Caribbean

Imagine being widely blamed for tragedies that befall your country. Earthquakes. Hurricanes. Floods.

Now imagine being excluded from disaster response efforts because of this.

Lesbian, gay, bisexual and transgender (LGBT) people in Haiti face profound prejudice. Discrimination often undermines life chances. Education and employment opportunities erode. Even accessing healthcare can be difficult.

Founded in 1999, the SEROvie Foundation pairs health promotion for the LGBT community with human rights advocacy and socioeconomic empowerment. Today the organization operates projects in nine geographical departments.

UNAIDS supports SEROvie to ensure that the needs of key population communities are addressed during disaster responses. This intervention ensures people living with HIV continue to receive HIV treatment and have timely access to aid. Beyond the emergency phase, beneficiaries get support to resume generating incomes and reintegrate into their homes. They also receive psychosocial support to cope with grief and trauma.

In 2016 SEROvie founded the J.C Ménard Clinic in Port au Prince. This clinic serves LGBT people and other key populations including female sex workers and their clients. Here SEROvie has distilled more than two decades' experience in providing health and social support into a complete service package.

With the assistance of several collaborators including the U.S. Agency for International Development (USAID), J.C Ménard offers a range of free-to-user services addressing gender-based violence, stigma and discrimination, family planning and HIV prevention, including PrEP. It also provides HIV, STI and TB treatment and care. 

At the in-house laboratory, technicians manage both diagnostics and treatment monitoring. They track individual journeys from positive test to viral suppression. Over the last year the clinic provided facility-based HIV testing for 6,000 people and supported HIV treatment management for over 1,500 clients. Apart from dispensing patients' medicines, the clinic coordinates with other treatment facilities to ensure there are no stockouts and drugs do not expire.

Social workers conduct individual assessments to determine clients' needs. Psychologist, Darline Armand says the most important moment in her work is the first interaction after someone has been diagnosed.

"They need to feel safe," she says.

Peer Supervisor, Gregory Jacques, explained that the clinic employs both peer education and peer navigation as strategic approaches. Educators engage clients about relationships, risk and safety, providing accurate information. Navigators are themselves people living with HIV who walk others through the treatment and care process.

"The thing that makes a difference is that they know you are just like them," one navigator explains.

In the community room clients learn about health and relationships through fun activities. This is also where they meet for support groups and dialogues.

The Monitoring and Evaluation team measures programme performance with painstaking detail. They track everything from the number of people living with HIV identified through index testing to the number of sensitization sessions conducted with Voodoo priests. Over the past year more than 15,000 people received awareness-raising messages on HIV, GBV, stigma and discrimination from the clinic. Over 1,500 people benefit from comprehensive HIV care and treatment services while more than 1,500 are on PrEP.

Steeve Laguerre, SEROvie's co-founder, reflects on the organization’s journey with both awe and clarity.

"The services we provide are entirely determined by the needs of the people we serve," he says. "We seek funding that aligns with their demands. The work is always client-driven." 

This client-centred approach is valuable for the wider Caribbean. According to the 2022 Global AIDS Update, In Danger, last year four of five new infections in the region were linked to key population communities and their sexual partners. At the same time, most of the funding for regional combination prevention activities with key populations comes from international sources. 

“Community-led strategies for patient care help reduce late diagnosis and loss to follow-up while improving treatment outcomes,” said Dr. Christian Mouala, UNAIDS Country Director for Haiti. “These approaches must be adequately resourced and integrated into the national response.” 

Last week Antigua and Barbuda’s High Court struck down laws criminalizing sexual acts between consenting, adult, same sex partners. Orden David, a gay man, brought the case.

In some ways, he’s an unlikely candidate. He describes himself as “private” and “quiet”—characteristics that make him an excellent HIV counsellor and tester. By day he works for the Health Ministry of the very government he challenged. For the past eight years clients have trusted him to treat their interactions with care and confidentiality. He almost seems wired for discretion.

When asked about the personal experiences that compelled him to become the face for a challenge to his country’s “buggery” laws, he’s reluctant to recount them. But the laundry list is included in the judgment.

