Media Releases – Page 37

Case study: PrEP Trial Implementation in UK

Editor’s note:

Large-scale implementation of Pre-Exposure Prophylaxis (PrEP) in the region continues to be a topic of much debate. Below is a description of the implementation of a trial PrEP programme in the United Kingdom which offers a wealth of knowledge on how to gather evidence on PrEP implementation. The editor of the PANCAP Newsletter wishes to thank Dr Jacqueline Wilthire-Gay, National AIDS Programme Manager, Barbados, for sharing this case study.

(United Kingdom) The National Health Service Commissioning Board (NHS England) announced in 2017 that pre-exposure prophylaxis (PrEP) will be available through the NHS as part of a three-year trial. This announcement came a year and a day after an historic win for NAT (National AIDS Trust) at the High Court that confirmed the NHS’s legal ability to fund the drug, which stops people from getting HIV.

The trial provided PrEP to a minimum of 10,000 participants. Eligible participants for the trial were able to access PrEP through sexual health clinics and included men, women, transgender people, and individuals with HIV positive partners whose viral load is not known to be controlled by HIV medication.

The medical effectiveness of the drug in preventing HIV infection is clear and well established. The NHS is using the trial to gather evidence on how to optimise uptake and implementation of a PrEP programme on a large scale.

Deborah Gold, chief executive at NAT (National AIDS Trust) said: “We already know that PrEP brings down rates of HIV infection, changing lives for those at risk and saving public money. We now need to work with NHS England, local authorities, and the sexual health sector to make sure the widest possible range of eligible people at high risk of HIV have access to the trial. We will continue to monitor the uptake of PrEP, aiming to learn as much as possible about how to get PrEP to all those who need it most.

“This is a pivotal moment in the fight against HIV. PrEP, if targeted properly at those in need and at high risk of HIV, offers the possibility of transforming the English HIV epidemic. From September, people at high risk of HIV will have access via the NHS in England to an empowering new tool that is truly individual controlled and not subject to negotiation with a partner, leading to the improvement of many, many lives. We warmly welcome this announcement.”

WHAT IS PREP?

Pre-Exposure Prophylaxis (PrEP) involves HIV negative people taking an antiretroviral drug to avoid getting HIV.
Multiple studies around the world have shown PrEP to be highly effective in reducing the risk of contracting HIV. The results of the PrOUD trial in England, released in 2015, prove that PrEP works and that concerns about it not working in a real-world setting were unfounded. Read more about the trial here: http://www.proud.mrc.ac.uk/

Most trials of PrEP and the US CDC Guidelines involve taking PrEP daily. A study in France, ANRS IPERGAY, has looked at the efficacy of PrEP when taken ‘on demand’, in other words not daily but only before and after sex. There was also significant preventive benefit shown in this trial.

JASL advocates for protection of health, sexual orientation and HIV status information

Image: Advocacy Officer and spokesperson, JASL, Patrick Lalor

The Jamaica AIDS Support for Life (JASL) wants the Data Protection Act to make provisions to protect information on an individual’s sexual orientation and behaviour as well as sexual activities and attractions.

The group made the suggestion on Tuesday 27 March in its submission to the joint select committee of the Parliament of Jamaica reviewing the Data Protection Act.

The human rights organisation which has as its clients many of Jamaica’s vulnerable sexual groups, made five recommendations to the committee.

Among them, a deliberate effort in the wording of the Act to protect people’s health information, sexual orientation and HIV status.

Advocacy Officer and spokesperson for the group, Patrick Lalor said the Data Protection Act should protect information on people’s sexual orientation and HIV status. He also wants the Bill to reflect prohibitions for insurance companies to require HIV tests to provide coverage, noting that it was easier for an individual who was hypertensive and had a pre-existing condition to get coverage, than for an HIV positive individual even as new medicines have emerged allowing people with the virus to live longer.

However, committee members Franklin Witter, Juliet Cuthbert Flynn and Julian Robinson disagreed with various aspects of the presentations.
Flynn said many individuals were denied policies with conditions other than HIV.

She said she was unable to get full coverage because of surgery done when she was 19 years old.

It was the view of most that insurance companies were driven by profits and were not keen on making payouts if it was determined that an individual’s pre-existing condition would cause early payout of massive sums.

