Release Type: Speech

Good Morning,

It is a pleasure and an honour to have been invited to officially open this Pan Caribbean Partnership Against HIV and AIDS (PANCAP) led sub-regional meeting on the National Action towards the Elimination of STIs and Viral Hepatitis in the Caribbean.

The data utilised in this feature address was acquired as a collaborative effort between the Ministry of Health and the National AIDS Coordinating Committee.

As Minister of State in the Office of the Prime Minister, with responsibility for the National AIDS Coordinating Committee, I am well aware of the significance of today’s meeting.

I would like to start by thanking the Pan American Health Organization, the World Health Organisation, PANCAP and all our Technical partners for their invaluable contributions to our regional response to HIV and STIs and the support to our pioneering spirit.

The Pan American Health Organization’s EMTCT Plus framework for elimination of mother-to-child transmission of HIV, Syphilis, Hepatitis B, and Chagas highlights the point that, “one of the greatest public health success stories, globally and in particular in the Americas, has been the development and implementation of interventions to prevent mother-to-child transmission of HIV [3].

Ladies and Gentlemen, in 2015, an estimated 670,000 women aged 15 and over in Latin America and the Caribbean were living with HIV, of whom an estimated 58% were receiving antiretroviral therapy (ART) (2015 data) [4]. Medication coverage in pregnant women rose from 55% in 2010 to 88% in 2015, and the estimated mother-to-child transmission rate decreased from 15% to 8% over the same period.

New HIV infections in children (0-14 years old) declined by 55% between 2010 and 2015 (from 4,700 [Confidence interval 3,500-6,400] to 2,100 [Confidence interval 1,600-2,900]), and an estimated 28,000 new HIV infections were averted in the same period.

In Trinidad and Tobago by the end of 2016, there was an estimated 3,800 women aged 15 and over living with HIV. Of that number an estimated 92% were receiving ART [5]. Antiretroviral medicine coverage in pregnant women reached 95% in 2016 [6], this represented a significant increase from 81% in 2010 [7]. Our estimated Mother to Child Transmission rate decreased from 16.3 in 2010 [7] to 3.38 in 2016 [6].

Ladies and gentlemen, the global data indicates that HIV shares a commonality with STIs and Viral Hepatitis given that these diseases are spread through pathways linked to sexual and reproductive health and changing societal behaviours.

In Trinidad and Tobago our 2016 data reveal that of the 13,482 pregnant women attending antenatal clinics, only 0.2 had a positive (reactive) syphilis serology [6]. Although our positivity rate for syphilis in pregnant women appears to be low, our surveillance of congenital syphilis needs to be strengthened.

The general positivity rate for Hepatitis B, decreased from 7.9% to 4.5% from January 2012 to June 2015 [8]. Data from one treatment and care site indicates that 3.7% of persons starting HIV antiretroviral therapy during 2017 had a co-infection with Hepatitis B [9]. Testing for Hepatitis C is expected to commence shortly.

Ladies and gentlemen, Great things come from the Caribbean. Leadership and vision are important aspects of everything we do and the Caribbean is on board as “Champions for Change” with the scaled up drive to address these illnesses. We are especially enthused at the prospect of being able to announce the elimination of mother to child transmission of HIV and Syphilis in our sub-region.

The Caribbean region was the first in the world to have a country applying for the validation of the elimination of Mother to child transmission of HIV & Syphilis in 2015 Cuba and in 2017 seven other countries received validation {- Anguilla, Antigua & Barbuda, Bermuda, Cayman Islands, Montserrat, St. Christopher & Nevis.}

Ladies and gentlemen, this is just one part of the evidence of our regional commitment to end AIDS by 2030 – an ambitious target as part of the Agenda for Sustainable Development adopted by the United Nations General Assembly.

To intensify our HIV response to “end of AIDS by 2030”, we are all aware that actions must be fast-tracked and the region’s response must be scaled up. To do so, it is paramount that we address the gaps and challenges in the STI response within the combination HIV prevention approach, as well as the viral hepatitis immunization. Here, in Trinidad and Tobago the Hepatitis B immunization was introduced in 2003.

We must as a region have access to the skills and best practice experiences that allow our wider Elimination of Mother-to-Child Transmission success and follow through on the new EMTCT Plus goals and the even wider goals to eliminate or significantly reduce the effect of other STIs.

As such we welcome this opportunity to lead the way in facing this new challenge and look forward to the expanded evaluation for the elimination of these diseases especially from mother to child.

Ladies and gentlemen, we must continue to work to make our country, region and globe a healthier, safer and happier place for all men, women and children by identifying and addressing structural, policy and programmatic barriers critical to the implementation of diagnosis, care and treatment for HIV/STI and viral hepatitis prevention, care and treatment; thus, contributing to the Sustainable Development Goals (SDG).

Cognizant of our roles and responsibilities to regional and global citizens, we are proud to be a part of these conversations and initiatives. It is broad partnerships and strong linkages with other health and development issues, like these, that must be emphasized in this response.

