Release Type: Speech

Today the Caribbean Regional Network of People Living with HIV (CRN+) commemorates World AIDS Day under the theme “Right to Health”. This theme is meant to encourage every individual to address the barriers that impede them from achieving optimal physical and mental health. At the same time, we urge our states to accelerate progress toward fulfilling the commitment made through the Sustainable Development Goals (SDGs) to ensure healthy lives and promote well-being for all, at all ages.

Caribbean progress toward ending AIDS but gaps remain

The Caribbean has joined the community of nations in committing to end the AIDS epidemic by 2030 as part of the Sustainable Development Goals. Significant progress has been made in scaling up access to HIV treatment. According to UNAIDS more than half (52%) of all people living with HIV in the Caribbean were on treatment in 2016. There was a 28% decline in AIDS-related deaths in the region between 2010 and 2016. And this region leads the world in progress toward eliminating mother-to-child HIV transmission.

But while this advancement is encouraging, there should be no room for complacency as there are still significant gaps. Roughly one-third of people living with HIV in the Caribbean (36%) do not know their status.

Additionally, just one of every three people (33%) on HIV treatment is virally suppressed.  This should not be the case when testing and treatment services are available.
In order to close the gaps, policy-makers, social and health care providers should be more responsive to the specific needs of people living with HIV. Stock-outs of antiretroviral medication must become a thing of the past. Diagnostic and monitoring laboratory services should be properly managed and resourced. The mental health and social needs of people living with HIV must be priorities.

Critically, stakeholders should ensure confidentiality and work to eliminate stigma and discrimination within healthcare settings. Everyone should feel safe and comfortable in accessing health services. No person should be discriminated against or denied access because of their HIV status, age, sex, gender, gender identity, sexual orientation, disability, race, ethnicity, language, geographical location, marital status or any other characteristic.

People living with HIV must assert their right to health

It is also incumbent upon people living with HIV to exercise their rights by seeking support, counselling, treatment and routine monitoring of their CD4 counts and viral loads. We must scale up the Greater Involvement of People living with HIV or GIPA principles, ensuring that we support full involvement and ownership by networks and communities of people living with HIV. By the same token, vulnerable and key populations including young people, sex workers, men who have sex with men and transgender people, need to be involved to ensure the strategies we develop are actually responsive to the needs of those we hope to reach

Remembering PLHIV in hurricane-ravaged islands

As we observe this day, we must pause to remember how the recent natural disasters in our region have exposed the need for policies and planning to ensure the availability of medicines and HIV services in emergency contexts. Assessments must be done now on the impact of these disasters on countries’ HIV responses. When our paths to sustainability can so easily be diverted by a hurricane or earthquake, disaster preparedness, recovery and building resilience must be priorities. As the islands of Dominica, Barbuda and the British Virgin Islands in particular work to recover, we urge government and development partners to address the health and social needs of the community of people living with HIV.

A call to the people of the Caribbean: Get tested! Held end stigma and discrimination!

As CRN+ joins the rest of the world in marking World AIDS Day 2017, we call upon all Caribbean people who have not yet taken an HIV test to do so today. Knowing your HIV status is very important as the experience can help 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.

Beginning today, we must 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 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.

We, the sixteen PANCAP Champions for Change (C4C), join the many voices on this World AIDS Day (WAD) in a clarion call for the right to health to be a fundamental human right for our people. This includes the right to be treated with dignity, irrespective of sexual orientation, social status, age, gender identity or disability.

Our diverse group of youth, religious, medical and media professionals, parliamentarians, academics and advocates come from The Bahamas in the north to Suriname and Guyana in the south.

Collectively, we pledge our support for Universal Health with access and coverage for all. We believe that our Caribbean babies deserve to be born HIV free, and there is no reason why the world’s largest vulnerable group, the disabled, should not enjoy the same rights and respect as others do.

On this WAD and every day of the year, we encourage all the people of our Region to participate in a relentless campaign against HIV/AIDS.  We want to empower our citizens to take responsibility for their health; include all citizens by providing access to health care services without stigma and discrimination; encourage and facilitate their full participation through effective partnerships for sustainability.

