The Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM) Agreement MAC-910-G02-H entitled “Fighting HIV in the Caribbean: a Strategic Regional Approach” was signed on behalf of the CARICOM Community on 5 October 2010.

This grant was guided by the Caribbean Regional Strategic Framework on HIV and AIDS 2008‐2012 (CRSF), and the GFATM’s mandates to focus on equitable access to services by key affected populations including sexual minorities, to respond directly to the current, documented epidemiological situation, and to use country‐oriented and results‐driven approaches.

This project grew out of a broadly inclusive consultative process to develop the Caribbean Regional Strategic Framework, CRSF. Contributions were made by a variety of stakeholders, including national agencies (28), Caribbean civil society agencies (6), regional health organizations (7), international development agencies (7), United Nations agencies (7), and international health and private sector collaborators (7).

The GFATM awarded a total of US$29,812,507 to the Pan Caribbean Partnership Against HIV/AIDS (PANCAP) for a period of five years. The grant was implemented in two Phases; Phase 1 January 2011 – December 2012 and Phase 2 January 2013 – December 2015. A total of $12,434,018 was available for Phase 1.

Project Goals and Objectives

Goals

The larger project goals were those of the CRSF:

• to reduce the number of new infections;
• to lower mortality due to HIV; and
• lessen the social and economic impact of HIV and AIDS on households, each by 25% (CRSF,p.21).

Objectives

To contribute to achieving the goals, the project pursued five objectives. These corresponded to five of the six CRSF Priority Areas. The sixth CRSF Priority Area, multi-sectoral coordination, was a cross cutting theme.

• Objective 1: An enabling environment that fosters universal access to HIV services.
• Objective 2: Reduced HIV transmission in vulnerable populations.
• Objective 3: Lower PLH morbidity and mortality (in the small islands of the OECS)
• Objective 4: Improved human and laboratory resources (health systems strengthening).
• Objective 5: Better information on the epidemic and the response.

Project Beneficiaries

Countries

The 16 beneficiary countries were:
Antigua and Barbuda, Belize, Bahamas, Barbados, Dominica, Dominican Republic, Grenada, Guyana, Haiti, Jamaica, Montserrat, St Kitts & Nevis, Saint Lucia, St Vincent & The Grenadines, Trinidad & Tobago, and Suriname.
Populations

• Men who have sex with men (MSM)
• Sex workers (SW)
• Drug users (DU)
• Prisoners
• Youth (including in-school and churches, and marginalized youth)
• Migrant and mobile populations
• People Living with HIV (PLH)

Sub-Recipients and Sub-Sub-Recipients

The project was implemented by seven sub-recipients (SRs):

• Center of Orientacion and Integrated Investigacion (COIN)
• Organisation of Eastern Caribbean States (OECS)
• University of the West Indies (UWI)
• Caribbean Medical Laboratory Foundation (CMLF)
• Caribbean Health Research Council (CHRC)
• PANCAP Coordinating Unit (PCU)
• Education Development Council (EDC)

COIN had one Sub-Sub-Recipient, the Caribbean Vulnerable Coalition (CVC). The PCU had four Sub-Sub-Recipients. These are:

• International Labour Organisation (ILO)
• Caribbean Broadcast Media Partnership on HIV/AIDS (CBMP)
• Caribbean Network of People Living with HIV (CRN+)
• Caribbean Conference of Churches (CCC) (Phase 2).

Rationale for a multi-country approach

As the regional coordinating body for HIV, the Pan Caribbean Partnership against HIV/AIDS (PANCAP) fosters cooperation and facilitates access to regional public goods and services that support the region’s response to the epidemic, guided by the Caribbean Regional Strategic Framework 2008-2012 (CRSF). The rationale for its multi-country approach to the issues targeted by this proposal is rooted in characteristics of the Caribbean region:

• Very small countries lack critical mass – social and economic capacity – to effectively meet on their own the complex demands of the response to the HIV epidemic. Regional cooperation makes them stronger.
• The diversity of capabilities on the larger islands and the different situations of the small ones provide opportunities to learn from one another and to share specialised skills and services across the region.
• The conservative societies tend to impose conformity, foster stigma and discrimination, and drive vulnerable populations underground, thus hindering access to services and to data on the epidemic; yet a need to keep up with evolving norms and cultural innovations in the region can help break down isolation and facilitate change.
• Migration and mobile populations have long connected Caribbean countries to each other and with the outside world. Some populations relevant to HIV, like sex workers and MSM, move fluidly among countries; yet barriers of language or legal status exclude many migrants from access to health services. Solutions require a regional perspective and reciprocal policy arrangements.
• Public health policy decisions in socially and culturally sensitive areas like those associated with sexuality and HIV can be delayed or deformed by shrill interest groups at the country level. Evidence-informed regional consensus allows sensitive issues to be addressed more widely and can help national leaders finesse resistance and achieve needed policy and legislative reform.
• There is a strong tradition of regional cooperation to face challenges like these, with existing cultural and political frameworks that lend substance to the regional HIV response. This has involved regional governmental institutions and public health agencies, as well as civil society organisations and networks.

How this regional project addressed needs/gaps in the national plans

This project addressed priority needs/gaps identified by the participating countries in their National Strategic Plans (NSPs) and in the CRSF that in addition met other criteria:

• they require regional action or particularly benefit from it.
• coincide with Global Fund priorities
• ensuring equitable access to services by men and women of all ages and by key affected populations including sexual minorities;
• responding directly to the current, documented epidemiological situation;
• leading to country-driven and outcome-focused interventions; and
• strengthening national, sub-national, and community systems (including those of most-at-risk-population (MARP) and PLH communities to increase demand for, access to, and quality of services.
  will not be covered by other regional programmes.
• are within the implementing capacity of the regional organisations that proposed them.