Key submissions by Jamaica AIDS Support for Life for Data Protection Act:

*A more deliberate effort in the wording of the Act to protect people’s information
*Revisiting the definition of a minor
*A more equitable system of obligation placed on data controllers
*The inclusion of an oversight body for the Information Commissioner
*The broadening of the definition of consent to include informed consent (consenting based on
knowledge of what is required) and coerced consent (information given by coercion).

Study: Transgender women have highest HIV prevalence rate in Jamaica

Image: Kandasi Levermore, Executive Director of the Jamaica AIDS Support for Life (JASL)

Facing life in Jamaica in a harsh social context, transgender women have emerged as the group with the highest prevalence rate for HIV in the island.

A 2016 study found that just over four in every 10 transgender women in Jamaica, persons classified male at birth but who identify as female, have tested HIV-positive, and there are fears that the figure could be even higher as many are not regularly tested.

According to Kandasi Levermore, Executive Director of the Jamaica AIDS Support for Life (JASL), who contributed to the 2016 study, the HIV prevalence rate of more than 40 percent for transgender women is higher than the general population, sex workers, gay men and other men who have sex with men.

“It’s a matter that their risks are way higher. We look at the research that we have done and we found that women of trans experience are more likely to be infected with HIV than just a typical gay man,” said Levermore, who added:

“Their vulnerabilities are higher, the social context is harsher for these persons (but) you find that these persons are usually more educated, most of them finished secondary school. However, they do not get to transition into a job because they were born males they live as females, so it’s hard for them to get employment, and more than likely you find a number of them actively involved in sex work, so it complicates the vulnerability.”

Trans Population Growing

According to Levermore, the trans population in Jamaica is very present and growing in the sense that they are more visible, even though they are not living the way they would like.

“The truth is, based on what we are seeing, more of these subpopulation persons are not hiding. We are in the information age, things that used to be in the darkness are now coming out. It’s not something you can run from, it’s not a matter of if you are going to accept them, yes or no. They are here and they need their space.

“I can say that in the immediate stages when we were trying to put together the research we thought that, ‘Oh my God, we would not find 40 persons in Kingston, Montego Bay or St Ann to participate in this research,’ but we had over 150 persons who we were able to find as a sample for the population, so that suggests that there are persons within the country who identify (as trans),” said Levermore.

She argued that the trans women are less likely to seek medical attention because of the high levels of stigma and discrimination when they try to access services in the healthcare system, which further drives up the HIV rate in that group.

Levermore has urged health-care providers and the society at large not to forget the human element when dealing with transgender women.

PANCAP Knowledge for Health Share Fair successfully used knowledge management for learning and collaborating on “Treat All”

This March, the PANCAP Knowledge for Health Project hosted a Share Fair on “Collaborating and Learning towards Treat All” in Port-of-Spain, Republic of Trinidad and Tobago with National AIDS programme (NAP) Managers and civil society representatives (CSOs) from 18 countries in the region. The share fair focused on key themes such as tackling adherence, testing, stigma and discrimination, linkage to care, integration, and CSO/NAP manager collaboration, within the context of how these topics contribute to achieving the 90-90-90 goals and getting countries to Treat All. Several participatory knowledge exchange approaches were utilized to garner best practices in the region, including conversation cafés, panel conversations, storytelling talks, and human spectrum exercises, all with the intention of enhancing the sharing and learning among those in the room.

Image: Participant Martha Carrillo from Belize facilitates a fishbowl exercise on stigma and discrimination.

In addition, the PANCAP Knowledge for Health team engaged participants in three skills building sessions focused on utilizing the “Adobe Spark” Programme for improving report writing, creating effective charts, posters and graphics using “Piktochart” and utilizing the audience response system and virtual evaluation software, “Poll Everywhere” for accurate monitoring, evaluation, and audience surveys.

The Share Fair was particularly unique to the PANCAP-K4Health team because of the significant involvement of selected participants who took the lead in facilitating sessions. While they received prior coaching on how to implement knowledge management approaches, the facilitators embraced the challenge and successfully implemented their sessions. The success of this Share Fair was truly evident from the engagement and excitement from all of the participants and their sharing and learning together, all with a common goal of achieving the global 90-90-90 HIV targets and getting the region to Treat All by 2020.

View images of the Share Fair on the event web page here.

Resource Mobilisation Needed To Fight HIV

Image: Health Minister, John Boyce, greeting Deputy Chief of Mission, US Embassy, Laura Griesmer. At left is Health Office Director, USAID Eastern and Southern Caribbean, Julia Henn (Photo credit: The Barbados Government Information Service – BGIS)

As external aid for HIV programmes decreases across the Caribbean, an increased mobilisation of domestic resources is necessary to ensure sustainability and continued access to programmes in affected countries.

