Photo Caption: Front row seated, extreme right, Dr. Shanti Singh-Anthony, Knowledge Management Coordinator, PANCAP, second from right, Ms. Sandra Jones, centre, Dr. Omar Sued, second from left Dr. Joel Palefsky, left Dr. David E. Koren, along with participants of the USAID-funded PANCAP training for regional HIV Clinicians addressing opportunistic infections in people living with HIV.
Tuesday, 5 September 2023, (PANCAP Coordinating Unit, CARICOM Secretariat): The Pan-Caribbean Partnership against HIV and AIDS (PANCAP), the mechanism that provides a structured and unified approach to the Caribbean’s response to the HIV epidemic, hosted a two-day regional training programme funded by USAID, for HIV clinicians, addressing opportunistic infections in people living with HIV, from August 24-25, 2023, in the Republic of Trinidad and Tobago.
Presentations were made by several technical experts from PANCAP, the Pan-American Health Organisation (PAHO) and other experts from within the field of medical academia. The overall objective of the training was to increase the capacity of HIV practitioners in the region to detect and manage common opportunistic infections that affect people living with HIV (PLHIV) in the Region.
To set the tone for the meeting, Dr. Shanti Singh-Anthony, Knowledge Management Coordinator, PANCAP, discussed the status of the Caribbean response, noting that there has been significant progress with a 15% reduction in new infections and a 53% reduction in AIDS-related deaths in the last ten years. Despite these achievements, there continue to be challenges that as a Region we must address to achieve our common goal of ending AIDS. Specifically, it is noted that more than 25% of PLHIV enter into treatment programmes with advanced HIV infection and opportunistic infections with implications for morbidity and mortality as well as for HIV transmission. The adequate management of opportunistic infections will improve the quality of care to PHLIV. World Health Organisation (WHO) guidelines were used to update participants on the management of Tuberculosis, Histoplasmosis, Cryptococcal disease, Human Papilloma Virus and cancers.
The training underscored the impact of HIV on key populations in the Region and the role of stigma and discrimination that hinders access to treatment. To address this a session was focused on health care workers delivering competent healthcare. The session delved into the components of a sexual health history and provided tips for facilitating patient-focused discussions on sexual health and promoting sexual health and wellness among sexual and gender-diverse populations.
The importance of using a highly efficacious treatment regimen as recommended by WHO was emphasized. An update was provided on treatment for adults and children living with HIV with optimized first-line therapy using Dolutegavir. Belize shared their experience including successes and lessons learned in transitioning their cohort of children living with HIV to first-line therapy with dolutegavir.
PAHO presented an update on the initiatives around the elimination agenda focusing on the elimination of mother-to-child transmission of HIV, congenital syphilis and hepatitis B. Countries-specific initiatives were shared. Guyana described their success in treating persons with Hepatitis C virus, and Jamaica AIDS Support for Life discussed the impact of their Hepatitis B programme for key populations.
Pre and post-test questionnaires were administered to participants at the start and end of the training exercise respectively, to assess the knowledge gained. It was revealed that 100 percent of the participants in attendance were in agreement that new knowledge was gained. All the participants agreed that they would apply the knowledge gained and also agreed that they would share the knowledge gained from this training programme with their colleagues and peers.
Commenting on the success of this training exercise Dr. Shanti Singh–Anthony Knowledge Management Coordinator, PANCAP said, “This training programme forms part of PANCAP’s continuous capacity-building efforts aimed at enhancing the quality, effectiveness, efficiency, equity, and sustainability of all HIV clinical services and related non-clinical support services being offered to PLHIV within the CARICOM region. Moving forward, we intend to broaden the scope of the training to encompass a wider diversity of healthcare workers in order that they will be better equipped to deliver more sustained, efficient, and equitable health outcomes to PLHIV within the region.”
Participants in the workshop included HIV physicians from Barbados, Belize, Dominica, Grenada, Guyana, Jamaica, Saint Lucia, St. Kitts and Nevis, St. Vincent and the Grenadines, the Republic of Trinidad and Tobago and Suriname who are providing care and treatment for persons with HIV.
PANCAP joins the Region in mourning the loss of HIV and public health adviser to the Caribbean, Dr. Michel de Groulard. Michel had more than 30 years of experience in International Public Health, with around 25 years dedicated to HIV.
