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World AIDS Day 2019: PANCAP Director pays tribute to the stellar contributions of Communities

This year’s World AIDS Day theme is “Communities make the difference”. According to UNAIDS, the observance of World AIDS Day is an important opportunity for stakeholders to recognize the essential role that communities have played and continue to play in the AIDS response at the international, national and local levels.

I believe that this theme shines a spotlight on the phenomenal work that is being done by communities. It allows us to pay tribute to the passion, advocacy, resourcefulness and relevance of communities and to honour and celebrate their stellar contributions to the HIV response. Communities include peer educators, networks of People living with or affected by HIV, such as gay men and other men who have sex with men, people who use drugs,  sex workers, women and young people, counsellors, community health workers, door-to-door service providers, civil society organizations and grass-roots activists. Since 1993 I have witnessed firsthand how communities have come together to do extraordinary things in their response to the needs of our brothers and sisters who were and continue to be challenged as People living with or affected by HIV.

As someone whose response was grounded at the grassroots level, I have seen communities give birth to groups and organisations to respond to HIV and the needs of key populations, speak up, inspire, and embrace our common humanity. I have seen communities stand alone against the self-righteous groups that see communities of men who have sex with men and transgender persons as a threat to the status quo and their authority over our so-called ‘” ordered societies”’. Communities have been an easy target for vilification and ridicule.

Communities have stood against the oppressors that seek to relegate them to second class citizenship. Communities have responded with compassion, enthusiasm, courage and practical solutions to effect positive change and to transform their lives.

It is the overwhelming response of communities that set us on this journey of resilience and has now given us hope that we can end AIDS. It is the advocacy and bold leadership of communities that forced the world to mount an unprecedented response to a public health threat such as we have never seen before. I am reminded of the words of Dr Jonathan Mann on the Tenth Anniversary of AIDS in August 1994. Quote – “We witnessed the birth of an authentic impulse of solidarity, our credo was tolerance; the scope and span of our communication were breathtaking. We helped open a new era in history and as we stormed the gates of the status quo, we knew we would prevail. Just as we learn about life by living, so we have learned about HIV and AIDS through real experience, hard work, joy and pain. There is nothing peripheral or superficial about what we have done. People around the world, facing specific immediate problems with prevention and care, or struggling against exclusion and discrimination, responded with creativity and courage which has no historical precedent, and which the world had no right to expect”. End of quote.

Communities were deeply affected and instead of crumbling in the midst of winter they rose up and found within themselves an invincible summer. It is their advocacy that saw the establishment of PANCAP, the first United Nations General Assembly Special Session on HIV and AIDS and global financing institutions such as the Global Fund to Fight AIDS, Tuberculosis and Malaria. It is communities that have strategically engaged with international development partners to ensure responsible transition and sustainability.

We must recognize communities as a coveted asset to the HIV response.  We must see communities as the glue that holds us together. We must see communities as the backbone of the HIV response. Communities can bring evidence of what is happening in their respective groups to inform advocacy.  We must see communities as worthy of investment. Therefore, as donor resources diminish, our governments and private sector must continue to invest in communities. When we invest in communities we are investing in our and our children’s future. We are investing in the vehicle to ending AIDS since communities are better placed to reach individuals that are underserved and who experience structural barriers, including stigma and discrimination, to access to prevention, treatment, care and support services. When we invest in communities, we are ensuring that we leave no one behind. Therefore, let us all commit to investing in communities for ending AIDS.

Director’s Message – November 2019

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

Achievements

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

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

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

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

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

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

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

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

Challenges

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

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

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

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

Appreciation

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

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

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

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

CRN+ Chair awarded the 2019 High Individual Value Award

Mr Tyrone Ellis, Chair of the Caribbean Regional Network of People Living with HIV/AIDS (CRN+), was recently awarded by the Ministry of Health and Wellness, Jamaica for being of “High Individual Value” in the response to HIV and AIDS in Jamaica.

The award was presented to Tyrone by the Ministry of Health and Wellness in November 2019 for his outstanding contribution to Jamaica’s national HIV response. PANCAP congratulates Tyrone on this significant achievement.

The Chair recently spoke with the Editor of the PANCAP Newsletter on new plans for CRN+. “As Chairman of CRN+, my vision is to work towards providing support and advocacy services for People Living with and affected by HIV in the Caribbean Community,” stated the Chair.  He also plans to enhance the promotion of broader sexual health objectives through education, training and health promotion.