With the help of organizations such as yours, the Caribbean has seen enormous investments in the HIV response, large declines in HIV-related deaths and increased access to antiretroviral therapy. Our successes only attest to the commitment, resources and innovations that you have already directed at this epidemic.

We welcome the opportunity for continuous improvement and expansion to meet our clients with a range of integrated services that address their risk and support program sustainability through the effective use of resources. Though the targets are lofty, the energy is high, the commitment of the teams is evident and I am filled with hope.

Ladies and gentlemen, Today and during the course of this PANCAP forum:
1. You will be made aware of:
• global recommendations and standards,
• commitments required for the planning of a national public health response to viral hepatitis,
• policies and best practices to expand screening and treatment of STIs.

2. You will identify recommendations for addressing specific barriers to HBV and HCV testing, care and treatment. Implementation of these recommendations is hinged on improving the quality of systems for reporting of STIS and viral hepatitis data within national surveillance systems.

3. You will commit to concrete actions to address the elimination of priority STIs and viral hepatitis and identify needs and opportunities for cooperation to strengthen national responses. In short, today you will develop the framework for realizing our joint goals and outline how these goals can be achieved together- as one region, one body of people committed to the same cause, one force.

The exchange and interaction that will take place with allow for the critical review of recommendations and provide an opportunity for us to contextualize new information and incorporate evolving and new practices into our respective responses.

Please note in this time of global economic constraints, when many nations health system are being burdened by overwhelming demand, this PANAP forum will allows for the expanse of client reach and sensitize all on urgent need for the optimization of medical financial and material resources to improve overall output as well as the improved our service delivery utilizing our available workforce.

It is only through proficient management at our health institutions will we be able to create the conducive environment for development of dynamic health sector and sustain an effective country coordinating mechanism to collectively fight HIV/AIDS, STIs and Viral Hepatitis.

Therefore, I implore you, despite the obstacles and challenges that we face today, it is engagements like these and your participation that allow me to have faith in our commitment to ending the AIDS epidemic by 2030 and creating meaningful targets to mitigate STIs and Viral Hepatitis.

These are goals that I wholeheartedly believe we can achieve if we continue to place HIV/AIDS, STIs and Viral Hepatitis at the forefront of issues facing the Caribbean.

On behalf of the Office of the Prime Minister, the Minister of Health and Trinidad and Tobago, I thank you for your commitment to solving the problems at hand.

Do enjoy today’s proceedings and God bless.

5. UNAIDS. (2017). Trinidad and Tobago 2017 HIV Estimates 1990 – 2017. UNAIDS

6. Ministry of Health. (2017). Global AIDS Monitoring Report 2017 – Health Sector Indicators Subnational 2016 Data. HIV and AIDS Coordinating Unit, Ministry of Health: Trinidad and Tobago (unpublished)

7. Office of the Prime Minister. (2012). Global AIDS Response Progress Trinidad and Tobago Country Progress Report January 2010- December 2011. Trinidad and Tobago: Office of the Prime Minister.

8. Ministry of Health. (2017). Trinidad Pubic Health Laboratory – Hepatitis B Testing Data. (Unpublished).

9. Ministry of Health. (2018). Global AIDS Monitoring Report 2018 – Health Sector Indicators Subnational 2017 Data. HIV and AIDS Coordinating Unit, Ministry of Health: Trinidad and Tobago (unpublished).

Honorable Minister of Health of the Republic of Trinidad and Tobago, Terrence Delyasingh, Honorable Minister of Education of Guyana, and RCM Chair Nicolette Henry, partners, NAPS directors, civil society, friends.

It is a great pleasure for the Global Fund to be a sponsor of this important meeting through the PANCAP regional program. Those in this room have a great responsibility and opportunity to lead the HIV response in this region and we are very happy to be a part of this meeting.

As I read through the Concept Note and agenda for the next three days I was excited to see that there would be a real opportunity to discuss challenges, share best practices and look at some important innovative approaches.

The Caribbean has some important successes, elimination of mother to child transmission and congenital syphilis in 7 countries, access to treatment has doubled, adherence to test and treat in eight countries. All work that countries have led- Important achievements to celebrate.

Despite these successes, this meeting is also a place to discuss and define a path for the challenges ahead and to ask some important questions at individual country and regional level –

1) How can we move to achieve 90-90 -90 targets? Do we know what our treatment cascades look like? Do we have a key pops treatment cascade? Are we using this to make important decisions on where to best invest donor or domestic resources?

2) Data? Do we have it? Do we have the right data? Are we using it to shape our decision and drive for domestic financing and investing it effectively?

3) Are we looking at our strategy and ensuring that it is sustainable? Are we planning effectively as donors reduce resources in the region?

4) What are the real barriers to reaching our targets? What role does stigma and discrimination play? What are we doing to reduce human rights violations, and involving communities and civil society, key communities in the response?

5) What role can innovative approaches play in the response? Self-testing, Prep, and others?