Michel was a French citizen who made the Caribbean his home. He lived in the Republic of Trinidad and Tobago for several years until his passing.
A medical doctor by training, Michel worked on several public health projects for the French Ministry of Foreign Affairs and provided healthcare to remote desert villages in Mauritania and Cameroon. He also served as a Public Health Officer in the Grenada Health Ministry and an HIV Project Manager at the Caribbean Epidemiology Centre.
Michel joined UNAIDS in 2001 as a Senior Partnerships Adviser. He went on to serve the Caribbean region in several positions with UNAIDS, including Senior Program Adviser to the region for more than seven years. Last month, he concluded a two-year appointment as interim Country Director for the Guyana/Suriname office which he opened in Georgetown in 2005.
In his HIV work over the years, he continuously emphasised the role of civil society at all levels of the response to address risk and vulnerability, gender issues and barriers to access services. Michel provided technical support for creating the Caribbean Network of People living with HIV in 1996 and establishing the Caribbean Vulnerable Communities Coalition in 2005. For several years he was Vice Chair of Community Actions Resource, Trinidad and Tobago’s oldest organization serving people living with HIV.
Above all Michel was a champion for the marginalized and excluded, especially people living with HIV and key populations. He ensured that communities’ concerns and voices were put at the centre of planning and advocacy. He is remembered by civil society for championing their critical importance in shaping public policy and delivering services.
Michel never truly retired. Always energetic and committed, he took on several challenges following his initial departure from UNAIDS in 2013. This included the role of Regional Manager for the USAID/PEPFAR LINKAGES programme for the Eastern and Southern Caribbean. He also volunteered with the Alliance Française in Port-of-Spain.
His interests in epidemiology and public health were enduring. Since the start of the COVID-19 pandemic, for example, he compiled and disseminated daily country and regional graphs tracking new infections and deaths in the Caribbean. His nightly WhatsApp messages to friends and colleagues continued until the night before his passing.
We extend our deepest condolences to his family, colleagues and friends. The Region has lost a dedicated champion for vulnerable populations.
The inequalities perpetuating the AIDS pandemic are not inevitable; we can tackle them. This World AIDS Day, 1 December, UNAIDS urges each of us to address the inequalities holding back progress in ending AIDS.
The “Equalize” slogan is a call to action. It prompts all of us to work for the proven practical actions needed to address inequalities and help end AIDS. These include:
Increase availability, quality and suitability of services for HIV treatment, testing and prevention so that everyone is well-served.
Reform laws, policies and practices to tackle the stigma and exclusion faced by people living with HIV and by key and marginalised populations so that everyone is shown respect and welcomed.
Ensure the sharing of technology enables equal access to the best HIV science between communities and the Global South and North.
Communities will be able to use and adapt the “Equalize” message to highlight the particular inequalities they face and to press for the actions needed to address them.
Data from UNAIDS on the global HIV response reveals that during the last two years of COVID-19 and other global crises, progress against the HIV pandemic has faltered, resources have shrunk, and millions of lives are at risk as a result.
Four decades into the HIV response, inequalities persist for the most basic services like testing, treatment, and condoms, and even more so for new technologies.
Young women in Africa remain disproportionately affected by HIV, while coverage of dedicated programmes for them remains too low. In 19 high-burden countries in Africa, dedicated combination prevention programmes for adolescent girls and young women are operating in only 40% of the high HIV incidence locations.
Only a third of people in key populations— including gay men and other men who have sex with men, transgender people, people who use drugs, sex workers, and prisoners—have regular prevention access. Key populations face major legal barriers, including criminalisation, discrimination and stigma.
We have only eight years left before the 2030 goal of ending AIDS as a global health threat. Economic, social, cultural and legal inequalities must be addressed as a matter of urgency. In a pandemic, inequalities exacerbate the dangers for everyone. Indeed, the end of AIDS can only be achieved if we tackle the inequalities which drive it. World leaders need to act with bold and accountable leadership. And all of us, everywhere, must do all we can to help tackle inequalities too.
Activities will build up to World AIDS Day in November. The World AIDS Day report will be released in late November.
