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Image: Prime Minister of Barbados, Mia Mottley meeting employees of the National HIV/AIDS Commission (NHAC) Barbados

Prime Minister of Barbados, Mia Mottley commended employees of the National HIV/AIDS Commission (NHAC) Barbados on their innovative educational tools during the Barbados Labour Day observance (1 May), which acknowledges the contributions of workers on the island.

The Prime Minister was impressed with the popular interactive game, “UPS AND DOWNS”, which was created by the NHAC as an HIV educational tool for Barbadians of all ages.

The Prime Minister visited the NHAC booth and interacted with several members of staff who were conducting HIV awareness and education with colleagues of the Barbados Workers’ Union and the International Labour Movement.

The NHAC also utilised the opportunity to extend its reach with condom distribution and demonstrations. Use of the female condom was emphasized to foster more awareness.

The Prime Minister recommended registering a patent for the digital educational tool and challenged NHAC employees to develop more interactive games and software for HIV education.

Image: Dr Sir Prince Ramsey, PANCAP Award Recipient 2012 (centre), with guests and special invitees

Dr Sir Prince Ramsey, who died on 3 May 2019, will be remembered as a stalwart in the Region’s response to HIV.  The Antiguan doctor played a pivotal role in advocating for HIV patients at the height of the AIDS crisis in the 1980s and contributed significantly to ground-breaking work for HIV services for pregnant women.

In recognition of his remarkable contributions, he received the PANCAP Award in 2012 for “excellence in advancing the Caribbean’s response to HIV and AIDS”.  During the ceremony, colleagues, friends and family members recounted not only his contributions to public health but his generosity, love for humanity and passion for life.

His work as a humanitarian has earned a wealth of recognition in the Region and beyond including an Honorary Doctor of Science Degree from the Open Campus of the University of the West Indies. Just last year he was awarded the 2018 United Nations Population Award, which recognises individuals who have made outstanding contributions to population and reproductive health solutions.

Colleagues have described Dr Sir Prince Ramsey as a professional motivated by service to those in need rather than financial gain.  This is evidenced by his voluntary contributions to public health.  He was a volunteer medical officer, lecturer and examiner for the Red Cross and St. John’s Ambulance Society.

He was a past president of the Antigua and Barbuda Medical Association and former treasurer of the Caribbean College of Family Physicians. He was Vice President of the Antigua and Barbuda Planned Parenthood Association; a board member of the Caribbean Family Planning Affiliation and the International Planned Parenthood Federation.

Dr Sir Prince Ramsey was the founder and chairman of the Friends of Fiennes Institute. He was the recipient of a Queen’s Commission as Major and Medical Officer of the Antigua & Barbuda Defence Force and was an Honorable Member of the Association of Military Surgeons of the USA. Sir Prince was the recipient of three National awards: The Order of Merit, The Order of Distinction, and The Knight Grand Cross of the Most Distinguished Order of the Nation.

His passion for service to his country extended beyond public health as Dr Sir Prince Ramsey was also a patron of Antigua and Barbuda’s culture including art and calypso music.

Indeed, the Region has lost a son of the soil who has contributed significantly to health care and better health outcomes for People Living with HIV.

Perhaps Dr Ramsey’s remarkable life is best captured in the words of H.E. Gaston Browne, Prime Minister of Antigua and Barbuda, who stated, “Dr Prince Ramsey was a superb physician who frequently delivered services to his patients at no cost. He was recognized as a very generous and thoughtful caregiver. Dr Ramsey was also a servant of the calypso community; his contribution to the art-form was surpassed by no-one.  His contribution to nation-building, to wellness, and to the development of the cultural life of Antigua and Barbuda are applauded by all”.

Guyana has drafted a significant 116-page nutrition strategy targeting persons living with HIV and others co-infected with Tuberculosis (TB).

The document is also a first for Caribbean countries.  The draft document, the ‘National Nutrition and HIV/AIDS Guidelines’ is “comprehensive and relevant” said Mr Somdatt ‘Amar’ Ramessar, Senior Social Worker and Nutritionist attached to the National AIDS Programme Secretariat [NAPS].

The document is one that seeks to assist various categories of infected patients, including adults, pregnant and lactating women, adolescents, severely malnourished adults and children, and people on medication.  The nutritional guidelines target health-care providers including physicians, counsellors, social workers, policymakers, teachers and trainers. The guidelines “are intended for practical application as well as policy formulation and implementation,” outlines the 116-page document. It said the historic strategy provides a standardised approach to nutrition care and support for people living with HIV [PLHIV] in diverse conditions throughout the country.