Tyrone further stated that he intends to increase public awareness and understanding around HIV and AIDS and to reduce stigma and discrimination, which will improve the quality of life for People Living with HIV.

Guyana Completes Key Populations Viral Load Assessment

By Dr Nastassia Rambarran and Joel Simpson, SASOD Guyana

SASOD Guyana was the local study partner for the Guyana Key Populations Viral Load Assessment.  Funding for this project was provided by the United States President’s Emergency Plan for AIDS Relief (PEPFAR) through the United States Agency for International Development (USAID) and the Global Fund to Fight Tuberculosis, AIDS and Malaria with technical support from MEASURE Evaluation in collaboration with the Ministry of Public Health’s National AIDS Programme Secretariat.

SASOD Guyana’s Public Health Consultant, Dr Nastassia Rambarran, and Managing Director, Joel Simpson led the fieldwork. The study surveyed 1082 Persons Living with HIV (PLHIV) who attended five care and treatment centres in Georgetown and collected blood for viral load (VL) testing in a subset of those surveyed. The enumerators were recruited from the staff of the five sites and were trained by the SASOD Guyana and MEASURE Evaluation research team.

The study showed that PLHIV reported almost no difficulty in accessing health services and that key populations (KPs) face elevated health, social and economic risks. For example, KPs in HIV treatment tended to be younger, more likely to be unemployed, engage in transactional sex and consume alcohol and illegal substances more than non-KP respondents.

In general, some PLHIV on treatment still engage in risky behaviour. It found that 19% of all clients did not use a condom at last vaginal sex, and 24% did not use a condom at last anal sex. This highlights the need for Pre-exposure Prophylaxis (PrEP) among couples who do not have the same HIV status.

Among those who engaged in transactional sex, only 55% had used a condom at the last paid sex. The study also showed that the HIV information system in Guyana has incomplete information on VL testing and results with health facilities not meeting VL testing targets and therefore not being able to provide optimal HIV services to their clients. The data from the study could, however, be used by implementers to fill those gaps at the programmatic level and to estimate the viral suppression in Guyana with more accuracy.

To read the complete study on PANCAP.org click here.

PANCAP Director’s reflection on the Caribbean Judges’ Forum on HIV, Human Rights and the Law

The UNDP Caribbean Judges’ Forum on HIV, Human Rights and the Law created awareness of the need for members of the judiciary to look at cases and persons accessing justice through different lenses to ensure equal access by all persons.

The Forum, which targeted judges, was convened on 5 – 6 November in Port-of-Spain, Republic of Trinidad and Tobago with the following objectives:

  • To discuss the latest international and regional guidance on HIV, human rights and the law.
  • To discuss the latest scientific, medical and epidemiological evidence pertaining to HIV prevention, treatment and care.
  • To discuss judicial and legislative responses to HIV and related law at national, regional and international level.
  • To review the social and structural factors that increase the vulnerability of People Living with HIV and key populations, including evidence on HIV-related stigma and discrimination.
  • To share experiences and challenges in the protection of rights in the context of HIV.

There was a strong recognition among the judges that such fora provide an excellent opportunity to bridge the gap between science and global developments in HIV and the application of laws. There was also increased awareness of the critical need for public health evidence, thus requiring public health practitioners to be proactive in sharing available data with the judiciary to enable them to increase access to justice to the most vulnerable.

The forum highlighted the need for emotionally intelligent judicial officers who can recognise the vulnerability of those seeking justice. It was agreed that the judiciary should be cognizant that people seeking justice are influenced by the behaviour of the judicial officers, clerks of the courts, bailiffs and other persons with whom they come into contact. It was underscored that people seeking justice should not be subjected to differentiated justice but should be recognized as persons with rights.

I was encouraged by the receptiveness of the judges to take into consideration the new developments in HIV when discussing legal case studies during the forum.

Several recommendations and commitments emanated from the forum, including:

  • Magistrates should be invited to future fora given that the magistrate court is the first court of contact for people accessing justice.
  • Convene a joint forum of judicial officers and senior police officers to create awareness among the police of the challenges people seeking justice encounter at the level of law enforcement officers.
  • Continue and expand sensitivity training of police recruits and police officers by civil society organisations.
  • PANCAP will encourage National AIDS Programme (NAP) Managers to liaise with the judiciary to provide up to date data as well as information on the global developments.
  • PANCAP will share the contact list of NAP Managers and other national partners with the judiciary to enable judicial officers to obtain public health evidence.
  • PANCAP will create a dedicated page on its website for the Judiciary and will include the judiciary in its Listserv.
  • PANCAP will collaborate with UNDP and UNAIDS to synthesise information which will be placed on the Judiciary page.