On World AIDS Day (1 December) events will take place worldwide. These activities will be led not only by official bodies but also, most importantly, by communities. Through photos and videos shared by groups on social media and aggregated by UNAIDS, people can have a sense of the kaleidoscope of events taking place and be inspired by determination and hope.
“We can end AIDS – if we end the inequalities perpetuating it. This World AIDS Day, we need everyone to get involved in sharing the message that we will all benefit when we tackle inequalities,” says UNAIDS Executive Director Winnie Byanyima. “To keep everyone safe, to protect everyone’s health, we need to Equalize.”
Adaptable materials for World AIDS Day will be shared on the UNAIDS special World AIDS Day page beginning in October.
Thursday, 15 September 2022 (PANCAP Coordinating Unit, CARICOM Secretariat): The Pan-Caribbean Partnership against HIV and AIDS (PANCAP), the mechanism that provides a structured and unified approach to the Caribbean’s response to the HIV epidemic, will facilitate a five-day South-South Knowledge Exchange event in collaboration with the Jamaica AIDS Support for Life (JASL) in Kingston, Jamaica from 19 to 23 September 2022.
The weeklong activity will allow regional stakeholders to examine the planning, implementation, and evaluation of JASL’s Prevention, Treatment, Enabling Environment and Human Rights programmes. The initiative aims to strengthen the regional HIV response by identifying best practices from JASL’s model in HIV Management/Programming with special emphasis on Pre-exposure Prophylaxis (PrEP) and other specialised treatment and care services that cater to vulnerable populations, including men who have sex with men (MSM), female sex workers and transgender persons.
The South-South Exchange is supported by the United States Agency for International Development (USAID) and the Global Fund to Fight AIDS, Tuberculosis and Malaria. It will include key civil society organisations (CSOs) that implement HIV programmes from seven (7) countries within the Caribbean Community (CARICOM), including the Commonwealth of Dominica, Guyana, Grenada, Jamaica, Saint Kitts and Nevis, Saint Lucia, and Saint Vincent and the Grenadines.
Kandasi Walton-Levermore, Executive Director, JASL, is delighted about the initiative, “regional participants will be exposed to the lessons learnt and the factors contributing to the successful delivery of HIV prevention and treatment services for key populations (KPs) and People Living with and affected by HIV and AIDS.” She added, “JASL will share its customised approach in service delivery to achieving an enabling environment for improved access to HIV services for all.”
The exchange will also focus on the coordination and collaboration mechanisms between JASL, the Ministry of Health and Wellness (MoHW), other CSOs, the private sector and other partners in delivering comprehensive HIV services. In addition, participants will develop country-specific action plans to enhance collaboration among participants in the South-South initiative.
JASL’s Executive Director underscored that the South-South Knowledge Exchange would be a significant step toward building capacity in HIV programme implementation to achieve the 95-95-95 Targets for ending AIDS.
Friday, 9 September 2022 (PANCAP Coordinating Unit, CARICOM Secretariat): The Pan-Caribbean Partnership against HIV and AIDS (PANCAP), the mechanism that provides a structured and unified approach to the Caribbean’s response to the HIV epidemic, will facilitate a “Joint Regional Dialogue among Key Stakeholders and Partners” of the Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM) multi-country grant in Port-of-Spain, Republic of Trinidad and Tobago, 13 – 15 September 2022.
The Dialogue is a result of a collaboration with the Global Fund, the Latin America and the Caribbean (LAC) platform and the consortium of Sub-Recipients consisting of the Pan Caribbean Partnership against HIV and AIDS (PANCAP), the Caribbean Vulnerable Communities Coalition (CVC) and the Centro de Orientación e Investigación Nacional (COIN) of the multi-country grant.
Over eighty (80) participants are expected to attend, including Caribbean Country Coordinating Mechanism (CCM) members, who represent communities affected by the three (3) diseases, as well as key and vulnerable populations (Belize, Cuba, Dominican Republic, Guyana, Haiti, Jamaica and Suriname), OECS Regional Coordinating Mechanism (RCM) members, Caribbean networks of key populations participating in the multi-country grant, National AIDS Programme (NAP) Managers, Civil Society Organisation (CSO) representatives implementing grant activities, technical assistance providers/agencies, International Development Partners including the Global Fund, USAID/PEPFAR, PAHO and UNAIDS.
