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PANCAP welcomes the Adoption of the 2021 Political Declaration on HIV and AIDS

The Pan Caribbean Partnership against HIV and AIDS (PANCAP) has been engaged over the past months with Member States and Civil Society Organizations (CSOs) to prepare for the United Nations High-level meeting on HIV.

This High-level Meeting is expected to be the springboard for a decade of action to reduce inequalities and root out the social determinants that fuel the HIV epidemic. All Member States were encouraged to participate in this meeting and to let their voices be heard. CSOs were especially encouraged to be part of country delegations since they play an important role in supporting the national and regional response.

The High-level Meeting is a call to action for Caribbean countries to recognize that despite the progress in the Region, there is still a lot of work to be done to fill the existing gaps. Countries must seize the opportunity to maintain their focus and commitment to ending AIDS as a public health threat as part of the 2030 Agenda for Sustainable Development.

PANCAP is pleased to see the progress represented by the new Political Declaration. Although we would have loved to see stronger language in some areas, and we are disappointed by some critical omissions and weaknesses in the Declaration, the Partnership pledges to continue working with all stakeholders in the Region to ensure that these are addressed as work towards ending AIDS continues.

There is much to welcome in the Political Declaration. PANCAP is pleased to see that key populations were named. This will ensure that the focus and response are placed where needed. Key populations have been at the heart of community-led responses to HIV for 40 years. Their continued leadership, along with the leadership of other vulnerable populations – women, adolescents and young people, Indigenous peoples, and people with disabilities – is essential and deserves greater recognition.

For this Political Declaration to mean something to the people affected and impacted by HIV, it must be supported at the highest level, and it must be backed with the financial and other needed resources.

Let us work together to ensure that this Declaration is not only words on paper but also means something to those crying out for our help.  Lets us all work together to END AIDS.

Guyana will make HIV-related discrimination illegal, address needs of LGBTI community – President Irfaan Ali

In a landmark speech to a United Nations High-Level Meeting on HIV and AIDS on Tuesday, President Irfaan Ali declared that Guyana would make HIV-related discrimination illegal and address the needs of key populations.

Guyana looks to end AIDS as a public health threat in the next ten years.

President Ali said that Guyana would make discrimination against people with HIV “unacceptable, illegal, and punitive, throughout society, including Government, the private sector and civil society.”

He said that in the coming years, Guyana would strive to reach “vulnerable groups such as LGBTI (Lesbians, Gays, Bisexual, Transgender, Intersex), sex workers and immigrants.”

The President said Guyana would focus on integrating mental health in all HIV policies and programmes and transforming the current paper-based HIV monitoring system into an IT-based system.

“The Government of Guyana is fully committed to providing universal access to prevention, care and treatment for everyone living with HIV or living under the threat of HIV infections,” the President stated.

He noted that Guyana’s HIV programme results are among the best in the Caribbean. A total of 95% of those living with HIV have been diagnosed. Seventy-three (73%) percent who are aware of their HIV status are on treatment and, almost nine out of every ten of these were virally suppressed.

He also noted that over the past 20 years, Guyana had reduced new HIV infections by more than half in Guyana. While impressive, like many countries around the world, we came close but missed the UN 2020 90-90-90 Targets. In the 2021-2025 period, Guyana is committed to reaching the new UNAIDS global 95-95-95 goal.

According to the President, Guyana has already embarked on a comprehensive Pre-Exposure Prophylaxis programme, ensuring that anyone, anywhere in Guyana, who is at risk of an HIV infection, can access Pre-Exposure Prophylaxis.

“Another innovative focus of our comprehensive response is increasing self-testing,” the President stated.

“We have already integrated testing, diagnosis and treatment for sexually transmitted diseases in our primary health care system. In addition, we are committed to the elimination of gonorrhoea and syphilis in our maternal population.”

See the President’s full speech below:

Secretary-General;

Distinguish Heads of State;

Other Distinguish Delegates;

When my country launched its HIV National Strategic Plan 2021-2025, we re-committed to the UNAIDS Global AIDS Strategy, which aspires to end AIDS as a public health threat by 2030.

The Government of Guyana is fully committed to providing universal access to prevention, care and treatment for everyone living with HIV or living under the threat of HIV infections.

Guyana’s HIV programme results are among the best in the Caribbean. A total of 95% of those living with HIV have been diagnosed. Seventy-three (73%) percent who are aware of their HIV status are on treatment and, almost nine out of every ten of these were virally suppressed.

Over the past 20 years, Guyana has reduced new HIV infections by more than half in Guyana. While impressive, like many countries around the world, we came close but missed the UN 2020 90-90-90 targets. In the 2021-2025 period, Guyana is committed to reaching the new UNAIDS global 95-95-95 goal.