Slurs.

Insults.

Bullying throughout school.

Photos taken by strangers and posted to social media.

Two unprovoked physical attacks: one on the street at night, another at work.

And most upsetting for Mr David, a string of interactions with police officers who either harassed him or seemed entirely unmotivated to offer the protection afforded to other citizens. Once when he tried reporting a robbery, an officer responded, “Why are you gay?”. Another time police officers neglected to notify him about a court appearance and the case against his assailant was thrown out.

Throughout the Commonwealth Caribbean, homophobic attitudes are not just a matter of personal opinion or conservative religious teaching. In many minds they are sanctioned by states that have retained laws dating back to the 19^th century which criminalize same-sex relationships.

A 2014 online survey of men who have sex with men in the Caribbean commissioned by UNAIDS found that within the past month one-third (33%) of respondents had been stared at or intimidated while almost a quarter (23%) experienced verbal abuse. About one in ten (11%) reported being physically assaulted in the past five years.

Mr David has a unique perspective on how these dynamics—intolerant social attitudes, homophobic abuse, punitive laws and a lack of legal protection—affect the LGBT community’s access to HIV services. He’s had clients refuse to accept calls or show up to treatment after testing positive.

“Because the country is so small and everybody knows everybody, there is a lot of fear,” he explains. (Antigua and Barbuda has a population of 98,000 people.) “People are scared to access services on their own or even pick up their medicines. I normally pick up stuff for people. At the Ministry of Health we distribute condoms and lubricants for free, and the test is free. The access is good, there is no doubt. But persons are sometimes not brave enough.”

The second claimant in the case was the non-governmental organization Women against Rape (WAR). For many years WAR has provided counselling to people from key and vulnerable communities. The group submitted that members of the lesbian, gay, bisexual and transgender (LGBT) population were often fearful of being treated in a hostile manner by healthcare workers, resulting in some avoiding HIV testing, treatment and follow-up care.

“HIV has been branded by society as a disease linked to immoral behaviour,” said Alexandrina Wong, WAR’s Executive Director. “Coupled with the stigma entrenched in our laws and policies, this creates a hostile environment for vulnerable populations, especially men who have sex with men, sex workers and transgender people who have already been pushed to the very margins of society. There is every indication that this contributes to the transmission of HIV.”

A 2021 round-up of research on human rights, HIV and men who have sex with men (MSM) by UNAIDS found worse outcomes across the testing and treatment cascade for LGBT people in countries where they are criminalized. Those living in states with the most repressive laws were three times less likely to be aware of their HIV status than counterparts in other places. And MSM in countries with criminal penalties were found to be between two to five times more likely to be living with HIV as those in countries without punitive laws.

The Antigua and Barbuda case was one from a five-country litigation strategy coordinated by the Eastern Caribbean Alliance for Diversity and Equality (ECADE). ECADE Executive Director, Kenita Placide, reflected that the initiative started in 2015 when activists gathered to discuss how punitive laws in the Caribbean increased stigma, discrimination and even violence.

“The process of litigation is important, as it underscores how these laws contribute to the stigmatisation of LGBT people, how they legitimise hate speech, discrimination and violence and tear at the fabric of our society. Our governments have sworn to protect and uphold the rights of all and act in a manner that promotes the prosperity and well-being of all. This judgment is in keeping with this commitment,” they said.

The partners in Antigua and Barbuda know law reform isn’t a magic bullet. But they consider it an important step forward toward ending the inequalities that drive HIV, injustice and lack of access to opportunities.

“We now have safety under the law. We have to look at how we get members of the family and church to see people as equal regardless of sexual orientation, class, creed or anything like that. The judgement paves the way for higher levels of acceptance for inclusion and diversity,” Ms Wong ended.

