Release Type: Speech

From its inception, PANCAP recognised the significant role that faith leaders can play in the prevention of HIV, provision of care and support and reducing the stigma and discrimination that is often associated with HIV and AIDS. More recently, PANCAP has been working closely with faith leaders both at the regional and national level to support them to clearly define and execute their role.

During the first half of this year, PANCAP has been conducting a series of annual national level consultations under the Justice for All programme with faith leaders in Grenada, Guyana, Jamaica, St Kitts and Nevis, Suriname and the Republic of Trinidad and Tobago. Our next stop is Barbados.  The need for faith leaders to engage in public campaigns to increase awareness of HIV has emerged as a common action among this community.  Many of the faith leaders who attended the consultations for the first time lamented the fact that they were unaware of the UNAIDS 90-90-90 Targets by 2020 and the goal to end AIDS by 2030; Ninety (90%) of all people living with HIV should know their status; 90% of all those who are diagnosed HIV positive to be on sustained antiretroviral treatment (ART); and 90% of those on ART having an undetectable viral load. If this target is achieved, we can end AIDS because People living with HIV (PLHIV) would have improved quality of life and longevity, and virally suppressed PLHIV would not transmit the virus thereby significantly contributing to the prevention of new HIV infections. This message continues to resonate with faith leaders.  Another message that is resonating with faith leaders is that stigma and discrimination are significant barriers to ending AIDS as they prevent persons from accessing prevention, treatment, care and support services.

Faith leaders have now clearly articulated their responsibility, particularly those who have been sensitised, to ensure that the information is shared among other faith leaders and their congregations. They have also taken responsibility for collaborating with their national AIDS programmes to support public awareness campaigns to remind people, especially adolescents and youth that we still live in a world of AIDS, and to provide them with correct information and education thus enabling them to assess their risk to HIV. They will continue to support HIV testing, care and support. Faith leaders also committed to advocating, on behalf of the National AIDS Programme, with policymakers for increased domestic resources for HIV, including for prevention. In one of the consultations, faith leaders, in recognising that religious leaders are not a homogeneous group, identified the need to explore the possibility of a ‘theological centering’ or areas of common agreements as they advance their response. Such centering is crucial as faith leaders confront stigma and discrimination that is also experienced by members of the LGBTI community who too require sexual and reproductive and HIV services.

I have assured faith leaders of PANCAP’s support through our Knowledge Management programme. They will be provided with information which can be accessed on our website, support for message design and facilitation of webinars, research articles, case studies, evidence, fact sheets and infographics tailored to their specific needs. I also reminded faith leaders that in an environment of limited resources, they do not necessarily need money to respond as information sharing can be incorporated into their existing programmes within and outside their place of worship. Technical support is also available to them through their national AIDS programmes and civil society organisations involved in the response to HIV and other social issues that make people vulnerable to HIV.

I am hopeful that the faith community’s response will be fully owned by faith leaders and that they will work collaboratively with their national AIDS programmes and civil society partners. The PANCAP Coordinating Unit, with support of the Global Fund, the 10th European Development Fund, Dr Edward Greene, PANCAP Advisor and the Policy and Strategy Working Group on Stigma and Discrimination, has given them wings and we will now let them fly and soar.

At its 41^st Meeting of the Board of the Global Fund to Fight AIDS, Tuberculosis and Malaria the Allocation Methodology was approved ahead of the Sixth Replenishment scheduled for October 2019 in France. The Global Fund has set a target of US$14 million. As a member of the Board of the Global Fund, I can attest that this global financing mechanism is one of the most transparent. The Global Fund’s governance has significantly improved over the last few years with the establishment of an Ethics and Governance Committee and the hiring of an Ethics Officer and staff to support his function.

In 2016 the USAID-Johns Hopkins University funded PANCAP Knowledge Health Project was established in response to the challenge faced by the Partnership in relation to a lack of knowledge management (KM) expertise and documentation of case studies and best practices among the PANCAP stakeholders, particularly National AIDS Programme Managers and Civil Society Organizations.  Another challenge was limited visibility of PANCAP and its achievements.