Guyana has already embarked on a comprehensive Pre-Exposure Prophylaxis programme, ensuring that anyone, anywhere in Guyana, who is at risk of an HIV infection, can access Pre-Exposure Prophylaxis.

Another innovative focus of our comprehensive response is increasing self-testing. We have already integrated testing, diagnosis and treatment for sexually transmitted diseases in our primary health care system. In addition, we are committed to the elimination of gonorrhoea and syphilis in our maternal population.

Other key areas of focus in Guyana for the coming period include:

Making the discrimination of HIV unacceptable, illegal, and punitive, throughout society, including Government, the private sector and civil society;

Reaching vulnerable groups such as LGBTI, sex workers and immigrants;

Integrating mental health in all HIV policies and programmes and transforming the current paper-based HIV monitoring system into an IT-based system.

Guyana is keen on ensuring that these areas of focus are reflected in the 2021 Political Declaration.

Distinguished Delegates,

As we gather again for another High-Level Conference on HIV, as we observe the 25th anniversary of the formation of UNAIDS, the global inequity that facilitated AIDS to leave a trail of death for forty years is very much evident as we combat the COVID-19 pandemic. The truth is we still live in two very different worlds. COVID-19 vaccine inequity is a moral dilemma.

Our 2021 Political Declaration emanating out of this meeting must ensure funding for UNAIDS and the Global Fund.

This 2021 High-Level meeting must become a trigger for concerted and sustained action over the next decade to root out the conditions that contribute to and fuel the HIV pandemic.

I thank you.

Caribbean stakeholders call for focus on key populations and community-led approaches to HIV and COVID-19

Caribbean partners from governments, civil society and the development community met on 7 June to discuss regional priorities for the 2021 United Nations High-Level Meeting on AIDS and its resulting political declaration. The virtual Caribbean Caucus was hosted by the Pan Caribbean Partnership against HIV and AIDS (PANCAP) and moderated by the Caribbean Community (CARICOM) Assistant Secretary-General, Dr Douglas Slater.

The PANCAP Director, Dr Rosmond Adams, noted that the Caribbean had made significant progress in key aspects of the HIV response. Eight countries and territories have been validated by the World Health Organization for eliminating vertical HIV and syphilis transmission. And between 2010 and 2020, AIDS-related deaths in the region fell by half (51%).

But to get on track to end AIDS by 2030, he said Caribbean countries must step up the pace around prevention, testing, treatment, care and ending stigma and discrimination. By 2020, 82% of people living with HIV in the region were diagnosed. Two thirds (67%) of all people living with HIV were on treatment, and 59% were virally suppressed.

While new HIV infections have fallen by 28% since 2010, the rate of decline is too slow. Overall, members of key population communities and their partners accounted for 60% of new HIV infections in 2020. Around one-third of new HIV infections were among young people aged 15–24 years.

Speaking on behalf of the Caribbean Regional Network of People Living with HIV (CRN+), Ms Diana Weekes noted that key structural barriers continue to block access to HIV prevention, treatment and care services. These include “stigma and discrimination … lack of privacy, breach of confidentiality and limited redress” when people’s rights have been violated. She noted that no country in the region had adopted the CARICOM Model Anti-discrimination legislation, which was developed almost a decade ago. CRN+ called for greater emphasis on policy and legislative changes and community-led responses to address these structural barriers.

Mr Ivan Cruickshank, the Executive Director of the Caribbean Vulnerable Communities Coalition (CVC), pointed to regional data that show that HIV disproportionately affects key populations, including gay men and other men who have sex with men, transgender people, sex workers and people who use drugs.

“According to the latest UNAIDS report, nations with progressive laws and policies, as well as robust and inclusive health systems, have had the best HIV outcomes. Therefore, we must create inclusive societies in which people are confident in their ability to seek medical treatment and exercise their social and economic rights. We must go beyond declarations to remove laws that continue to criminalize communities and limit young people’s access to sexual and reproductive health and rights,” Mr Cruickshank said.

The Guyana Health Minister and Caribbean representative on the UNAIDS Programme Coordinating Board, Dr Frank Anthony, reaffirmed the region’s commitment to the HIV response, saying that “governments in the region stand ready to do their part in ending AIDS by 2030.”

He pointed to longstanding challenges in the region, such as “removing the legal obstacles that foster discriminatory practices” and “prevention sustainability.” But he also emphasized the new threat posed by COVID-19, noting that “finite financial resources had to be reprogrammed to meet these urgent demands.” He called for increased vaccine equity and a review of plans to transition countries in the region away from international HIV funding.

“We must use the platform available to us at this United Nations High-level meeting to ensure that we highlight our vulnerabilities to the HIV epidemic and the COVID-19 pandemic,” he said.

During discussions, civil society participants also emphasized the profound negative impact of COVID-19 containment measures on lives and livelihoods. They said there was an additional need for solutions to provide nutrition, mental health and financial support to People Living with HIV and members of key population communities.

