Caribbean

High-level officials from the Caribbean Community (CARICOM) and the African Union (AU), along with selected ministers of health from both regions, met in Geneva, Switzerland, this week to explore the role of shared responsibility and the global solidarity agenda in ending the AIDS epidemic in the Caribbean. The dialogue, held on 20 May and convened by UNAIDS Executive Director Michel Sidibé, examined the first steps in developing a Caribbean road map towards such shared responsibility.

In 2012, the African Union produced its own Roadmap on Shared Responsibility and Global Solidarity for AIDS, TB and Malaria Response in Africa, with technical assistance from UNAIDS, which built on the considerable progress the continent has made in transforming its response to HIV, tuberculosis and malaria. The AU Roadmap is based on three central pillars: more diversified, balanced and sustainable financing models; access to medicines, local production and regulatory harmonization; and leadership, governance and oversight for sustainability.

AU delegates at the Geneva meeting were able to share their wealth of experience on the processes, mechanisms and political support required to attain these goals, promote greater self-reliance and ensure the success of the road map. The meeting also facilitated further exchanges and links between countries of both regions regarding their HIV and health responses.

It emerged that there were major common challenges and opportunities facing the Caribbean and Africa in terms of health and development issues in the post-2015 context. These include equitable access to health services, social protection and human rights issues and, as incomes rise, an increasing lack of access to official development assistance, which has profound implications for sustainability. 

The meeting formally endorsed a CARICOM–AU–UNAIDS partnership to assist the development of the CARICOM road map. Initial steps will consist of gathering evidence to help define Caribbean-specific road map pillars and drawing up a schedule of meetings at the very highest technical and political levels.

During a visit to the Commonwealth of the Bahamas the Deputy Executive Director of UNAIDS Luiz Loures commended the government on the progress made in curbing its AIDS epidemic. 

Once a country with the highest rates of HIV prevalence in the Caribbean, the Government of the Bahamas has taken strong ownership of its response to HIV from the outset, providing most of the funding and human resources from domestic sources. This commitment has resulted in marked progress and the Bahamas was cited by Dr Loures as an example of how political will and leadership are key to advancing progress towards the end of the AIDS epidemic.

Dr Loures also recognized the valuable contributions of civil society, care providers and private sector partners and confirmed that in this global effort, UNAIDS is looking forward to supporting the Bahamas leadership in its quest to end the national epidemic.

The Government reconfirmed its commitment to providing high-quality, accessible HIV services to improve the health and well-being of people living with and affected by HIV.

On 9 April a high-level delegation of international partners involved in the response to HIV met with the Jamaican Prime Minister, the Most Honourable Portia Simpson Miller, to discuss the country’s role in accelerating the Caribbean’s efforts to end stigma and discrimination and reduce new HIV infections and AIDS-related deaths.

The visiting delegation included the Prime Minister of St Kitts and Nevis, Denzil Douglas; the United Nations Secretary General’s Special Envoy on HIV for the Caribbean, Edward Greene; UNAIDS Deputy Executive Director, Luiz Loures; and the Executive Director of the Global Fund to Fight AIDS, Tuberculosis and Malaria, Mark Dybul.

The issue of the importance of full respect for human rights was discussed, as was the need to collaborate with other countries on innovative approaches to strengthen HIV responses. The challenges regarding the balance of financial responsibility between Caribbean countries and international partners for sustaining HIV responses was also high on the agenda.

The Global Fund reiterated its role as part of a worldwide partnership to support countries in responding to HIV and announced a US$ 10 million grant to Jamaica to support its continued efforts in HIV prevention, treatment and care.

UNAIDS offered to facilitate an exchange of ideas between the African Union and the Caribbean Community (CARICOM) on the principles of shared responsibility and global solidarity to propel efforts toward ending AIDS.

The Caribbean response to HIV has known many successes in recent years. Since 2001 there has been a 54% decline in AIDS-related deaths while new HIV infections have dropped by 49%. Twenty times more people are accessing HIV treatment now than there were ten years ago. And several countries are on track to virtually eliminate new HIV infections among children by 2015.