6) What other actors can we integrate into the response? Does and can the private sector play a role?

And finally, how can we as partners and donors support you in achieving these results?

I am looking forward to this opportunity over next three days where rich discussion, information sharing and planning and hopefully collectively ensure we leave having responded some of these questions.

SALUTATIONS

HON. NICOLETTE HENRY, MINISTER OF EDUCATION, GUYANA/CHAIR OF PANCAP REGIONAL COORDINATING MECHANISM, MR. DERECK SPRINGER, DIRECTOR OF THE PAN CARIBBEAN PARTNERSHIP AGAINST HIV/AIDS(PANCAP) COORDINATING UNIT, DR. EDWIN BOLASTIG, PAHO/ WHO REPRESENTATIVE, T&T, DR CESAR NUNEZ, UNAIDS DIRECTOR, LATIN AMERICA AND CARIBBEAN, MS ANNELISE HIRSCHMANN, GLOBAL FUND REGIONAL MANAGER FOR LATIN AMERICA AND THE CARIBBEAN, DR NIKKIAH FORBES, DIRECTOR, NATIONAL AIDS PROGRAMME, MINISTRY OF HEALTH, THE BAHAMAS, DR. AYANNA SEBRO, TECHNICAL DIRECTOR, NATIONAL AIDS COORDINATING COMMITTEE (NACC) SECRETARIAT IN THE OFFICE OF THE PRIME MINISTER, DR. KEVEN ANTOINE, DIRECTOR, HIV/AIDS COORDINATING UNIT, MINISTRY OF HEALTH, MR IVAN CRUICKSHANK, ADMIN AND FINANCE MANAGER, CARIBBEAN VULNERABLE COMMUNITIES COALITION, OTHER NATIONAL AIDS PROGRAMME DIRECTORS AND MANAGERS SPECIALLY INVITED GUESTS.

LADIES AND GENTLEMEN.

Good Morning,

Introduction

I am pleased to attend today’s proceedings as HIV and AIDS continue to be a significant, regional and global concern. For this
reason, it is important that we move in a united manner to develop strategies for sustaining HIV prevention, treatment and care services. Prevention, early detection and access to antiretroviral treatment are essential to the reduction of HIV transmission.

Governments, health service providers, international organizations, civil society organizations, people living with HIV, key populations and other stakeholders must work together in the response to HIV and AIDS.

I wish to thank the international organizations such as the Pan American Health Organization (PAHO), the PEPFAR agencies, the Centre for Disease Control and Prevention (CDC), the Health Resources & Services Administration (HRSA) and the International Training and Education Center for Health (ITECH) for the significant technical support we have received over the years in tackling HIV/AIDS.

Regional Sustainability Level of the Program

It has been more than 34 years since the first reported HIV/AIDS case in Trinidad and Tobago and the Caribbean and over 17 years since highly
active antiretroviral treatment (HAART) became a reality. HIV and AIDS remain a major health burden in the Caribbean.

The Caribbean continues to have the unenviable position of having the second highest HIV prevalence after sub-Saharan Africa.  At the end of 2016, UNAIDS estimated that there were between 280,000–350,000 persons living with HIV in the region with five countries accounting for 92%, namely: Haiti (48%) The Dominican Republic (22%), Jamaica (10%), Cuba (8%) and Trinidad and Tobago (4%).  The annual number of new infections among adults across the Caribbea remained static at an estimated 18,000 since 2010, with countries such as Trinidad and Tobago, Haiti and The Dominican
Republic all experiencing declines in new infections, while Belize, Surinam, Guyana and Cuba are reported to have registered increases in new infections over the period 2010-2016. New infections among children aged 0-14 years decreased by 44% from 1800 to less than 1000 between 2010 and 2016.

As at 2016, the HIV Testing and Treatment Cascade in the Caribbean revealed that on average:

– Sixty-four (64%) of People Living with HIV, knew their status (gap
of 81,000 persons)
– Fifty-two (52%) of Persons Living with HIV were on Treatment (gap
of 92,000 persons), while
– Thirty-four (34%) of People on treatment were virally suppressed
(gap of 120,000 persons).

We are meeting today at a time when the region and the rest of the world has united with a sense of urgency and tremendous optimism at ending the HIV epidemic as expressed in the Resolution adopted by the United Nations General Assembly on 8 June 2016 entitled “On the Fast-Track to Accelerate the Fight against HIV and to End the AIDS Epidemic by 2030”.

In the latter half of 2016, the Government of Trinidad and Tobago adopted WHO’s “Treat All” policy – recommending that all patients are initiated on treatment immediately following an HIV diagnosis. The Medical Research Foundation (MRF) – the largest treatment site in Trinidad and Tobago with over 8000 PLHIV registered in care (i.e. just over 73% of all PLHIV in care nationally) is a key partner in this regard.

On the heels of this success, the MRF, supported by the government of Trinidad and Tobago, embarked on a “Treat All” tour to share its successes and interventions with other treatment sites across Trinidad and Tobago and, in so doing, advocated for the government’s vision for expanded access to HIV treatment nationally.

