Caribbean

The United Nations Special Envoys for HIV/AIDS are individuals specially selected by the UN Secretary-General to help advance the AIDS agenda in the regions they cover. In a series of interviews, we explore their motivation and commitment to ensuring that AIDS is kept high as a political priority within their respective regions of responsibility and operation.

Sir George Alleyne was appointed by the UN Secretary-General in February 2003 to serve as his Special Envoy for AIDS in the Caribbean Region.

A national of Barbados, Dr Alleyne entered academic medicine in 1962, and his career included research in the Tropical Metabolism Research Unit for his Doctorate in Medicine. In 1990, Dr Alleyne was made Knight Bachelor by Queen Elizabeth II for his services to medicine and in 2001 he was awarded the Order of the Caribbean Community—the highest honour that can be conferred on a Caribbean citizen. From 1995 to 2003 he served as Director of the Pan-American Health Organization (PAHO).

Sir George, what motivates you to work on AIDS?

There was no single thing that first motivated me to work on the AIDS epidemic, no sudden epiphany. In the beginning, there were several factors: I had been concerned about AIDS when I was director of PAHO and I always had tremendous regard for Dr Peter Piot (the founding Executive Director of UNAIDS). Then the Secretary-General asked me to be his special envoy, and you don’t say no to the Secretary-General. It was only later that I realised the scale of what I’d taken on. An appreciation of the magnitude of the problem stimulates me to remain involved. HIV is one of the major health issues facing us.

What do you see as the role of a Special Envoy for AIDS?

It’s about getting access to the people who make decisions and exerting influence on them.

I have access to Prime Ministers and Ministers of Health and first I ask them to include AIDS in their public discourse. Second, I ask them to be seen publicly embracing people living with HIV. Third, I advocate for the inclusion of funding for HIV work in all ministerial budgets – not just at the Ministry of Health.

In Barbados there are now co-ordinators for HIV in every government ministry. The Prime Minister of Trinidad and Tobago convened a meeting of HIV co-ordinators to give him an account of what they are all doing in their ministries. It is a very healthy trend. I can’t claim to have achieved this alone, to do so would be arrogant and nothing in this area is done by one person. But what a special envoy can do is propose and advocate, but there are many factors and persons who exert influence to make sure something occurs.

 

What are the challenges facing the region?

In my view, the major challenge is getting the message across to politicians that preventing the spread of HIV is as important as HIV treatment and survival.

In general we are doing quite well in providing treatment to those who need it. However there is a danger of complacency about certain successes. For example mother-to-child-transmission (MTCT) of HIV is decreasing and the Caribbean has set a goal to eliminate MTCT in 2 to 3 years.

I’d like to see equal enthusiasm for HIV prevention. The time will come when it will be incredibly difficult to maintain treatment for an expanding number of people living with HIV. For all kinds of reasons, economic as well as human, it is important to spend more effort and a lot more time thinking about how to prevent people acquiring HIV.

The second main problem is the increasing incidence of HIV among young women. Many more young women are becoming infected than young men. It represents one of the more explicit manifestations of the power imbalance in our society – the inability of many women to negotiate whether they have sex, for example, and the economic disparities between the sexes.

Some years ago the Secretary-General said that education is a vaccine against HIV. It is true that in the Caribbean many of the younger girls who become infected have not reached the same educational level as their peers who are not infected. However, there are many more girls finishing high school and going to universities than boys, so education is not the only answer. The major answer lies in gender imbalance.

What do you think are possible solutions to this gender imbalance?

We are talking about something that is widespread and deeply ingrained. It is difficult to transform a societal problem with a single solution.

You can advocate about gender imbalance, expose it, discuss it and try to link up the groups working against it. You can encourage family-led education programmes in schools to be more explicit with boys and girls about their responsibilities.

You can encourage those who are like-minded to be more proactive in speaking out and encourage the kinds of educational approaches that will deal with it, for example in university gender studies.

Another solution is greater condom use and we strongly advocate this. When you talk to youngsters there is no doubt that lots of them engage in sex at an early age but some schools do not allow condom distribution. In some countries it is illegal to distribute condoms in prisons. So it’s not just about making people aware of condom use, but also establishing appropriate ways to make them accessible. These are very delicate issues. One hopes to work through channels that will allow not only debate but also acceptance.

How can you make a difference?

