Caribbean

The Trinidad and Tobago transgender activist and community leader Brandy Rodriguez has died.

Ms Rodriguez was a stalwart of national and regional efforts to advance the rights of lesbian, gay, bisexual and transgender people. She was the President of the Trinidad and Tobago Transgender Coalition (TTTC). Through her collaboration with the United Caribbean Trans Network (UCTRANS) and the Latin American and Caribbean Network of Transgender People, she contributed to the movement for increased visibility, advocacy and community organization around gender identity issues. She also contributed to policymaking and workplace engagement efforts, including as a member of the Pan Caribbean Partnership against HIV and AIDS.

But her impact went even deeper. As a peer navigator for many years at the Family Planning Association of Trinidad and Tobago (FPATT), Ms Rodriguez provided direct support to members of the transgender community, including street-based sex workers.

She also supported transgender people living with HIV to access testing, treatment and care services. Among Caribbean countries that have reported on HIV prevalence for transgender people, the median HIV prevalence is more than 27%, far higher than that among any other key population group. Ms Rodriguez worked to ensure that members of this community not only started treatment but stayed the course.

From the base of the TTTC in Tunapuna, Trinidad and Tobago, Ms Rodriguez worked to ensure that the most marginalized people in her community had access to food, health care and mental health support. During the COVID-19 pandemic, her organization coordinated relief for transgender people who had lost their means of generating income.

This May she was recognized by Queen Elizabeth II for her advocacy and service when she received the 180th Commonwealth Point of Light award.

“Brandy fought fearlessly against discrimination. And in this fight, she didn’t just ask for recognition or plead for equal access to quality health care, but she made the point that it was a right that must come without conditions. She was determined to settle for nothing less,” a release from FPATT said.

In 2018, she addressed journalists at a regional media sensitization hosted by the UNAIDS Caribbean Sub-Regional Office and the Caribbean Vulnerable Communities Coalition. For most of the reporters it was their first time speaking to a transgender person and hearing how stereotypes and prejudice in their reporting were harmful to the community.

“For 22 years it has been an uphill battle, especially in the Caribbean. My conviction to not be silenced and to help vulnerable people keeps me committed to my goal of a better, more inclusive future for all,” Ms Rodriguez said.

The Director of the UNAIDS Caribbean Sub-Regional Office, James Guwani, recognized Ms Rodriguez for her work as a voice for the voiceless.

“She shows why it is imperative that we support community organizations with the ability to connect to those who are hardest to reach. At a time that the global HIV response is focusing on ending inequalities and supporting community-led interventions, we draw inspiration from Ms Rodriguez’s life and work,” he noted.

“The mother of the LGBTI community of Trinidad and Tobago has gained her wings,” said Alexus D’Marco, UCTRANS’ Executive Director. “The work of Brandy Rodriguez will not be forgotten and we must ensure that it continues.”

At the GHESKIO (Groupe Haïtien d'Étude du Sarcome de Kaposi et des Infections Opportunistes) clinic in Port au Prince, Haiti, a young woman learns that she is HIV-positive. Along with counselling, she is offered immediate enrolment into a treatment programme at the facility.

Same-day treatment initiation is among the approaches Haiti has used to turn the tide on its HIV epidemic. HIV prevalence among adults is now 1.9%, down from a high of 3.2% in the mid-1990s. According to government statistics, of the estimated 154 000 people living with HIV, 89% know their status. Ninety-three per cent of diagnosed people are on antiretroviral therapy and 87% of people who are on antiretroviral therapy are virally suppressed. Over the past decade, deaths due to AIDS-related illnesses fell by 63% in the Caribbean country.

These achievements are the result of collaboration between the Government of Haiti, civil society and international development partners.

But they are also due to considerable donor investment. The vast majority of total HIV expenditure in Haiti comes from international sources.