I congratulate UNDP for convening this important forum and for a very thoughtful agenda that stimulated spirited discussion and increased the judges’ awareness of the needs of vulnerable people who access justice and the need for data and information on global developments to inform decisions.

Message from the Caribbean Family Planning Affiliation in Observance of the International Day for Elimination of Violence Against Women

25 November marks the International Day for the Elimination of Violence against Women and kicks off 16 days of activism to stop gender-based violence (GBV). The Caribbean Family Planning Affiliation (CFPA) joins the rest of the world in calling for governments to take urgent action to ensure discriminatory laws and practices are reviewed, and to implement policies and mechanisms to enable women to access justice, support and provide the necessary tools to combat this horror that plagues their lives, families and the entire region.

Violence against women remains pervasive and far too often a fatal phenomenon across the Caribbean with severe consequences for women and children, and also negatively impacting men, some of whom commit suicide, after murdering their partners and /or their children. GBV has harmful effects on a child’s mental, emotional and physical health with long term impact, which can result in boys modelling the abusers’ behaviour and becoming perpetrators of GBV.

GBV is most commonly committed by an intimate partner or family member. The World Health Organization (WHO) estimates that globally 35% of women have been victims of physical and/or sexual violence at some point in their life, typically by an intimate partner. As of December 2014, the total number of women who were murdered in Latin America and the Caribbean had increased to 1,906 cases (ECLAC) with 38% of the cases resulting from domestic violence (WHO).

GBV has serious health challenges for women, whose vulnerability can increase, losing their ability to control their reproductive health. Women who live in abusive situations often have less ability to negotiate the use of condoms or other contraceptives in order to protect themselves.  They become exposed to sexually transmitted infections (STIs), including HIV and unwanted pregnancy.

A woman who has been raped carries the trauma of the violence and often has to deal with an unwanted pregnancy. With the exception of Barbados and Guyana, women in the English speaking Caribbean are further violated by restrictive laws and policies, which limit their reproductive choices and put them at severe health risks and high susceptibility to a never-ending cycle of violence.  A woman with an unwanted pregnancy, especially resulting from rape, usually has an urgent need to terminate her pregnancy, even if safe and legal abortion options are unavailable. In this situation, she is put at high risk for complications, including debilitating injuries and death.

The Caribbean Family Planning Affiliation, which is a member of the International Planned Parenthood Federation (IPPF), has a high priority on the right of a woman to choose and decide what to do with her body. Ending gender-based violence and reproductive injustices are key steps in transforming the lives of women and girls. Family Planning Associations across the region work to provide women, girls and also men and boys with quality rights-based services, counselling and education, including age-appropriate comprehensive sexuality education.

Today, we join with women and girls who cry out from the terror of GBV and gender injustices, calling on our governments to accelerate actions towards the 2030 Agenda, with attentiveness to gender justice and equality goals that address critical issues affecting the lives of women and girls, such as gender-based violence, sexual and reproductive health and rights, adolescent pregnancy, the feminization of poverty, including unpaid care work, and climate justice.

Women’s Rights and Youth Organisations need to be strengthened to take leadership in transforming the region’s unjust heteronormative and patriarchal social norms which police and stigmatize women’s sexuality, and prevent women and girls from seeking and accessing the information and services they need to protect themselves and live a healthy life.

The advancement of our societies will be quashed if we fail to ensure that women and girls are assured of a life free of violence, and are free to fully exercise their sexual and reproductive rights.

#stopgenderbasedviolence #standagainstrape

Global Fund Board Steps Up Efforts to Expand Impact Against HIV, TB and Malaria

GENEVA – The Board of the Global Fund to Fight AIDS, Tuberculosis and Malaria approved funding decisions for ambitious investments over the next three-year period to significantly increase impact against HIV, TB and malaria and to build resilient and sustainable systems for health.

At the Board’s 42nd meeting, coming one month after a successful Sixth Replenishment that secured pledges of over US$14 billion for 2020-2022, Board members expressed appreciation for the collective efforts that led to such a strong mobilization of resources, calling it a compelling affirmation of commitment toward achieving greater social justice all over the world.

Peter Sands, Executive Director of the Global Fund, expressed determination to use the unprecedented level of resources to maximum effect, within a coordinated approach by partners to achieve Sustainable Development Goal 3, good health and well-being, with a special focus on reaching the most vulnerable people so that no one is left behind in efforts to end epidemics.