According to Dr. Shellon Bovell, Project Coordinator, Global Fund (GF), CARICOM Secretariat, the Dialogue will maximise learning, coordination and synergies among recipients of the multi-country grant.
She further explained that this would allow stakeholders to discuss priority issues, including the effective use of resources and added value for beneficiaries of the grant, while sustaining the gains in HIV programming.
Specifically, the Dialogue will seek to improve coordination and collaboration between the regional GF project, national GF grants, national programmes, civil society and communities in their responses to HIV, Tuberculosis (TB) and malaria through sharing experiences, strategies and best practices.
“We will also seek to identify challenges affecting the expansion of the response to HIV, TB and malaria in the Caribbean and to improve the understanding of the Global Fund processes by all stakeholders, including communities and beneficiary countries that will have a significant impact on our Region”, stated Dr. Bovell.
She further explained that national programmes and CSOs would share their experiences and lessons learned from involvement and engagement in Global Fund-related processes in the Caribbean.
The overarching objective is to foster more synergies among stakeholders of the multi-country grant to fulfil the vision of an AIDS-free Latin America and the Caribbean.
The consortium of Sub-Recipients consisting of the Pan Caribbean Partnership against HIV and AIDS (PANCAP), the Caribbean Coalition of Vulnerable Communities (CVC) and the Centro de Orientación e Investigación Nacional (COIN), submitted a funding request to the Global Fund in August 2018 to provide sustainable prevention, treatment and care services for key populations in the Caribbean region. In response to this request, the Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM) approved a budget of US$6,500,000 for implementing a three-year Project (1 October 2019 – 30 September 2022).
The Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM) reaffirmed its commitment to strengthening the voices of communities and civil society in Global Fund processes, investing in a third phase of the Community Engagement Strategic Initiative (CE SI), former Community, Rights and Gender Strategic Initiative (CRG SI) for the period 2021-2023.
The primary objective of the CE SI is to strengthen the engagement of civil society and communities in the Global Fund and related national processes. Engagement of community and civil society actors at all stages in the grant life cycle is critical in designing, developing and implementing effective responses to the three diseases and systems strengthening, ensuring that Global Fund investments evolve as responsive to those most impacted.
The CE SI works through the following three components:
Technical Assistance (TA) to support communities and civil society groups to engage in national processes linked to Global Fund investments.
Long-term strengthening of HIV, TB and malaria organisations and networks and engagement funds for women and girls, and
Regional Civil Society Platforms for Communication and Coordination.
The Global AIDS Update 2022, released in July, shows that during the last two years of the Coronavirus (COVID-19) pandemic and other global crises, progress against the HIV pandemic has faltered, resources have shrunk, and millions of lives are at risk.
On average, the AIDS pandemic took a life every minute in 2021. There were 650 000 AIDS-related deaths last year despite the availability of effective HIV treatment and tools to prevent, detect, and treat opportunistic infections.
The Caribbean
Regarding the Caribbean, there were an estimated 330 000 people living with HIV last year. According to the report, from 2010 to 2021, AIDS-related deaths in the Region declined by 50 percent.
There were 5700 deaths last year, and new HIV infections decreased by 28 percent since 2010. An estimated 14 000 people contracted HIV during 2021, translating into 270 new HIV infections every week in the Caribbean.
“While the Caribbean has not had the increase in new infections experienced in other regions, the rate of decline is far too slow,” explained Luisa Cabal, UNAIDS Director of the Latin America and Caribbean Regional Support Team.
“Thousands of avoidable HIV infections every year are making it ever harder and more expensive to ensure People Living with HIV have access to lifesaving treatment and that the targets to end the AIDS pandemic by 2030 are reached,” Cabal added.
The report recommends that countries in the Region urgently prioritize combination HIV prevention. This includes behavioural interventions like comprehensive sexuality education as well as moving to large-scale implementation of prevention projects reaching vulnerable populations at elevated risk of HIV so that innovations such as HIV self-testing and pre-exposure prophylaxis or PrEP become more widely available.
PrEP is daily medicine taken by an HIV-negative person who is at substantial risk to prevent contracting the virus (View the PANCAP PrEP Knowledge Suite).