The UNAIDS Country Office for Haiti is currently supporting the United States President’s Emergency Plan for AIDS Relief (PEPFAR) and the Ministry of Public Health and Population to conduct the Sustainability Index and Dashboard (SID) exercise in Haiti. This is a tool completed every two years to sharpen understanding of countries’ sustainability landscapes and inform HIV investment decisions. Through the exercise, stakeholders assess national HIV responses from the point of view of sustainability and across four thematic areas. This is Haiti’s fourth SID. 

“The impressive gains Haiti has made over the past decade can be compromised in the future by overreliance on external funding. UNAIDS is pleased to support the Ministry of Public Health and Population along with PEPFAR and the Global Fund to Fight AIDS, Tuberculosis and Malaria through this exercise to build a more sustainable response,” said the UNAIDS Country Director for Haiti, Christian Mouala.

UNAIDS will continue to work together with the national leadership, PEPFAR, the Global Fund to Fight AIDS, Tuberculosis and Malaria, civil society and other key partners of the HIV response to ensure that national interventions are equitable. The focus is on reaching the most vulnerable communities through coordinated programming and implementation and consistent inclusion of people living with HIV and key populations, including in humanitarian contexts.

The Executive Director of the Unit for the Control of Infectious and Transmissible Diseases (UCMIT), Pavel Desrosiers, noted that the SID exercise is crucial to identifying weaknesses in the current HIV response.

According to Hamfrey Sanhokwe, the PEPFAR Coordinator for Haiti, the SID also helps donors, “Measure progress on programmatic and financial sustainability and focus efforts for an optimal HIV national response.”

The optimum participation of all HIV stakeholders is key to the process. “People living with HIV were represented in and contributed to all the thematic meetings during the week and the exchanges were productive,” said Maria Malia Jean, a representative of the Haitian Federation of the Associations of People Living with HIV (AFHIAVIH).

The results of Haiti’s 2021 SID will be finalized and validated by all stakeholders before the end of October. HIV stakeholders will then be able to visualize and focus on areas that need further strengthening, while noting the successes they have worked so hard to achieve.

“Haiti has achieved much progress in the fight against HIV; however, efforts must be sustained and increased to ensure that targets are achieved by 2030,” said the Director-General of the Ministry of Public Health and Population, Lauré Adrien.

GENEVA, 8 July 2021—UNAIDS is shocked and saddened by the assassination of Jovenel Moïse, the President of Haiti, during an attack by gunmen at his private residence. It also sends its sincere hopes that the First Lady, Martine Moïse, will recover from the injuries that she sustained during the incident.

“My thoughts are with the family of President Moïse at this incredibly difficult time,” said the UNAIDS Executive Director, Winnie Byanyima. “I sincerely hope that the First Lady will recover from her injuries. She is a strong friend to UNAIDS and a staunch champion in the response to the HIV epidemic, both in Haiti and across the region.”

Ms Moïse, above left, has chaired Haiti’s Global Fund to Fight AIDS, Tuberculosis and Malaria Country Coordinating Mechanism since 2017 and is a close ally of UNAIDS. She is also a member of the Spouses of Caribbean Leaders Action Network and champions its work around the Every Woman, Every Child initiative in Haiti. Among Ms Moïse’s priorities are combatting violence against women and girls, teen pregnancy and human trafficking. She also supports the agenda to prevent and eliminate mother-to-child transmission of HIV.

In June, Ms Moïse spoke on behalf of the Caribbean Community at the United Nations General Assembly High-Level Meeting on AIDS.

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.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

HIV outcomes rely on far more than the availability of services or treatment.

According to the 2020 Jamaica People Living with HIV Stigma Index, more than one third (38%) of respondents delayed HIV testing due to fears about how others would respond if they received a positive diagnosis. And 30% were slow to start treatment because of concerns that people might learn about their status.

Many of those fears are founded.

Almost half of the study’s respondents (48%) had experienced stigma or discrimination related to their HIV status. Members of key population communities reported even higher rates of prejudice and worse mental health than other people living with HIV.

“More needs to be done to get those living with HIV, and communities impacted by HIV, to live in a country and society where they are accepted and appreciated. That will also make their health outcomes better,” said Jumoke Patrick, the Executive Director of the Jamaica Network of Seropositives.