However, stigma and discrimination are still hampering efforts to reduce new HIV infections, increase the numbers of people accessing antiretroviral treatment and ensure that all people living with HIV can live full and productive lives. Prejudice towards people living with HIV and other key populations such as men who have sex with men, transgender people, sex workers, people who use drugs, homeless people and prisoners, remains a major obstacle throughout the region.

“HIV is a by-product of social inequities,” said Carolyn Gomes, Executive Director of the Caribbean Vulnerable Communities Coalition at the Caribbean Consultation on Justice For All in Kingston, Jamaica. “We need a bottom-up approach. We have to find ways to be heard. We have to apply resources to what we know would bring about transformative change.”

The “Justice For All” initiative is meant to link the voices and actions of members of civil society with governments, faith communities and the private sector. It is an attempt to collectively propel Caribbean countries toward improving citizens’ access to justice and equity. It also aims to build alliances in order to increase awareness and support for human rights.

Coordinated by the Pan-Caribbean Partnership Against HIV and AIDS (PANCAP), the effort is led by the United Nations Secretary General’s Special Envoy on HIV for the Caribbean, Professor Edward Greene, supported by UNAIDS.

“The world now knows what to do to end this epidemic,” UNAIDS Deputy Executive Director, Luiz Loures told participants. “We have the tools but we have entered a phase in which some people are getting left behind. The Caribbean is part of this contradiction. The general epidemic is going down but there are still laws, attitudes and practices that stop us from achieving our goals.” Dr Loures encouraged participants in the consultation to choose concrete targets and milestones to chart their progress towards ending stigma and discrimination.

The Executive Director of the Global Fund to fight AIDS, Tuberculosis and Malaria, Mark Dybul, noted that this regional approach to building a culture of respecting human rights is unique. "The Caribbean can become the leader in ending AIDS,” said Mr Dybul. “We are at an historic moment when we can end AIDS as a public health threat. No other epidemic is pushing us to respond to one another differently and to embrace everyone, every small subset of people, as part of the human family.”

Mr Greene identified key areas of focus including reducing gender inequality, promoting sexual and reproductive health and rights and repealing discriminatory laws that infringe human rights. Sex between men is a criminal offence in 11 nations in the region and several Caribbean countries prohibit aspects of sex work. Some countries also have laws that restrict entry on the basis of sexual orientation, HIV status and disability. The Prime Minister of St. Kitts and Nevis, Denzil Douglas, assured that “Justice For All” will be a focus of discussion for the region’s political leaders. 

GENEVA/WASHINGTON, 10 January 2014—UNAIDS and the Organization of American States (OAS) have signed a Memorandum of Understanding (MoU) in efforts to advance the response to HIV among the OAS Member States. 

Through the MoU, UNAIDS and the OAS will increase HIV outreach activities such as information and education campaigns, policy roundtables, forums, lectures and scholarships programmes aimed at reducing new HIV infections, expanding access to antiretroviral treatment and supporting people living with HIV. UNAIDS and the OAS will also foster collaboration with regional networks of HIV positive youth to strengthen HIV awareness and prevention education, enhance social protection for young people, counter gender-based violence and challenge harmful gender norms among young people.

“HIV is more than a disease. It is an issue of security, social justice and distribution of opportunities,” said Michel Sidibé, Executive Director of UNAIDS. “We must leverage this partnership to ensure that no one is left behind in the response to HIV in the Americas and that people most affected by HIV have access to essential HIV prevention and treatment services.”

Key populations including men who have sex with men, sex workers, people who use drugs and transgender people remain most affected by HIV in Latin America and the Caribbean. Although new infections have stabilised, they are still not declining.  The existence and enforcement of punitive laws as well as widespread stigma and discrimination against men who have sex with men, transgender people and sex workers continue to marginalize people most in need and block access to lifesaving HIV services.