I’ve tried hard to play a constructive role in relations with faith-based organizations and I think I am getting somewhere. All the world’s great religions speak of inclusion rather than exclusion. My approach is to advocate a doctrine of inclusion – to think of people living with HIV as worthy of the same consideration as the rest of the flock. We enter into discussions of morality. Some groups are not enthusiastic about condom use but I argue that condoms are pro-life and not the other way round.

I also speak out openly against stigma and discrimination. For example, homophobia is very, very widespread in the Caribbean. People can be quick to assert that one should be more aggressive in the approach to politicians. But a politician who campaigns as specifically pro-homosexual would lose an election straight away in this region. So you have to look at how you can change public opinion to be less judgemental, how you can change perceptions.

This is not a moral issue – it’s about the rights of all people who are disadvantaged and discriminated against, including people living with HIV, men who have sex with men and sex workers.

Sex work has been with us since time immemorial and there are three things I would like to see change. Society should be such that men and women do not have to go into sex work to make a living. Secondly, if they do, we should make sure that they don’t have to run the risk of acquiring HIV. They need to be informed about the risks and be able to negotiate condom use, for example, be able to say to all clients: “no condom, no sex.” Thirdly, the state should provide opportunities for people who wish to stop sex work so that they can make a living in a less dangerous occupation. A woman recently told me: “If I could get another job less hazardous I would be happy to come out of sex work.”

A lot of the population close their eyes to the realities of things like this.

What is your proudest achievement as Special Envoy for HIV/AIDS?

I was very pleased to get the Caribbean Business Coalition against AIDS formed. It was something I promised the Secretary-General. Caribbean businesses have got together to see how business can respond to AIDS. For example, staff at a major bank in Guyana wear T-shirts once a week to promote HIV awareness, and businesses have been looking beyond philanthropy to outreach. One organization now provides confidential voluntary HIV testing and counselling facilities in its own establishment.

The Caribbean Association for Industry and Commerce has been a driving force in this, led by its energetic chief executive Ms Carol Ayoung and with the leadership of founding UNAIDS Executive Director Peter Piot. Karen Sealey, the current UNAIDS Regional Director for the Caribbean, has also been particularly strong at supporting this initiative.

Sir George, who or what inspires you?

The dedication, passion and enthusiasm of health workers is an inspiration. I was recently in Jamaica and met health workers setting up public information booths on street corners and chatting to passers-by about how to use condoms and protect themselves from HIV. Initially people were reluctant to engage with them but their professionalism was absolutely tremendous and people responded. You see this throughout the Caribbean.

I am also very inspired by the people I meet who are living with HIV. Their energy and commitment to improving the AIDS response on behalf of others makes you really want to be able to support them.

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Those at highest risk of being infected by HIV in the Caribbean are not generally included at the heart of HIV prevention strategies. This is one of the conclusions of Keeping Score II, a publication launched by UNAIDS Caribbean Regional Support Team recently in Trinidad and Tobago.

Keeping Score II is a consolidated analysis of Caribbean country progress reports presented by governments to the 2008 United Nations General Assembly High-level meeting on AIDS.

However, nearly 80% of the country updates did not report on prevention programme coverage for men who have sex with men, sex workers and those who use non-injecting drugs. These gaps, it is argued, indicate that in many national decision-makers and implementers of country responses don’t have a clear understanding of the role played by these most-at-risk populations in their epidemic and the need for prevention programmes to specifically reach them.

Addressing the recent launch of the report in Port of Spain Dr Karen Sealey, Director of the UNAIDS Caribbean Regional Support Team, stated that more effort was required to ensure that HIV prevention programmes reached those at most risk.

The need for greater prevention success was echoed by Dr Amery Browne, Trinidad and Tobago’s minister of Social Development who addressed the launch. Noting that last year 20,000 people in the region became newly infected with HIV, Dr Browne said, “this shocking statistic should give us more than pause for thought. It should encourage us to look at innovative ways to reach key audiences with prevention messages. We need to be bold."

Along with an examination of challenges, Keeping Score II also highlights achievements in the AIDS response in the Caribbean. There has been notable success in terms of HIV treatment, which has been dramatically expanded. By the end of 2007, 30,000 people were receiving antiretroviral therapy, an increase of 50% in twelve months. However, treatment coverage remains below 45% in the region.