To accelerate progress towards that goal, in 2020 Jamaica became one of the first countries to join the Global Partnership for Action to Eliminate all Forms of HIV-Related Stigma and Discrimination. The initiative combines the power of governments, civil society, donors, academia and the United Nations. It reaches beyond the health sector to address ignorance and bias in education, the workplace, the justice system, families and communities.

On 4 June, the Jamaica Partnership to Eliminate HIV-Related Stigma and Discrimination launched its first annual report, Enabling environment and human rights.

The State Minister in the Health and Wellness Ministry and Chair of the Partnership, Juliet Cuthbert Flynn, reiterated the government’s commitment to addressing the social and legal issues that are barriers to an effective HIV response. She called for political leadership across party lines to recognize their role in helping to create an enabling environment.

“This is an imperative as we strive to allow every individual—regardless of their occupation, socioeconomic status, sexual orientation, gender identity, age, health status, disability and other status—to enjoy their human rights,” Ms Cuthbert Flynn said.

“We strongly believe that AIDS in Jamaica is not over, but it can be,” said the UNAIDS Country Director for Jamaica, Manoela Manova,

She noted that the new UNAIDS report, Global commitments, local action, showed that while dozens of countries had achieved the 2020 targets, many, including Jamaica, are entirely off track.

“HIV remains driven by inequality. The countries with progressive laws and policies as well as strong and inclusive community and health systems have the best outcomes. New HIV infections and AIDS-related deaths reduce faster. That is what we would like to achieve for Jamaica,” Ms Manova said.

Jaevion Nelson, a UNAIDS consultant, detailed the achievements of stakeholders in the national HIV response in Jamaica. A national human rights public education campaign was led by the National Family Planning Board. Sensitization exercises were conducted with police and correctional officers, health-care workers and faith leaders and congregants. People living with HIV received legal support, with several securing resolutions such as being reinstated in their jobs and receiving settlement costs. A National Transgender Health Strategy was launched, and nongovernmental organizations collaborated to develop model antidiscrimination legislation. 

The next steps for the initiative include strengthening monitoring, evaluation and learning for its human rights agenda, increasing the engagement of legislators and creating a more sustainable framework for sensitizing health-care workers, law enforcement officers and other duty-bearers.

The UNAIDS Deputy Executive Director, Programme, Shannon Hader, delivered the feature address at the virtual event. “Societal enablers and HIV outcomes are linked,” she said. “We will only end AIDS if we strive to respect, protect and promote the rights of everyone, everywhere. It is the evidence-based thing to do.” 

Over four consecutive years, no child in the eastern Caribbean country of Dominica was born with HIV, including in 2017 when, within two weeks, the island braved back-to-back hurricanes that ultimately damaged 90% of its infrastructure.

Dominica has now received validation from the World Health Organization (WHO) for the elimination of mother-to-child transmission of HIV and syphilis. It is the eighth Caribbean country or territory to have achieved this dual elimination goal—joining Cuba, which achieved it in 2015, and Anguilla, Antigua and Barbuda, Bermuda, the Cayman Islands, Montserrat and Saint Kitts and Nevis, which achieved it in 2017.

During a virtual ceremony, partners reflected on the mix of political, health-care and community components required to create a sustainable framework for preventing HIV and other illnesses in the maternal and child health context.

Roosevelt Skerrit, the Prime Minister of Dominica, reiterated the importance of the government’s commitment to the Sustainable Development Goal health agenda. He noted that the investments made in health infrastructure and systems would help Dominica reach other targets, including a “reduction in maternal and child mortality, universal access to sexual and reproductive health services and universal health coverage.”

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

All pregnant women in Dominica are offered HIV and syphilis testing when they enrol for antenatal care. For those found to be positive, treatment is provided free of charge. Access to health services is available to everyone regardless of nationality. And Dominica now provides early infant diagnosis in-country, thereby ensuring accurate and timely care for infants exposed to HIV.