Our vision for HIV has progressed from a horizon of mitigating the effects of HIV to the new horizon where we can foresee the halting of the
transmission of HIV by 2030. Indeed, we are meeting today as the Caribbean and the rest of the world to begin the final fight as we come to
the end of the HIV and AIDS drama.

The keys to ending HIV and AIDS as a public health threat include:

1. Prevention: with a heightened emphasis on empowering adolescent girls, young girls and key populations.2. Treatment of all persons infected,
3 Elimination of HIV-related stigma and discrimination
4. Articulating a framework with strategies to achieve stable base of resources for achieving sustainability.

Sustainability

From the outset of the HIV epidemic in the Caribbean, there have been varied efforts to ensure that our regional and local communities
achieved sustainability in our response to HIV.  Sustainable HIV programs are characterized by the ability of a national government and regional partners to increasingly assume full strategic and financial responsibility for its HIV and AIDS response over the long term.

It requires the development and strengthening of policies, infrastructure, skills, processes, human and financial resources to ensure the
response can survive, adapt and scale-up.  Financing is key to mounting a sustainable response. With 2020 deadline for the “90-90-90 Fast Track target” approaching, the region finds itself in a global environment with complex development priorities that pose challenges to national budgets and affect bilateral cooperation.

The region is expected to experience reduced technical and financial inflows and must collectively mobilize domestic resources especially, for the support of prevention and the elimination of HIV-related stigma and discrimination among key and vulnerable populations, as complimentary
external financing dwindles.

While the desire to achieve sustainable responses is widespread, little formal research has been undertaken to assess the resilience of
Caribbean territories, in the face of the withdrawal of external support.

As a region, we need to urgently heighten the research and the debate on the sustainability of the HIV response.

Other issues that may be discussed:

1. Joint negotiation for drugs and other supplies
2. Strategic Information:
To improve the capacity of Caribbean national governments and regional organizations to increase the availability and use of quality, timely HIV and AIDS data to better characterize the epidemic and support evidence-based decision-making for improved programs, policies, and health services;
3. Strengthening of Caribbean Public Health Laboratory Network: Increase the capacity of Caribbean national governments and regional
organizations;
• Caribbean Medical Laboratory Foundation (CMLF)
• CARICOM Regional Organisation for Standards and Quality
(CROSQ)

To improve the quality and availability of diagnostic and monitoring services and systems for HIV and AIDS and related sexually transmitted
and opportunistic infections, including tuberculosis, under a regional network of tiered laboratory services;

4. Human Capacity Development:

Improve the capacity of Caribbean national governments and regional organizations to increase the availability and retention of trained health care providers and managers – including public sector and civil society personnel, as well as PLHIV and other HIV-vulnerable populations –capable of delivering comprehensive, quality HIV-related services, according to national, regional, and international standards.

5. Prevention:

The region needs to bring the rate of new infections very close to zero.  The focus should be on key populations and other venerable groups such as adolescent girls and young women who represent over 4% of new HIV infections in the Caribbean. Women account for over 45% of infections among adults with varied reasons in various territories.

Conclusion

Ladies and gentlemen, I thank you for allowing me to address you today. I look forward to the outcomes of today’s exercise as we work towards delivery of essential services for HIV patients.  It is only through feedback mechanisms such as today’s workshop that can we achieve our goal of ridding the population of HIV/AIDS by 2030.  I urge you to keep this goal in mind and the significance of your efforts. It is only together that we can achieve a Healthy me…Healthy You…a Healthy Trinidad and Tobago, and a healthy region.

I thank you.

It is a pleasure to serve the people in the Caribbean as Chair of the Regional Coordinating Mechanism, Global Fund Project. Over the past years there, has been strong growth in the region’s HIV response, however, more still needs to be done to in order to sustain the response and gains made.

Mr. Chair, I see on the draft agenda for this meeting a number of important topics like where are we in fast tracking the regional AIDS response, addressing fast-tracking the HIV response and integration as a key strategy for sustainability.

These are all relevant topics for this particular National AIDS Programme Managers and Key Partners meeting which has strategic importance as it is happening in the year when the Caribbean Regional Strategic Framework 2014-2018 comes to an end.

It is clear that some objectives of this Strategic Framework would not have been achieved. Among them, are those associated with integration and collaboration, there is still need to strengthen country ownership of the response and shared responsibility to strategically align efforts to end HIV as a public health problem in the Caribbean

As a region we still challenged with late diagnosis, particularly for men. Yet there is much to celebrate. People are living much longer with HIV and AIDS, many more patients are on ART and there are greater methods and practices for fast-tracking prevention, operational financing mechanisms, authority and responsibility of National AIDS Programme. These are all essential requirements for closing the gap and shepherding an AIDS free generation.

Our International Partners have provided support and impetus to advance the Caribbean region’s response. And I say thank you.

