Caribbean

Although the Caribbean as a region has the second highest HIV prevalence after sub-Saharan Africa, most countries have concentrated epidemics which disproportionately affect certain groups including gay men and other men who have sex with men (MSM). In many countries men who have sex with men experience considerable social stigma and are not reached with vital HIV prevention, treatment, care and support services. Not only are men afraid of disclosing their sexual activity, they are also deterred from finding out what they need to know to reduce their risk or to buy condoms.

An environment of homophobia is often reinforced by anti-sodomy legislation which exists in 11 of 16 Caribbean countries*. This can contribute to an intolerant cultural and social environment which risks keeping men who have sex with men away from accessing HIV testing and counselling and education services that would reduce the vulnerability to HIV infection.

In Jamaica—a country with anti-sodomy laws—there is 32% HIV prevalence among MSM, versus 1.6% in the general population. In Trinidad & Tobago and Guyana, countries which also criminalize sex between men, the HIV prevalence ranges from 20% to 32%. While in Cuba, Suriname, the Bahamas, Dominican Republic, countries without such legislation, the HIV prevalence in MSM ranges from 1% to 8%.

According to 2007 UNGASS Country Progress reports less than 40% of MSM in the Caribbean are reached by prevention programmes. Local groups in many countries in the Caribbean have been urging civil society and government programmes to include MSM issues and organizations within the AIDS response. These efforts have been supported by regional networks including PANCAP.

UNAIDS Executive Director Michel Sidibé has called for an end to punitive laws which hamper the AIDS response in this region.

“In most of the countries in the Caribbean that don't have repressive laws, HIV prevalence is between 1% and 8% among men who have sex with men,” said UNAIDS Executive Director Michel Sidibé. “This contrasts sharply with a range of between 20% and 32% in countries which outlaw sex between men.”

“Reducing homophobia and removing punitive laws that criminalize sex between men creates the right conditions for achieving universal access,” Mr Sidibé continued.

A collaborative effort is underway between UNAIDS, UNDP and PAHO/WHO to develop strategies for Latin America and the Caribbean on human rights and improvement of access to health services for MSM and other sexual minorities.

UNAIDS will lead a regional effort in the Caribbean to strengthen HIV prevention programmes among these groups, to bring together the human rights and service provision components for their improved health, human rights and well-being.


* Countries in the Caribbean with laws that criminalize men who have sex with men: Antigua and Barbuda, Barbados, Belize, Dominica, Grenada, Guyana, Jamaica, Saint Kitts and Nevis, Saint Lucia, Saint Vincent and the Grenadines, Trinidad and Tobago. Countries in the Caribbean with no laws criminalizing men who have sex with men: Bahamas, Cuba, Dominican Republic, Haiti, Suriname. According to ILGA web site accessed 16 March 2010

The Sixth Central American Congress on HIV/AIDS and Sexually Transmitted Infections (CONCASIDA) will take place in San Jose, Costa Rica from 1-5 March 2010 with the theme "Youth: for my right to know and decide."

CONCASIDA, a multi-sector event which aims at sharing experiences, scientific information and research, takes place every two years in a Central American country. This year, the congress aims to focus its attention on youth vulnerability of Central American countries due to the lack of sexual education and the increase in infections within this age group. CONCASIDA also aims to analyze the social impact of this on Central American nations.

A 2008 study carried out by the United Nations Population Fund and UNICEF with support from UNAIDS showed that the majority of young people in Costa Rica were sexually active at the age of 16. The study also highlighted that there was lack of HIV information and knowledge among Costa Rican youth.

The study shows that in Limón only about 28% of the young people interviewed know how to use a condom correctly whereas in Puntarenas the percentage drops to about 17%. Furthermore, in both provinces, more than 50% of the adolescents find that asking a partner to use a condom could be interpreted as a sign of mistrust. Finally, 43% in both provinces think that a young girl carrying condoms in her purse is a woman with a “doubtful reputation.”