“Donors have responded magnificently to our challenge to step up the fight,” said Sands. “We must now convert those funds into a step change in lives saved, a sharp acceleration in progress toward ending the epidemics, and turbocharged progress toward SDG3.”

Donald Kaberuka, Chair of the Board, underscored the importance of moving swiftly to escalate efforts toward ending epidemics within the next ten years. “Time goes by fast,” said Dr Kaberuka. “We have to extend and improve our work to make the greatest difference, and to deepen country ownership as a foundation for sustainability that includes greater domestic resource mobilization and fiscal space for health.”

Roslyn Morauta, Vice-Chair of the Board, stressed the need to remain focused on reaching the most vulnerable and marginalized with effective interventions. “We must keep sight of our mission,” said Lady Roslyn. “All our investments in health should have a relentless focus on value-for-money, outcomes and impact.”

The Board approved a decision that translates pledges made at the Replenishment Conference into funding for country allocations for the 2020-2022 period, as well as certain catalytic investments that can further enhance impact in priority areas. The Global Fund plans to finalize the allocation and inform countries in December 2019.

The Board also approved a decision to advance the development of wambo.org, an innovative online tool that gives in-country procurement teams the power to search, compare and purchase quality-assured products used by health programs. The Board’s decision allows wambo.org to be made available for non-Global Fund-financed orders by governments and nongovernment development organizations on a variety of products.

During Board discussions, several members highlighted the need to improve data quality, timeliness and granularity, an essential element in improving planning, decision-making and oversight of health programs.

Several Board members also welcomed plans announced by the Global Fund’s Executive Director to establish a Youth Council to facilitate greater engagement of young people in finding solutions, since people under 25 are disproportionately vulnerable.

Peter Piot, Director of the London School of Hygiene & Tropical Medicine, addressed the Board in a special discussion session on the SDG3 agenda, giving his personal reflections and insights from a rich career in global health. He stressed the importance of keeping a long-term view, of working collaboratively with partners, of embracing innovation faster.

“There are certain things that the Global Fund cannot lose,” he said, and then listed several, including a laser focus on measurable outcomes; prioritizing people-centred services, human rights and a commitment to social justice; and preserving a passion for saving lives.

“I love the language of SDG3: Good health and well-being,” he said. “It’s not just adding years to your life, but adding life to your years.”

PANCAP welcomes Winnie Byanyima, new UNAIDS Executive Director

The Pan Caribbean Partnership against HIV and AIDS (PANCAP) extends a warm welcome to Ms Winnie Byanyima, as she begins her tenure as UNAIDS Executive Director.

Since its inception, UNAIDS has collaborated with regional and national partners to achieve epidemic control and remains a valued partner in the HIV response. The Partnership acknowledges Ms Byanyima’s wealth of experience working with governments, multilateral agencies, the private sector and civil society whose comparative advantage she can now leverage  for the multisectoral response to HIV at the global, regional and national level.

We look forward to further strengthening our relationship with UNAIDS and working collaboratively with Ms Byanyima to achieve the UNAIDS Fast Track Targets 90-90-90 and ending AIDS as a public health threat by 2030.

We wish Winnie every success in her new role and assure her of the Partnership’s support.

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.

Director’s Message – October 2019

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

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

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

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

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

CRN+ develops Organisational Development Strategy and Action Plan

The Caribbean Regional Network of People Living with HIV and AIDS (CRN+) has been challenged to sustain its operations in an environment of reduced donor funding. To establish a foundation for sustainability and growth, the leadership of CRN+ has embarked on a multi-prong initiative which included the development of an organisational development (OD) strategy and action plan and a resource mobilisation strategy.

In light of available funding, CRN+ agreed to maintain the current organisational structure with the addition of a dedicated Finance Officer and to recruit volunteers who could support CRN+ Programmes.  The organisation will also seek to establish an independent oversight committee for governance and accountability.

Sustainability

The goal of the CRN+ Resource Mobilisation Strategy is to diversify the organisation’s resource base for sustaining the network’s response which will be guided by the CRN+ Strategic Plan and costed operational plan.

The Resource Mobilization strategy adopts a dual approach – mobilising resources for operating costs (rent, staff salaries, maintenance costs, utility bills, etc.) through fundraising activities, and mobilising programme costs from conventional donor sources. A mapping of donors and funding agencies was conducted to identify and engage with potential donors to secure resources for CRN+ to continue its advocacy for People Living with HIV (PLHIV) and key populations’ access to prevention, treatment, care and support services, and to strengthen national networks.