The data indicated that these prevention strategies are especially important for vulnerable groups like adolescent girls and young women as well as key populations such as gay men and other men who have sex with men, sex workers, transgender people and people who use drugs.
One-third or 34 percent of new HIV infections last year were among Caribbean young people aged 15 – 24. There were twice as many infections among young women (23 percent) as compared to their male peers (11 percent).
The report notes that during the disruptions of the last few years, key populations in the Region have been particularly affected.
As of the end of 2021, an estimated 84 percent of People Living with HIV in the Caribbean were aware of their status. Eighty-three percent of all diagnosed people were on treatment. Of these, 87 percent were virally suppressed last year. The target for 2025 is 95 percent for each of these result areas.
At present, the Caribbean is below the global averages for both HIV treatment coverage and viral suppression.
The report recommends that Caribbean countries implement policies that remove structural barriers to HIV services and repeal laws and policies that criminalize people living with and at risk of HIV.
Finally, deliberate action is required to ensure sufficient and sustainable funding for the Caribbean HIV response.
Image: Ms Luisa Cabal, UNAIDS Director Latin America and Caribbean Regional Support Team
The PANCAP Coordinating Unit and the Pan American Health Organisation (PAHO) have developed a Pre-exposure Prophylaxis (PrEP) knowledge suite available on the PANCAP website. The suite comprises digital posters for Social Media, Information, Education and Communication (IEC) materials, including digital brochures, clinical guidelines for PrEP and nPeP, PrEP registry, monitoring tools and capacity-building materials, including training videos.
The resource was developed to support countries in setting up services for PrEP and nPeP with emphasis on key populations. The package will allow for the standardisation of the services in the Region and data collection to support region-wide analysis for evidence-based decision-making.
Mr Timothy Austin, Senior Project Officer, Communications, PANCAP Coordinating Unit, explained that the IEC materials were developed based on input and feedback from a virtual focus group earlier this year. The focus group consisted of civil society representatives, key populations, technical staff from the National AIDS Programme Secretariat in Guyana, and technical staff from PANCAP and PAHO. He highlighted that the social media visuals and digital brochures contain essential PrEP information and detailed explanations on who should use PrEP, its effectiveness and its side effects.
Ms Sandra Jones, Advisor, HIV/STI, TB & Viral Hepatitis, PAHO/WHO – Subregional Program Coordination, Caribbean, emphasised that NAPS and CSOs can utilise the IEC materials to create demand for PrEP. She explained that the clinical guidelines and other tools would support the delivery of a comprehensive package of services that will facilitate a combination approach to HIV prevention.
Technical guidelines available in the suite also offer comprehensive information on procedures for initiating PrEP (first visit), a checklist for counselling clients and a list of medications that interact with PrEP, among others.
The PrEP Suite forms part of the initiatives under the current Global Fund project, with the technical guidance and support of PAHO. The overarching goal is to provide the necessary guidance and tools to support countries establishing and strengthening services for key populations.
PANCAP, with technical support from the Jamaica AIDS Support for Life (JASL), will facilitate a “Training of Trainers on the use of Oral Pre-exposure Prophylaxis (PrEP) for the prevention of HIV, 16 – 18 August 2022 in the Republic of Trinidad and Tobago.
The capacity-building activity is designed for health care providers working at the community and facility level to equip them with knowledge about PrEP as an additional tool for prevention. The course will sharpen their skills in negotiating tailored prevention plans for their respective beneficiaries.
In addition, the training activity will provide basic PrEP information and employ participatory activities to allow participants to effectively promote/support PrEP as another prevention strategy for some of their clients. For medical practitioners, the training will provide guidance on how to administer, monitor and manage PrEP.
The training is supported by the United States Agency for International Development (USAID) and facilitated by JASL trainers with capacities across clinical aspects of PrEP services and administration, understanding referrals and linkages approach to PrEP, communication, messaging, monitoring and evaluation.
The capacity building is happening several weeks after the launch of the PANCAP PrEP Knowledge Suite, developed with technical support from PAHO for use by National AIDS Programmes, civil society organisations, and other stakeholders involved in HIV programme implementation for capacity building and community health promotion activities on PrEP.