In the areas of prevention of mother-to-child transmission of HIV and blood safety, progress has been made in a range of countries. In addition, there has been an increase in high-level political commitment, more resources have been allocated to national responses and the multisectoral approach is widening and deepening.

Ms Angela Lee Loy, chair of the National AIDS Coordinating Committee (NACC) in Trinidad and Tobago, hoped that Keeping Score II would be used extensively to help the Caribbean shape and sharpen its response to HIV. "I believe it is a critical initiative that will enable the NACC to improve our strategic planning," she said.

The Caribbean is the second most-affected region in the world after sub-Saharan Africa with an adult HIV prevalence rate of 1.1% and AIDS remains one of the leading causes of death among people aged 25 to 44 years in the Caribbean. The epidemic has stabilized in several counties—though this has tended to occur at a high level. At the end of 2007 an estimated 230,000 people were living with HIV in region.

The National AIDS Programme Secretariat of the Ministry of Health in Guyana (NAPS/MOH) convened a National Conference on “faith-and-HIV,” supported by the Joint United Nations Programme on HIV/AIDS (UNAIDS) on 11 December 2008. The aim of the conference was to establish a national coalition of faith leaders of all denominations in Guyana to address HIV-related stigma and discrimination.

At the opening of the 'Guyana National faith-and-HIV Conference', faith leaders from the Hindu, Christian, Islamic, Rastafarian and Baha’i faiths agreed to move from commitment and rhetoric to action, by endorsing the ‘Guyana faith-and-HIV Declaration.’

Through the declaration, faith leaders recognize the need to incorporate appropriate HIV information into their discourses, rituals, religious education, and training of future leaders of faith. They also agreed to safeguard the rights of people living with HIV and affected by HIV, and ensure their complete inclusion in religious, social, familial and economic life.

Furthermore, they pledged to exhort women and their male partners to access formal healthcare, including HIV testing, in recognition of the fact that HIV is a treatable disease and HIV positive parents can have children free from HIV. They also committed to addressing all the vulnerabilities faced by children affected by and living with HIV, especially to ensure that their right to access education, treatment, care, and support in a loving environment is respected.

Finally, they agreed to utilize their places of worship, their educational and health facilities, and their women and youth programmes, to provide the full range of HIV prevention, treatment, care and support services.

During his opening remarks, Health Minister Dr. Leslie Ramsammy emphasized the importance of faith based organizations taking on a more active role in the response to AIDS and pointed to the results of a recent survey which revealed that only 50% of such organizations fully support people living with HIV.

Religious communities, mosques, temples, churches, hospitals and clinics have reached out to provide support to those living with and affected by HIV worldwide. Their leadership has great influence in the lives of many people, and leaders speaking out responsibly about HIV can make a powerful impact at both community and international level. However, the response of the religious community can also be negative. People living with HIV have been stigmatized by some religious leaders and communities of faith. Approaches to HIV prevention methods and attitudes towards people at increased risk of HIV infection such as men who have sex with men, sex workers or injecting drug users have sometimes hindered the response. Much work remains to be done to eradicate HIV-related stigma and discrimination.

Despite goodwill and a commitment to finding ways of working together, there is a gap between good intentions and effective joint action. Misunderstanding of how different faith communities are organized; tolerance and respect of what their followers believe, and how to identify and engage in joint initiatives that transcends organized religion can stand in the way.

The conference was used to guide the discussions through which the faith leadership in Guyana will address the issues of HIV-related stigma and discrimination and how, through the 'Guyana faith-and-HIV Coalition,' a major contribution will be made, in partnership with the National AIDS Programme Secretariat of the Ministry of Health and its partners, to achieve the national targets set towards achieving universal access to HIV prevention, treatment, care and support for all Guyanese, whoever they are, and wherever they are.

“The response to HIV, in any country, is heavily dependent on the broad mobilization of its leaders, institutions and movements. Faith leaders and their communities are present literally everywhere people live their lives - with enormous outreach as well as in-reach. They are important stakeholders in responding to HIV, as they have a strategic advantage in supporting, understanding and accepting people living with HIV, and in playing a crucial role in preventing new HIV infections,” said Dr. Ruben del Prado, UNAIDS Country Coordinator in Guyana.

Faith-based leadership plays an influential role in the efforts to stop the spread of HIV and, as demonstrated in Guyana, this important leadership can be strengthened in partnership with governments, civil society and the international community.