This year’s main themes of the congress include care, control and surveillance; prevention and promotion; risk factors for social and psycho-emotional; human rights and legislation; and monitoring and evaluation of HIV and AIDS commitments.

During the congress, different stakeholders will present the result of their work and search alternatives for more effective ways to respond to the AIDS epidemic.

Functioning ARV dispensing site in Port-au-Prince after the devastating 12 of January earthquake.
Credit: UNAIDS

As Haiti begins to rebuild after the destruction left by the 7.0 magnitude earthquake that struck 10 miles outside Port-au-Prince on 12 January, first reports are coming in on the impact the tremble has had on Haiti’s AIDS response.

Haiti is the country with the most severe HIV epidemic among the Caribbean states–home to half of all people living with HIV in the region. Before the quake, there were an estimated 120 000 people living with HIV in the country with an estimated 6 800 children under the age of 15 also carrying the virus.

Data is starting to emerge on people living with HIV who have been affected by the quake and on critical infrastructure needed to provide essential services. An initial report estimates that out of 120 000 people living with HIV just under 70 000 live in affected areas. Prior to the quake, around 19 000 people were estimated to be on Anti-Retroviral Treatment (ART).

“The world has a real opportunity to rebuild Haiti better, we must sustain the outpour of support now and tomorrow,” Mr Michel Sidibé UNAIDS Executive Director said when speaking of the pledges made by the international community.

The UNAIDS country team and cosponsors are working with the government of Haiti and partners such as PEPFAR and Global Fund to Fight HIV, TB and Malaria as well as non-governmental organisations to gather information to asses the impact of the quake on clinics, lab equipment and as well as human resources. It is now critical that HIV prevention, treatment care and support services are resumed in affected areas.

The UNAIDS country team met staff working in Haiti’s oldest ART centre GHESKIO. The organization provides treatment for 6000 people of whom 80% have now been accounted for.

UN Health Cluster coordination meeting in Port-au-Prince
Credit: UNAIDS

While the clinic has suffered some damage to its structure, essential equipment and tragically also suffered human losses, staff at GHESKIO reported that they have enough stock of anti-retrovirals to cover the immediate need.

Other centres were not as fortunate. The UNAIDS country team visited the Hospital de la Paix which provides prevention of mother-to-child transmission services in Port-au-Prince. Here staff reported destruction of stock as well as lack of financial abilities to buy breast milk substitute necessary to prevent transmission from mother to child through the breast milk. Services at the clinic were only resumed 12 days after the quake.

Members of the UN country team on AIDS will visit five major PMTCT centres in the coming days to establish if similar damages are found.

An initial situational analysis indicate immediate short term needs include limiting treatment interruption, provide nutritional support of people on treatment, and make sure PMTCT services are resumed. Networks of people living with HIV report that they urgently need food and water, tents, and hygiene kit in meeting with the UNAIDS country team.

In Haiti heterosexual transmission, often tied to sex work, is the primary source of HIV transmission although emerging evidence indicated that substantial transmission is also occurring among men who have sex with men. A challenge will be to ensure that key prevention commodities are made available to the displaced populations in and around Port-au-Prince.

“We are seeing real suffering. It is in moments like this where those most at risk are forgotten. We must ensure that the marginalized members of our communities have access to HIV prevention, treatment, care and support services,” Mr Sidibé said, promising that UNAIDS would be part of the global effort to support Haiti to build a better tomorrow.

UNAIDS is committed to working with the Haitian government and other development partners such as Global Fund and PEPFAR to look at how Haiti’s AIDS response can be strengthened over the long-term.

Support is needed to re-establish the AIDS-infrastructure as well as strengthening civil society, ensuring special attention towards HIV prevention, treatment, care and support services to populations at higher risk and put in place on coordinating authority to ensure no gaps or overlaps in the national response.

As part of the United Nations family, UNAIDS stands in solidarity with the people affected by the devastating earthquake that struck Port-au-Prince on Tuesday 12 of January.