UNAIDS

The Joint United Nations Programme on HIV/AIDS (UNAIDS) leads and inspires the world to achieve its shared vision of zero new HIV infections, zero discrimination and zero AIDS-related deaths. UNAIDS unites the efforts of 11 UN organizations—UNHCR, UNICEF, WFP, UNDP, UNFPA, UNODC, UN Women, ILO, UNESCO, WHO and the World Bank—and works closely with global and national partners towards ending the AIDS epidemic by 2030 as part of the Sustainable Development Goals. Learn more at unaids.org and connect with us on Facebook, Twitter, Instagram and YouTube.

COVID-19 is having a devastating impact on the Jamaican economy. In 2020, the economy declined by more than 5%. According to the World Bank, the poverty rate increased from 19% in 2018 and 2019 to about 23% in 2020. Working women have been among the most affected by the crisis, accounting for approximately 78% of health-care and humanitarian employees and 55% of staff in industries that are highly susceptible to COVID-19, including commerce and tourism. Jamaica’s tourism industry, for example, which reached 4.2 million visitors in 2019, plummeted in 2020 and 2021 as a result of the global travel restrictions related to the pandemic.

In response, the Jamaican Government has implemented a series of recovery strategies, including a reduction in taxes. It also launched the COVID-19 Allocation of Resources for Employees (CARE) programme, aimed at assisting workers and businesses during these difficult times.

People living with and affected by HIV have also felt the impact. The strains caused by COVID-19 on health-care workers and facilities, compounded by loss of income and movement restrictions, have generated disruptions in access to HIV and other health-related services.

In response, Jamaica’s National Family Planning Board and UNAIDS, in partnership with key stakeholders in the design and implementation of the country’s social protection strategy, including the Ministry of Labour and Social Security, the Planning Institute of Jamaica, the Ministry of Local Government and Rural Development and civil society organizations, collaborated to produce an assessment of national social protection and HIV. The assessment provided a mapping of social protection services in the country, identified gaps in outreach and opportunities to respond to the specific needs of people living with and affected by HIV, such as increasing awareness on the existence of and application requirements to benefit from these programmes, and provided recommendations for the improvement of social protection.

Of the more than 100 people questioned, a considerable number were not aware of the existence of social protection programmes, despite several programmes being offered in the country. There was also an apparent lack of clarity on who is eligible to participate in the programmes. In general, people living with HIV, specifically mothers less than 25 years old who are living with HIV, are among the populations facing the most barriers in accessing HIV and social protection programmes in Jamaica, particularly the Programme of Advancement Through Health and Education (PATH). For example, to apply for PATH, a family score is assessed, which includes all members of the family. Where the family is deemed not poor, it would not qualify for PATH, including the young mother.

“Social protection schemes are critical for ending the AIDS epidemic because they address socioeconomic inequalities, which fuel HIV risk and vulnerability, including stigma and discrimination and other human rights abuses, by breaking down barriers to accessing HIV services,” said Richard Amenyah, the UNAIDS Country Director for Jamaica.

Among its recommendations, the assessment stressed the importance of raising awareness of existing social protection programmes, revising the selection criteria for social assistance, digitalizing enrolment and transfer payments, enhancing local coordination and consolidating labour market programmes.

“Social protection programmes play an important role in cushioning society’s most vulnerable from the harsh social and economic realities brought about by circumstance such as the COVID-19 pandemic. As such, the recommendations of this assessment can only enhance existing social protection programmes and strengthen multisectoral collaboration in this area for the benefit of those most affected, including persons living with HIV,” said Lovette Byfield, the Principal Director of the National Family Planning Board.

Michael James (not his real name) was shell-shocked when he was fired. He scanned the dismissal letter. It cited his performance and tardiness as reasons for the job loss. But years of performance appraisals told a different story. He’d consistently received positive evaluations and there were no memos about late-coming or substandard work on his file. The only reason he could discern was that colleagues recently learned that he was living with HIV.

HIV-related prejudice remains rife in Jamaica. One third of people living with HIV responding to the 2020 Jamaica People Living with HIV Stigma Index reported experiencing stigma and discrimination. Verbal harassment, gossip and discriminatory remarks were the most common violations. But one in 10 said they were refused employment or lost a source of income because of their HIV status. No legislation prohibits a Jamaican employer from discriminating on the basis of HIV status.