Let us therefore take the opportunity afforded by this Sixth Meeting of the National AIDS Programme Managers and Key Partners to update our strategies and activities for achieving prevention and reaching those vulnerable populations and those most in need. Let us resolve at this meeting to eliminate inequalities.

Let me conclude by repeating the words of Mr. Peter Sands Executive Director of Global Fund who advocated that there are five key messages for the global health community as we address emerging infectious disease threats: “First, we have to get better at articulating what’s at stake in making the world safer from infectious disease threats; Second, we need to talk about health security in a way that makes sense both to taxpayers in high-income countries and to the people most at risk from infectious diseases, third, we have to embed and broaden our approach to antimicrobial resistance, so that antimicrobial resistance becomes an integral component of how we tackle infectious disease; Fourth, we need to get better at working together to tackle specific diseases and to build stronger, more resilient health systems, and finally, we need to ensure that gender considerations inform health security strategies in a powerful, practical — and effective — way.

The observance of International Women’s Day is more significant than ever in 2018.  From well-organized marches to workshops and events in our region, women continue to make their fight for equality in health, economics, politics among others a very relevant part of our daily discussions.  While progress has been made since the days of the suffragettes, there is still work to be done.

I endorse the 2018 theme “press for progress” as the World Economic Forum’s 2017 Global Gender Gap Report findings revealed that gender parity is over 200 years away.  This makes it even more critical for women and men to sincerely support advocating for equal pay and especially more access to health and sexual reproductive services.  There has never been a more important time to keep motivated and find ways of removing barriers to fast-tracking equal access for women.

In 2014, the Pan American Health Organization (PAHO) called on Caribbean countries to guarantee all women access to essential health services and interventions.  Have we heeded this call?  Are we adequately vigilant that our women and girls are receiving equal access to health care services?  These are questions that we should be constantly examining, not just on International Women’s Day, but at every opportunity possible in recognition that women and girls have invaluable contributions to make to our society.

The right to health for women and girls forms a fundamental aspect of the PANCAP Justice for All Roadmap, as we believe that no society can truly progress without equal access to health services by all.  This concept is also at the heart of PANCAP’s Vision: An AIDS-Free Caribbean. Indeed, fast-tracking the 90-90-90 goals[1] cannot be achieved without adequate focus on ensuring women and girls have equal access to sexual and reproductive health services.

I reflect on the launch of the “Spouses of Caribbean Leaders Action Network (SCLAN)” in September 2017 to tackle issues related to the health and well-being of women, adolescents and children in the Caribbean. This advocacy and action platform is advancing the ‘Caribbean Woman Caribbean Child’ (CariWaC) initiative in its championing of four major pillars:  reducing gender-based violence, reducing adolescent pregnancy, eliminating cervical cancer and eliminating mother to child transmission of HIV and syphilis.

By championing CariWaC’s four pillars, the Spouses of Caribbean Leaders have signaled their commitment to press for progress. We must support SCLAN to enable women and girls to have access to life-saving services, including HIV prevention and care, thereby achieving their potential.

I salute women, girls, and men across our region and the world, who have committed to “press for progress”. 

 Editor’s notes:

 What is PANCAP?

PANCAP is a Caribbean regional partnership of governments, regional civil society organisations, regional institutions and organisations, bilateral and multilateral agencies and contributing donor partners which was established on 14 February 2001. PANCAP provides a structured and unified approach to the Caribbean’s response to the HIV epidemic, coordinates the response through the Caribbean Regional Strategic Framework on HIV and AIDS to maximise efficient use of resources and increase impact, mobilises resources and build capacity of partners.

What is International Women’s Day (IWD)?

International Women’s Day (8 March) is a global day celebrating the social, economic, cultural and political achievements of women. The day also marks a call to action for accelerating gender parity. International Women’s Day (IWD) has occurred for well over a century, with the first March 8 IWD gathering supported by over a million people in Austria, Denmark, Germany and Switzerland. Prior to this the Socialist Party of America, United Kingdom’s Suffragists and Suffragettes, and further groups campaigned for women equality. Today, IWD belongs to all groups collectively everywhere. IWD is not country, group or organisation specific.

The theme for International Women’s Day 2018 is #PressforProgress

Follow updates using #IWD2018 and #PressforProgress

[1] What are the Joint United Nations Programme on HIV and AIDS (UNAIDS) 90-90-90 Targets?

• By 2020, 90% of all people living with HIV will know their HIV status.
• By 2020, 90% of all people with diagnosed HIV infection will receive sustained antiretroviral therapy.
• By 2020, 90% of all people receiving antiretroviral therapy will have viral suppression

7th February 2018

Excellency Patrick Pengel, Minister of Health, Suriname, Dr Yitades Gebre, PAHO/WHO Representative, Suriname, Canon Garth Minott, Mr Colin Robinson and members of the Planning Committee, Dr Edward Greene, UNAIDS and PANCAP Advisor, Ms Monique Holtuin, National AIDS Programme Manager, Ms Mylene Pocorni, CCM Coordinator, faith leaders, key population leaders, colleagues, members of the media.