Health-care workers, including a cadre of community health nurses and staff of the National HIV and AIDS Response Unit, who coordinated psychosocial support and care services, were critical for the strategy’s success.

Critically, Dominica worked to strengthen its health information system so it could provide evidence relating to the coverage of antenatal care, testing and treatment services and their impact. The validation process also included assessments on human rights, gender equity and community engagement.    

Meeting the rigorous data and reporting requirements for elimination of mother-to-child transmission certification is a key next step for several Caribbean countries that have already achieved remarkable gains in the prevention of mother-to-child transmission of HIV. Since 2010, the proportion of pregnant women living with HIV in the region receiving antiretroviral therapy to prevent transmission to their babies has doubled. 

The Director of the UNAIDS Caribbean Sub-Regional Office, James Guwani, noted during the ceremony that next month the world will adopt a new United Nations political declaration on AIDS.

“One of the most powerful testaments to our capacity to end the AIDS epidemic is success in ensuring that children are not born with HIV. But the work does not end there,” Mr Guwani said. “We must shift the attitudes and prejudices that make it difficult for families affected by HIV to live, learn, work and play freely. We must give all young people the education, empowerment and access to services they need to remain HIV-free throughout their lives. And we must do a better job at preventing HIV infections at all age groups and among all communities. By putting people first, we can end the AIDS epidemic.”

Early diagnosis of infants who have acquired HIV vertically (from their mother) is vital. Swift testing of infants exposed to HIV and an immediate start of antiretroviral therapy upon diagnosis can ensure the survival of children who have acquired HIV. Without early diagnosis and treatment, about half of infants with HIV die by the age of two years, but many HIV-exposed infants in low- and middle-income countries are not accessing early infant diagnosis.

In the Caribbean, coverage of virological testing for early infant diagnosis varies from 21% in Jamaica to 99% in Cuba.

On International Transgender Day of Visibility (March 31), the United Caribbean Trans Network (UCTRANS) launched the results of its survey Over-policed, Under-protected: The Experiences of Trans and Gender Diverse Communities in the Caribbean.

The study was conducted in 2020 with the support of OutRight Action International. It features feedback from transgender and other gender diverse respondents from 11 countries, garnered from surveys, individual interviews and focus group sessions.

Respondents identified the inability to change their gender marker, employment discrimination and discrimination in health services as the top challenges facing the community.

Except for Cuba, no Caribbean country allows transgender people to modify their gender on official identification.

“Gender identity recognition is important,” said Alexus D’Marco, UCTRANS’ Executive Director. “Every aspect of a trans person’s life—access to education, employment, housing, and healthcare—depends on their ability to show a valid identity card or documentation that aligns with their gender identity and expression.”

“It is beyond hormones,” said Yaisah Val of Community Action for the Integration of Vulnerable Women in Haiti (Action Communautaire pour l’integration des Femmes Vulnerable en Haiti, or ACIFVH). “We need legal recognition and documents.”

Forty-two percent of the study’s respondents indicated that they were currently unemployed. According to the report, discrimination and the lack of workplace and social protections compound this issue.

“We had someone who was working with the government and told they had to go home. They said they didn’t employ ‘she’, they employed ‘he’,” said Brandy Rodriguez of the Trinidad and Tobago Transgender Coalition, pictured above.

Around four of five respondents (78%) reported having experienced depression or anxiety. But just one-third (32%) of those who were receiving accessed health services said that it was trans-affirming or at least trans-competent.

HIV prevalence is disproportionately high among Caribbean transgender people—51% in Jamaica, 28% in the Dominican Republic, 8% in Guyana and 3% in Cuba. In 2019, 5% of new HIV infections in the Caribbean were among transgender people.

“The cycle of displacement contributes significantly to this HIV risk,” Ms. D’Marco said.  “If you are thrown out of the at an early age, experience gender-based violence and find yourself sleeping on beaches or the streets, you are more likely to have sex for a meal or a place to stay. Someone with education, access to housing and healthcare would be less likely to contract HIV.”