“We have managed to break the curve of growth of infection,” said Miguel Jose Insulza, OAS Secretary General. “We now need to address structural, cross-cutting issues, including gender-based violence.”

In June 2013 the OAS General Assembly passed the Resolution on the Promotion and Protection of Human Rights of People Vulnerable to, Living with, of Affected by HIV/AIDS in the Americas. The Resolution urges Member States to continue their efforts in support to laws and public policies to protect the human rights and fundamental freedoms of people living with HIV, and to increase HIV prevention and treatment for pregnant women and mothers, including preventing mother-to-child transmission of HIV. The Resolution also promotes greater involvement of people living with HIV in decision-making and in the drafting of policies and programmes in response to the epidemic.

The Pan-Caribbean Partnership Against HIV/AIDS (PANCAP) launched the Justice for All Programme on World AIDS Day, 1 December 2013. The new initiative will help guide countries as they address AIDS related stigma and discrimination, improve the legal environment and remove discriminatory laws related to HIV.

Under the leadership of the Prime Minister of St Kitts & Nevis and Head of PANCAP, Denzil Douglas, and spearhead by the United Nations Secretary General’s Special Envoy for AIDS in the Caribbean, Edward Greene—national consultations are taking place throughout the Caribbean to pursue legislative reforms and related key programmes to increase justice for all in all countries.

Co-editors Sir George Alleyne and Professor Rose-Marie Belle Antoine at the launch of the publication in Port of Spain, Trinidad and Tobago, 22 October 2013. Credit: UNAIDS

A book exploring the challenges and legal stumbling blocks to overcoming stigma and discrimination in the Caribbean was launched on 22 October in Port-of-Spain, the capital of Trinidad and Tobago. Legal and Policy Perspectives on HIV and Human Rights in the Caribbean was co-edited by former United Nations Special Envoy on HIV for the Caribbean, Sir George Alleyne and law professor, Rose-Marie Belle Antoine. The publication includes contributions from a range of experts who participated in a high-level symposium convened by UNAIDS, the Pan Caribbean Partnership against HIV and AIDS (PANCAP) and the University of the West Indies (UWI) in 2010.

The book highlights issues surrounding discriminatory laws and policies in the region. It also provides academics and policy-makers with options for removing laws that limit people’s right to health, freedom of movement and equal access to housing, education and work.

Sir George stressed one of the key recommendations of the book—challenging discriminatory laws in courts—could be an effective process for their removal.  “The only countries in the Western Hemisphere that have laws criminalizing homosexual sex in private are in the Caribbean,” he said. “The possibility of changing that by appealing to the constitution is virtually zero. It has to be done through litigation.”

Sir George also applauded the UWI Rights Advocacy Project which aims to promote human rights, equality and social justice in the Caribbean by participating in human rights litigation.

Current UN Special Envoy on HIV and AIDS for the Caribbean, Edward Greene called the book “a launch pad—which will help the region’s progress toward ensuring equal rights and protection for all its people.”

UNAIDS provides technical support to the Caribbean Coalition for Social Justice (CCSJ), which provides legal counsel and financial aid to people who have experienced discrimination. UNAIDS is also working with countries to address stigma issues associated with sexual orientation and sexuality. It is developing a database on changes in public attitudes and its effect on electoral politics. Within the justice system it supports sensitivity training for court officers and police officers. UNAIDS will shortly release the findings of a new survey, the Caribbean Men’s Internet Survey (CARIMIS), which surveyed more than 3500 men who have sex with men in the Caribbean. 

UNAIDS Caribbean Regional Support Team Director, Ernest Massiah attended the book launch and welcomed its publication. “In 2013, one of the irrationalities we are living with is stigma based on HIV status, sexual behaviour and sexual orientation,” he said.

The President of the North, Central America, and Caribbean Association Football (CONCACAF), Jeffrey Webb, will be the recipient of the 2013 UNAIDS “Protect the Goal” Special Award for the Diaspora. The announcement was made during the opening of the 2013 CONCACAF Sports Summit taking place in the Cayman Island.