The Director of the UNAIDS New York Liaison Office, Mr César Núñez, noted that in response to both HIV and COVID-19, the role of communities is clear.

“The response must include a key role for civil society at the table when frameworks are being put together and implemented,” he said.

Mr Núñez ended by calling for CARICOM’s support in securing an ambitious, action-oriented and laser-focused political declaration.

PANCAP Meeting opens with Call to sustain HIV Response as Public Health Systems are challenged with COVID-19

Wednesday, 2 June 2021 (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 Second Special Meeting of National AIDS Programme (NAP) Managers and Key Partners (Virtual), Wednesday, 2 June 2021.   The three-day meeting focused on the impact of the COVID-19 pandemic on national and regional HIV programmes.  The meeting also discussed how countries are coping and adjusting programme delivery during COVID-19 to ensure sustainability.

In his opening remarks, Dr Rosmond Adams, Director, PANCAP, acknowledged that COVID-19 had exposed weaknesses in health systems at the global, regional and national levels. “It is important for us to ensure that the gains made against HIV that are threatened by the disruptions caused by the pandemic are maintained and that we continue to work as a Region to end AIDS by 2030”, stated Dr Adams.

Dr Adams underscored that the epidemic is fueled by stigma and discrimination, marginalisation and criminalisation of communities and lack of access to health, education and other essential services.  He also emphasised that the widening inequity gaps further compounded these factors. Key populations and their partners continue to be disproportionately affected by the epidemic.

The PANCAP Director reiterated PANCAP’s commitment to work with countries and Key Partners to ensure that no one is left behind. “We will continue to advocate for increased domestic funding for HIV”, stated Dr Adams, “We continue to encourage countries to engage Civil Society Organisations (CSOs) and communities by investing in civil society and community-led responses that tailor approaches to the needs of affected communities, particularly Key Populations, and to build strong primary health care systems that can deliver quality, people-centred care”.

Mr Tyrone Ellis, Chair, Caribbean Regional Network of People Living with HIV/AIDS (CRN+), led the meeting in a moment of silence to acknowledge persons who have died from AIDS and COVID-19 in the past year.

“With access to overall health care reduced during this pandemic, lockdowns and physical distancing exposed marginalised populations to a host of other threats including intimate partner violence, income loss, homelessness, and anxiety,” stated the CRN+ Chair.  He expressed gratitude to health care professionals for continuing to offer HIV prevention, treatment, care and support during COVID-19.

Ms Aldora Robinson, Director of Health Promotion and Advocacy Unit, Ministry of Health, Agriculture and Human Services, Turks and Caicos Islands, underscored that there are still gaps in HIV services.  She urged stakeholders to find ways to link mental health resources and People Living with HIV (PLHIV).  She explained that this intervention would make HIV care and treatment for clients more impactful and holistic, especially during COVID-19. She also illustrated how COVID-19 has disrupted services, interrupted supply chains and caused persons to access HIV prevention, care and treatment differently. “These disruptions must be overcome, and lessons must be learned as we move forward”, stated Ms Robinson.

Ms Victoria Nibarger, PEPFAR Coordinator, Caribbean Regional Program, reiterated the U.S. Government’s gratitude to NAP Managers, CSO representatives and key stakeholders for their continued commitment to combating HIV, especially with the COVID-19 challenge.  She highlighted that the U.S. Government had provided more than $55 Million United States dollars in assistance to Caribbean countries to help meet COVID-19 related needs.  “These funds have supported emergency response, risk communications, surveillance, lab capacity, and more”, stated the PEPFAR Coordinator, “ In addition, specific to HIV, our Caribbean team has provided critical food and travel support for vulnerable individuals, as well as personal protective equipment and sanitisers, helping to keep both clients and healthcare workers safe”.

Ms Nibarger highlighted that the Region could anticipate additional new funding via the American Rescue Plan Act, to support the recovery of HIV programmes from COVID-19 related impact and prevent further damage. “For Jamaica and Trinidad and Tobago alone, we have received approval for an additional $1 million United States dollars in assistance, which will help meet needs in lab, mental health, vaccine advocacy, and more,” stated the PEPFAR Coordinator.

In addition, Ms Nibarger explained that the Caribbean Regional PEPFAR Program received approval for the next Regional Operational Plan. “We are so happy to report that we have received a budget increase, to more than $23 Million United States dollars, which we will use to support activities in Jamaica and Trinidad and Tobago, as well as regional programming via PANCAP”, stated the PEPFAR Coordinator.   She also said that PEPFAR is pleased to have the opportunity to extend programming in Guyana, where an additional $1.5 Million United States dollars will be provided to the government and civil society partners through fall 2022.

“We also have separate PEPFAR programmes in Haiti and the Dominican Republic, so it’s a robust presence across the Caribbean – and a signal of our unwavering commitment to working hand-in-hand to see an AIDS-free future for the Region,” stated Ms Nibarger.