Responding to HIV in the trans community calls for increased investments in psychosocial support. Ms. Rodriguez who is a peer navigator for transgender people accessing HIV treatment in Trinidad and Tobago says COVID-19 has increased the proportion of her clients who do not have money for transportation, food and housing. A Guyanese respondent said many of her friends committed suicide due to being unable to cope with their HIV status.

Trans advocacy in the region has burgeoned over the last decade with important strides made toward increasing public awareness and political will. Ms. D’Marco credits RedLacTrans, the regional transgender network for Latin America and the Caribbean, with helping to build advocacy capacity in the Caribbean. In many countries activists and community organizations have scaled up public awareness and political engagement efforts.

UNAIDS is supporting this movement in different ways. UNAIDS Jamaica helped TransWave develop the Trans and Gender Non-Conforming National Health Strategy, a five-year rights-based road map for advancing the community’s health and well-being. UNAIDS Caribbean has collaborated with the Caribbean Vulnerable Communities Coalition, the Caribbean Broadcasting Union, the Caribbean Media Workers Association and the University of the West Indies Rights Action Project to conduct hands-on regional and national journalist trainings on how to cover transgender people and their issues responsibly. UNAIDS Caribbean has also supported community engagement and strategic communications around two successful strategic litigation cases challenging discriminatory laws that affect LGBT people, including a colonial-era crossdressing law in Guyana.

“As we increase our focus on achieving excellent HIV prevention, treatment and human rights outcomes for all key population groups, it is critical that we address the unique challenges facing the Caribbean transgender community,” said Dr. James Guwani, UNAIDS Caribbean Director. “We need more strategic information, more investments in community-based services and comprehensive strategies to increase transgender people’s access to education, employment, justice and healthcare.”

Since school doors closed last March due to COVID-19, the majority of Jamaican students are still receiving tuition exclusively online. Social media and messaging services are more relevant than ever as a channel to share knowledge and resources with young people, as well as to receive their feedback.

The United Nations Children’s Fund (UNICEF) U-Report is an innovative message-based tool designed to engage with young people, provide them with information and give them an opportunity to weigh in on issues of national importance. Jamaica became the first Caribbean country to launch U-Report, joining a global movement of more than 5 million U-Reporters. UNAIDS Jamaica recently collaborated with UNICEF to find out what young people know, or don’t, about HIV. The 10-question quiz also provided correct information to the participants.

Almost 2000 young people responded to the survey, with just 214 achieving a perfect score. The quiz pointed to some worrying gaps in knowledge relating to both HIV basics and access to information on HIV prevention. One in 10 respondents mistakenly thought HIV could be transmitted by mosquitoes, for example. Almost one in three were not aware of the local solution for delivering school-based sex education, the Health and Family Life curriculum.

The results of the survey corroborate Jamaica’s most recent Knowledge, Attitude and Behaviour (KAB) survey results and demonstrate that there are still glaring HIV knowledge gaps among young people. The survey revealed that only 33% of young people between the ages of 15 and 24 years correctly identified the ways in which HIV can be transmitted. This was a 6% decline in knowledge levels as compared to the 2012 KAB survey. The 2017 study also found that 40% of respondents with multiple partners did not use a condom during their last sexual encounter.

“The results of the HIV U-Report quiz have reinforced the need for efforts to be made to address the decline in knowledge on information on HIV among young people in Jamaica,” said the UNAIDS Country Director for Jamaica, Manoela Manova. “Particularly in the context of COVID-19, it is critical that we innovate to ensure that this messaging and engagement takes place on digital platforms and with a view to ensuring that no child or young person is left behind.”

The U-Report social messaging tool has proved to be a quick and useful way to gather information that can be used to inform programmes and plans focusing on young people in Jamaica. UNICEF Jamaica has supported innovations to ensure that children and young people have access to education and support during COVID-19, including tele-mental health services, virtual instruction training for teachers and strategies to close the digital divide.