This has marked implications for the HIV response. Twenty-one per cent of respondents were worried about mistreatment or confidentiality breaches by health-care workers. Thirty-eight per cent delayed testing and 29% delayed starting treatment because of concerns about how they would be treated.

Shelly John (not her real name) recounts hopping from one treatment site to another before landing at Jamaica AIDS Support for Life. At other facilities she overheard nurses gossiping about patients’ medical histories.

“I felt uncomfortable. If I am hearing about other clients, other clients can come inside and hear about me as well,” she reasoned.

“The fear of stigma drives some persons underground and away from much needed health services. Owing to stigma and discrimination, some persons delay accessing needed services and, as a result, some are diagnosed with HIV at an advanced stage,” acknowledged State Minister in the Health and Wellness Ministry and Chair of the Jamaica Partnership to Eliminate HIV-Related Stigma and Discrimination, Juliet Cuthbert Flynn.

Jamaica’s testing and treatment outcomes bear this out. While an estimated 86% of people living with HIV were aware of their status in 2020, just 40% of people living with HIV were on HIV treatment.

While the Jamaica Charter of Fundamental Rights and Freedom guarantees protection against discrimination, it is limited in scope. The protected grounds are race, sex, place of origin, social class, colour, religion and political opinions. There are piecemeal anti-discrimination provisions in different pieces of legislation, such as the 2014 Disabilities Act and the 1975 Employment Act. But neither the constitution nor ordinary legislation make discrimination on other grounds unlawful.

Since 2020, UNAIDS and the United Nations Development Programme have been providing technical and financial support to local nongovernmental organizations, including Jamaica AIDS Support for Life, to support the rollout of a national survey on the public’s perspectives and experiences with stigma and discrimination in Jamaica and on the need to have more adequate protections in the law. The results of the survey will be used to advocate for legislation to adequately deal with discrimination experienced by vulnerable and marginalized groups.

The proposed legislation should provide protection across areas including discrimination based on health status, pregnancy or childbirth, hiring or termination decisions and the denial of services to minority groups. It should also address discriminatory conduct based on assumptions about a person’s competence, capabilities, age, self-expression, income level, the neighbourhood in which they live or their educational background.

“Comprehensive anti-discrimination legislation will strengthen the legal framework for the protection of human rights towards achieving equality for all,” Manoela Manova, the UNAIDS Country Director for Jamaica, explained.

In real terms, this means that duty-bearers will have to consider how their policies, programmes and services will affect people with the protected characteristics. Critically, the focus on markers related to poverty would mean that for the first time public bodies will have a duty to consider socioeconomic disadvantage when making strategic decisions about how to exercise their functions and when proposing to use public funds.

“Our overarching finding has been that regardless of health status, sex, age or sexual orientation, the factor that fuels discrimination and makes people more vulnerable is poverty. Moving forward, it is critical that we don’t treat HIV as a stand-alone concern but address the full picture of what makes people marginalized and vulnerable in Jamaica,” said UNAIDS Community Support Adviser for Jamaica, Ruben Pages Ramos.

Marcia John (not her real name), a Guyanese transgender woman, readied to leave a transgender support group meeting. She slipped off her black wig, replacing it with a bandana and hat. Her employer only allows her to perform her duties if she presents as a man.

“I have no choice,” she said. “I have to work.”

In 2018, the Caribbean Court of Justice ruled that an 1893 Guyana law that prohibited cross-dressing was unconstitutional. Last August, lawmakers formally removed that section from the law books. But for Ms John and other transgender women, this has not been enough to transform the way they navigate social spaces. Intolerant attitudes remain, with sometimes dire implications for transgender people’s welfare and livelihoods.

Led by the University of the West Indies Rights Advocacy Project, the cross-dressing law challenge started with a constitutional action filed in the Guyana High Court in 2010. Eight years and two appeals later, the litigants earned a historic win.

“At the heart of the right to equality and non-discrimination lies a recognition that a fundamental goal of any constitutional democracy is to develop a society in which all citizens are respected and regarded as equal,” the Caribbean’s final appellate court ruled in 2018.