Three years into its implementation, the project has had achievements. These include building the capacity of the PANCAP Coordinating Unit staff and PANCAP partners, particularly National AIDS Programme Managers and civil society partners to use knowledge management approaches, document good practices, synthesise, package and share information.  Partners are now utilising knowledge management approaches in their work.  The PANCAP website was revamped and is now the ‘go to’ website for up to date information on HIV.  The PCU now uses various social media platforms such as Facebook, Twitter and Instagram to reach a wider audience, including youth.  Several NAP managers and other ministry of health staff, and civil society representatives from various countries have benefited from the learning exchanges to HIV programmes in the Dominican Republic, Jamaica and The Bahamas.  The project also established a virtual learning experience through PANCAP webinars focused on 90-90-90, Treat All, innovative prevention strategies and sustainability.  A Knowledge Management Working Group has been established to encourage and support a culture of collaboration and knowledge sharing across the region.  The work of the Partnership is now very visible and has contributed to increased ownership and appreciation of the added value of PANCAP countries and the region.

While the Johns Hopkins support to PANCAP ends in September, the PANCAP Knowledge for Health Project will continue with funding from PEPFAR-USAID. The responsibility for the management and coordination of the Knowledge for Health Project will now fully reside with the PANCAP Coordinating Unit. This development demonstrates that Johns Hopkins University has successfully built the PCU’s capacity to sustain knowledge management within the Partnership.

I wish to thank Johns Hopkins Knowledge for Health Project team for their technical guidance and for building our capacity to fully serve as the knowledge hub, and for transforming our website and communication. We are appreciative of PEPFAR’s commitment to supporting our knowledge management function. I am particularly pleased with the performance of the two knowledge management staff, Dr Shanti Singh-Anthony, Knowledge Coordinator and Mr Timothy Austin, Communications Specialist. They have the confidence of the Partnership and continue to provide knowledge management support and share their expertise with the Partnership.

The Partnership, including our countries and regional and civil society partners, are being requested to sustain the HIV response and to implement innovative approaches and services to achieve prevention, increase the number of persons who know their HIV status, retain more people on treatment and to ensure that those that are retained on treatment achieve viral suppression.  The goal is for countries to achieve the UNAIDS 90-90-90 Targets by the end of 2020 and ultimately end the AIDS epidemic by 2030. Despite the challenges such as tight fiscal space, the high economic cost of natural disasters including hurricanes, and other competing issues such as crime and violence and rise in non-communicable diseases and emerging diseases our countries are progressively increasing domestic investment for HIV.  Concomitantly, external donors are continuing to reduce their funding while urging countries to scale up, implement innovative approaches and demonstrate political will.

The Global Fund to Fight AIDS, Tuberculosis and Malaria will be hosting its Sixth Replenishment in France in October this year. A target of US$14billion has been set. In preparation for the replenishment, the Board of the Global Fund will place a spotlight on the Allocation Methodology at its 41st Meeting which will be held on 15 and 16 May 2019 in Geneva, Switzerland.

France, Germany, Communities, Developing Country NGO and Developed Country NGO constituencies of the Global Fund Board prepared a paper titled: Ensuring an optimal allocation of resources for the next cycle in 2020-2022.  The paper acknowledges that allocation is the Global Fund’s main vehicle to steer its investments, therefore decisions about its methodology have tremendous consequences for people, countries and the response.  The paper cautions that when the Board approves the allocation methodology at the May meeting, it needs to be confident that it is allocating its resources optimally for the next cycle. A strong argument advanced in the paper is that this decision (of the Board) must rest solidly on a demonstration that the allocation methodology provides the best possible answer to the question: what needs to be funded, and how?