On Sunday United Nations Secretary-General Mr Ban Ki-moon reiterated the UN’s continued support to Haiti and the people affected by this natural disaster. Speaking in Port-au-Prince, Mr Ban ensured that the search and rescue operation for people trapped in the rubble was still ongoing.

As emergency relief efforts, with food, water and tents being distributed by the UN and its partners are stepped up; the UN Secretary-General stressed the importance of coordination of the emergency operation.

“My heartfelt sympathies are with the people of Haiti in these difficult times,” said Mr Michel Sidibé, UNAIDS Executive Director. “As the UN Secretary-General Ban-Ki moon has said, the international community must support Haiti during this crisis and in the long term.”

On Friday the 15 the UN launched a flash appeal for $ 600 million, which outlines the support needed to start meeting the devastation suffered by Haiti. This includes support for the National AIDS Response, and delivery of HIV prevention, treatment, care and support services.

The United Nations family too has been affected by the earthquake and it is still uncertain of the status of many of the staff. UNAIDS has accounted for all of its staff in the UNAIDS Country office and has pledged support during this crisis.

Amidst the uncertainties the world body's peacekeeping and field support departments are utilizing the social networking sites Facebook and Twitter to keep families, friends and colleagues of UN personnel in Haiti up-to-date on the latest developments

Ministers of Education and Health in Latin America and the Caribbean and other officials during the First Meeting of Ministers of Health and Education to stop HIV/AIDS in Latin America and the Caribbean. Mexico City, 1 August 2008.
Photo credit: agencialibrefoto

A year ago Latin America and the Caribbean Ministers pledged to provide comprehensive sex education in schools. The historic Prevention through education declaration was signed at the end of the First Meeting of Ministers of Education and Health to prevent HIV in Latin America and the Caribbean.

The Ministers committed to promoting concrete actions for HIV prevention among young people in their countries by implementing sex education and sexual health promotion programmes.

The declaration noted that “Sexuality is an essential part of being human and it is expressed throughout ones lifetime. Childhood and adolescence are important periods for the development of people and their countries, and for this reason, it is necessary to provide quality education that includes comprehensive education on sexuality both as a human right, as well as one that contributes to present and future quality of life.”

The Ministers also committed to two specific targets:

1. By the year 2015, we will have reduced by 75% the number of schools that do not provide comprehensive sexuality education, of schools administered by the Ministries of Education.
2. By the year 2015, we will reduce by 50% the number of adolescents and young people who are not covered by health services that appropriately attend to their sexual and reproductive health needs.

The 1 August meeting took place in Mexico City and was co-hosted by Dr José Ángel Córdova Villalobos (México), Minister of Health and Lic. Josefina Vázquez Mota (Mexico), Minister of Public Education in collaboration with Canciller Patricia Espinosa Cantellano (México), Minister of Foreign Affairs.

The event led to renewed commitment to education to prevent HIV in both Latin America and the Caribbean regions. Thanks to the declaration a new agreement was signed earlier this year in San Jose by the Government of Costa Rica which will lead in the sharing of sexual health information among young people, aged 15 – 25 years in two provinces. The young leaders will provide education on a wide range of issues such as modes of HIV transmission and how to use a condom.

Dr César Nunez, UNAIDS Regional Director for Latin America, points out that young people aged 15-24 accounted for 45% of all new HIV infections in 2007, however only 40% of young people aged 15-24 had accurate knowledge about HIV and transmission.

“Effective sexuality education can provide young people with age-appropriate, accurate and sensitive information equipping them to make informed decisions. Governments in Latin America and Caribbean are showing increasing leadership in this area.”