Despite successes in the Caribbean AIDS response, every day in the region 38 people lose their lives to AIDS and 55 become infected with HIV. This was the sobering message delivered by Dr Karen Sealey, UNAIDS Director of the Caribbean Regional Support Team, at the opening of the 7th Annual US Chiefs of Mission Conference on HIV/AIDS in the Caribbean held in Port of Spain, Trinidad and Tobago.

The annual high-level gathering which ran from October 22-23 was organized by the US Embassy in Trinidad and Tobago, in collaboration with USAID and Centers for Disease Control. Ambassadors from the Bahamas, Barbados, Belize, the Dominican Republic, Guyana, Jamaica, Suriname and Trinidad and Tobago attended. Haiti was also represented.

There were myriad challenges to draw their focus. In the region the epidemic is increasingly affecting young women. Disproportionately affected too are people who practice certain behaviours including men who have sex with men, people who buy and sell sex, crack cocaine users and prisoners. Stigma is rife throughout the small island nations of the region and discrimination based on differences in sexual orientation is fuelling the epidemic. Following the recent decriminalization of homosexuality in Panama, the seven countries in the Americas where homosexuality is still effectively a crime are all in the Caribbean.

HIV treatment and prevention

There has, however, been significant momentum in several areas including treatment. In 2003 4000 people were receiving antiretroviral therapy, by the end of 2007 that figure had increased to 30,000.

According to Patrick Manning, the Prime Minister of Trinidad and Tobago who addressed the conference, his country shares in this notable success: “There has been a 50% reduction in reported deaths. Some people have been able to return to relatively normal lives due to treatment from antiretroviral drugs.” He also stressed that complacency remained a clear danger.

Treatment success however has not been matched by prevention success across the region. For every 50 people put on antiretroviral therapy in 2007, there were 100 new infections.

US President’s Emergency Plan for AIDS Relief

One of the main areas for discussion was the second phase of the US President’s Emergency Plan for AIDS Relief (PEPFAR) and how the Caribbean could spearhead implementation. In July President Bush signed the reauthorization of PEPFAR to the tune of US$ 39 billion for AIDS and the Global Fund over the next five years. Haiti and Guyana have been recipients to date however other countries in the Caribbean are set to receive support from this new PEPFAR allocation. Although details of how the region will benefit have not been decided, UNAIDS is committed to helping ensure that this is maximized by working hand in hand with partners in Washington DC and in the region, such as the Pan Caribbean Partnership against HIV/AIDS (PANCAP).

The conference expanded the knowledge base of the US Ambassadors in the Caribbean and encouraged them to use their leadership role to highlight the epidemic and better support their host country’s challenge to it. In the past this gathering has helped to give the Ambassadors a powerful advocacy voice in the region.

Keeping HIV high on the agenda

Looking ahead to 2009, UNAIDS Regional Director Dr Sealey called for AIDS to be kept on the highest political agenda. The Government of Trinidad and Tobago will host three significant gatherings in the coming year; the Summit of the Americas, the First Caribbean Games and the Commonwealth Heads of Government Meeting which present potential opportunities to create new regional momentum in the challenge to HIV.

São Paulo - Business Coalitions on AIDS have emerged as an effective platform for the private sector response to the epidemic. AIDS has already claimed the lives of 25 million in the global workforce and remains a serious threat to business. Although some companies are already effectively addressing AIDS in the workplace, others simply do not know how or where to start mitigating risks. Business Coalitions have emerged to fill this gap and provide the private sector with the tools and processes it needs to effectively address AIDS in the workplace and in their surrounding communities.  

Emergence of Business Coalitions on AIDS

Business Coalitions also act as a voice for the private sector, often through representation on national AIDS committees and by interacting with other key stakeholders. Coalitions have formed partnerships with international donors, civil society groups, governments, other regional and national Business Coalitions. These relationships are critical in delivering a coordinated response to the epidemic.

UNAIDS has supported the development of a number of national business coalitions on HIV in regions heavily impacted by the epidemic. UNAIDS is currently working with over 30 national business coalitions, helping to support the private sector response to AIDS.