This declaration came from Minister of Health, Barbados, John Boyce as he addressed the opening of a two-day workshop on Domestic Resource Mobilisation for HIV in the Caribbean at the Courtyard by Marriott.

The meeting has brought together technocrats from Ministries of Finance and Health in Barbados, Guyana, Suriname and Trinidad and Tobago.

The primary objectives are to discuss the most urgent priorities for problem-solving and funding HIV and to develop a country-specific action plan to ensure countries are able to respond with their own resources in the face of the expected decline in external financing.

Mr. Boyce maintained that the “huge mobilisation of resources” for the global HIV response over the course of the epidemic had been unprecedented in the history of public health.

In the last decade, he disclosed, tremendous progress had been made in the prevention, care, and treatment of HIV. He noted the massive rollout of antiretroviral treatment, adding that because of dedicated programmes within countries and increased funding, HIV-related health outcomes had improved and HIV incidence had stabilised and even declined in some countries.

However, he stated, the shift towards domestic funding was now necessary as external aid declined, with the United States, which remained the largest contributor to the global HIV response, proposing cuts of almost 20 per cent amidst competing demands for donor budgets.

The Health Minister told the audience: “I therefore encourage you to support your own programmes and strategies for mobilising domestic resources and take responsibility for your own needs. As Health Ministers, we are often the most aware of the challenges the health sector faces in regard to ineffective or insufficient spending. Thus, we can play an important role in creating advocacy messages that put health at the top of our governments’ agendas.”

Mr. Boyce submitted: “Shifting the funding paradigm towards domestic funding is challenging, but it has the advantages of fostering ownership and accountability in the implementation of the national HIV response and increasing its sustainability.”

Introducing: Ms Victoria Nibarger, PEPFAR Coordinator U.S. Embassy Kingston

From the Desk of the Director, Pan Caribbean Partnership against HIV and AIDS (PANCAP):

Dear Partners,

Please join me in welcoming our new PEPFAR Coordinator, Ms Victoria Nibarger who is based in Kingston, Jamaica. Victoria is a U.S. Foreign Service Officer. She arrived in Kingston in January 2018 and will oversee the United States’ assistance to combat HIV and AIDS in Jamaica, Barbados, Guyana, Suriname, and the Republic of Trinidad and Tobago.

I had the opportunity to speak with Victoria and I would like to assure you that she is eager to provide the leadership required for advancing PEPFAR’s support and to serve the region.

Best regards,

Dereck.

Biography

Victoria Nibarger
PEPFAR Coordinator
U.S. Embassy Kingston

U.S. Foreign Service Officer Victoria Nibarger arrived in Kingston in January 2018 to assume the role of Coordinator for the President’s Emergency Plan for AIDS Relief (PEPFAR). In her capacity, she will oversee U.S. assistance to combat HIV/AIDS in Jamaica, Barbados, Guyana, Suriname, and Trinidad and Tobago.

This assignment marks a return to Kingston for Victoria, who previously served in the Consular Section of Embassy Kingston. During that tour, she led the Embassy’s efforts to evacuate American citizens from Haiti following the tragic January 2010 earthquake. Victoria then moved to Belgrade, Serbia, where she served as an Economic Officer responsible for reporting on developments in the country’s macroeconomic situation, including the aviation, agriculture, environment, and health sectors, as well as on women’s entrepreneurship and labor relations. Her most recent overseas assignment was at the U.S. Embassy in Kyiv, Ukraine, where she served as a Political Officer focusing on humanitarian issues – and the related U.S. policy response – resulting from the ongoing armed conflict in the Donbas region of eastern Ukraine.

Prior to joining the Foreign Service, Victoria worked in the non-profit sector, first in government relations for the American Cancer Society and then in international research for the Campaign for Tobacco-Free Kids. She also taught English to university students in Wuhan, China. Victoria graduated cum laude with B.S. degrees in biology and political science and a minor in leadership studies from Kansas State University. She completed her M.A. at Kansas State in the field of political science, for which she earned summa cum laude honors; her master’s thesis explored the relationship between HIV/AIDS and democracy in sub-Saharan Africa. Victoria studied in the Czech Republic and Turkey, and she speaks Russian.

A native of Kansas, Victoria is married to Daniel Nibarger, also a Foreign Service Officer with the U.S. Department of State. They have three children.