We call for prevention efforts to be scaled up to include testing and behaviour change and development communication as we accelerate our efforts to end AIDS by 2030.  We recommend, among other initiatives, the critical involvement of the media in shaping messages for social change.

The media are very important given their power to inform and educate, break the silence, challenge stigma and discrimination, follow-through by connecting audiences to HIV services, and help build political will.

In this regard, we believe that increased engagement of the religious community is a critical factor in this quest; that Social Media and Mass Media should be used strategically for the widest and most instantaneous reach and impact; that the strategic partnership with religious Organisations will reduce the challenges created by ‘miscommunication’ and enhance stakeholders participation in the HIV response.

Indeed, networking with all stakeholders must be the way forward for sustainability. This means redoubling our efforts to get the public and private sectors as well as civil society and religious organizations to join the promotion of Treat All, which includes the concept of Test and Start. In all of this, our Youth must also be at the forefront of the decision-making.

Practical challenges to the status quo and responses to the challenges are needed.  HIV/AIDS/Gender Sexual Violence (GSV) programmes and interventions must outline the importance of religious organizations in the response to GSV as part of the overall response/commitment to the AIDS response; their powerful influence in family life—where much of GSV occurs—and therefore their ability to develop attitudes that lead to non-violent family relationships must be exploited. These are issues that make populations vulnerable to HIV. It is therefore imperative that the Region begins to confront them openly so that the shame and stigma that attend them are to be removed.

As our Region moves towards ending AIDS by 2030, we, the PANCAP Champions for Change, recommend strengthening social norms and policies by involving people living with HIV in planning and implementing relevant and sustainable programmes and services. As everyone has a right to health, health practitioners and facilities must offer innovative modalities for prevention (e.g., Pre- Exposure Prophylaxis [PrEP]).  We must explore and provide the best and preferred HIV treatment options, especially low cost generics, for the preferred medicines that have been recently brokered. For years, there has been advocacy at all levels for better medications for the Caribbean.  Now that this is possible, they must be available for every patient in every Caribbean country.

We think it is important to highlight the World Health Organisation (WHO)’s definition of health: “Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity”. Within this context, as Champions, we have committed to focus on the promotion of healthy living. We reiterate that future interventions and advocacy against stigma directed at key populations, we believe that as a Region, we can end AIDS by 2030.

Finally, we implore the Region (Governments and Civil Society) to invest in behaviour change for development in Caribbean societies as the benefits are a secure and enabling environment that facilitates access to health irrespective of identity and status.

It is also vital to keep stakeholders updated on the results of interventions. In this context, as well we urge our parliamentarians to remove the legal strictures that have hampered prevention, treatment and care programmes.

This World AIDS Day highlights the importance of the right to health as an essential condition to achieve the end of AIDS by 2030, as set forth in the Sustainable Development Goals.
The right to health is a fundamental human right. It is the right of everyone to enjoy the highest attainable standard of physical and mental health.

For the right to health to be fulfilled, it is imperative:

-that everyone, regardless of race, sex, ethnicity, sexual orientation, gender identity or social status, has access to the prevention and treatment of any disease,
-that health is affordable or free,
-and that quality health services are free from discrimination.

The right to health goes beyond access to health services and medicines. It is also linked to a variety of important rights, such as access to a comprehensive and quality education, good nutrition and healthy working conditions.

Fulfilling the right to health enables everyone to fulfil their promise and their dreams.
Latin America and the Caribbean have made important progress towards the Fast-Track goals. Latin America is among the regions of the world with the highest proportions of people living with HIV who know their status and in the Caribbean, the proportion of people living with HIV who know their status and are on treatment is over 80%.

But we cannot be complacent:

– Not when there are still millions of people such as people living with HIV; lesbian, gay, bisexual, transgender and intersex people; sex workers; indigenous populations and migrants, who do not have access to health services because of stigma and discrimination.
– Not when there are still young people and adolescents who are denied the possibility of making informed decisions about their health and well-being, because they do not receive the education they need.
-Not when there are women who, due to inequalities and gender violence, encounter barriers that prevent them from accessing comprehensive health services.