Reflecting on the impact of the landmark law reform effort, Alessandra Hereman, Guyana Trans United (GTU) Project Coordinator, said that the main benefit has been more visibility.

“The community’s increased media presence in the lead-up to the case brought transgender issues into the public space. People realized that transgender Guyanese exist and are part of our society. Some thought we should be treated equally and others held on to their religious beliefs. But transgender issues were brought to the fore and were part of public discourse,” she said from GTU’s Georgetown office.

Formed in 2012, GTU has worked over the past decade to facilitate the dialogue and sensitization that are needed alongside key law and policy reforms to create a safe and empowering social context for transgender people. They contribute to the ongoing effort to shift the attitudes and perceptions of health-care providers around sexual orientation and gender identity. This work strengthens the community’s access to health services, including HIV prevention, testing and treatment. With support from UNAIDS, GTU also trained journalists on covering transgender people and issues ethically and accurately.

“Law reform is essential, but it is not a stand-alone,” said James Guwani, the Director of the UNAIDS Caribbean Sub-Regional Office. “Alongside strategies like judicial review and political advocacy, there must be ongoing community dialogue and targeted efforts to increase social inclusion.”

At present, GTU has two high law and policy reform priorities. First, Guyana’s Prevention of Discrimination Act of 1997 makes no mention of sexual orientation or gender identity.

“Employers use the lack of this protected status to discriminate against lesbian, gay, bisexual and transgender (LGBT) persons. Amending that legislation would mean that if you violate the rights of an LGBT person there would be some mechanism for redress. Having that in place will tell people you can’t discriminate because there will be consequences,” Ms Hereman explained.

The CARICOM Secretariat, through the Pan Caribbean Partnership against HIV and AIDS (PANCAP), has developed a model anti-discrimination bill to guide Caribbean countries in creating anti-discrimination laws. PANCAP continues to advocate with regional stakeholders, including policymakers, for countries to adopt the model as it provides for the protection of persons against discrimination, including discrimination involving harassment, victimisation and vilification on the grounds of HIV status, sexual orientation, etc. It is hoped that the model will lead to more access to health care for key populations with the overarching goal of a Caribbean free of AIDS and new HIV infections, in which all people are happier, healthier, productive, safe and respected. Next on GTU’s list is the revision of the Teachers’ Code of Conduct to be inclusive of the needs of LGBT students.

“They must know that they have a duty to create an enabling environment for all students so that LGBT pupils have an opportunity to learn without bullying,” Ms Hereman said.

Lack of gender recognition legislation and the criminalization of sex between people of the same sex remain challenges in the Guyana and wider Caribbean contexts. The United Caribbean Trans Network has mounted a campaign around gender identity recognition, while the Society against Sexual Orientation Discrimination is working to remove Sections 351 to 353 of the Criminal Law (Offences) Act, which make sex between men punishable with life imprisonment. However, GTU is first prioritizing issues that it says go to the heart of transgender’s people’s ability to get an education and access employment. Exclusion from these spaces compounds their vulnerability to poverty, violence and disease.

“We occupy the lowest socioeconomic level in society. Guyana is now an oil-producing nation. LGBT people should have opportunities as well,” Ms Hereman insisted.

“I have not been taking my meds for seven months,” said Carla Joseph (not her real name), a transgender woman living with HIV in Haiti. “I need a reliable, direct place that will not ask me for a referral letter … to get back into care.”

She is speaking to one of Haiti’s community-led monitoring (CLM) field officers from the Civil Society Forum Observatory, who over the past year have been working to learn more about how to connect diagnosed people to treatment and ensure that those already in care are better served.

“During the monitoring we met many clients waiting for their turn to be consulted and get their drug refilled,” said Elisabeth Jacques, a Community-Led Monitoring Field Coordinator. “Shouldn’t the services be at the best day and time for the patient?”

UNAIDS is supporting the community-led monitoring work being conducted by Haiti’s Civil Society Forum Observatory. Community-led monitoring is an accountability mechanism to improve people’s access to HIV services and the quality of care they experience. The process is led and implemented by communities of people living with HIV, key populations and other vulnerable groups.