First regional Workshop of Business Coalitions from Latin America and the Caribbean

On October 6 and 7 2008, UNAIDS and the Brazilian Business Council on HIV-AIDS Prevention (CEN) convened a regional workshop of business coalitions and initiatives from Latin America and the Caribbean in Sao Paulo to recognize the critical role that the private sector play in the response to HIV, exchange experiences and discuss challenges and opportunities.

The workshop was attended by coalitions from Barbados, Belize, Brazil, Guatemala, Guyana, Jamaica, Mexico, and Suriname as well as the Trade Union Confederation of the Americas, the Barbados Workers Union, the Brazilian national AIDS Program, several companies members of the CEN, a state company from Paraguay, the national council of private companies from Panama and Venezuela, Futures Group, Impulso - a network of Mexican NGOs working on AIDS, the Pan-Caribbean Partnership Against HIV/AIDS (PANCAP), and the ILO.

Participants discussed best practices, issues of funding, brainstormed on how to improve the coordination with labour unions and on how to optimize the integration of the private sector and workplace into national AIDS plans as well as the development of national HIV anti-discrimination workplace regulations.

“Too often we see companies developing lovely policies but falling down on the implementation side. You need to work on behaviour change education to leave something significant and sustainable behind,” noted Madhuri Supersad, HIV/AIDS technical adviser for ILO in the Caribbean region.

The workshop provided a forum for stakeholders working with business coalitions such as the ILO to reiterate the importance of the tripartite mechanism involving workers, employers and governments as well as to present the current process undertaken by the ILO leading towards a global standard on HIV/AIDS in the workplace in 2010.

Civil society was represented by a Mexican NGO and participants felt that much more needed to happen in many countries to build partnerships between the private sector and civil society to mutually benefit one another.

It was decided to revitalize some Latin American coalitions especially in the Mercosur region, or improve the visibility and impact of the existing ones - having in mind that there can not be a “one size fits all” approach in the region. These efforts could lead to the establishment of a Pan Latin America business coalition in the near future. The upcoming regional AIDS conference in Peru next April 2009 could be a great platform to launch such an initiative.

Participants committed to continue the dialogue started during this workshop by exchanging materials and activities and seeking advice from each other on specific topics.

The workshop was followed by the 10th anniversary celebrations of the CEN an anniversary which is a landmark for the private sector response not only in Brazil but for whole Latin America.

For further information, please contact UNAIDS focal points:

Marie Engel
Partnerships Adviser Private Sector Partnerships UNAIDS
Tel: +41 22 791 554
Email : engelm@unaids.org

 

In the Caribbean region: Dawn Foderingham, Tel. +1 868 623 7056 x 278,
email foderinghamd@unaids.org

 

In the Latin American region: Rosemeire Munhoz, Tel. +507 302 4509,
email munhozr@unaids.org

 

In Brazil: Naiara Garcia da Costa Chaves, Tel. +55 61 3038 9222,
email costan@unaids.org  

To address the inclusion of the persons with disabilities in HIV-related public education the “Education and economic empowerment for persons with disabilities: Responding to HIV” programme is being implemented by  the Jamaica Council of Persons with Disabilities (JCPD) in the Ministry of Labour and Social services and is financially and technically supported by UNAIDS Jamaica.

“Individuals with disability are often overlooked in HIV prevention and AIDS outreach efforts,” said Miriam Maluwa, UNAIDS Country Coordinator for Jamaica, The Bahamas and Belize. “To ensure their inclusion in HIV-related public education, this innovative information and economic empowerment programme is being implemented as part of the national response to HIV.”

Using a creative approach, the programme directly addresses the disabled community on the subject of HIV, customizing messages and information and delivering it in accessible formats to suit their disabilities such as providing information in Braille for blind and visually impaired individuals; texting HIV prevention messages and ensuring that public health information on television has the necessary sign language for the deaf community.

The programme is coupled with an income generation component to assist people in accessing business skills and small grants to initiate and manage their own business, thus reducing their vulnerability to HIV.

Empowering deaf women and girls

The programme is a scale-up of a very successful island-wide project carried out in 2006 which educated deaf women and girls, and their service providers, about HIV and on the wider issue of gender relations.

This project came about in response to results of a needs assessment survey which showed that deaf women experience gender-based violence at a disproportionate rate, particularly violence of a sexual nature including rape, battery, incest and sexual abuse. These unsolicited sexual encounters place deaf women at significantly greater risk of contracting HIV and other sexually transmitted infections.