National AIDS Programme Managers, Civil Society Leaders and Development Partners commit to support country ownership for HIV response sustainability

Friday, 16 March 2018 (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, concluded the Sixth Meeting of National AIDS Programme (NAP) Managers and Key Partners in the Republic of Trinidad and Tobago on Wednesday, 14 March 2018. The meeting came two years ahead of the 2020 deadline for reaching the 90-90-90 targets—90% of people living with HIV diagnosed, 90% of diagnosed people on treatment and 90% of those on treatment virally suppressed.

The forum opened on Monday, 12 March with a Feature Address by the Honourable Terrence Deyalsingh, Minister of Health, Republic of Trinidad and Tobago. Minister Deyalsingh noted that in light of reduced technical and financial support from international partners, the region must collectively mobilize domestic resources especially for the support of prevention and the elimination of HIV-related stigma and discrimination among key and vulnerable populations.

These sentiments were echoed by the participants including National AIDS Programme (NAP) Managers, Chief Medical Officers, Permanent Secretaries, development, and implementing partners, including civil society organizations that work with people living with HIV and key population groups and youth.

In closing remarks, Dr. Nikkiah Forbes, Director, National HIV/AIDS and Infectious Diseases Programme at the Bahamas Ministry of Health, proposed integration of HIV care into other healthcare services in order to assure sustainability of the HIV response. She highlighted that participants recognized integration as one potential solution for improving the accessibility of health services and suggested that it could help countries meet the demand for increased HIV-related treatment, care and support services in the context of scaling up to “Treat All”. (“Treat All” involves offering treatment to all people diagnosed with HIV regardless of CD4 count.)

“Caribbean countries are diverse and integration will need to be tailored for each country context,” stated Dr Forbes, “HIV should never have been completely separated from the health agenda and synergies need to be fostered with sexual reproductive health services”.

She further stated that integration requires healthcare worker training on “Treat All” as well as the meaningful and sustained involvement of Civil Society Organizations (CSOs). For example, there should be leadership and inclusion of People Living with HIV (PLHIV) and key populations on the prevention, treatment and care needs of their communities. Dr. Forbes noted that there should be a focus on quality of care, with steps taken to ensure that members of key populations can access sexual and reproductive health services including HIV and AIDS prevention.

She posited that to achieve integration the region should conduct south-to-south collaborations and draw on regional expertise for training healthcare workers on the front-line response.

Dr Forbes emphasized the integral role of civil society organizations, “CSOs we have not forgotten you”, she stated. “You must be placed and supported in the planning and implementation process which only strengthens the argument for the need for social contracting and crystalizing this in policy. This is how we will sustain the regional response”.

She concluded with an urgent plea for heightened government involvement in funding the HIV response. She advocated that governments need to own the HIV response and in owning it, they need to make the investments needed to reach the prevention, testing and treatment targets that will set the region on course to end AIDS by 2030.

“I make a respectful but urgent plea to our governments to commit to, as well as finance, their National and Regional AIDS response”, stated Dr Forbes. “Without an urgent strategy to sustain the response, we risk leaving many vulnerable groups behind and undoing the gains we have made in reducing HIV transmission”.

– ENDS –

What is PANCAP?

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

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

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

Background to the National AIDS Programme Managers and Key Partners Meeting

The Caribbean Regional Strategic Framework (CRSF) 2014-2018 articulates the vision and collective priorities of Caribbean states through their membership in the Pan Caribbean Partnership against HIV and AIDS (PANCAP). The core premise is that stemming the HIV epidemic in the Caribbean rests on the commitment, capacity and leadership of national authorities and effective response. The primary goal of regional collaborative efforts is to support country responses by addressing common challenges in the areas of evidence based policy formulation, and innovative responses to addressing legislative gaps, resource mobilisation, coordination and technical assistance., An effective regional response, guided by the CRSF 2014-2018, therefore requires that the links and interfaces between country programmes and regional support programmes be defined and agreed to by country partners. This is critical for strengthening country ownership of the PANCAP response and a shared responsibility to strategically align efforts to end HIV as a public health problem in the Caribbean.

The NAP (National AIDS Program) Managers and Key Partners Meeting provides an opportunity for joint decision-making in setting programmatic priorities and identifying partner contributions in order to strategically align efforts in the fight against HIV. The Meeting Agenda is intended to allow for in-depth analysis and discussion on the relevant aspects of the UN Post 2015 Agenda, and the overall advancements of the Caribbean Region in implementing new initiatives for HIV. It is within this context that opportunities and challenges for the Region and individual countries to expand the national responses will be discussed. PANCAP acknowledges the need for greater attention to inter- country linkages and greater collaboration with regional partners. This will serve to maximise synergies, and provide a mechanism for making regional public goods available to national programmes to enhance their delivery and impact.