The Latin America and Caribbean (LAC) constituency endorsed this paper as the decision on the allocation methodology could have serious implications for LAC, particularly in relation to funding for regional grants such as the PANCAP and CVC-COIN grants.  The criteria being used by the Global Fund to make decisions on allocation are the ability to pay (World Bank’s assessment of countries’ gross national income) and the burden of the disease.  The majority of LAC countries are classified as Upper Middle Income. Of concern is that key populations in the Caribbean, particularly men who have sex with men, transgender persons and sex workers have much higher prevalence rates due to the existence of discriminatory laws that hinder their access to services. Global Fund resources are therefore still needed to enable national programmes that include civil society organisations to deliver critical programmes to reduce key populations’ risk and vulnerability to HIV.

The LAC constituency delegation is fully committed to intensifying its advocacy and engagement at the pre-board and board meetings on the allocation methodology. We are hopeful that the decision on the allocation methodology will result in the maintenance of the current level of funding for our countries as well as the retention of an allocation for regional grants. Such outcomes would cushion countries’ efforts to progressively increase domestic resources for HIV while pursuing full country ownership and sustainability.

“We are PANCAP”. Upon my assumption to the office of Director of PANCAP I was struck by partners who referred to us – the staff in the PANCAP Coordinating Unit (PCU) – as “you all at PANCAP”. Every time I heard that statement I cringed because it seemed at that time that they limited PANCAP to the secretariat – PCU. My response was to work to ensure that every partner understood that we are all PANCAP. I repeated that phrase so often that eventually partners, even those who were new, began to also say “we are PANCAP”.

I reflected on this statement many times during the recently held Seventh Meeting of National AIDS Programme Managers and Key Partners. I reflected on my one-on-one meetings with staff at the PCU when I would remind them that although we were fewer in number, we must work smarter to demonstrate PANCAP’s added value to the Region.  But we had to ask ourselves several questions and to be brutally honest with ourselves. Why would anyone want to support PANCAP in an environment of declining resources when countries are also struggling with the sustainability of their response? What is it that PANCAP does that others do not or cannot do? We could not just say that we are a best practice because UNAIDS said we were several years ago. We will be judged based on what we deliver now. Are we responsive to the needs of the people whom we were established to serve? Are we utilizing the comparative advantage of each partner? Are we really giving a voice to the voiceless? Are we judging our key population brothers and sisters? Are we embracing them or are we just ticking a box to satisfy our donors? The responses to those questions led us in the PCU along a journey to transform our image and how we work.

Weeks before the Seventh Meeting of NAP managers and Key Partners I began to sense that the Partnership’s goodwill was restored. I did not need any entity to tell me that the tide had turned. The response to our invitation was overwhelming. Our civil society, government, regional and development partners were calling and writing to us to be included on the agenda or as participants in the meeting. We sought donor approval to increase the budget to meet the demand but eventually our dedicated meeting coordinator informed me that we had surpassed the maximum.

As I escorted Honourable Terrence Deyalsingh, Minister of Health, Republic of Trinidad and Tobago and Chair of the PANCAP Executive Board to the podium to begin the opening ceremony, I was overcome with emotions. My staff know that I am very emotional. I struggled to hold back the tears of gratitude and joy. I felt the energy of the Partnership in that room. I felt the feeling of ownership of the Partnership. In that moment I knew for sure that “we are PANCAP”. I remembered the CSO representative from Antigua and Barbuda looking over at me. As I passed her, she said “smile just smile”. Those words helped me to put a smile in my voice. The post below from Anderson Langdon, Executive Director of the Barbados Family Planning Association following the PANCAP Knowledge for Health Share Fair sums up what we can achieve as a collective – our regional vision of an AIDS-Free Caribbean.

Do you know your status? If you do not, as Champions for Change we urge you to do so this World AIDS Day so you can feel empowered.

Know Your Status is the theme for World AIDS Day this year. It is both a call to action and an opportunity to celebrate the achievements that have been made and recommit ourselves to continue the work towards the end of AIDS as a public health threat by 2030. The success of the regional response is evident in significant achievements for the Caribbean especially since seven of our Caribbean countries were recognized on World AIDS Day last year for eliminating the transmission of the HIV virus from Mother to an unborn child. In April 2015, Cuba became the first country in the world to achieve the target for elimination of mother-to-child transmission of HIV and Congenital Syphilis, along with 6 additional countries (Anguilla, Antigua and Barbuda, Bermuda, Cayman Islands, Montserrat, and Saint Kitts and Nevis, in 2017).