Inequities in access to health are not acceptable and have to be eradicated.  States have a duty to respect, protect and guarantee the right to health of their citizens.

AIDS is not over, but it could be if we make sure that everyone, without exception, anywhere in the world, can fully exercise their right to health.

This World AIDS Day, we are highlighting the importance of the right to health and the challenges that people living with and affected by HIV face in fulfilling that right.

The right to health is a fundamental human right—everybody has the right to the enjoyment of the highest attainable standard of physical and mental health, as enshrined in the International Covenant on Economic, Social and Cultural Rights.

The world will not achieve the Sustainable Development Goals—which include the target of ending AIDS by 2030—without people attaining their right to health. The right to health is interrelated with a range of other rights, including the rights to sanitation, food, decent housing, healthy working conditions and a clean environment.

The right to health means many different things: that no one person has a greater right to health care than anyone else; that there is adequate health-care infrastructure; that health-care services are respectful and non-discriminatory; and that health care must be medically appropriate and of good quality. But the right to health is more than that—by attaining the right to health, people’s dreams and promises can be fulfilled.

On every World AIDS Day, we look back to remember our family members and friends who have died from AIDS-related illnesses and recommit our solidarity with all who are living with or affected by HIV.

From the beginning, the AIDS response was built on the fundamental right to health and well-being. The AIDS community advocated for rights-based systems for health and to accelerate efforts for the world to understand HIV: how to prevent it and how to treat it.

Too many people—especially those who are the most marginalized and most affected by HIV—still face challenges in accessing the health and social services they urgently need. We all must continue to stand shoulder to shoulder with the people being left behind and demand that no one is denied their human rights.

This year has seen significant steps on the way to meeting the 90–90–90 treatment targets towards ending AIDS by 2030. Nearly 21 million people living with HIV are now on treatment and new HIV infections and AIDS-related deaths are declining in many parts of the world. But we shouldn’t be complacent. In eastern Europe and central Asia, new HIV infections have risen by 60% since 2010 and AIDS-related deaths by 27%. Western and central Africa is still being left behind. Two out of three people are not accessing treatment. We cannot have a two-speed approach to ending AIDS.

For all the successes, AIDS is not yet over. But by ensuring that everyone, everywhere accesses their right to health, it can be.

The Caribbean Community joins the rest of the world in observing World AIDS Day 2017.

Through its specialised agency, the Pan Caribbean Partnership Against HIV and AIDS (PANCAP), the Community has been directly engaged with issues relating to this disease since 2001. The importance of a healthy population was underscored by our Heads of Government when in the Nassau Declaration of that same year, they asserted that the “Health of the Region is the Wealth of the Region”. In preserving that wealth, we must be prepared to engage with any threat that diminishes it.

In that regard, the Region has made significant strides in its efforts to reduce the incidence of HIV and AIDS. For example today six new countries will be certified as having achieved the target for elimination of mother-to-child transmission of HIV, Anguilla, Antigua and Barbuda, Bermuda, Cayman Islands, Montserrat and Saint Kitts and Nevis. That is just the latest evidence that the goals are attainable particularly with the requisite support from our international partners.

Unfortunately, the Caribbean remains one of the most affected regions with serious concern about the increasing prevalence among our youth. It is crucial, therefore for us to maintain and increase our efforts if we are to reverse that trend and preserve the gains that we have made.

The on-going collaboration between PANCAP and the Caribbean Public Health Agency (CARPHA) is a key element as we seek to fulfil the goal of expanding access to quality treatment, care and support of people living with HIV and Aids.

To make this year’s observance of World Aids Day meaningful, let us commit ourselves today to the vision of an AIDS-Free Caribbean.