Dr James Guwani, Director, UNAIDS Caribbean Sub-Regional Office, declared that 2021 was a year of renewal — an opportunity to take stock of progress, reflect on lessons learned, and lay the groundwork for more optimised HIV responses in the future.  He acknowledged the achievements of National AIDS Programmes and Health Ministries, supported by civil society and the development community to provide treatment to all despite challenges with existing antiretroviral therapy protocols. He reported that at the end of 2020, 82% of PLHIV in the Caribbean were diagnosed, two-thirds of PLHIV were on treatment, and 59% of PLHIV were virally suppressed.

Dr Guwani highlighted that the expansion of rapid testing, community-based testing and more streamlined lab services has contributed to four in five PLHIV being aware of their status by the end of 2020.  However, he underscored that there is a clear path toward even better results.

While referring to the need to address the social determinants that lead to new HIV infections, delayed diagnosis and poor adherence, Dr Guwani urged all stakeholders to ensure that their concerns are included in the 2021 Political Declaration. He also advocated for all stakeholders to participate at the upcoming United Nations General Assembly High-Level Meeting on HIV and AIDS 2021.

Mr Dean Chambliss, Sub-regional Director for the Caribbean, PAHO/WHO, reiterated  PAHO’s commitment to working with its Member States to expand HIV prevention and treatment services based on global evidence-based interventions; while at the same time ensuring universal access and coverage are guaranteed for everyone, including vulnerable populations

He advised that as countries advance in the expansion and provision of high-quality HIV prevention and treatment services, it was necessary to note that achieving universal access and coverage requires a robust integrated approach.  The approach should include integrating services for HIV within primary care facilities and other health conditions, such as other sexually transmitted infections that have not received the same level of attention as HIV.  “Global evidence clearly shows a link between STIs and HIV, and therefore an investment in STIs is an investment in HIV prevention”, stated Mr Chambliss.

He explained that the integration of HIV with Viral hepatitis is of utmost significance as countries advance with the implementation of Pre-exposure prophylaxis (or PrEP) for key populations.  “We know that both Hepatitis B and C are bloodborne, share similar modes of transmission as HIV, and affect key populations”, stated Mr Chambliss, “WHO estimates that Hepatitis C virus affects 2–15% of PLHIV worldwide and up to 90% of those are people who inject drugs”.  He also emphasised that Chronic Hepatitis B viral infection affects an estimated 5–20% of PLHIV.

Based on PAHO’s estimates for the Caribbean, there are approximately 887,000 people chronically infected with Hepatitis B and 240,000 with chronic hepatitis C.  The profiles of these individuals are unknown. Therefore, integrating services for viral hepatitis with HIV will spotlight the public health problem while giving the Region better information on who is affected.

Dr Douglas Slater, Assistant Secretary-General, Human and Social Development, CARICOM Secretariat, applauded the Region’s Public Health workers.  He indicated that a key objective during this time is protecting the gains made in the HIV response as Public Health systems are challenged with managing COVID-19.

He also acknowledged the immense gains the Region has made in the HIV response.  “Through collaborative efforts of CARICOM-PANCAP and Member States, the Caribbean has seen significant achievements at the end of 2019, including a decline in overall regional prevalence from 2.2 % to less than 1.1% in 2019; a decrease in new HIV infections by 29% in the Region since 2010, a reduction in AIDS-related deaths by 37% since 2010 and total antiretroviral treatment coverage for the Region was 63%–71% for women and 56% for men (compared to 5% in 2001).

Dr Slater recognised the tremendous progress with the Elimination of Mother-to-child Transmission of HIV in eight countries, including Anguilla, Antigua and Barbuda, Bermuda, Cayman Islands, Cuba, Dominica, Montserrat and Saint Kitts and Nevis.

The ASG underscored that beyond COVID-19, the Region’s HIV response mandate had expanded significantly with the new targets set out in the UNAIDS’ “Global AIDS Strategy 2021–2026, End Inequalities, End AIDS.”  He reminded participants that Member States have bold new targets and policies to be reached by 2025.

“We already have a roadmap for achieving the targets of the new strategy”, stated Dr Slater, “the theme of ending inequalities and access to health for all is embodied in the PANCAP Model Anti-discrimination Legislation, which despite extensive engagement by PANCAP, has not yet been adopted by any Member State.  Propelled by the new Global AIDS Strategy, it’s time that we change this”.

Dr Slater concluded the opening ceremony by applauding the participants for their dedication to the HIV response, “I challenge you to ensure your voice is heard as we face the challenges of COVID-19 and propel the Region’s HIV response to new heights of success”.