This initiative is part of a coordinated effort by partners, including the Ministry of Public Health and Population and the United States Government through the United States President’s Emergency Plan for AIDS Relief (PEPFAR). It aims to maintain and expand access to HIV services for Haiti’s estimated 150 000 people living with HIV, including 30 000 who are not yet aware of their status.

In its first report, the Civil Society Forum Observatory called attention to the need to improve client-centred services by extending service hours and reducing waiting times. It has also recommended an increase to six months for the supply of antiretroviral medicines dispensed to stable people living with HIV. Additionally, the community-led monitoring exercise unearthed a need to improve treatment literacy related to the concept of U = U (undetectable = untransmittable).

“We should build the capacity of civil society to do this sensitization work. They are more familiar with the clients. When someone is lost to follow-up, community members know how to speak to them and encourage them to come back. If we empower the community through community-led monitoring we can have a better handle of what’s going on,” said Soeurette Policar, the Coordinator of the Civil Society Forum Observatory.

The Head of HIV Prevention at the Ministry of Public Health and Population, Steve Mc Allan Smith, welcomed the recommendations. “Community-led monitoring will tell us how services are being rendered in the community and how people are experiencing those services from a client perspective. This approach will tell us how to tailor interventions to the specific needs of the patients. It will also help us address testing issues. But mostly it will help us retain people in care. Reaching the targets is really good,” he said. “But maintaining them long-term is what we are going for.”

Over the past year, the country has contended with intersecting crises. One month after the assassination of its president, Haiti endured a devastating earthquake, followed by a tropical storm. Worsening organized crime and an epidemic of kidnappings have had dire implications for the daily life of Haitians. In recent months a fuel shortage has made it even more difficult for people and organizations to conduct their affairs. And all this under the spectre of COVID-19.

Poverty, gender-based violence and the discrimination faced by people living with HIV and key population communities undermine people’s ability to stay on treatment. The challenging socioeconomic and security context only makes things worse. According to PEPFAR data, almost 8000 Haitians came off HIV treatment last year.

However, as the UNAIDS Country Director for Haiti, Christian Mouala, noted, Haiti was able to successfully implement multimonth dispensing of antiretroviral medicines to 88% of people on HIV treatment during COVID-19. This was thanks to coordinated efforts under the leadership of the Ministry of Public Health and Population and the collaboration of many stakeholders, including Haitian civil society.

“The people and health system here are resilient and adaptable,” Mr Mouala said. “At this time community leadership must become even more central to developing and implementing strategies to ensure people enjoy the best possible HIV, health and social support services.”

In 2001, Micheline Léon felt unwell. The then 33-year-old mother of three journeyed from her home in the small town of Corporand in central Haiti to a clinic in Cange. There she was diagnosed with HIV and tuberculosis.

Fortunately, three years earlier an organization called Zanmi Lasante—Haitian Creole for Partners in Health—had launched the HIV Equity Initiative. (Zanmi Lasante is the sister organization of the United States-based nonprofit health-care group Partners in Health.) This was one of the first projects in the world to effectively deliver antiretroviral therapy in poor, rural settings.

Twenty years later, Ms Léon is one of 2000 community health workers called accompagnateurs in the Zanmi Lasante network. Multiskilled teams of accompagnateurs are the link between patients and health facilities. They are also part of all HIV Equity Initiative discussions regarding patient care, treatment and social support.

Community health workers live in the areas where they work. They help to ensure that patients recover and stay healthy. Their main roles include medicine distribution and home visits, as well as linking people to care. They accompany patients to clinics and track those who have missed appointments. During the COVID-19 pandemic, the accompagnateurs were key to Zanmi Lasante’s care and treatment work. The home-based care and contact tracing skills refined in response to HIV are now being used for COVID-19.

Zanmi Lasante has a holistic approach to care that includes social services such as providing accommodation, food and transport. Community health workers help to coordinate all the support needed. They also serve the wider community by running educational campaigns on topics such as mental health and sexually transmitted infections.