UNAIDS World AIDS Day 2018 data collected in 2017, reveals that we still have much to do and each of us needs to take action.

• Our Caribbean region still has 310, 000 people living with HIV
• The number of new infections among adults stands at 15, 000 [11 000–26 000] as reported in 2017.
• Adults aged 15 years and over, there are reports of 14,000 new infections [10 000 – 24 000]
• New infections among children (aged 0–14 years) are an estimated 1100 [710–1900] in
• AIDS-related deaths in 2017 were an estimated 10 000 [7100–17 000]
• 181,000 Caribbean people living with HIV were on treatment in 2017
• Treatment coverage for pregnant women accessing treatment is at 75% but only 58% for adults 15 years and older and just 52% for children 0-14 years and 57% overall for all people living with HIV.

This tells us that despite these efforts and in spite of the overall gains towards epidemic control, throughout the Region, prevalence continues to be higher in key populations, including women, MSM, transgender, sex workers, youth, migrants and mobile populations, incarcerated persons and people who use drugs. The legal, social and cultural barriers that drive transmission and prevent key populations from accessing comprehensive and high-quality health services are deeply rooted in Caribbean cultures and societies. As the Region is faced with rapidly declining donor support to HIV programming, interventions targeted at key populations, including through community-based organizations (CSO), are likely to be most affected, especially as national programs are challenged to find the resources needed to scale-up treatment programs in line with Treat All. At a minimum, there must be a commitment at the regional and national level to sustaining investment in prevention, treatment, communication for development, moral and values education and care programs.

It is now, therefore, a strategic imperative to work in partnership and collaboration with all stakeholders, operating as a unified, coherent and cohesive whole (without prejudice to individual/respective organizations objectives) in order to achieve the overall goal of ending AIDS as a public health threat by 2030.

Each of us must do more, and we can start by simply doing an HIV test- today or as soon as possible- which will allow us to seek treatment or continue and improve our prevention efforts. Our region needs our collective action!

This year’s World AIDS Day theme “Know your status” encourages us to be tested to know whether we are HIV negative or positive. This theme is very relevant as the world has committed to Fast Track actions towards achieving the 90-90-90 treatment targets by the year 2020. The UNAIDS 2018 Global AIDS Monitoring (GAM) report informs us that there are an estimated 310,000 adults and children living with HIV in the Caribbean, of which nearly 55,000 are unaware that they have HIV.

While many people experience anxieties when contemplating being tested, it is good to know that the majority of these will test HIV negative. What is important is those who know that they are HIV negative have an incentive to keep themselves free from HIV by adopting changes to their lives that can reduce their risk and vulnerability to HIV. The few who test positive for HIV can have immediate access to life-saving antiretroviral drugs that would enable them to enjoy a good quality life and live much longer.

The 2018 UNAIDS GAM report also helps us to understand that we still need to place 74,400 persons who are living with HIV on treatment and 103,000 are yet to achieve viral suppression, that is, having very low levels of virus in the body, even though the virus is still present.

Science and evidence show that AIDS can be defeated once we get 90 percent of people to know their HIV status, of those who are HIV positive 90 percent receive anti-retroviral drugs and are retained in care, and 90 percent of those on treatment achieve viral suppression. Once this happens, we are well on the way to achieving the end of AIDS, by 2030.

So what is stopping us from achieving these 90-90-90 targets? The biggest challenges we face are persistent judgment and unfair treatment of people living with HIV and persons belonging to key population groups such as gay men and other men who have sex with men, transgender persons, sex workers, persons who use drugs, migrants and other mobile populations, and persons with disabilities. We judge persons who are different from us and we often times treat them differently. We do so because we do not take the time to understand.  This year’s theme must, therefore, serve as a catalyst for increased strategic advocacy using the PANCAP Regional Advocacy Strategy 2017 and national advocacy plans for increasing political will to remove the policies and legislative barriers that obstruct people from coming forward to know their HIV status. The fear is real as people are concerned that they will be treated differently if they test positive.