A version of this story was first published at UNICEF.org

With the picturesque backdrop of Speyside, northern Tobago, in the distance, Kalifa Martin and her colleague Kerlan conduct a UNICEF-supported 'Kicking Aids Out' workshop. Credit: UNICEF Trinidad and Tobago/2009

A UNICEF-supported programme called 'Kicking AIDS Out' (KAO) has recently begun in Speyside, northern Tobago, by the Trinidad and Tobago Alliance for Sport and Physical Education (TTASPE). The new programme uses sports and games to teach young people and adolescents about HIV. Speyside is a small community that is best known as a destination for fishermen and divers. In 2007, UNICEF and TTASPE, along with the Red Cross of Trinidad and Tobago, teamed up to conduct a youth-led Vulnerable Community Assessment. Based on this assessment, Speyside was selected as the first area to initiate 'Kicking AIDS Out'.

Training for adolescents

Soon after the assessment, UNICEF and TTASPE began conducting workshops to train adolescents to become KAO peer facilitators. Kalifa Martin, 15, is one these young trainees.

"I heard there was an HIV workshop at the community centre and decided to go and learn more about HIV, because I knew it was important to get the right information," Kalifa says. "What I wasn't expecting was that I would learn about it through games and fun activities. I liked this and invited my sisters to attend and we are now all involved in the programme."

Growing up in Speyside, Kalifa saw firsthand how AIDS can have a ripple effect.

"When something happens to one person, it affects the whole community," she says. "I want more people to get tested and start making wise choices. I would like Speyside to be an example to other communities."

Increasing the level of knowledge of HIV among young people in Trinidad and Tobago is an important step. According to a recent UNAIDS/WHO/UNICEF country report, in 2007 56% of young people aged 15-24 had correct knowledge of, and rejected myths about, sexual transmission of the virus. A significant minority, 12%, in this group had also had sex before the age of 15. The same report suggests that the situation is especially serious for young women as they are over three times more likely than their male counterparts to be living with the virus (0.3% of boys compared to 1% of girls aged 15-24).

'I want to help people'

Since her training, Kalifa has conducted many ‘Kicking AIDS Out’ workshops – where lectures are replaced by educational games that resonate with young people. One such game is similar to dodgeball, except that in the KAO version, being hit with the ball symbolizes being exposed to HIV. The message is that anyone who doesn’t protect themselves is vulnerable to infection.

"It is through projects such as KAO that UNICEF hopes to empower young persons such as Kalifa to actively re-create their communities as places where young persons make informed choices," explains UNICEF Trinidad and Tobago HIV Officer Marlon Thompson.

There are currently about 20 peer educators like Kalifa in the KAO programme. And she knows that the initiative is having positive results. She has seen her peers in Speyside become more knowledgeable about AIDS and then readily share their knowledge with their family members and friends.

The programme has also changed Kalifa, who now dreams of becoming a doctor. "I want to help people living with HIV and even find a cure for it," she says.

UNAIDS Executive Director Michel Sidibé (left) with Dr Edward Greene, Assistant-Secretary General, CARICOM Secretariat. 20 May 2009 Geneva. Credit: UNAIDS/P. Virot

UNAIDS Executive Director Mr Michel Sidibé met on Wednesday 20th May with a delegation of the Caribbean community (CARICOM) at the 62nd World Health Assembly to discuss the Caribbean priorities for collaboration with UNAIDS.

Dr Edward Greene, Assistant-Secretary General of the CARICOM Secretariat and Mr Karl Hood, Minister of Health of Grenada and Chair of the Council of Human and Social Development of CARICOM, opened the meeting acknowledging Mr Sidibé’s leadership in accelerating the global response to HIV as well as the vital role played by UNAIDS in setting up and fostering growth of the Pan Caribbean Partnership against HIV (PANCAP).

In October 2008, during CARICOM’s 7th general assembly, participants approved the Caribbean Regional Strategic Framework for 2008-2013 which focuses on actions that will enable countries to achieve universal access to HIV prevention, treatment, care and support by 2010.

Participants at the meeting made a call to UNAIDS to institutionalize and further strengthen the support it provides in the region. They called for UNAIDS to focus country assistance upon fully implementing the agreed regional Strategic Framework.