– ENDS –

Contact:

Timothy Austin

Senior Project Officer, Communications

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

Helpful links:

Global AIDS Strategy 2021–2026, End Inequalities, End AIDS

https://pancap.org/pancap-documents/global-aids-strategy-2021-2026-end-inequalities-end-aids/

Caribbean Regional Strategic Framework on HIV and AIDS (CRSF) 2019-2025

https://pancap.org/pancap-documents/caribbean-regional-strategic-framework-2019-2025/

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.

EDITOR’S NOTES

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.

GAINS MADE IN THE REGION’S HIV RESPONSE

  • Through collaborative efforts of CARICOM-PANCAP and Member States, the Caribbean has seen significant achievements at the end of 2019, including a decline in overall regional prevalence from 2.2 % to less than 1.1% in 2019; a decrease in new HIV infections by 29% in the Region since 2010, a reduction in AIDS-related deaths by 37% since 2010 and total antiretroviral treatment coverage for the Region was 63%–71% for women and 56% for men (compared to 5% in 2001).
  • In 2019, 77% of People Living with HIV in the Caribbean knew their status; 81% of those diagnosed were on treatment, and 80% of those on antiretroviral therapy were virally suppressed.
  • The Region achieved tremendous progress with the Elimination of Mother-to-child Transmission of HIV in eight countries, including Anguilla, Antigua and Barbuda, Bermuda, Cayman Islands, Dominica, Montserrat and Saint Kitts and Nevis. Cuba became the first country in the world to achieve elimination in 2015.

Regional Stakeholders to discuss Scaling Up and Sustaining the Regional HIV Response during COVID-19

Tuesday, 18 May 2021 (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 convene a virtual three-day meeting of National AIDS Programme (NAP) Managers, Civil Society Organisations (CSOs) and Key Partners, 2 – 4 June 2021 to discuss the impact of the COVID-19 pandemic on national and regional HIV programmes.  The meeting will also discuss how countries are coping and adjusting programme delivery during COVID-19 to ensure sustainability.

Stakeholders will also decide how the Partnership and Key partners can support countries in ensuring programme continuity despite disruptions.

The meeting is occurring several weeks after the Joint United Nations Programme on HIV/AIDS (UNAIDS) launch of the Global AIDS Strategy 2021–2026, End Inequalities, End AIDS.  The strategy focuses on inequalities and closing the gaps hindering progress to end AIDS.  It sets out new targets and policies to be reached by 2025.

Dr Rosmond Adams, Director, PANCAP, stated that the meeting is critical to the new trajectory of the Region’s HIV response as countries continue to be challenged by COVID-19.

“A survey conducted by PANCAP and Pan American Health Organisation (PAHO) last year showed that during 2020, facility-and community- based HIV testing services reduced by two-thirds (69%) in countries due to COVID-19”, stated Dr Adams, “The meeting will facilitate essential discussions on how national programmes and civil society organisations can collaborate to ensure continuity of access to HIV prevention, care and treatment for the most vulnerable populations”.

The PANCAP Director also expressed concern about protecting the gains made in the HIV response even as the Region is experiencing another wave of COVID-19 infections.  “COVID-19 has strained health systems and exposed gaps in public health”, stated the PANCAP Director, “From the highest levels of national leadership to community-based health facilities, human, financial, and research resources were diverted from HIV efforts”.

He indicated that it is critical for stakeholders at the upcoming meeting to reach a consensus on advocating and encouraging governments and policymakers to increase, maintain, and guard domestic resources allocated for HIV.

The forum is also occurring as the world marks 40 years since the first cases of AIDS were reported and prior to the upcoming United Nations General Assembly High-Level Meeting on HIV and AIDS 2021. The outcome of the meeting will determine the continued success of the HIV response in the face of strained public health systems and what the response will look like in the post-COVID Caribbean.

– ENDS –

Contact:

Timothy Austin

Senior Project Officer, Communications

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

Helpful links:

Global AIDS Strategy 2021–2026, End Inequalities, End AIDS

https://pancap.org/pancap-documents/global-aids-strategy-2021-2026-end-inequalities-end-aids/

Caribbean Regional Strategic Framework on HIV and AIDS (CRSF) 2019-2025

https://pancap.org/pancap-documents/caribbean-regional-strategic-framework-2019-2025/

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.

EDITOR’S NOTES

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.

GAINS MADE IN THE REGION’S HIV RESPONSE

  • Through collaborative efforts of CARICOM-PANCAP and Member States, the Caribbean has seen significant achievements at the end of 2019, including a decline in overall regional prevalence from 2.2 % to less than 1.1% in 2019; a decrease in new HIV infections by 29% in the Region since 2010, a reduction in AIDS-related deaths by 37% since 2010 and total antiretroviral treatment coverage for the Region was 63%–71% for women and 56% for men (compared to 5% in 2001).
  • In 2019, 77% of People Living with HIV in the Caribbean knew their status; 81% of those diagnosed were on treatment, and 80% of those on antiretroviral therapy were virally suppressed.
  • The Region achieved tremendous progress with the Elimination of Mother-to-child Transmission of HIV in seven countries, including Anguilla, Antigua and Barbuda, Bermuda, Cayman Islands, Montserrat and Saint Kitts and Nevis, in 2017. Cuba became the first country in the world to achieve elimination in 2015.