On 17 May 2022, the World Bank released a White Paper with a proposal to create a Financial Intermediary Fund (FIF) for Pandemic Prevention, Preparedness, and Response. For some, the idea of creating a new global fund for pandemics was only a matter of time, not unexpected and even anticipated given that the world has lost trillions of dollars due to the COVID-19 pandemic and no-one would want to go through a similar situation in the near or intermediate future.
The pandemic is not over. While the world’s predominant Omicron variant and its different sublineages do not seem to be as devastating in terms of deaths, it continues to cause tens of thousands of infections almost daily around the world. This raises the burden of disease and causes labor disabilities, flight delays or cancellations, supply chain interruptions, and other serious disruptions to society. Furthermore, the high inflation that is currently being experienced worldwide and the risk of a global recession have not only been exacerbated by the Russian invasion of Ukraine but are symptomatic of economic phenomena already being driven by the impact of the pandemic.
The Global Fund was too slow to act
Last year, when the Global Fund Board discussed its new 2023-2028 Strategy, several of us sent letters to Board members and made our position known: that the Global Fund should expand its mandate beyond the three diseases so it could explicitly incorporate prevention, preparedness and response to COVID-19 and other potential pandemics. Given that we saw the risk that a new type of Global Fund would have to be created for that purpose, we advocated for these functions to be incorporated into the work that is already being successfully performed by the Global Fund.
Unfortunately, the expansion of the mandate was not explicitly authorized.
Yet if nothing else, COVID-19 has shown us that the world was ill-prepared to deal with a global pandemic of this nature and that existing modalities were not fit for purpose and would need to be severely overhauled to deal with any such future threats.
At that time, and to some extent still remaining, there was a lot of controversy regarding the placement of pandemic preparedness and response (PPR) within the new Global Fund Strategy, with many fearing that its inclusion would detract from attention to HIV, TB and malaria. This has undoubtedly impacted on the decision not to given PPR the same weight as the three diseases and health system strengthening in the new Global Fund Strategy 2023-2028.
It is hardly surprising, therefore, that someone else has stepped in to take up the challenge of addressing global prevention, preparedness and response to future pandemics.
Upping the competition for scarce financial resources
The World Bank’s new proposal to create the FIF has started to compete for the same international resources for global health. However, while the Global Fund model is inspired by a bottom-up approach to develop and create responses through partnerships, the World Bank model appears to adopt a top-down approach, in that a group of intellectuals have generated a model whereby donors define the flow of resources with decision-makers at the top deciding how to help poor people at the base. This is best described as a paternalistic or colonialist model and is a step backwards.
The model proposed by the World Bank seems to be inspired by organizational models from the last century. In this model, only the member states have a voice and a vote: the donors are at the top of the pyramid and the countries, which are called beneficiaries, are at the bottom. Under the proposed FIF, the implementers would be the World Bank itself, WHO, other United Nations (UN) agencies, the Regional Development Banks (RDBs), and a potential space for others defined as “etcetera” in the original White Paper.
How do the two models differ?
We can see the main components of both models below.
Table 1. A comparison of the Global Fund and World Bank implementing models
Global Fund
Financial Intermediary Fund
Model at Inception
Bottom-up
Top-down
Decision-making
Through partnerships
Pyramidal decision making,top to bottom
Country defined as
Country Coordinating Mechanisms (CCM) comprising governments plus relevant stakeholders
Member-States (governments)
Implementers
Eligible developing countries
RDBs, UN Agencies, World Bank, and WHO
Beneficiaries
People and communities from eligible countries
All developing countries
Civil society, communities, private sector and private foundations
Role as partners from CCMs to the Board levels
Civil society is considered to be an observer and participate as such, while the private sector is still undefined
Allocations
Grants to eligible countries
Grants and potentially loans and/or bonds to all interested developing countries
Funding
Replenishment cycles every three years
Replenishment processes are being considered
Disease focus
HIV, TB, malaria, health system strengthening, and human rights barriers associated with the three diseases, plus COVID-19 -related responses
COVID-19 and other future pandemic prevention, preparedness, and response
Governance and accountability issues
Of course, the elements listed in this table are not the only components that can be compared, there are other elements that should also be considered. For example, the track record in transparency: the mechanisms for allocating Global Fund grants are explicit and based on epidemiology and the capacity to pay indicators of each country and the country proposal is prepared and endorsed not only by the government but also by all non-governmental entities represented on the country’s CCM. In the case of the World Bank, as is the case with almost all multilateral organizations created after World War II (e.g., the World Bank, the International Monetary Fund and other Bretton Woods institutions, WHO and most UN agencies), its mandate is to negotiate only with member states. And the results of those negotiations are only made public once they are completed and the agreement has been signed. Transparency was not exactly one of the most cherished values of the last century, as it is in the current 21st century.