Contact:
Timothy Austin
Communications Specialist
PANCAP Coordinating Unit
CARICOM Secretariat
Turkeyen, Greater Georgetown, Guyana
Email: taustin.consultant@caricom.org
Tel: (592) 222-0001-75, Ext. 3409 | Visit www.PANCAP.org

Remarks by Ms Annelise Hirschmann, Regional Manager for Latin America and the Caribbean, The Global Fund on the occasion of the Sixth Meeting of National AIDS Programme Managers and Key Partners

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

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

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

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

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

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

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

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

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

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

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

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

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

Feature Address by the Honourable Terrence Deyalsingh, Minister of Health Sixth (6th) Meeting of the National AIDS Programme Managers and Key Partners

SALUTATIONS

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

LADIES AND GENTLEMEN.

Good Morning,

Introduction

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

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

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

Regional Sustainability Level of the Program

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

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

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

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

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

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

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

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

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

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

Sustainability

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

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

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

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

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

Other issues that may be discussed:

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

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

4. Human Capacity Development:

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

5. Prevention:

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

Conclusion

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

I thank you.

Sixth Meeting of National AIDS Programme Managers and Key Partners opens with call for more Country Ownership of HIV Response

Tuesday, March 13, 2018 (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, commenced the Sixth Meeting of National AIDS Programme (NAP) Managers and Key Partners in the Republic of Trinidad and Tobago from 12–14 March 2018.

Delivering the Feature Address, Honourable Terrence Deyalsingh, Minister of Health, Republic of Trinidad and Tobago highlighted that it has been more than 34 years since the first reported HIV and AIDS case in Trinidad and Tobago and the Caribbean and over 17 years since highly active antiretroviral treatment (HAART) became a reality.

However, he emphasized the need to focus on the sustainability of the response. “From the outset of the HIV epidemic in the Caribbean, there have been varied efforts to ensure that our regional and local communities achieved sustainability in our response to HIV”, stated Minister Deyalsingh, “Sustainable HIV programmes are characterized by the ability of a national government and regional partners to increasingly assume full strategic and financial responsibility for their HIV and AIDS response over the long-term”.

The Minister explained that this requires the development and strengthening of policies, infrastructure, skills, processes, human and financial resources to ensure that the response can survive, adapt and scale-up. He highlighted that financing is key to mounting a sustainable response and referred to the approaching 2020 deadline for the “90-90-90 Fast-Track Target”. Further, he explained that “the region finds itself in a global environment with complex development priorities that pose challenges to national budgets and affect bilateral cooperation. The region is expected to experience reduced technical and financial inflows and must collectively mobilize domestic resources especially, for the support of prevention and the elimination of HIV-related stigma and discrimination among key and vulnerable populations, as complimentary external financing dwindles”.

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

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

Addressing the participants, Chair of the Regional Coordinating Mechanism (RCM), Global Fund Project and Minister of Education, Guyana, Honourable Nicolette Henry advocated for more country ownership of the HIV response.

“To achieve the objectives of the Caribbean Regional Strategic Framework on HIV and AIDS there is still need to strengthen country ownership of the response and shared responsibility to strategically align efforts to end HIV as a public health problem in the Caribbean”, stated Minister Henry, “As a region we are still challenged with late diagnosis, particularly for men. Yet there is much to celebrate. People are living much longer with HIV, many more patients are on ART and there are greater methods and practices for fast-tracking prevention, operational financing mechanisms, and authority and responsibility of National AIDS Programmes. These are all essential requirements for closing the gap and shepherding an AIDS-free generation”.

The Minister’s sentiments on low diagnosis figures for men were echoed in remarks by Dr Cesar Nuñez, UNAIDS Director, Latin America and Caribbean Regional Support Team, who stated “the region as a whole is lagging behind on the HIV testing and viral suppression targets. One of three people (36%) living with HIV in the Caribbean is not aware of their HIV status, and late diagnosis is a challenge in several countries, particularly for men. In 2016, one-third of those on treatment were not virally suppressed (33%). This is what we must seek to understand and address. Why are most systems able to initiate treatment once people are diagnosed, but not to retain them in care and achieve the gold standard of viral suppression?”