The “Protect the Goal” Award ceremony will take place on 15 January 2014 in Dakar, Senegal during the fourth Pan-African Youth Leadership Summit. Mr Webb will be honored for his exceptional work in using sport to advocate for social development.

The “Protect the Goal” campaign aims to raise awareness of HIV and mobilize young people to commit to HIV prevention. The special award highlights the value of football as a tool for social change. It emphasizes the importance of social responsibility and features individuals and organizations that play an important role in promoting social good and advocacy for HIV awareness and prevention through sport.

Hard-won gains against the HIV epidemic in Jamaica could be at stake due to national budgetary constraints and the country’s increasing HIV treatment costs, a study shows. As a result, the Jamaican government has taken steps to enhance the planning and efficiency of its national AIDS programme.

“Since 2004, with the introduction of antiretroviral treatment, AIDS-related deaths in Jamaica have dropped by 41% and mother-to-child transmission of HIV has fallen from 25% in 2004 to below 5% in 2011,” said Health Minister, Fenton Ferguson. “Jamaica is on the way to success and we can’t have it derailed.”

With support from the World Bank and UNAIDS, the country conducted a landmark study on the financial sustainability of its AIDS response. The study projected that the annual cost of Jamaica’s HIV programme may double by 2030. It also reported that Jamaica’s ability to increase domestic spending for HIV is limited by its high levels of public debt—the country is classified by the World Bank as an upper middle income country, however, the island has a debt-to-GDP ratio of 140%. The country’s agreements with major partners including the Global Fund to Fight AIDS, Tuberculosis and Malaria, the World Bank and the United States Government, are set to expire over the next two years.

According to Dr Ferguson the work has already begun. The UNAIDS investment approach was used to develop strategies to help the country’s HIV response survive and succeed.

For example, Jamaica has re-focussed its National Strategic Plan, with a strong emphasis on the needs of key populations at higher risk of infection, including men who have sex with men, sex workers and people who use drugs. It has also announced the establishment of an authority which joins the Family Planning Board with parts of the HIV Programme to lower administrative costs. The country is also exploring regional opportunities to lower the prices of antiretroviral medicines.

UNAIDS Country Coordinator, Dr Pierre Somse, commended the Ministry of Health and the Ministry of Planning and Finance for jointly addressing the financial sustainability issues surrounding the HIV response. “HIV is being dealt with as a development issue by the Government of Jamaica within the context of the country’s 2030 national development plan,” said Dr Somse. “The HIV response continues to enjoy the highest level of political commitment across political parties,” he added.

In the 2013/2014 fiscal year, the Government increased its share of HIV spending, however to facilitate the implementation of the new strategies the Health Minister has called for “a more gradual transition from international funding”.

The United Nations Secretary-General’s Special Envoy for AIDS in the Caribbean, Dr Edward Greene, visited the UNAIDS Headquarters in Geneva on 23 August to meet with UNAIDS Executive Director Michel Sidibé. 

Among the issues discussed, Dr Greene highlighted the new initiative of the Pan Caribbean Partnership Against HIV/AIDS (PANCAP) co-lead by him and the Prime Minster of St Kitts & Nevis, Dr Denzil Douglas, called Justice for All: taking action to reduce stigma and discrimination and increase access to justice in national HIV responses in the Caribbean by 2015.

The new initiative will unite stakeholders—including faith-based organizations, people living with AIDS, civil society, legislators and government officials—at national and regional levels to dialogue on the existing legal environment related to HIV in the Caribbean. The initiative aims to develop a roadmap for national and regional actors to reduce stigma and discrimination and to increase access to justice in national HIV responses including the abolition of punitive laws. The first national consultation is planned for St Kitts and Nevis in Fall 2013. 

The Special Envoy also stressed the need to strengthen dialogue with faith-based organisations in the Caribbean and work collaboratively with their representatives. Dr Greene stressed the historical role played by such organizations in delivering social services and support in the region.