Participants during the UNAIDS - CARICOM delegations meeting that took place on the sideline of the 62nd World Health Assembly. 20 May 2009 Geneva. Credit: UNAIDS/P. Virot

In response, Mr Sidibé reaffirmed UNAIDS’ commitment to provide its experience and technical support to help improve PANCAP’s capabilities to support its work at the international, country and community levels.

Mr Sidibé noted to participants that he recognised the need for strengthened technical support in the region. To this end he highlighted the importance of establishing a Technical Support Facility in the region.

During his intervention, Mr Sidibé highlighted the need to bring together all United Nations organizations working in the region under one action results framework. He also proposed the creation of an advisory group with representatives of CARICOM that could advise the UNAIDS Regional Director in identifying and coordinating priorities for an effective response to the epidemic in the region.

All participants agreed that the CARICOM – UNAIDS collaboration is producing positive results in the response to AIDS and reiterated their commitment to further strengthen the partnership.

The Miller School of Medicine of the University of Miami and the Fogarty International Training Programme on AIDS and TB organized in collaboration with UNAIDS the ‘Health Research in the Americas V’ Conference on 7 and 8 May 2009, in Miami, Florida.

The aim of the conference was to highlight current evidence on HIV prevention, discuss the sustainability of comprehensive HIV prevention efforts as well as to debate how HIV prevention is situated within the broader discussion of ‘health in the Americas’ and other international development strategies.

Sir George Alleyne, Special Envoy of the United Nations Secretary General for HIV/AIDS in the Caribbean, was invited as a keynote speaker on the second day of the conference.

Numerous local and national achievements in curbing the epidemic have created a body of evidence about what works, but these successful approaches have not yet been fully applied.

At the conference, scientists, HIV prevention practitioners and policy makers explored scientific and programme experiences for prioritizing comprehensive, evidence-informed HIV prevention approaches and discussed effective solutions that could bridge the interface between HIV and other health and development issues.

The conference was open to behavioral scientists and researchers who work in the area of HIV prevention in the Americas, with a special focus on Guyana, the Dominican Republic, Jamaica, Brazil, Colombia and Peru.

This story was first published on UNFPA.org

Clients at Kevin's Reflextions have an opportunity to talk about HIV.
Credit: Carina Wint

Barber shops across Georgetown, Guyana, are buzzing with chatter about the latest trends, community happenings, neighbourhood gossip and now, ways to protect young people from AIDS. The United Nations Population Fund (UNFPA), in collaboration with UNAIDS Secretariat, has identified barber shops and beauty salons as information hubs, and is using them to spread the word about HIV prevention.

The project involves the training of shop staff to answer simple HIV-related questions, pass out informational material, dispense both male and female condoms to clients – and even provide on-site counselling and testing. As a result, young people in Guyana are given access to information and resources not readily available elsewhere in their communities. And this is important because their small country (population 751, 223) has one of the highest HIV prevalence levels in the region: about 1.6 per cent for pregnant women, according to UNAIDS. Among sex workers, prevalence rises up to 26.6 per cent.

Male and female condoms are available at selected hair salons.
Credit: Carina Wint

Juanita Huburn, a customer at DJ’s Magic Fingers, a hair salon that participates in the programme, described Guyanese society as “closed” when it comes to issues regarding sexuality. “You do not talk about sex, they just say you should not have sex, but this is not realistic,” she said.

Shops and salons were chosen based on their location in malls, parks, popular attractions, or low-income communities. Owners who opened their doors to the project got added marketing exposure for their small businesses and were provided with incentives, such as access to promotional materials. “Shops were informed how their companies would be promoted through the project, and the economic value of participating,” said UNFPA Guyana Liaison Officer, Patrice La Fleur “They would most importantly provide safe places to discuss sexuality and the prevention of HIV.”

Once the locations were identified, two employees from each shop were sent for training on basic HIV education and prevention means. They were also taught to properly monitor the project and introduced to safe practices within the context of their own work (for example, ensuring the sterility of hair cutting machines, razors, needles for stitching and weaving, manicure and pedicure implements, and tattooing and body piercing equipment).