We must bring into the spotlight the critical need for laboratory improvements and increased coverage in our region. We need more laboratory facilities including those led by the communities themselves to know our status. We need laboratories to confirm community-led HIV screening tests.  We need laboratories and point-of-care diagnostic systems to monitor our viral loads and health care providers who are trained to provide clinical management for HIV-related illnesses.

We cannot get people tested if we do not have test kits, the right diagnostic equipment, and the right human resources. When we talk about placing 90 percent of people who are HIV positive on treatment and retaining them on treatment we must also ensure that we do not have stock-outs of key drugs. How can we be taken seriously when we encourage people to be tested and then fail to provide uninterrupted treatment? How can we fail to respond to people living with HIV when sometimes drugs are not available and people become anxious because their health care provider had stressed the importance of adherence to treatment and the impact of non-adherence on their health, including the potential for drug resistance?

If we are serious about getting people to know their status, we must move beyond the rhetoric to decisive actions to demonstrate that we understand the full implication of what it means to move someone who tests HIV positive to sustained viral suppression. We must guarantee good quality laboratory testing and laboratory services, uninterrupted treatment and monitoring within our health care system. And we must begin to tackle the reform of the justice system to enable persons who suffer discrimination to obtain redress in a timely manner. This calls for the engagement and involvement of our ministries of justice and attorneys general among others.

I call upon our governments and all who can make this happen to take the necessary actions to create an enabling environment in which people who want to know their status can come forward with the knowledge that they will not be treated differently, and that if they test positive they will be provided with the treatment, care and support they need to enjoy good quality lives and achieve viral suppression. Only then can we get them to know their status and begin the journey towards ending AIDS as a public health threat in the Caribbean.

As we mark another World AIDS Day, 30 years after the start of this epidemic, we have come a long way and are fortunate to today be standing in a better place than in prior years. But after 30 years, AIDS is still not over as yet and we have much more work to do.

Today the Caribbean Regional Network of People Living with HIV (CRN+) commemorates World AIDS Day under the theme “Know Your Status”. This theme is meant to encourage every individual who do not know their HIV status to GET TESTED NOW. Many barriers to HIV testing remain and UNAIDS estimates that more than 9.4 million people living with HIV still do not know their status. Stigma and discrimination deter people from taking an HIV test. If people don’t know their HIV status, people who are living with HIV can’t start treatment, and people who are HIV-negative can’t get the knowledge and skills they need to keep that way.

HIV has always had an enormous impact on individuals and communities. Children, mothers, and fathers are affected by each new infection. HIV knows no economic or geographic boundaries. This diverse Caribbean of ours has the second highest HIV prevalence (1.3%) in the world outside that of sub-Saharan Africa, with 310,000 persons estimated to be living with HIV.

A renewed call to the people of the Caribbean: Get tested!

We must continue to shout out and pledge that stigma and discrimination end with me. Let us commit to reinvigorating our efforts to realize a world free of AIDS and to ending the scourge of discrimination.
I urge our fellow Caribbean countries to protect the basic human rights of ALL people, especially people living with HIV, including their rights to physical and mental health and well-being, social and economic opportunities, and full participation in shaping prosperous and sustainable societies.

Even as CRN+ joins the rest of the world in remembering those we have lost by marking World AIDS Day 2018, we must also take hope in the successes we have made to date. We call upon all Caribbean people who have not yet taken an HIV test to do so today. 54,800 people living with HIV in the Caribbean do not know their status. Knowing your HIV status is very important and the experience can help to either strengthen your efforts to stay HIV-free or guide you to the treatment and care services that will allow you to live a long, healthy and productive life with HIV.

Let us Live Life Positively.

This is our 30th commemoration of World AIDS Day. Over the last three decades the global response to HIV has evolved from a place of desperation to one of hope. Today we have a formidable toolkit to prevent HIV infections and deaths.