US Govt. gives Guyana US$1.5M to support HIV fight

The United States Government has renewed its support towards the fight against HIV in Guyana with a grant of US$1.5 million geared at assisting the country in crossing the finish line in controlling the HIV epidemic here.

The grant is part of the US President Emergency Plan for AIDS Relief (PEPFAR), under which Guyana has already benefitted from some US$185 million for HIV prevention, testing, care, and treatment programmes since 2004.

Speaking at a press conference on Friday, US Ambassador to Guyana, Sarah-Ann Lynch, said the partnership between the two countries on the HIV epidemic has saved lives.

Ambassador Lynch noted that this new grant would support the Ministry of Health and civil society partners until September 2022 in their fight against HIV.

She noted that Guyana had made significant strides on this front, with over 90 per cent of persons living with HIV knowing their status, which is critical for them to have access to life-saving HIV treatment. However, in the same breath, she pointed out that much more needs to be done in the area of treatment.

“With treatment, individuals’ health can be sustained, and the levels of the virus can be reduced so low that the virus cannot be transmitted to others.

However, of every four individuals diagnosed, only three are on treatment. This is not enough – and lives are at stake. Therefore, our priority must be to increase treatment coverage, aiming to ensure that everyone diagnosed with HIV is immediately linked to life-saving treatment services. We believe strongly that services must be client-centred, meeting individuals where they are, with what they need. Our PEPFAR support will help strengthen this, including for the most vulnerable,” the US diplomat posited.

Against this backdrop, Health Minister Dr Frank Anthony reassured the US diplomat that this US$1.5 million grant would be injected into addressing HIV treatment and other critical areas, where efforts have been lagging due to the COVID-19 pandemic.

“We have developed a strategy of introducing self-testing, and so we want to roll that out, and we’re going to do more on that to roll it out. But this is going to ensure that we get more people to test and to know their status… We are aiming to get more people into treatment, and therefore, we are going to work – using some of the resources from this grant – to get some of the people who were on treatment and fell off to get them back on treatment. And also, for some of the people who know their status but were not linked to treatment sites, we’ll be able to do some of that as well. So, we’ll be able to increase those numbers to get closer to the desired numbers that we’re looking for… but that’s going to take a lot of work,” the Minister posited.

Dr Anthony explained that another area they will be using this grant for is to ensure that those HIV persons on treatment become virally suppressed and unable to transmit the infection.

But the Health Minister noted that one of the challenges they have been facing is not being able to do viral loads for all the patients who need it. As such, he said monies would be directed into addressing the viral loads needs.

Additionally, efforts are also afoot to eliminate mother-to-child HIV transmission. He explained that there are still a few cases of HIV transmission from mothers to their unborn child, and one way they are looking to eliminate this by testing exposed babies with dry blood spots.

“For a number of years, Guyana was not able to do that properly, and so we are now introducing this process of dry blood spots. And this grant is also going to help us with that. We also have decided to provide PrEP (medicine people at risk take to prevent getting HIV) for all persons who want PrEP. Before, this was quite limited to discordant couples, so we want to now make sure that anyone who feels at risk could come into any one of our clinics and get PrEP. Again, we’re going to get some assistance through this grant,” Dr Anthony stated.

On this note, the Health Minister acknowledged that a lot of work has to be done for Guyana to achieve its 90-90-90 UNAIDS goal, which aims to ensure that 90 per cent of all people living with HIV will know their status, 90 per cent of all people diagnosed will receive sustained antiretroviral therapy (ART), and 90 per cent of all people receiving ART will have viral suppression, all by 2020.

However, Minister Anthony said because of the COVID-19 pandemic, Guyana could not achieve all three of the 90s.

“In terms of testing, getting people to know their status, about 93 per cent of those persons who have been tested know their status… We want 90 per cent of those patients who know their status to be on treatment, and unfortunately, when we look at our 2020 statistics, we only have about 74 per cent of those patients who have been on treatment. And of those who have been on treatment, we want at least 90 per cent of them to be virally suppressed, and in 2020, we’re seeing only about 69 per cent of those patients have been virally suppressed,” he noted.

The Minister further added, “So for us to really work to achieve the 90-90-90, and even to get to the 95-95-95 by 2025, there is still a lot of work to be done. And that’s why it’s so important that this grant is coming at this time… It is going to help us to focus on all three of these 90s and try to get us close to where we ought to be and even aspire to get to the 95s.”

Dr Anthony went on to laud the partnership between Guyana and the US because local capacity has been tremendously enhanced to fight against the HIV epidemic.

