challenge us all, particularly our policymakers to move beyond the conversations in these rooms to decisive action following this meeting. I wish us all a productive meeting.

Thank you.

[1] https://pancap.org/what-we-do/youth/