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Four times more Jamaican women than men in the 15 to 19 age group have been reported with AIDS, according to a 2015 epidemiology report.

Against this backdrop, the new Consolidated guideline on sexual and reproductive health and rights of women living with HIV was introduced by the World Health Organisation (WHO) and the Pan-American Health Organisation (PAHO) to the Jamaican multisectoral HIV response group at a three-day workshop in Kingston last Tuesday.

The WHO Consolidated guideline includes guiding principles to a ‘woman-centered’ approach and creating an enabling environment for women and girls living with HIV. It also includes global best practices and recommendations for the implementation of a strategic plan to integrate sexual and reproductive health rights and HIV services, maternal health services, counseling, and community empowerment.

Person-Centred Approach

“We are taking a new approach to reaching more persons that is person-centered and over a life course,” disclosed Dr Manjulaa Nalasimhan, representative of WHO Geneva. “A person-centered approach acknowledges women as active agents, not passive agents, of accessing sexual and reproductive health services and rights,” she added.

According to the National Family Planning Board, socio-economic, cultural, and behavioural factors have made young women and girls three times more likely to contract HIV than boys of the same age group. Although Jamaica has been reaching many of these persons and providing treatment and care, some females are hard to reach. Therefore, the new WHO guidelines will specifically target the female population.

“At a time when women’s rights are just now being acknowledged globally, this workshop is appropriately timed. Our girls are being raised in a society that dictates their sexual and reproductive health outcomes,” said Lovette Byfield, executive director of the National Family Planning Board,

According to the WHO, in 2015, there were an estimated 17.8 million women aged 15 and older living with HIV.

GENEVA – The Global Fund today suspended its partnership with Heineken based on recent reports of the company’s use of female beer promoters in ways that expose them to sexual exploitation and health risks.

“We take these allegations very seriously and have challenged Heineken to examine their operations and make changes to protect women from sexual exploitation and health risks,” said Peter Sands, Executive Director of the Global Fund. “We are suspending the partnership until such time as Heineken can take appropriate action to address these issues.”

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The Global Fund is a 21st-century partnership designed to accelerate the end of AIDS, tuberculosis and malaria as epidemics. As a partnership between governments, civil society, the private sector and people affected by the diseases, the Global Fund mobilizes and invests nearly US$4 billion a year to support programs run by local experts in more than 100 countries. By challenging barriers and embracing innovative approaches, we are working together to better serve people affected by the diseases. 

The PANCAP Knowledge for Health Project conducted an HIV information session with approximately 40 students of the Centre for Communication Studies, University of Guyana.

Dr Shanti Singh-Anthony, Knowledge Coordinator exposed participants to knowledge on the basics of HIV and AIDS, the global and regional HIV epidemiology, HIV diagnosis, disease progression and management and current concepts and frameworks such as the 90-90-90 Targets and Sustainable Development Goals (SDGs) 2030 Target for ending AIDS.

Mr Timothy Austin, Communications Specialist, PANCAP Coordinating Unit provided illustrations of  PANCAP’s use of an integrated marketing and communications strategy to effectively share relevant knowledge and information on the region’s response to HIV and AIDS with a wide range of stakeholders.

Participants were also provided with an illustration of the PANCAP Digital Strategy for website content creation and management of PANCAP’s online platforms.

In an effort to increase awareness of HIV and AIDS, The National AIDS Commission (Belize) collaborated with the Ministry of Labour to provide a two-day workshop to key Labour Officers at the Best Western Biltmore on 15-16 March 2018. The training explored a variety of topics pertinent to HIV prevention and the effects of HIV-related workplace stigma and discrimination.

A total of 22 key Labour Department managers and administrators were present at the two-day workshop. Facilitators of the HIV training included Mr. Arthur Usher, Communication Officer of the National AIDS Commission, Mr. Keron Cacho, Programme Coordinator of the National AIDS Commission, Mr. Antonio Coyoc and Jevan Chavarria of Ministry of Health, Mrs. Eva Burgos of Go Belize, Ms. Derricia Salazar of Our Circle and Ms Dominique Noralez from The National Youth Council of Belize.

Facilitators presented on Belize’s HIV Statistics, the Belize Health and Information System, the concerns and issues surrounding Key Affected Populations in Belize and addressed the many ways in which the Ministry of Labour can assist in alleviating stigma and discrimination.

Facilitators also informed participants of Belize’s commitments to various international Human Rights and HIV service provision targets.

The NAC continues to maintain a dynamic and multi-sectoral approach to the HIV response in Belize.

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.

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).

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.

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. 

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.”

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.