Today, the Partnership celebrates another significant milestone. Our faith and key population leaders are gathered here in Suriname to engage in a dialogue on reducing stigma and discrimination at this regional consultation on the right to health and wellbeing for all. This builds on PANCAP’s separate engagement with faith leaders and key population leaders and demonstrates the progress we have made as a region.

I believe that this dialogue, which is consistent with the PANCAP Justice for All Programme of affirming human rights and reducing stigma and discrimination, will contribute to the regional efforts that are directed toward the removal of barriers that impede access to HIV and sexual and reproductive health services for key populations.

We cannot end AIDS unless no one is left behind. The Justice for All Roadmap reflects a consensus that increasing uptake of health services by key populations requires a synergistic approach to strengthen both the enabling environment as well as the provision of sound evidence-based prevention, treatment and care services.

This consultation, therefore, brings faith leaders and key population leaders to the same table to increase understanding of (i) the effects of stigma and discrimination on health outcomes, (ii) the public health rationale for work to improve the enabling environment, including law and policy reform, and (iii) PANCAP’s efforts in this area, including the Justice for All programme.

I am confident that this consultation will open the door for further dialogue at both the regional and national levels, and increase support for efforts to reduce stigma and discrimination, including law and policy advocacy efforts, and ending AIDS by 2030.

I look forward to a successful consultation and the joint agreements that will emanate. I end by assuring you of PANCAP’s commitment to supporting you in your work ahead.

Thank you.

Ladies and gentlemen,

‘Our ordinary acts of love and hope point to the extraordinary promise that every human life is of inestimable value.’ – Desmond Tutu
While the freedom of religion is a core value in a democratic society that’s protected by the Constitution, religious freedom doesn’t give anyone the right to discriminate.

The World Health Constitution states that ‘The enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion, political belief, economic or social condition’.

‘Globally, men who have sex with men, are 24 times more likely to acquire HIV than adults in the general population, while transgender people are 18 times more likely to acquire HIV than adults in the general population. Though further research is still needed existing studies suggest that such discrimination intersects with other forms of social advantages and disadvantages across axes such as ability, geography, health status, and age.’

However, it is important to note that human rights violations and marginalization can fuel the spread of HIV and jeopardize access to HIV prevention and treatment services. Factors such as stigma, discrimination, criminalization, and violence based on sexual orientation and gender identity contribute to hindering access to healthcare and social services, as well as HIV prevention, treatment and care services for these populations. As Navars Diaz and colleagues described “Stigma is not only related to personal or social attitudes that serve to devalue a person or group, rather, these ideas are also deeply embedded in social structures that shape individual beliefs and behaviours. They are influenced by power dynamics that serve to oppress the stigmatized and maintain social control over them through the use of restrictive, stereotyped, or punitive beliefs.’ “The right to health also means that everyone should be entitled to control their own health and body, including having access to sexual and reproductive information and services, free from violence and discrimination”. WHO DG. “Everyone has the right to privacy and to be treated with respect and dignity. Nobody should be subjected to medical experimentation, forced medical examination, or given treatment without informed consent.” The study from Puerto Rico by Varas-Diaz in the case of HIV/AIDS stigma; “the stigmatisation of PWHA is not solely based on fears of contagion, but on the social use of power as a means to control particular groups and maintain hierarchies through social institutions and their representatives, such as public policymakers and medical personnel.’

As seen in many Caribbean countries ‘some research suggests that religious organisations and their leaders may interpret their role as keepers of morality and religious tradition in their communities an obligation that can appear to contradict the marginalised or stigmatised groups that are often more vulnerable to HIV infection (such as intravenous drug users or homosexual men, transgender women )’. Although some aspects of religious participation have been found to be health fostering in certain contexts, it may be that religion can also foster HIV/AIDS stigma. For example, some studies have found that religious beliefs are related to the idea that infection is a punishment from God, and that PWHA are to blame because they did not follow established moral or religious code. The United Nations Systems acknowledge that “States bear the primary duty under international law to protect everyone from discrimination and violence”. These violations, therefore, require an urgent response by governments, parliaments, judiciaries and national human rights institutions. Community, religious and political leaders, workers’ organizations, the private sector, health providers, civil society organizations and the media also have important roles to play. Human rights are universal – cultural, religious and moral practices and beliefs and social attitudes cannot be invoked to justify human rights violations against

WHO states that “Human sexuality includes many different forms of behavior and expression. It is increasingly acknowledged that recognition of the diversity of sexual behavior and expression contributes to people’s overall sense of well-being and health. Understanding the related risks and vulnerabilities associated with the way sexual behavior and expression are perceived in society is also key to understanding barriers to health and how to address these.”

“Another feature of rights-based approaches is meaningful participation. Participation means ensuring that national stakeholders – including non-state actors such as non-governmental organizations – are meaningfully involved in all phases of programming: assessment, analysis, planning, implementation, monitoring and evaluation.”