From another perspective, the Global Fund itself is a financial intermediary fund which temporarily receives resources from donors that are finally assigned to implementers in eligible countries. Creating a new FIF would be an unnecessary bureaucratic duplication that is based on a model that is less inclusive and potentially less impactful for countries and communities.
The reaction from stakeholders
Following the publication of the White Paper, interested parties were offered the opportunity to respond with written feedback to be received by 1 June 2022. Many of these comments from interested stakeholders – including civil society, academics, and other non-government representatives or entities – expressed concern that the Global Fund was not included in the proposed process. As a reaction to these comments, the newspaper Politico has reported that the Coalition for Epidemic Preparedness Innovations (CEPI), Gavi, the Vaccine Alliance, and the Global Fund have now been included as potential FIF fund recipients.
Communities, civil society and non-state actors are excluded
But is this the solution? That the Global Fund becomes a FIF recipient? Competing for FIF resources with the World Bank itself, not to mention against RDBs, other UN agencies, and WHO? Perhaps the World Bank is still not very clear about how it wants to operate the FIF: it has called on civil society and non-state actors to listen to their ideas and potentially invite them as observers, but not to sit down at the table together to make decisions jointly, at the same level as member states. This is because – according to the top-down model – they are not equal and there are hierarchies to be observed.
The fact that the World Bank is still unclear on exactly how to operate the FIF, and assuming that its creation is inevitable and will possibly be endorsed by the majority of the G20 countries, does not mean that we cannot continue to question its existence. The RDBs, UN agencies, World Bank and WHO cannot and should not be implementers, as set out in the FIF White Paper. The implementers must be the countries themselves, whether it be through governments, the private sector, civil society, and/or communities based in those countries. The role of WHO and other agencies in the UN system should be one of technical collaboration and technical partnership, but not as implementers or financial intermediaries; on the other hand, both the RDBs and the World Bank have been and must continue to be financial intermediaries.
The implications for the Global Fund
While the World Bank clearly defines exactly how the FIF will operate, one thing is obvious and must happen. The Global Fund Board, its respective Committees’ members and the Secretariat need to continue the discussion on how the Global Fund should prepare and adapt/reform itself to continue to be the most relevant actor in the global financing of prevention, preparedness and response to future and existing pandemics.
Through experience gained over the past twenty years, the Global Fund has amply demonstrated how to respond to pandemics: not only what works best but how countries can be motivated to co-invest with domestic resources so that the best possible results can be obtained. Its partnership model includes not just three diseases of pandemic dimensions, but also health and community systems strengthening within the context of a human rights and gender framework. Additionally, during these past two years the Global Fund has also shown how to respond swiftly and decisively to a fourth pandemic, allocating more than $4 billion to help developing countries fight COVID-19 through the COVID-19 Response Mechanism (C19RM) ¾ see Article 4 in this issue of the GFO, on the Office of the Inspector General‘s Audit of C19RM.
The Global Fund has shown flexibility in the past and demonstrated its ability to be nimble, and if its internal decisions impose barriers to be more effective, in doing so it reforms itself and adapts to new realities. This is reflected in differentiated funding modalities, policies for countries facing challenging operating environments or for ineligible countries in crisis, etc. In 2010, faced with a critical situation for the successful continuation of the financing of the Global Fund, its Board approved the creation of a comprehensive reform working group, whose proposed and subsequently approved plan allowed the Global Fund to quickly adapt to a new financial reality and continue developing what it knew how to do best: invest to save millions of lives.
*Jorge Saavedra is a medical doctor from Mexico, with masters’ degrees in Public Health and Health Policy & Management. He has been the Director General of Mexico’s National HIV Program and is currently President of the AIDS Healthcare Foundation (AHF) Mexico and Executive Director of the AHF Global Public Health Institute at the University of Miami. Has been a member of the Global Fund’s Latin American and Caribbean Constituency and is still a member of the Developing Country NGO Constituency on the Board.