Dominica eliminates Mother-to-Child Transmission of HIV and Syphilis

The country is the eighth in the Caribbean to receive validation from WHO for the dual elimination. New HIV infections among children in the Caribbean declined by nearly 40% between 2019 and 2010. Reported cases of congenital syphilis are at 9.6 cases per 100,000 newborns, well below the goal of no more than 50 cases per 100,000 newborns.

Washington, D.C., May 14, 2021 (PAHO) – Dominica today celebrated its World Health Organization certification for the elimination of mother-to-child transmission of HIV and syphilis. With the achievement, Dominica joined seven other Caribbean countries that have received the dual validation, demonstrating continuing regional progress against the two diseases.

During a virtual celebration today, Dominica Prime Minister Hon. Roosevelt Skerrit said “what we are celebrating here is truly a remarkable achievement. Eliminating mother-to-child transmission of HIV and syphilis as a public health concern requires the strengthening of primary prevention and treatment services for HIV and syphilis for pregnant women within an established and successful maternal, perinatal and child health services.”

Dr Carissa F. Etienne, WHO Regional Director for the Americas and Director of the Pan American Health Organization (PAHO), said, “Dominica’s journey to this ambitious achievement represents a cumulation of years of expanding the capacity of its primary care services to address communicable diseases and adopting harmonized and integrated approaches to improving the health outcomes for women and their children within maternal and child health services.”

While Dominica received the certificate for elimination during the ceremony today, the country was recommended by WHO for certification last September.

New HIV infections among children in the Caribbean declined by nearly 40% between 2019 and 2010 – the year that the Regional Initiative for the Elimination of Mother-to-Child Transmission of HIV and Congenital Syphilis in Latin America and the Caribbean was launched. During that period, the number of cases declined from 3,400 to 1,500. Reported cases of congenital syphilis in the Caribbean are now at 9.6 cases per 100,000 newborns, well below the goal of no more than 50 cases per 100,000 newborns.

The seven other Caribbean countries and territories that have received the dual certification are Cuba in 2015 and Anguilla, Antigua and Barbuda, Bermuda, Cayman Islands, Montserrat and Saint Kitts and Nevis in 2017. Worldwide, the rest of the countries that have received the certification include Maldives (2019), Sri Lanka (2019), Malaysia (2018), and Armenia (HIV only), Belarus and Moldova (syphilis only), and Thailand (HIV and syphilis) in 2016.

Dr James Guwani, Director for the Caribbean Sub-regional Office of UNAIDS, noted that Dominica’s success brings the country and region a step closer to ending AIDS. “Dominica’s achievement in ensuring that its children are born free of HIV is truly inspiring and is testament to the combined strength and leadership of government, civil society activists and communities living with and affected by HIV. By putting people first, we can end the AIDS epidemic,” he asserted.

Jean Gough, UNICEF’s Regional Director for Latin America and the Caribbean, said, “From now on, every child will be born free of HIV and congenital syphilis in Dominica. No mother will transmit these diseases to her children. Today is a moment of pride for the country, but also a source of hope for many others in Latin America and the Caribbean.”

Dr Rosmond Adams, Director of the Pan Caribbean Partnership against HIV and AIDS (PANCAP), described the elimination as remarkable. “This is a commitment by Dominica that no child is born with HIV or congenital syphilis. It is also an indication of the country’s commitment and the hard work of the health care providers to reduce new HIV infections, which is a key strategy towards achieving the 2030 Sustainable Development Goals.”

Dominica’s efforts to achieve elimination were intensified and accelerated under the umbrella of the Regional Initiative for the Elimination of Mother-to-Child Transmission of HIV and Congenital Syphilis in Latin America and the Caribbean, coordinated by PAHO and UNICEF with support from other regional partners.

LINKS

Virtual celebration of certification of elimination of mother-to-child transmission of HIV and syphilis (English)

Virtual celebration of certification of elimination of mother-to-child transmission of HIV and syphilis (Spanish)

Global Validation of Elimination of Mother-to-Child Transmission (EMTCT) of HIV and Syphilis

Regional Initiative for Elimination of Mother-to-Child Transmission of HIV and Congenital Syphilis in Latin America and the Caribbean

Video – Dominica’s Road to EMTCT Validation

Gender-Based Violence – The Quiet pandemic holding back HIV Progress

The COVID-19 pandemic has exposed and exacerbated existing inequalities within countries and across the globe. Gender-based Violence (GBV), an expression of gender inequality and toxic masculinity, is another pandemic that exists in all societies at varying degrees of prevalence and severity.

GBV has been a significant problem before the COVID-19 pandemic and continues to occur, impacting the lives of many. Unfortunately, this situation has not received the type of attention that it should get, and, in some places, it goes on quietly.