Hon Mr. Justice Peter Jamadar, Chair, Trinidad and Tobago Judicial Education Institute, Hon Mr. Justice Ivor Archie, Chief Justice of Trinidad and Tobago, Hon Dame Janice Pereira, Chief Justice of the Eastern Caribbean Supreme Court, Hon Mr. Justice Dennis Morrison, President of the Court of Appeal of Jamaica, Judges of Appeal, High Court and Supreme Court Judges, Parish Judges and Magistrates, Professor Rose Marie Bell Antoine, Faculty of Law, The UWI St Augustine Campus. I bring you greetings on behalf of the Chair of PANCAP, The Right Honourble Timothy Harris, Prime Minister of St Kitts and Nevis, Lead Head with Responsibility for Human Resources, Health and HIV within the CARICOM Quaisi Cabinet, and Ambassador Irwin LaRocque, Secretary-General of the Caribbean Community.

The Pan Caribbean Partnership Against HIV and AIDS (PANCAP) fully welcomes this Caribbean Judicial Dialogue that is consistent with PANCAP’s Justice for All programme which establishes human rights as a priority of the regional response through a Pan Caribbean Declaration and Roadmap. The programme is aimed at reducing stigma, eliminating discrimination and strengthening rights-based legislative frameworks through the reform of laws that are incompatible with international commitments. PANCAP recognises the value of this dialogue given the importance of judicial awareness of implicit bias in relation to key population groups as well as the role that our legal infrastructure plays in facilitating access to justice by such populations.

We will be observing World AIDS Day tomorrow, December 1st, under the theme Right to Health. The universal and undeniable right to health provides everyone with the right to realize the highest attainable standard of health without stigma or discrimination. The Partnership believes that only by placing human rights at the centre of global health can we ensure that health care is accessible, acceptable, available and of good quality for everyone, leaving no one behind. I am reminded of Justice Sir Dennis Byron’s feature address at the PANCAP Relaunch Champions for Change in September 2017, in which he contended that law is a determinant of health. In this context, you the members of the judiciary are best placed to facilitate the right to health of all individuals, and particularly that of key populations, by creating a more favourable climate for those most vulnerable to HIV.

I wish you a very fruitful dialogue. Thank you

I salute UNAIDS’ choice of the World AIDS Day theme – ‘Right to Health’. This theme is even more relevant today since advances in treatment have brought HIV into the realm of chronic diseases as persons living with HIV are now having to deal with other chronic diseases such as hypertension and diabetes. These developments, therefore, warrant a comprehensive approach to delivering health care to persons living with HIV.

The universal and undeniable right to health provides everyone with the right to realize the highest attainable standard of health without discrimination or stigma. UNAIDS acknowledges that only by placing human rights at the centre of global health can we ensure that health care is accessible, acceptable, available and of good quality for everyone, leaving no one behind.

The Pan Caribbean Partnership Against HIV and AIDS (PANCAP) has long recognised the critical need to situate access to health within a human rights framework. This is reflected in our Justice for All programme which focuses on affirming human rights and reducing stigma and discrimination that hinder people living with HIV and other key population groups’ access to health care services.

PANCAP has recently finalised its Regional Advocacy Strategy and five-year Implementation Plan for a coordinated and streamlined approach for systems advocacy, access to justice and redress, community and health services and financing and sustainability that will assist in creating an enabling environment for vulnerable groups to access HIV prevention and treatment without the fear of stigma and discrimination. A PANCAP message has been developed for each strategy. Included in these messages is the Right to Health.

The UNAIDS theme also acknowledges that the Sustainable Development Goals, underpinned by human rights, provide a framework to leverage opportunities between the right to health and other rights, including the right to education, equality, non-discrimination, access to justice, privacy and food.

Our regional Partnership has collectively committed to be guided by our Regional Advocacy Strategy, the framework for advancing our advocacy efforts to work toward creating an enabling environment for people living with HIV and key populations to realize the highest attainable standard of health without stigma or discrimination. Like you, they too have a right to health.