Within the project women were empowered with self-defense and alternative economic skills to strengthen their economic independence.

The above programmes complement efforts of UNICEF and UNFPA Jamaica who are specifically addressing matters of children with disabilities and HIV and sexual reproductive rights of persons with disabilities, respectively.

Background

The disabled community constitutes one of the most vulnerable groups within Jamaica.  Statistics are show that of the approximately 200,000 persons living with a disability in the country, less than 1% of this community is in paid employment.

Through a ripple-on effect, the education and economic empowerment for persons with disabilities programme should positively impact the lives of many, preventing HIV through reducing people vulnerabilities by empowering them with knowledge and economically, equipping them with a means of generating their own income.

At the conclusion of the 1st Meeting of Ministers of Education and Health to prevent HIV in Latin America and the Caribbean, Ministers of Education and Health have signed an historic declaration pledging to provide comprehensive sex education as part of the school curriculum in Latin America and the Caribbean.

Ministerial Declaration

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 sex education programmes will cover a broad range of topics including biological information, social and cultural information with discussion on gender, diversity of sexual orientation and identity along with ethics and human rights.

The Declaration also recognized the responsibility of the State to promote human development, including education and health, as well as to combat discrimination.

Promoting sexual health to impact HIV prevention

The meeting took place on 1 August 2008 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.

UNAIDS Executive Director Dr Peter Piot and UNFPA Executive Director, Dr Thoraya Ahmed Obaid delivered an address on HIV prevention on behalf of the UN System.

The Ministerial meeting was preceded by a technical meeting held on 31 July. Advisors to the Ministers of Health and Education, technical experts from UN agencies, academics and civil society representatives discussed a broad range of issues around comprehensive sexuality education and HIV prevention.

Discussions took place in three regional working groups and included analysis of the barriers to strengthening sexuality education and sexual health promotion programmes and how to enhance collaboration between the Ministries of Health and Education.

The Coalition of First Ladies and Women Leaders of Latin America on Women and AIDS held its IV meeting in the Dominican Republic on 27 and 28 March 2008. The meeting, supported by UNAIDS and UNFPA, brought First Ladies and women leaders from around the region together to discuss ways of moving the AIDS response forward. The newly created Caribbean Coalition on Women, Girls and AIDS also participated in the event bringing vital impetus in addressing the challenges faced by women and girls in the Caribbean.

UNAIDS Deputy Executive Director Deborah Landey stressed the importance of speaking on women and AIDS. She said, “You are here because you are ready to speak out and act on issues facing women. This takes courage. It is not always easy to talk about AIDS because it involves talking about issues many people prefer not to mention. So I congratulate you for being prepared to stand up and speak out.”

The Coalition was set up in 2006 under the leadership of the First Lady of Honduras, Mrs. Xiomara Castro de Zelaya, to promote political commitment and mobilization of regional and national resources to strengthen and enhance HIV prevention, treatment and care services and reduce the impact of the epidemic on women and girls.

The meeting in the Dominican Republic was hosted by the country’s First Lady Dr Margarita Cedeño de Fernández. The President of the Coalition and First Lady of Honduras Mrs Xiomara Castro de Zelaya also attended the meeting along with the First Ladies of Guatemala, Sandra Torres de Colom; Surinam, Liesbeth Anita María Venetiaan-Vanenburg and Panamá, Vivian Fernández de Torrijos; as well as representatives of MÉxico, Ecuador, Haití, El Salvador, Costa Rica and Chile.

The meeting took place under the theme "Stopping the feminization of the epidemic: Prevention and Care within Family and Community Context ". Sessions included; Women and HIV in the Dominican Republic; Living with HIV within the family and community context; and Cooperation for Development: Generating alliance for stopping the feminization of the epidemic and to obtaining universal access to HIV prevention, treatment, care and support.

A session was also dedicated to discussing the next steps for implementing the Action Platform in the run up to the International AIDS Conference, being held in Mexico in August 2008. The Action Platform is a strategy which was approved at the second meeting of the Coalition held in Buenos Aires in April 2007 which was designed to mitigate the impact of AIDS in the region, particularly focusing on actions to achieve universal access to HIV prevention, treatment, care and support. The platform also aims to promote women rights in a supportive environment, free of stigma and discrimination. The session included an analysis of the Action Platform to assess progress and to identify weaknesses and opportunities for further action.