It also notes that “each service provider needs to adopt the recommendations to her/his context and client population.”

It is further explained that good nutritional status is key from the onset of infection with HIV. Moreover, the document states that “Nutrition education at this early stage gives the person a chance to build up healthy eating habits and to take action to improve food security in the home, particularly as regards the cultivation, storage and cooking of food.”

“A healthy and balanced diet, early treatment of infection and proper nutritional recovery after infection can reduce this weight loss and reduce the impact of future infection,” the draft document continues.

The momentous move by the Ministry of Public Health to help protect the nutritional status of PLHIV has attracted wide private sector support, which is also a first in the Caribbean, said Dr Nicolette Boatswain, NAPS Deputy Programme Manager.  More than 20 local private firms have been backing the initiative since it commenced more than a decade ago.  Globally, ‘fatigue’ usually steps in and overtake firms supporting these types of enterprises after five years. However, after 13 years in Guyana, the consistent engagement of the private sector agencies in the HIV national nutritional response has helped widen the approach to tackling the problem.

“The partnership has opened greater channels for HIV awareness and information flows to employees of the private sector agencies. Communication materials, condoms and lubricants are all accessible to these employees for self-empowerment and for safe sexual practices,” Ramessar told a Regional conference in Trinidad and Tobago earlier this year.  In the first 11 years of the programme [2007-2017], 34,357 hampers which comprised 10 food items, were given to some of the most vulnerable patients from all strata of society living and affected with HIV and those co-infected with TB.

The beneficiaries include in and out-of-school youths, unemployed young adults, HIV positive single parents, persons living with disabilities and senior citizens, Dr Boatswain said.

For 2017, official NAPS figures show 404 new patients benefited from nutritional support from the Food Bank. This is a 40 percent increase over 2016 figures. The NAPS 2018 Food Bank Annual Report is expected soon. However, under the 2017 review period it was found that 62.8 percent of HIV positive single parents accessed the Food Bank services which is the highest figure in its first 11 years, the 2017 Annual Report stated.  “This represented a 24.12 percent increase when compared to 2016 and 18.6 hike over 2007 when the Food Bank began its operations in Guyana,” the report added.

It said the greatest number of beneficiaries from the food distribution programme was residents living in Essequibo Islands/West Demerara [Region Three]. The annual report states that 66.67 percent were from that predominantly-farming Region while 39.7 percent were from Demerara/Mahaica [Region Four] the most populous of the 10 Administrative Regions.

On the gender front, more women than men benefit from the food bank’s resources. Of those receiving hampers, 53 percent are women and 47 percent, men.  “Females were always the greater proportion of beneficiaries for nutritional support since the programme commenced,” the NAPS report adds.

The socio-economic challenges experienced by PLHIV are numerous and globally food banks are viewed as safety nets for them. Information out of the Public Health Ministry suggests that “when the programme started, Global Fund and the local private sector were the main arteries of the support. Since then, the charitable organisation, Food For the Poor and government, through the Ministry of Public Health, joined the list in 2017.”  Typically, food insecurity affects people who are socioeconomically disadvantaged. Some, because of changing fortunes, move in and out of food insecurity. However, the 2017 Annual Report noted that “increasingly, PLHIV do experience chronic food insecurity.”

Disturbingly, it has been observed that food insecurity has become a barrier to adherence to care and treatment recommendations for those living with HIV/AIDS, especially “pregnant women and their HIV-exposed infants as well as children and adolescents living with HIV infection,” the report said.

It said too that “Food Banks no doubt act as a buffer to the vicious cycle of food insecurity and HIV, which can be regarded as ‘syndemic’, that is, there is a positive biological and social interaction in which one exacerbates the negative health effects of the other. It is increasingly recognised that food insecurity both heightens vulnerability to HIV infection and at the same time exacerbates poor clinical outcomes among PLHIV.”

According to the document, the Food Bank handed out the highest number of hampers to patients between the years 2009 and 2013. The figure tapered off between 2014 and 2016 rising marginally again in 2017.

Among its recommendations, the 2017 NAPS Food Bank Annual Report underscored the need to accelerate support for hinterland residents; research undertaken to verify the efficacy of the support programme to its beneficiaries and “addressing the rising numbers of PLHIV who are 55 years and older accessing support mechanisms.