   Ms Alexus D’Marco

For me, this is a very important and significant day. Just as there is a day that commemorates the fight against violence suffered by cisgender women, we – the transgender community – deserve a day, too. It makes me proud that there is a day on which members of the global transgender community that have become victims of gender-based violence, can be remembered because we are also an important part of society.

My work has empowered me and helped me understand the importance of education and training. Being able to share my knowledge and life experiences with my peers has strengthened my own identity as a transgender individual and, in turn, helps my peers empower themselves and know their right to live free of violence.

I teach my community about important gender-based violence information – including its links with HIV – we need to provide information on the route of available services and give information about our rights and how to identify violence. The members of my community feel more confident in seeking health and gender-based violence services and demanding that their rights be upheld.

Most transgender people in the Caribbean community have no services available to them if they become victims of gender-based violence. There are no clinical and psychological services provided. We must educate on gender-based violence to our Attorney Generals Office, the local police.

We must strengthen these services and make them more friendly to trans people.We need more entry doors to free KP-friendly services than ever before. We need to sensitize staff at the institutions on gender-based violence training.

To end gender-based violence against trans people, we need to do a very big job. We need to create a new generation with a new way of thinking. We need to educate people from a young age to understand that being different is not a bad thing and that being different does not mean that we do not have the right to live free of stigma and discrimination. We have the right to live a dignified life.

Many trans people are ignorant of their rights. We have been mistreated for so long that many of us are afraid to seek help because we are afraid of being rejected and discriminated against while seeking services. So, after being victims of violence, many transgender people do not go to services on time or do not go at all, increasing their risk of HIV and other physical and mental health complications.

It is very important for programs to talk about violence because when people go to a workshop or an educational session about violence in the community, they empower themselves and discover their value as a human being. Then they are more willing to seek services, including HIV services, when needed. As a trans woman, I have fought and will keep fighting so these kinds of programs continue to increase empowerment in the trans community and reduce the incidence of violence.

The participation of partners and clinics in offering gender-based violence services is fundamental for all key populations. Transgender people in the Caribbean should now able to get stigma-free and cost-free clinical services, like post-exposure prophylaxis, and psychological counselling if they are victims of violence.

His Excellency Jovenel Moise, President of Haiti, Mrs Kim Simplis Barrow, First Lady of Belize, Honourable Marie Greta Roy Clement, Minister of Health and Population, Haiti, Dr Cesar Nunes, UNAIDS Director LAC, Mr Mamadou Diallo, Deputy Special Representative of the United Nations Mission for Justice Support in Haiti and Resident Coordinator, Representatives of other UN agencies, PEPFAR, The Global Fund, GCTH, PAHO, AHF, the Caribbean Sex Worker Coalition, and the indomitable Kate Spring.

Ladies and gentlemen, I bring you greetings on behalf of the Chair of PANCAP, The Right Honourble Timothy Harris, Prime Minister of St Kitts and Nevis, Lead Head with Responsibility for Human Resources, Health and HIV within the Caribbean Community (CARICOM) Quaisi cabinet as well from Ambassador Irwin LaRocque, Secretary-General of the Caribbean Community.

The Pan Caribbean Partnership Against HIV and AIDS (PANCAP) is pleased to be part of this Third Latin American and Caribbean Forum. I wish to thank the Government of Haiti, UNAIDS and other organisers for making this forum a reality.

Since its establishment in 2001, PANCAP has seen many successes including unprecedented collective regional negotiation with five pharmaceutical companies for significant price reduction for ARVs; sharpest regional decline in HIV incidence by 48.1% between 2001 and 2013; declining AIDS-related deaths by 55% from 2000 to 2016; ARV coverage increased to 52% from less than 5% in 2001; eight countries have adopted the WHO recommendation that ARV therapy should be initiated in every person living with HIV at any CD4 cell count; elimination of mother-to-child transmission of HIV in seven countries; and capacity building of healthcare providers. These successes are due to the combined efforts of all PANCAP partners with strong leadership from national programmes, and regional, national and community partners supporting national responses.