A project to implement a system of micro-credits for women living with HIV in the region was presented during the meeting which was an initiative, supported by the Nobel peace prize and UNAIDS Special Representative Mr. Mohamed Yunus. The project focuses on ways of empowering women to stand up to violence, protect themselves against HIV and achieve greater respect among their families and communities.

A study on gender violence and HIV in several countries in the region produced by UNFPA was also presented at the meeting.

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Photo credit: UNAIDS

“There are never enough hours in the day,” says Miriam Maluwa, Jamaica, the Bahamas & Cuba UNAIDS Country Coordinator. “The one thing I have learnt is that as country coordinator you have got to be responsive to the needs of the county. Like a constant half moon—there’s always the half you see and the other half that you can’t yet see, but you know is to come. And you need to be ready and responsive.”

Maluwa, who trained and practiced as a lawyer with experience of AIDS legal and human rights issues, joined UNAIDS headquarters ten years ago to head a unit on Law, Human Rights and HIV. In 2004 she was given the challenge of starting the new office for Jamaica, Cuba and the Bahamas, based in Kingston, Jamaica. “It’s not a job,” she says, “this is a personal mission. I see UNAIDS as a channel to fulfil that mission and I completely believe that I should be part of this.”

Leadership and advocacy

Alongside the unpredictable day-to-day demands and coordinating role, the office in Jamaica has a full agenda that is guided by the five UNAIDS strategic functions. Leadership and advocacy for the AIDS response has been an important one of these, and to date there have been many successes in this area. UNAIDS and its Cosponsors have put energy into moving the response beyond the health sector. As a result of this collaboration with the Government, in Jamaica there are now eight government ministries with policies and programmes for HIV.

UNAIDS Office and Cosponsors have also supported the government in the development of the Jamaica Strategic Plan for 2007- 2012, which is before the cabinet for endorsement. This $201 million plan has an integral Monitoring and Evaluation framework with embedded indicators and targets for its goal: “the achievement of universal access to prevention, treatment and care”.

Maluwa is very encouraged by the enthusiasm for the new plan. “It is so accepted that when the Prime Minister spoke at the last World AIDS Day breakfast Meeting he actually referred to the plan,” she said. “He spoke about its contents. He had no notes and he was speaking off the cuff. It was a good feeling.”

Jamaica's first ever private sector led Business Council on HIV and AIDS with 20 large companies was established in 2006.

One challenge in Jamaica is that few people know their HIV status or believe that they are at personal risk. An estimated three quarters of the some 25,000 people living with HIV in the country have not been diagnosed. The Prime Minister and his wife have drawn attention to this issue by taking HIV tests in public. During the 2007 official World AIDS Day event, which UNAIDS helped to organise, Voluntary Counselling and Testing facilities were provided and over 1000 people came forward for the service. 

Legal reform

On the invitation of the authorities, UNAIDS Office has also played an active role in the process of HIV related legal reform. With her legal expertise Maluwa was able to support an extensive assessment of existing legislation and draw up reform proposals which have been submitted to Cabinet and discussed with the Parliamentary Joint Select Committee.
A series of reforms are being recommended including enactment of an anti Discrimination provision in the Jamaica Constitution prohibiting discrimination based on all status; amending the Public Health Act and enacting a comprehensive stand alone Anti Discrimination Act with mechanism to investigate and redress discriminatory actions and amending the Criminal Offences Act to decriminalize homosexuality.

 “A lot of the value that Governments place on UNAIDS is on the technical support and our ability to provide strategic support at critical times,” says Maluwa.

Strengthening partnerships

The UNAIDS office also works to strengthen partnerships and support civil society. It has supported the development of a mini-TV series that will be broadcast in 2008. Called Red Ribbon Diaries, the series documents the lives of ordinary young Jamaicans affected by HIV. UNAIDS has also partnered with the Jamaica Council of Persons with Disabilities to implement an Island-wide prevention programme to educate deaf women and girls, and their service providers about HIV.

The Jamaican Network of Sero-positives (JN+) is supported through the provision of office space for its Board of Directors and UNAIDS also technically supports the network’s Island-wide capacity building workshops for people living with HIV and has served as Elections Returning Officer at the recently held elections of new JN+ Board.