Washington, D.C., 26 April 2019 (PAHO/WHO) –The Pan American Health Organization (PAHO) has published a guidance document on migration and health that suggests five areas of action countries should take to improve the health of migrants and the populations that receive them.

The five areas of action are: strengthening surveillance, information management and monitoring; improving access to health services for the migrant and host populations; improving communication and information exchange to counter xenophobia, stigma and discrimination; strengthening partnerships, networks and multicountry frameworks to understand the status and promote and protect the health of migrants; and adapting policies, programs and legal frameworks to promote and protect the health and well-being of migrants.

PAHO also created a web portal with information and resources on the health of migrants in the Americas and other regions, and where countries can exchange information, best practices, lessons learned and national health plans for improving migrant health, among other support documents.

The guidance and web portal are both part of a commitment PAHO made in November 2018 in response to a series of priority actions identified by ministries of health from throughout the Americas for improving the health system response to mass migrations that have been occurring in the region.

“We need to have an emergency short-term response, with medium- and long-term planning that addresses the health needs of migrants,” said PAHO Assistant Director Jarbas Barbosa. “It is nearly impossible to think of an isolated response to addressing health and migration. We need to work in a collective way to address the health needs of migrants and of the populations that receive them, and to protect our region’s achievements.”

The phenomenon of mass migration has intensified in recent years in the Americas, in particular from Central America toward Mexico and the United States, and from Venezuela toward other South American countries and the Caribbean.

Countries in the Americas have demonstrated regional solidarity in providing support for migrants, but the high demand for health services coupled with a lack of resources and the re-emergence of previously eliminated diseases such as measles has put pressure on health care systems to meet the health needs of migrants while also meeting the needs of local populations.

Five lines of action for migrant health

PAHO proposes a series of interventions aimed at integrating migrant health needs into national policies, strategies and programs. It also seeks to bridge the short-term emergency response and medium- to long-term actions for integrating the health needs of the migrant population while ensuring the sustainability of actions currently being implemented.

The five lines of action and proposed interventions are:

• Strengthen health surveillance, information management and monitoring to ensure that health systems in migrant-receiving countries are able to adapt and implement health interventions that meet the specific needs of migrants.
• Improve access to health services for the migrant and host population by identifying and eliminating or mitigating specific barriers these groups face in access to services.
• Improve communication and information exchange to counter xenophobia, stigma and discrimination and to promote a culture of inclusion and solidarity as well as information exchange between countries.
• Strengthen partnerships, networks and multicountry frameworks to promote and protect the health of migrants effectively and efficiently, involving actors from different sectors, agencies and countries.
• Adapt policies, programs and legal frameworks to promote and protect the health and well-being of migrants, by including migrant health in local and national policies and programs and by developing or modifying legal frameworks to address migrants’ rights to the highest attainable standards of physical and mental health, in accordance with international human rights obligations.

In the November 2018 meeting at PAHO headquarters in Washington, D.C., ministers of health discussed short- and medium-term actions in areas including surveillance, epidemiology, outbreak preparedness and prevention, and guaranteed access to health systems and services, among others. In addition to its technical guidance and web portal, PAHO also committed to developing a regional plan of action addressing the health needs of migrants, an initiative that will be developed in consultation with PAHO member states.

Links

— Guidance document on Migration and Health
— Migration and Health in the Americas (web portal)
— PAHO and ministers of Health from the Americas identified a series of actions that seek to improve the health of migrants in the Region

The Anguilla Community Action Network (ACAN) in collaboration with Eastern Caribbean Cancer Centre hosted a breast and prostate cancer awareness outreach on 11 – 14 April 2019.

The initiative facilitated public discussions via radio and television, a panel discussion focusing on “Managing the Rising Incidents of Cancer in Anguilla” and free breast and prostate cancer screening and follow- up consultations.

ACAN’s Director and Founder, Mr John Lake, a cancer survivor himself, expressed the importance of such initiatives and reinforced that “our health is our responsibility”. He further stated, “Knowing is crucial, and it is the first step to staying healthy. I am elated that the public in Anguilla took advantage of the outreach”.

This is the second cancer outreach facilitated by ACAN in an attempt to make cancer screening a regular service not only for People Living with HIV (PLHIV) but all citizens of Anguilla.

What is the Anguilla Community Action Network (ACAN)?

The Anguilla Community Action Network seeks to support persons infected and affected with HIV and AIDS by eliminating stigma and discrimination in the communities in which they live through advocacy, education, empowerment, and integration while working to stop the spread of all sexually transmitted infections.