During COVID-19, virtual dialogues and behaviour change communication have been scaled up. A UNICEF-supported initiative aims to address the gaps in HIV and sexual and reproductive health knowledge for young people in Jamaica. The National Family Planning Board’s Adolescent Sexual and Reproductive Health Campaign focuses on teen health, including targeting sexually active teenagers with messages on condom use and dispelling myths about HIV transmission. The campaign disseminates sexual and reproductive health/HIV information through social media and uses animated characters to reach adolescents. The campaign also speaks about the benefits of abstinence and birth control. 

Stakeholders of the Caribbean HIV response have launched the In Your Hands HIV self-testing campaign, which advocates for self-testing policies to be developed and implemented as part of a comprehensive strategy to ensure that HIV diagnosis does not decline during the COVID-19 pandemic.

Even before COVID-19, the Caribbean was not on track to achieve the 90% testing target due at the end of 2020. In 2019, 77% of all people living with HIV in the Caribbean knew their HIV status. A survey conducted by the Pan Caribbean Partnership against HIV and AIDS (PANCAP) and the Pan American Health Organization (PAHO) showed that during 2020 facility- and community-based HIV testing services were reduced in 69% of countries due to COVID-19.

“This decline means that people with undiagnosed HIV are not getting life-saving antiretroviral treatment and, of course, continue to be unaware of their HIV status, with the risk of potentially exposing others,” said Sandra Jones, PAHO’s Technical Advisor for HIV/STI, TB & Viral Hepatitis in the Caribbean.

“The COVID-19 pandemic has presented the opportunity for us to explore new and innovative approaches that are result-oriented,” Rosmond Adams, the PANCAP Director, said.

According to James Guwani, the Director of the UNAIDS Caribbean Sub-Regional Office, it is particularly important to increase testing uptake among men, who are more likely to be diagnosed late. In 2019, 85% of Caribbean women living with HIV were aware of their HIV status, compared to just 72% of men. There is also a need to increase testing coverage among members of key populations, who have reduced access to HIV services due to stigma and discrimination. 

The World Health Organization recommends that HIV self-testing be offered as an additional approach to facility- and community-based services. Evidence shows that self-testing is safe and accurate and increases testing uptake among people who may not test otherwise.

Through the campaign, partners are advocating for national policies to include a communication package with information to link testers to HIV prevention and treatment services, as well as minimum standards for the procurement and distribution of HIV self-testing kits in the private and public sectors.

“We strongly believe that HIV self-testing can help close the gap on the first 90. It can be targeted to individuals not being reached by existing HIV testing services, particularly those populations with low testing coverage and at high risk of HIV. It’s not a replacement for all testing services, but it should be included in the toolbox,” said Victoria Nibarger, the Caribbean Regional Programme Coordinator for the United States President’s Emergency Plan for AIDS Relief (PEPFAR).

Under a Global Fund to Fight AIDS, Tuberculosis and Malaria project for the region, work is under way to conduct a verification and feasibility assessment for the introduction of HIV self-testing across countries. Already Guyana has announced plans to roll out HIV self-testing this year, while several countries have either made a commitment to develop policies or are now in the process of doing so. 

UNAIDS is helping to coordinate the campaign in the Caribbean, with a focus on supporting a knowledge management strategy that ensures all stakeholders have the information, messages and tools they need to successfully lobby at the national level. A key priority is ensuring civil society engagement and addressing community concerns about how self-testing policies will be implemented.   

While representatives of communities of people living with HIV and key populations endorsed the call for HIV self-testing, they have advised that increased investments are needed in post-test counselling and adherence counselling for the entire HIV response.

Deneen Moore, a Caribbean representative of the International Community of Positive Women, said, “We need to improve peer navigation so that when people test positive they have someone there to help them. We also need more social contracting so that civil society organizations can help reach people who test positive. There is definitely a need for us to be involved in the process.”

The advocacy initiative is jointly endorsed by UNAIDS, PAHO, PANCAP, PEPFAR and the Caribbean Med Labs Foundation.