GBV requires the same effort and attention that governments globally have given to COVID-19. With many countries under lockdown due to governments’ response to COVID-19, GBV has increased significantly. This increase is a reminder of the need to have a contingent mitigating mechanism to protect the marginalized, women and girls, against a co-existing pandemic.

In the Caribbean, nearly half of Caribbean women surveyed in five Caribbean countries face at least one form of violence; physical, sexual, economic, or emotional. This is way above the global average of one in three women who suffered physical and/or sexual violence by an intimate partner in their lifetime. This is unacceptable and should motivate all of us working and living in the Caribbean into action to end this violence.

Gender inequality links GBV and HIV as one of two indirect pathways that have a more significant impact on HIV transmission than the direct pathways. In societies where patriarchy and unequal gender norms are deeply entrenched, men are more likely to perpetrate sexual violence, pay for sex, and are less likely to use condoms.

Intimate partner violence is also an indirect risk factor for HIV acquisition. Women who experience intimate partner violence have more mental health issues, including depression and anxiety, higher use of alcohol and less control over their sexual decisions. Experiences of intimate partner violence increase the likelihood that a woman will acquire HIV by up to 55%.

If we are to end AIDS in the Caribbean Region, we must tackle this silent pandemic immediately. GBV is a significant contributor to the HIV epidemic. There is growing evidence that GBV is not only a human rights violation but also a barrier to HIV prevention, treatment, and care.

The Commonwealth of Dominica achieves EMTCT certification

The Caribbean has achieved another significant milestone in the fight to end AIDS.  The Commonwealth of Dominica was certified by the World Health Organisation (WHO) for the Elimination of Mother-to-Child Transmission of HIV and Syphilis (EMTCT) in 2020.  The certification was granted following a thorough in-country validation assessment by the Regional Validation Committee, an independent body responsible for EMTCT certification.

Dominica joins six Caribbean countries that have been validated for EMTCT, including Anguilla, Antigua and Barbuda, Bermuda, Cayman Islands, Montserrat and Saint Kitts and Nevis. In April 2015, Cuba became the first country in the World to achieve EMTCT validation and was recertified on 1 December 2017.

The Pan American Health Organisation/World Health Organisation (PAHO/WHO), the Caribbean Community (CARICOM) and other regional stakeholders have extended congratulatory messages to Dominica on the achievement.

A virtual ceremony highlighting the country’s achievement is scheduled for 14 May 2021.  Key stakeholders from PAHO/WHO, UNAIDS and CARICOM, are expected to deliver remarks at the virtual event.

For more information on the certification ceremony, visit the PANCAP event web page here.  To register for the event, click here.

HIV self-test prices to be slashed in half in 135 countries

Poorer countries are set to see their access to HIV self-tests increase dramatically following a deal to slash prices in half and boost production, Unitaid said Wednesday.

The international health agency said it had closed a deal with US-based global healthcare company Viatris that will see blood-based HIV self-tests made available for under $2 across 135 low and middle-income countries.

HIV self-tests are seen as vital tools to help people more easily discover their status and move towards the treatment they need, and thus also to reducing the HIV burden globally.

This is particularly relevant in poorer countries, where concerns around stigma and difficulties accessing healthcare can create significant barriers, said Unitaid, which works on innovations on major diseases.

“Access to self-tests has been recognised as a key factor in meeting the global goal of 90% of people knowing their HIV status,” Unitaid spokesman Herve Verhoosel said in a statement.

In just the past six years, that rate has nearly doubled, from 45 to 81 percent, he said.

But achieving broader testing has been hampered by the fact that the market for HIV self-tests in low- and middle-income countries has been dominated by a single affordable oral HIV test, the OraSure.

That test is sold at cost in a limited number of poorer countries for $2, but elsewhere the price is higher, and other options have cost significantly more.

– Eight million unaware of status –

To try to fix that problem, Unitaid and US non-profit Population Services International (PSI) launched a call for proposals last July on ways to drive forward access to the tests.

The result was the Viatris deal, which Unitaid said should significantly expand the market and give countries more choice when it comes to self-tests.

This, Verhoosel said, would make “it easier to acquire the products and embed them in health systems, with the ultimate aim of helping the eight million people estimated to be unaware of their HIV status know they are infected and get treatment.”

Meg Doherty, who heads the World Health Organization’s global HIV, hepatitis and STI programmes, hailed “the wider availability of affordable HIV self-testing kits to increase access to testing.”

She said Wednesday’s announcement was timely at a time when the Covid-19 pandemic had in many places complicated access to a range of HIV services.

Self-testing allows “people to test when other options are difficult to access or restricted,” she said.

In addition to Viatris, Unitaid said another recently developed blood-based HIV self-test from US-based health care company Abbott Laboratories, which is currently undergoing regulatory review, would also be part of the expanded Unitaid programme, which would see around one million tests distributed “to stimulate in-country demand”.