For more information visit the ACAN Facebook page:

Image: Participants of the Stakeholder Consultation on Violence and Discrimination in Access to Public Transportation

In observance of International Transgender Day of Visibility, 31 March, the Guyana Trans United (GTU) and the Society Against Sexual Orientation Discrimination (SASOD Guyana) in collaboration with the Ministry of Public Infrastructure hosted a Stakeholder Consultation on Violence and Discrimination in Access to Public Transportation for LGBTQ+ Persons at the Ministry’s Fort Street Kingston board room on Wednesday, 27 March 2019.

The consultation aimed to share information, facilitate dialogue and formulate solutions about the standard of respect and treatment required for all persons utilising public transportation. The meeting discussed the effects of anti-LGBTQ discrimination in accessing public transportation and regulations and solutions aimed at preventing and punishing violence and discrimination against LGBTQ+ persons seeking to utilise public transportation services.

Representatives from the United Mini Bus Union, Ministry of Public Infrastructure, Ministry of Business, Guyana Police Force, UNAIDS, USAID Advancing Partners and Communities Project, GTU and SASOD Guyana were in attendance.

In brief opening remarks, Managing Director of SASOD Guyana, Joel Simpson, noted that the goal of the consultation was to find collective solutions to prevent the violence and discrimination some LGBTQ+ persons, especially transgender persons, suffer when using public transportation. SASOD Guyana’s Human Rights Coordinator, Valini Leitch, pointed out the difficulties some LGBTQ+ persons encounter in accessing public transportation. She stated that discrimination affects access to healthcare, basic needs and has been an ongoing problem, especially for transgender persons who face the brunt of the abuses because of their visibility.

Simpson emphasised that every citizen should be able to access public transportation without fear of violence or discrimination. The problem, he said, is not just limited to mini-buses, but cuts across the local transportation sector, including taxis and speed boats. He also noted the limitations that LGBTQ persons encounter in accessing justice while also pointing out that the Caribbean Court of Justice (CCJ) struck down Guyana’s law against cross-dressing in November 2018.

The Traffic Chief, Senior Superintendent Linden Isles explained that the law is clear on the obligation to carry passengers. He recognised that cases of discrimination do occur and highlighted the importance of reporting swiftly to the police and giving a clear and detailed statement to the police when these infringements arise. Mr Simpson noted that in some cases the traffic ranks do prejudicially take the side of the taxi driver or mini-bus operator. Simpson emphasised the need for sensitising traffic ranks and transport operators.

Muriel Tinnis-Duke, Director of Consumer Affairs at the Ministry of Business, noted that the recently released Code of Conduct for Minibus Operators was prepared with the prevention of all forms of discrimination in mind.

Recognizing gender as a prohibited category of discrimination in the Code of Conduct, Simpson noted that “sexual orientation, gender identity and gender expression” need to be expressly included in the list of grounds in the Code’s nondiscrimination provision. He expressed the need for broader consultations on future iterations of the document.

Clive Williams, Planning Officer at the Ministry of Public Infrastructure’s Central Transport Planning Unit, noted that his Ministry was in full agreement that persons should not suffer any discrimination in accessing public transportation. He emphasised the need to engage transportation bodies to have sensitisation sessions.

In closing, Simpson acknowledged the role of education and expressed interest in further collaborations and bilateral meetings with the other stakeholders at the meeting. He also noted the need for GTU and SASOD Guyana to undertake community education to inform LGBTQ+ persons of their role in the process.

The Caribbean Regional Network of People Living with HIV/AIDS (CRN+) Board Meeting was convened at the Hilton Hotel, Port of Spain, Republic of Trinidad and Tobago on 15 March 2019.

The Meeting brought together CRN+ Board of Directors, Technical Advisory Group and Secretariat staff to further review and solicit input for improved governance and management of CRN+.  The principal objective of the meeting was to review and revise the CRN+’s strategic direction for CRN+.

The meeting provided an opportunity to reflect on the current operations of CRN+ and develop new plans for the organisation.  It was agreed that in order to improve the governance and management of CRN+, an organisational assessment must be conducted to determine the impact and relevance of CRN+.  The results of the assessment will inform the new strategic direction of the network and the development of a resource mobilisation strategy and operational plan. The board will mobilise funding to conduct the assessment and develop the resource mobilization strategy and operational plan.

The meeting agreed that increased involvement of PLHIV in the regional and national HIV responses will require continued and improved collaboration with National AIDS Programmes.

It was also agreed that board members will be assigned to support select national networks.