Critically, the accompagnateurs empower and inspire people to take charge of their own health. Ms Léon is a role model within reach. Since starting treatment she has stayed adherent to it and her HIV viral load has remained undetectable since she began receiving viral load tests in 2017. She owns a small fruit and poultry business and sometimes spends time in Port au Prince, where she has a new grandson. She takes part in various group activities at the Zanmi Lasante site in Cange, including support groups, viral load classes and mothers’ clubs.

“The psychosocial support I received from Zanmi Lasante made me realize that my diagnosis was not a death sentence and I could go on and live a healthy and fulfilled life,” Ms Léon said.

Another stalwart Haitian HIV programme employs a community health approach. GHESKIO, the Haitian Study Group on Kaposi’s Sarcoma and Opportunistic Infections, was founded in 1982, the year before HIV was formally discovered. It is the world’s oldest HIV organization and has conducted research and provided clinical care over the past four decades.

GHESKIO has leveraged a community-based model to help Haiti respond to HIV and other public health crises. When the COVID-19 pandemic reached the country in March 2020, GHESKIO reinforced an existing programme—Distribution of ART in the Community—to ensure that clients living with HIV were provided with a three-month supply of medication. From a small room at the National Solidarity Association (ASON), a team packages medicines into plastic bags and pours over their client list. If a person is unable to come for their medicines, they’ll receive a home delivery.

GHESKIO also strengthened training activities for their multiskilled community health workers. In this way they provided social support for patients as well as home care for cases that did not require hospitalization.

“Our Community Unit played an essential role in the acceptance of new COVID-19 treatment centres in the impoverished, crowded slums,” said GHESKIO’s Program Coordinator, Patrice Joseph. “In collaboration with the Ministry of Health, we have strengthened contact tracing, case investigation and outbreak management for COVID-19.”

One of the newest community health workers is CV, a 35-year-old mother of three from Village de Dieu, a slum south of Port au Prince. She herself survived COVID-19. When she began feeling ill a community health worker accompanied her to get tested. Following five days at GHESKIO’s COVID-19 hospital, a community team conducted home visits to ensure her full recovery.

Now she works as a greeter at GHESKIO. She is also a GHESKIO community health agent, encouraging patients to come to scheduled visits. CV supports community sensitization around COVID-19 prevention by promoting sanitation and educating people about the importance of COVID-19 vaccination.

“I don’t take one day for granted,” she said.

Members of parliament have reaffirmed their commitment to tackle all forms of HIV-related stigma and discrimination in Jamaica and to help enhance efforts to create an enabling environment for people living with and affected by HIV.

At a meeting co-hosted by UNAIDS and Juliet Cuthbert-Flynn, the Minister of State for Health and Wellness and Chair of the country’s Partnership for Action to Eliminate all Forms of HIV-Related Stigma and Discrimination, members of parliament, from both the ruling and opposition parties, came together to review evidence on stigma and discrimination in Jamaica and its impact on health outcomes and to craft a way forward in which their role as lawmakers can contribute to eliminating stigma, discrimination and violence.

Jamaica’s legal landscape poses substantial barriers for people living with and affected by HIV to access health services. For example, same-sex sexual relations are criminalized in Jamaica, which continues to represent a considerable deterrent for marginalized communities. Moreover, the country lacks general legislation against discrimination, a national human rights institute and a gender recognition law that could provide further protection for transgender and gender non-conforming people in Jamaica.

Harmful laws, policies and generalized stigma and discrimination against people living with and affected by HIV have a profound negative effect on people’s health outcomes and life prospects. The most recent Knowledge, Attitudes, Practices and Behaviour Survey and the People Living with HIV Stigma Index showed that only approximately 12% of the general population have accepting attitudes towards people living with HIV, while close to 60% of people living with HIV have feelings of self-stigma. A 2019 study about the economic survivability of transgender and gender non-conforming communities in Jamaica found  that experiences of workplace stigma and discrimination were widespread, with about 60% of survey respondents declaring such incidents. Furthermore, 71% of respondents felt that transgender and gender non-conforming people had a harder time getting jobs than cisgender people. Another study suggests that approximately 20% of lesbian, gay, bisexual and transgender people in Jamaica have been homeless at some point of their lives.