Ms Annelise Hirschmann, Regional Manager for Latin America and the Caribbean, The Global Fund noted the success of the region’s response to HIV. She reminded the participants of their critical role in defining a path for the challenges ahead and emphasized the need to use treatment and key population cascades to make decisions on investing domestic and donor funding. Ms Hirschmann advocated that data should be used to shape decisions on the response more effectively. “We know that the region does not have huge increases in domestic financing for health, but are we effectively utilizing what is available?” stated Ms Hirschmann. She also urged participants to continue to plan for the sustainability of the HIV response in light of reduced donor funding.

Dr Edwin Bolastig, PAHO/WHO Representative (ag.), Republic of Trinidad and Tobago reiterated PAHO/WHO’s commitment to all partners involved in the HIV response towards achieving the 90-90-90 Targets by 2030. Dr Bolastig stated that country ownership of the HIV response aligned with the Regional Strategic objectives are indeed essential for the response. He also noted that while more countries have been validated for the Elimination of Mother-to-Child Transfer of HIV and Syphilis (EMTCT), there is still work to be done. In light of this, he recognized PANCAP’s consistent efforts to bring together regional minds for the collective thought process towards building consensus, creating synergies and generating collective action towards ending HIV. He also highlighted the synergy between PAHO/WHO and PANCAP in advocating for universal health coverage and ensuring that no one is denied health care because of age, sexual orientation, occupation, religious beliefs, etc.

Mr Ivan Cruickshank, Administrative and Finance Manager, Caribbean Vulnerable Communities Coalition (CVC) highlighted the critical need for data necessary to achieve the 90-90-90 Targets. He also advocated for full involvement of civil society representatives at all levels in the implementation of HIV programmes and the region’s overall response.

Dr Nikkiah Forbes, Director, National HIV/AIDS and Infectious Diseases Programme, Ministry of Health, The Bahamas continued the theme of the meeting, calling for more interest by governments in the sustainability of the response. She stated “I make a respectful but urgent plea to our governments to commit to, as well as finance their National and Regional AIDS response”.

Dr Forbes acknowledged the financial costs of such a commitment but implored governments to also consider the costs associated with inaction. “I also want you to remember that the colour of AIDS awareness is blood red, for its connection to blood and passion – not just red for anger in the face of injustice”, stated Dr Forbes, “The AIDS response must prevail beyond party colours, such as in The Bahamas where fortunately HIV has been a matter that our successive government administrations have consistently supported”.

Director of PANCAP and Chair of the opening ceremony, Mr Dereck Springer highlighted that the meeting provided an opportunity to reflect on the Region’s progress towards achieving the 90-90-90 Targets, to identify gaps in the region’s response and discuss strategies for filling the gaps. He noted that the meeting was being convened at a time of declining resources therefore the region must ensure greater efficiencies and effectiveness of HIV programmes.

The three-day forum will culminate on Wednesday, 14 March as National AIDS Programme Managers, Chief Medical Officers, Permanent Secretaries, Development, Regional and Implementing Partners, including civil society organizations that work with people living with HIV and key population groups (including youth), are expected to reach an agreement on approaches for integration as a key strategy for sustainability of the HIV response.

-ENDS –

What is PANCAP?

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

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

Background to the National AIDS Programme Managers and Key Partners Meeting

The Caribbean Regional Strategic Framework (CRSF) 2014-2018 articulates the vision and collective priorities of Caribbean states through their membership in the Pan Caribbean Partnership against HIV and AIDS (PANCAP). The core premise is that stemming the HIV epidemic in the Caribbean rests on the commitment, capacity and leadership of national authorities and effective response. The primary goal of regional collaborative efforts is to support country responses by addressing common challenges in the areas of evidence based policy formulation, and innovative responses to addressing legislative gaps, resource mobilisation, coordination and technical assistance., An effective regional response, guided by the CRSF 2014-2018,therefore requires that the links and interfaces between country programmes and regional support programmes be defined and agreed to by country partners. This is critical for strengthening country ownership of the PANCAP response and a shared responsibility to strategically align efforts to end HIV as a public health problem in the Caribbean. .

Contact:

Timothy Austin

Communications Specialist

PANCAP Coordinating Unit

CARICOM Secretariat

Turkeyen, Greater Georgetown, Guyana

Email: taustin.consultant@caricom.org

Tel: (592) 222-0001-75, Ext. 3409 | Visit www.PANCAP.org