In addition to training participants about sexual and reproductive health and gender issues, the project also focuses on building life skills such as communication, healthy relationships, and leadership. “Participants expressed personal gains in their quality of relationships with friends, family, and clients,” said UNFPA Programme Officer, Babsie Giddings who monitors the project.

DJ's Magic Fingers hair salon is another venue for building awareness of HIV prevention.
Credit: Carina Wint

Since the programme was put in place businesses report a steady boost in clientele and more shops have come on board. “Business has increased about 5 per cent since we joined this programme,” said Kevin John, owner of the Barber Shop Kevin’s Reflections. He believes it may be partly because people know his salon equipment is sanitized. Currently over 7000 male and 400 female condoms are distributed monthly by requests in the shops and salons.

Work on the project was initiated last year through efforts of the UN Country Theme Group and it has been fully funded by UNAIDS. Also collaborating on the project is a local NGO, Youth Challenge Guyana.

UNFPA provides continuous support with regular follow-ups and monitoring for participating barber shops and salons. The project aims to afford some 2000 young people access to information, skills, services and supplies they can use to protect their health.

Dr Jean Ramjohn-Richards, wife of President George Maxwell Richards, presents Brent Benjamin, winner of the Caribbean Coalition on Women, Girls and Aids (CCWA) regional  Logo Competition, with a cheque of US $500 at the launch of CCWA launch on 4 March 2009, Port-of-Spain.
Credit: UNAIDS

Violence against women is increasing women and girls’ vulnerability to HIV in the Caribbean region. This is the stark message which emerged from the launch of the Caribbean Coalition on Women, Girls and AIDS (CCWA) hosted on 4 March by the UNAIDS Caribbean Regional Support Team at the National Library, in Port of Spain, Trinidad.

Sexual violence against women and girls in the Caribbean is pervasive. According to a regional study, 47% of adolescent girls’ first sexual experience was “forced” or “somewhat forced” (Halcon, L. Beuhring T and Blum, R.: 2000). Violence or the threat of violence increases women’s vulnerability to HIV by making it difficult or impossible to negotiate safer sex and condom use. It also affects women’s expectations in relationships and can also stop women from accessing HIV prevention, care and treatment services.

The CCWA, a broad coalition of women from a diversity of backgrounds pledged to vigorously challenge not just violence against women but all aspects of female vulnerability to HIV. The First Lady of the Republic of Trinidad and Tobago, Her Excellency, Dr. Jean Ramjohn-Richards, who is a member of the CCWA, was in attendance as well as Yolanda Simon, Director of Caribbean Regional Network of People Living with HIV/AIDS (CRN+), founding member and advocate of the CCWA.

According to Roberta Clarke, Regional Programme Director of UNIFEM, much more needs to be done to transform unequal and harmful gender relations between women, men, boys and girls; as this culture of inequality is a root cause of women’s vulnerability to HIV.

“We know that the Caribbean is an unsafe space for women. Several Caribbean countries have amongst the highest homicide rates and all have higher than global averages of sexual violence, with three countries having amongst the top ten highest rates,” said Ms Clarke.

The CCWA therefore has a role to play in drawing attention to the persistence of inequality and violence and in advocating societal transformations which are consistent with the full respect for human rights.

The launch event also saw the unveiling of a new logo for the Coalition. Young Trinidadian, Brent Benjamin, was the winner of the competition to design the logo and he was presented with his prize by her Excellency, Dr. Jean Ramjohn-Richards.

The CCWA has been supported by the UNAIDS Caribbean Regional Support Team, along with UNIFEM and regional civil society organizations including CRN+, Caribbean Association for Feminist Research and Action (CAFRA) and the Centre for Gender and Development Studies (CGDS) for 15 months leading up to the official launch. This support will continue in 2009 during which time the Coalition will be hosted by UNIFEM with continued assistance from UNAIDS.