PAHO/WHO has made a commitment to mainstream human rights into healthcare programs and policies on national and regional levels by looking at underlying determinants of health as part of a comprehensive approach to health and human rights. Please allow me to end my remarks with one quote from the former president of South Africa, H.E Nelson Mandela. “A good head and a good heart are always a formidable combination. Indeed, we need to use our good heart and a good head to have this meeting to be successful.

Thank you.

Paramaribo, Suriname
Courtyard Marriott
February 7-9
Opening Remarks

Pan Caribbean Partnership against HIV and AIDS Dialogue between Regional Faith Leaders and Regional Key Population Leaders

His Excellency, Patrick Pengel, Minister of Public Health

Greetings to our Caribbean friends and colleagues.  Welcome to Paramaribo, Suriname. Hope you will have a wonderful stay in Suriname.

The Government of Suriname is honored the PANCAP brought this Dialogue between Regional Faith Leaders and Regional Key Population Leaders to Suriname. Suriname is known for its peaceful co-existence of a multi-ethnic, multi-religious population. It is our pride and our benchmark and will prove to be a fertile environment for this dialogue.

This year the world will commemorate 35 years of HIV, 30 years of World AIDS Day, 20 plus years of life saving HIV combination anti-retroviral medicine, four years since the proclamation of the 90-90-90 targets, 2 years since the United Nations High Level Meeting and the proclamation of elimination of AIDS by 2030 and leaving no one behind.

Progress is being made in the world in the fight against HIV, 19.5 million people are reportedly now accessing anti-retroviral treatment, but there are still another 17 million people left to access treatment.

In Suriname there are 2400 persons on treatment, this is a 60% increase from 2014 and the gap of persons still needing treatment is expected to swiftly decline as Suriname as a country has officially committed to ‘Treat All’ on World AIDS Day 2017.  However, there still remains a gap of more than 40% of persons living with HIV in Suriname that require access to treatment. In the Latin America- Caribbean Region 46% of persons living with HIV are successfully on treatment. At least another 40% of persons living with HIV will be added to this number before this gap is sufficiently bridged.

The Region is doing much better in eliminating Mother-to-Child Transmission. We applaud the six Caribbean countries that were validated for the elimination of mother-to-child transmission this past World AIDS Day. We applaud this achievement and are motivated to work towards our own validation.

But amidst these successes, we in Suriname, in the Caribbean, in the World know there are gaps that exist in access to treatment and prevention of HIV under Men having Sex with Men, Transgenders, Sex Workers, youth at risk, women, elders, and people who use drugs in our societies.

What is the gap we need to bridge in order to reach the 90-90-90 targets for all? Do we know where we stand in our communities specifically for those at higher risk?  If you want to go fast go alone, but if you want to go far, as in 90-90-90 far, go with many – take your whole community along the journey, leave no one behind!

Do we know in each of our respective countries what the gaps are? Is everyone in our society involved in the journey towards 90-90-90? Are our communities well informed about HIV and  AIDS? Do they know that it is always better to know than not know; as the Brazilians say “living better Knowing” and we in Suriname say “Sab I Libi, Tek a Test”

Do we know how to prevent ourselves from getting infected?  But also, do we know how to live a healthy fulfilling life, if needed, with HIV?  Do we know that a person on treatment who is undetectable, He/ She also is Un-infectious?  Do our programs share this very important information with our population?  Do share this important message to everyone; leave no one behind!

In Suriname like all other countries it takes daily commitment, improvement of health information systems, sharing these data and developing strategies with the involvement of all stakeholders to strengthen the health programs in general, and the HIV programs specifically.

In Suriname, we have been able to better analyze the continuum of care in key populations, due to linking data acquired during HIV prevention outreach in key population and linking those with our treatment database. We are convinced that the continuum of HIV care will be improved by practicing knowledge management and strategic alliances.

Humans are social beings

All children that are neglected, are withheld tender love and care, stop growing, stop reaching their developmental milestones.  This is the same with adults, they may be deeply affected and not reach their God-given potential when not accepted or when rejected by their loved ones, by their friends and families, by their colleagues at work, by their churches, by society as a whole. Rejection on the bases of how one looks, dresses, acts in accordance or not with one’s biological sex creates and maintains inequity in our society.

The vision of the Ministry of Health is ‘Health for All’ also stated in our Surinamese constitution as the ‘Right to Health’ in line with WHO’s ‘Universal Access to Health’. Equity in health is a beacon which governments are working towards and governments know it will not be easy reaching these goals. Policies and laws designed to guarantee equity in life circumstances and in health do not always work as intended. Even when redress mechanisms are in place, stigma and discrimination often prevent victims from coming forward.

If stigma and discrimination are existing, their roots run deep. Too many persons rather suffer or die in pain than come forward and get help and treatment for HIV and AIDS because of the stigma, because of the discrimination.

Too many persons rather not know their status than come forward and have a fellow community member judge and reject them for the profession they do, the sexual preference they have, or maybe the age of their first sexual encounter. Too many persons don’t access care for these reasons. They are being left behind.