Resource mobilisation

An achievement which Maluwa is particularly proud is UNAIDS Jamaica’s  role in Chairing the Oversight Monitoring Committee of the Country Coordinating Mechanism which is implementing a model plan for resolving potential conflicts of interest between Principle Recipients and sub-recipients of the Global Fund to Fight AIDS, TB and Malaria.
This is part and parcel of the technical support to the Jamaican government, but has international relevance. “It is an innovative contribution to resource mobilisation. The Global Fund is currently publishing the Jamaica model as a Best Practice,” she said.

Personal fulfilment

Looking to the future, Miriam Maluwa sees the subsisting deep-seated culture of stigma, discrimination and homophobia as one of the main challenges to the Jamaica AIDS response.

However, important work is underway. The National AIDS Committee, in collaboration with UNAIDS Jamaica and the legal fraternity has secured free legal services from 25 lawyers to address matters of discrimination for people living with HIV and other key populations. These lawyers also support human rights workshops for the general public, media, religious leaders, people living with HIV and civil society to enhance a culture of tolerance.

 “This work is personally rewarding,” says Maluwa, “because in the field you are not pushing paper, you are dealing with real issues every day. Each issue that comes to you, you are managing either the person before you or the relationship between that person and other partners you are trying to coordinate, so that everybody comes together over an issue. I find that very fulfilling because I can count on my fingers the difference that I am making every day.”

Her four years in the country office has given her new insights into UNAIDS. “The life of UNAIDS is really at country level,” she says. “It’s the best way for UNAIDS to showcase its work. Either we are there or we are irrelevant. I think the country offices bring credibility to UNAIDS, because they are what people see. We need to put our money and our efforts there.”

AIDS has become the “greatest leadership challenge to nations and regions” in the 26 years since its discovery, the UNAIDS Deputy Executive Director UNAIDS Michel Sidibe said in his keynote speech at the 7th Annual General Meeting of the Pan Caribbean Partnership Against HIV/AIDS (PANCAP), held in Antigua and Barbuda (24 - 26 October).

Addressing some hundred participants, Sidibe said AIDS has become a defining issue of our time. “We are really in the turning point in my point of view. It is important for us to not to just deal with this pandemic like if it is just about managing a short term crisis, it is time for us to look at how we can really think about long term sustainable approach to deal with this pandemic,” he said.

In order to meet that challenge, Sidibe reinforced the urgent need for countries to turn commitments into action by setting and achieving targets for universal access to HIV prevention, treatment, care and support services for all those in need. Resonating strongly with the theme of the PANCAP meeting— Universal Access by 2010: Ensuring Success—the UNAIDS Deputy Executive Director maintained that the greatest legacy to future generations would be the attainment of this critical goal.

Taking into account new factors such as the increasing numbers of women becoming infected with HIV, growing stigma and discrimination, and the lack of capacity to get treatment to all those in need, Sidibe said action must be accelerated. “We need to quicken the pace of action,” he said.

Established in 2001, PANCAP is the regional mechanism responsible for coordinating the Caribbean’s response to the HIV epidemic. It is based in the Caribbean Community (CARICOM) Secretariat, in Georgetown, Guyana. The PANCAP Annual General Meeting is an important regional event in the Caribbean bringing together the principal leaders in the AIDS response in this Region.

Mr Sidibe, on his first trip to the Caribbean in his capacity as UNAIDS Deputy Executive Director and Under Secretary General of the UN, also met with various leaders and UNAIDS partners in the Caribbean region. These included: Prime Minister of Antigua and Barbuda, the Honorable Winston Baldwin Spencer, Antigua’s Minister of Health, John Maginley, Assistant Secretary General of CARICOM, Dr Edward Greene, Chairman of the Barbados National HIV/AIDS Commission and former Chair of the Global Fund, Dr Carol Jacobs, Belize AIDS Ambassador, Dolores Balderamos Garcia and Dr James St Catherine of the Organization of Eastern Caribbean States. Commending all for their exemplary leadership shown in working to expand the AIDS response and achieve universal access both nationally and regionally, Sidibe pledged increased UNAIDS technical support and assistance to further strengthen efforts.

The Caribbean region is the second most affected by AIDS after sub-Saharan Africa. An estimated 250,000 people are living with HIV in the region, more and more of them women. In 2006 there were 27,000 reported new HIV infections.

 

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Links:

Visit the PANCAP web site
Visit the CARICOM web site