Despite the overall gains, considerable challenges remain. The Caribbean has a mixed HIV epidemic consisting of a low-level generalised epidemic in the adult population, but an unacceptably high HIV prevalence among key populations, particularly MSM. While 64% of PLHIV knew their status in 2016, 36% did not; 52% were on treatment while 48% were not. Only Haiti has >89% of diagnosed people living with HIV on treatment. One-third (33%) of Caribbean people living with HIV on treatment were not virally suppressed in 2016.

The Partnership is conscious that the progress towards an AIDS-free Caribbean in the face of shrinking financial resources, requires strategic investment in effective interventions that save lives, maximise the impact of regional efforts, ensure value for money and scale-up work where HIV is most heavily concentrated. Further reductions in AIDS-related mortality and transmission will only be possible through improved efforts to meet the needs of people who are disproportionately affected by HIV. Achieving universal access to comprehensive, high-quality, integrated HIV prevention and treatment services requires inclusive and harmonised multisectoral action, including the removal of legal, social and cultural barriers.
At our 13th Annual General Meeting held in November 2014, the Partnership reaffirmed the central principle of shared responsibility through strong and mutually accountable partnerships with strengthened voice and participation in decision making for communities and people living with HIV; called for the acceleration of regional efforts to mobilise resources, and to implement measures to further reduce the cost of ARV treatment and laboratory reagents and commodities.

PANCAP’s leadership is engaged in a dialogue on how to sustain the gains of the last 10 years and have taken action towards sustainability of the regional response including an assessment of the Partnership. We are collaborating with development partners to engage our governments for increased HIV investment at the national level through shared responsibility, particularly with the private sector, human resource capacity building, health systems strengthening including laboratory and efficiencies in the supply chain, and are poised to accelerate these efforts.
I look forward to robust discussions over the next three days that will lead to identification and agreements on sustainable regional fast track targets.

Thank you.

I wish to congratulate the Partnership and to acknowledge the significant progress made towards achieving the 90-90-90 targets, as highlighted in the UNAIDS Report, July 2017.

I thank the Joint United Nations Programme on HIV/AIDS (UNAIDS) for responding to the National AIDS Programme Managers’ (NAPs) request to provide the Caribbean with disaggregated regional data. This information is very useful as it allows us to track progress towards the 90-90-90 targets, and to identify the gaps.

HIV testing has been significantly scaled up with the use of rapid diagnostic technology, greater community involvement and prioritizing key populations testing. These efforts have yielded results as more than two-thirds of people living with HIV in the region know their status.

Over the last six years, the number of persons accessing treatment in the region has more than doubled. More recently, guided by scientific evidence on the benefits of earlier initiation, eight countries in the region have adopted the World Health Organisation’s recommendation of initiating antiretroviral therapy irrespective of CD4 count. This shift has contributed to an increase of 81% of persons who know their HIV status accessing treatment. This increase has played a significant role in reducing AIDS related deaths from 21,000 in 2000 to 9,400 in 2016.

Although less robust, there has been progress in achieving viral suppression. In 2016 about half of the people receiving antiretroviral treatment had access to viral load testing and among these, 67% were virally suppressed.

While we celebrate the progress made, we acknowledge the significant gaps along the 90-90-90 continuum. To achieve these targets, the region has to scale up HIV testing to ensure that the additional 81,000 persons living with the disease receive their diagnosis. There must be greater community engagement and increased use of rapid diagnostic technologies and point of care testing. On the treatment front, it is crucial for the region to increase access to high quality, effective antiretroviral therapy in order to initiate and maintain an additional 92,000 persons living with the disease who are not on treatment.

In this regard, programmes must continue to be evidence driven and more countries must make the shift to Treat All and introduce newer ARV regimen with high potency, high genetic barriers to HIV drug resistance, low toxicity and low cost that will enhance retention and achieve viral suppression. We must continue to build our laboratory systems to support treatment programmes so that all persons receiving treatment will have access to viral load testing.

The Partnership remains committed to achieving 90-90-90 by 2020 and ending AIDS in the region by 2030.

Read the UNAIDS report here.