But nonetheless, key populations are part of our communities. They are our brothers, sisters, sons, daughters, colleagues, sport team members, our fellow churchgoers, our fellow human beings, they are us.  The key populations are part of our communities.  They are religious, they live, love, work, and contribute to our societies.  We are aware of the challenges existing between religious teachings and non-alignment with certain behaviors. We are not here to deny that gap, to force alliance no matter what.  But we do think compassion for all and the opportunity of consolation through religion is a basic human right.  Religion is often a fundamental part of the life of human beings, certainly in our Caribbean Region. Even more so in those that are marginalized and ill. In illness, even non-religious persons often seek closure and healing in faith.  Thus it is even more important to have faith leaders included in the discussion on the prevention and care of HIV.  Even more important to have faith leaders informed about the facts and the myths in HIV care.  Even more important to have faith leaders supporting messages that advocate for health.

The legislative environment

We are aware that key populations seeking redress often face barriers of exposure, stigma, and discrimination in the process. In practice, this amounts to that although having a health for all policy, as well as workplace policies that adhere to ILO conventions in place, as is the case in Suriname, there still is a need to have additional measure taken to have justice served. Human Rights Help desks could serve an additional purpose in this regard.

In practice, this will also amount to the need for collaborative partnerships among LGBTI representatives, parliamentarians, and Religious Leaders, as well as with other representatives of key populations to complement and to sustain the positive legislative environment.

The relationship between faith and governance

In Suriname, there is freedom of religion and religious expression. Different religious groups are co-existing peacefully side by side. There is a council consisting of representatives of the different religions present in Suriname. The religious council in Suriname, IRIS= Inter Religieuse Raad in Suriname, is an important organ for Faith Leaders in Suriname to voice opinions and views on all kinds of socially relevant issues. This council, IRIS- Inter Religieuse Raad in Suriname, is well respected, already often consulted on social issues, already a best practice of organized involvement of Faith Leaders in socially important matters and could serve as a stepping stone towards greater alliances with government and disadvantaged groups in our society to improve health for all.

The Dialogue

This PANCAP dialogue between Regional Key Population Leaders and Regional Faith Leaders to reduce stigma and discrimination for all and create a positive environment for partnerships between stakeholders in order to bridge gaps in universal access to health in general and gaps in HIV and AIDS health services in specific. This dialogue is applauded by the Government of Suriname.

Suriname applauds PANCAP and all partners involved for taking innovative actions to achieve Health for All, amounting to the fact that this consultation is already a success before it has even happened.

In conclusion, the Government of Suriname again wishes to emphasize how honored and proud we are for having been chosen as a hosting location for this Regional Dialogue. On behalf of the Government of Suriname, we wish all participants a fruitful consultation and we are convinced that at the end of this consultation we will have closer alliances between all stakeholders involved, ensuring we are leaving no one behind on our journey to 90-90-90, our journey to Health for All.

Wishing you again a Fruitful Meeting, a great stay in Suriname and looking forward to having more PANCAP regional activities in Suriname

“As a transgender woman in Guyana, I face discrimination on a daily basis with seemingly no end in sight.

Last September I was returning from a training session for LGBT leaders on Thursday afternoon and was at the route 32 minibus park, downtown by Stabroek Market. The bus was collecting passengers at the time and I entered and sat in the back seat.

The bus driver then came and abusively pulled opened the bus door and said to me, “Not in here!!!!! Not in here if you know what is good for yourself, you will come out of this bus right now.” He proceeded to ask me how much I am paying and I responded saying “$200” that is the bus fare to Uitvlugt which is en-route to Parika. The driver once again said to me, “If you know what is good for yourself you will come out this bus.” Fearing for my safety, I quickly exited the bus. I then saw a traffic police officer and reported what had transpired to him. The traffic rank then asked me to identify the bus driver which I did.

The bus driver and I were both escorted to the Stabroek Market Police Outpost where I reported the matter and gave a statement to the police.
After that, there was no form of redress, even after following up with both the Stabroek Police Outpost and the Brickdam Police Station several times. It wasn’t until SASOD’s intervention when the Homophobia(s) Education Coordinator, Anil Persaud, accompanied me to the Brickdam Police on the 5th January where an officer finally listened to me and he admitted that they had misplaced the report and he collected it again. Only then a court date was set for yesterday, January 16. The perpetrator did not attend court yesterday when the case was called and Magistrate Melissa Mendonca issued a warrant for his arrest. SASOD’s Human Rights Coordinator Valini Leitch accompanied him to court yesterday. SASOD’s attorney Mishka Pooran is also now monitoring the case to see if I will get justice.

Through this Community Paralegal Services Initiative, I received the support I needed. Often times it is difficult for LGBT persons to get legal support and representation because we can’t afford it. With this Initiative in place, vulnerable persons more, like me, now have access to qualified and trained advocates who can navigate us through the legal system and we also have lawyers who are willing to represent us pro-bono when our rights are being violated”.