Release Type: Speech

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/

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.