He would like to thank Guilherme Ferrari Faviero for his edits and suggestions.
Tuesday, 21 June 2022 (PANCAP Coordinating Unit, CARICOM Secretariat): The Pan-Caribbean Partnership against HIV and AIDS (PANCAP), the mechanism that provides a structured and unified approach to the Caribbean’s response to the HIV epidemic, will facilitate a South-South knowledge exchange event in Georgetown, Guyana from 27-29 June 2022 in collaboration with Ministry of Health-Guyana and the National AIDS Programme Secretariat (NAPS). The knowledge exchange is funded by the United States Agency for International Development (USAID) and will focus on Guyana’s experience implementing Pre-exposure prophylaxis (PrEP) and HIV self-testing (HIVST).
The countries participating in the learning exchange event are Antigua and Barbuda, Belize, Jamaica and the Republic of Trinidad and Tobago. Eight (8) persons from the four (4) countries will participate, including National AIDS Programme (NAP) Managers and Clinical Care Coordinators, HIV clinicians and civil society organisation (CSO) representatives who work closely with the national programme in the implementation of PrEP, HIVST and other aspects of the HIV response.
Participants will interact with representatives of the Ministry of Health, clinical, CSO representatives and beneficiaries of the Guyana HIV programme.
According to Dr Shanti Singh-Anthony, Coordinator, Knowledge Management, PANCAP, “participants will experience firsthand how the Ministry of Health, National AIDS Programme has coordinated and collaborated with CSOs, the private sector, and other stakeholders in delivering comprehensive HIV services in the community and to key populations (KPs), including implementing a PrEP programme and HIVST.
She also explained that site visits would be conducted to public, private and community clinics, where participants would have the opportunity to interact with clinic staff. “This will allow participants to understand how the PrEP service delivery and HIVST are organised and delivered, the number and skill set of the clinical team, and other resources available for supporting service delivery,” stated Dr Singh-Anthony.
In addition, participants will interact with the beneficiaries of the clinics, particularly KPs. There will also be opportunities for participants to accompany the NAP and CSO teams to community outreaches to identify and recruit KPs for HIV prevention, HIVST and PrEP.
Why Guyana?
Dr Singh-Anthony explained that Guyana was selected because of the progress made by the NAPS in PrEP and HIVST implementation and the wealth of experience to be shared with the Region. Guyana is one of the first countries in the Region to have achieved the First 90. At the end of 2020, 94% of People Living with HIV knew their HIV status. Guyana has also made significant progress in delivering PrEP to KPs; the NAPS has developed PrEP guidelines, trained clinicians, and developed systems. PrEP is available at fifteen (15) public, private and CSO locations.
HIVST is in the pilot phase, and Guyana’s testing algorithm was validated. HIVST kits can be accessed from four (4) public, private and CSO locations. In addition, the NAPS has plans to scale up and make more sites accessible.
The South-South knowledge exchange is part of PANCAP’s overarching strategy to enhance the skills of National AIDS programme technical teams and CSO representatives in implementing PrEP and HIVST.
Pre-exposure Prophylaxis (PrEP) is the use of antiretroviral (ARV) drugs by persons without HIV infection to prevent the acquisition of HIV. It can be taken daily or on-demand, also known as event-driven PrEP.
What is HIV self-testing?
HIV self-testing allows people to take an HIV test and get their results in their home or other private location using an HIV self-testing kit. It offers a way to make testing discreet, comfortable, and empowering.
HELPFUL LINKS:
Global AIDS Strategy 2021–2026, End Inequalities, End AIDS
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 are the Global AIDS Strategy 2021–2026 targets and commitments?
If targets and commitments in the strategy are achieved:
The number of people who newly acquire HIV will decrease from 1.7 million in 2019 to less than 370 000 by 2025
The number of people dying from AIDS-related illnesses will decrease from 690 000 in 2019 to less than 250 000 in 2025.
The goal of eliminating new HIV infections among children will see the number of new HIV infections drop from 150 000 in 2019 to less than 22 000 in 2025.