Babies of mothers living with HIV can be born HIV free. HIV positive people can be treated so that the level of virus in their blood is undetectable and they are no longer infectious. HIV negative people can take medicines to prevent contracting the virus. All this was unimaginable during the 1980s. In short, we now have the tools to end the AIDS epidemic.  Yet the pace of progress is not matching global ambition.

This year’s World AIDS Day theme points to a simple action that ordinary people can take to bring us closer to that goal: know your status.

HIV testing is a critical strategy for both prevention and treatment. For people who test negative there is the occasion to assess their risks and devise a strategy to stay HIV free. For those who test positive there is an opportunity to start treatment, stay healthy and thrive.

An estimated 77% of people living with HIV in Latin America and 73% of people living with HIV in the Caribbean knew their status in 2017. This means that roughly one of every four HIV positive people in our region are not aware. Knowledge is power. Knowing your status means you can take steps to protect yourself and others. People’s ignorance of their HIV status undoubtedly contributed to the 100,000 new infections in Latin America and 15,000 new infections in the Caribbean last year.

In 2017 29% of newly diagnosed cases in Latin America and almost quarter of new diagnoses in the Caribbean were among people at an advanced stage of infection. This is a particular risk factor for men who are less likely to go to the clinic or visit a doctor unless they are gravely ill. It is in everybody’s interest to build a culture in which regular HIV testing is expected and supported. This makes early diagnosis, effective treatment and prevention possible.

Just as there have been innovations in treatment, there have also been innovations in testing. Throughout our region there is free access to rapid HIV testing. It takes just minutes to learn your status.

HIV self-tests are becoming more widely available. Brazil has led the way in terms of regulating this industry and ensuring that people have the information and resources they need to follow-up following a home test.

Community organizations are using peer outreach to test the most marginalized and vulnerable populations. We encourage governments to do more to support these organizations in reaching the people who find it difficult to access public healthcare services.

Service providers are increasingly using a method called index testing which involves offering tests to the sexual partners, children and other household members of people who have been diagnosed.

Governments, healthcare systems, civil society and development partners are all playing their parts. You can play your part by getting tested.

This year marks the 30th anniversary of the first World AIDS Day. Thirty years of activism and solidarity under the banner of World AIDS Day. Thirty years of campaigning for universal access to life-saving services to treat and prevent HIV. But after 30 years, AIDS is still not over. We have miles to go.

World AIDS Day is a day to remember the millions of people who have lost their lives to AIDS-related illnesses, many of whom died because they couldn’t access HIV services, because of stigma, because of discrimination and because of criminalization of key populations.

On this World AIDS Day, UNAIDS is campaigning for people to know their HIV status and their viral load. In 2017, 9.4 million people were simply unaware that they are living with a potentially deadly, but treatable, disease. If people don’t know their HIV status, people who are living with HIV can’t start treatment, and people who are HIV-negative can’t get the knowledge and skills they need to keep that way. If people don’t know their HIV status, they can’t protect themselves, their families, their partners. If people living with HIV don’t know their viral load, they won’t be sure that the treatment is effective, protecting their health and stopping HIV transmission.

Live life positively. Know your HIV status.

Thirty years after the first World AIDS Day, the response to HIV stands at a crossroads.  Which way we turn may define the course of the epidemic — whether we will end AIDS by 2030 or whether future generations will carry on bearing the burden of this devastating disease.

More than 77 million people have become infected with HIV and more than 35 million have died of an AIDS-related illness.  Huge progress has been made in diagnosis and treatment, and prevention efforts have avoided millions of new infections.

Yet the pace of progress is not matching global ambition.  New HIV infections are not falling rapidly enough.  Some regions are lagging behind and financial resources are insufficient.  Stigma and discrimination are still holding people back, especially key populations — including gay men and other men who have sex with men, sex workers, transgenders, people who inject drugs, prisoners and migrants and young women and adolescent girls.  Moreover, one in four people living with HIV do not know that they have the virus, impeding them from making informed decisions on prevention, treatment and other care and support services.

There is still time to scale up testing for HIV; to enable more people to access treatment; to increase resources needed to prevent new infections; and to end the stigma.  At this critical juncture, we need to take the right turn now.