In view of these pending challenges in the country’s HIV and human rights response, members of parliament explored creating a working group tasked with performing periodic reviews of relevant data, supporting the enactment of protective legislation, challenging harmful laws and policies and hosting permanent dialogues with communities of people living with and affected by HIV.

“We have a lot of work to do to ensure that all Jamaicans enjoy the full respect, protection and promotion of their rights. This meeting and its outcomes are a small step to achieving that goal, but a step that certainly is pointing us to the right direction on the role that members of parliament should play to end discrimination,” said Ms Cuthbert-Flynn.

These efforts, which aim to tackle deeply rooted misconceptions in society, require strong partnerships. As stated by Morais Guy, the Opposition Spokesperson on Health, who co-chaired the meeting, “The enhancement of people’s rights and collective efforts to ensure that every Jamaican can live a life free from stigma, discrimination and violence is not an issue of only one person, one entity or one political party. It is the business of all of us, to work in partnership for the dignity of all Jamaicans.” 

Members of parliament also discussed some of the challenges that they face as legislators to perform their duties, and the contributions that UNAIDS can make in facilitating a more efficient, effective and transparent law-making process in parliament. Moreover, options to mobilize and engage citizens at the community level to challenge stigma were also discussed in response to the critical need of raising more awareness, tolerance and respect towards people living with and affected by HIV.

“We are proud to partner with members of parliament to tackle stigma and discrimination in Jamaica and to provide all of the evidence, instruments and support that we can mobilize to leverage their role as allies and critical influencers in the future of the country,” said Manoela Manova, the UNAIDS Country Director for Jamaica. 

A resolution calling on the Kingston and Saint Andrew Municipal Corporation to declare World AIDS Day as a commemorative day for the City of Kingston, received unanimous approval by the City’s Councilors today.

The resolution, which reaffirms Jamaica’s commitment with the Sustainable Development Goals, the Fast Track City Initiative, and the 2021 Political Declaration on HIV and AIDS: Ending Inequalities and Getting on Track to End AIDS by 2030, resolves that on December 1^st of every year, the City of Kingston, in partnership with the public and private sector and affected communities, will commemorate World AIDS Day.

The Mayor of Kingston, Senator Councilor Delroy Williams lauded the resolution as an important step towards transforming Kingston into a stigma-free city. “This resolution stems from a commitment by the Municipality to keep contributing to the end of AIDS, which will only be possible if we effectively tackle the root causes, including stigma, discrimination, and violence that put Jamaicans at risk of acquiring HIV and not adhering to their medications”, stated Mayor Williams.  

Acknowledging that “ending discrimination, stigma and marginalization will result in more persons getting tested, accessing treatment and reducing HIV in the municipality”, the resolution further resolves that “events be held each year within the Municipality of Kingston and St Andrew to raise awareness and to end discrimination, stigma, and HIV related violence”.

According to Jamaica’s latest People Living with HIV Stigma Index, launched in 2020, a third of people living with HIV have experienced at least one form of stigma and/or discrimination due to their HIV status in the last 12 months. Furthermore, more than half of the participants reported experiencing self-stigma, and the majority expressed that they find it difficult to tell others about their HIV status.

“Strong partnerships and commitments from local governments are critical to enhance our efforts to end discrimination. As we continue to work towards an equitable and enabling Jamaica for our brothers and sisters living with HIV who continue to be marginalized, I am heartened and welcome this move by the Municipality, led by the Mayor. The passing of this declaration brings awareness and local buy-in,” stated Jumoke Patrick, Executive Director of JN+.

Manoela Manova, UNAIDS Country Director, highlighted these commitments are a step in the right direction. “We have a lot of work to do to end inequalities, discrimination, and AIDS. The commitment shown by the Municipality and the Councilors, through the passing of this resolution, are both a gesture of solidarity and leadership that must be nurtured and replicated across all levels of government.”