Caribbean

Participants in the UNAIDS/PEPFAR Caribbean Meeting on Strategic HIV Investment and Sustainable Financing held in Kingston, Jamaica from May 29th - 30th 2013

For almost ten years Ainsley Reid has had access to life-saving antiretroviral treatment in his native Jamaica. The payoff comes not just in his individual health, but in his work raising awareness about HIV prevention and positive living as a local programme coordinator at Jamaica’s HIV/STI Programme. “Like me, many of my colleagues who have been on HIV treatment are ready and able to work, to take care of their families, to contribute to society,” he said.

Mr Reid is one of many who are working to ensure HIV responses in the Caribbean are more than pills or abstract HIV programmes.

“It’s about people! It is about keeping people living with HIV well so that they can be productive and creating societies that allow them to thrive,” said the Director of the UNAIDS Caribbean Regional Support Team, Ernest Massiah, at a meeting to help countries in the region build financially sustainable HIV programmes.

The review, which took place in Kingston, Jamaica from 29-30 May, reviewed countries’ HIV epidemics and responses and explored how HIV programmes could be built to succeed in the long run. “We have to look carefully at where we can make efficiencies, where we are spending more than we should to get certain results and where we must stop doing the things we are accustomed doing because they are not having the impact we would like,” Mr Massiah said.

The dialogue which was jointly supported by UNAIDS Caribbean and the United States President's Emergency Plan For AIDS Relief (PEPFAR) included international development partners, civil society organizations and representatives from eight Caribbean ministries of health, finance and planning.

Since 2000, the region’s investments in reducing stigma and discrimination as well as scaling up access to HIV treatment have shown results. New HIV infections dropped 42% between 2001 and 2011; 67% of people living with HIV who need treatment now have access to it; and AIDS-related deaths continue to decline with a 48% drop recorded between 2005 and 2011. The number new HIV infections among children has gone down by 32% from 2009 to 2011.

However, currently two-thirds of the financing for HIV programmes in the Caribbean as a whole comes from international partners. With several donor agencies soon to reduce or withdraw support due to changes in eligibility criteria for upper- and middle-income countries, and with Caribbean economies feeling the crunch of the global economic slowdown, the gains of many national HIV programmes are at risk.

The Director of the United States Agency for International Development (USAID) Mission in Jamaica, Denise Herbol, noted that the partnerships of international agencies are  meant to help countries reach a point where their HIV programmes are “led, implemented and eventually paid for” by their own governments, communities, civil society and private sectors.

What does that mean for the Caribbean? Experts agree that the regional tendency to direct most HIV prevention resources to the general population must end. Instead, more work is needed to understand who is most at risk and why. And then, concerted work will be required to provide HIV prevention programmes to the populations most affected by HIV.

Participants highlighted the need to lower administration costs related to HIV programming and stressed that the region must intensify its joint efforts to secure lower prices for drugs. But much of the work involved in making choices about where to invest, involves confronting deep-seated social prejudices and inequities.

Karl Theodore, a health economist from the University of the West Indies in Trinidad, urged participants to position HIV as an issue that places the very survival of Caribbean societies at stake.

“There is a sense in the region that things are getting better and maybe the epidemic is now under control so we don’t have to put as much resources in it. That is a mistake. The epidemic is undermining something that is crucial to us—our human resource. If we don’t keep up the investments we are going to pay a very heavy price,” Mr Theodore emphasised.

“These discussions on the financial sustainability of the HIV response ignite a spark of hope in my heart,” Mr Reid said. “We have a lot more work to do, a lot more systems to strengthen and more people to reach so we can end the HIV crisis and save lives,” he added.

 For more information on the meeting and its outcomes go to www.unaidscaribbean.org

The Organization of American States (OAS)—the world’s oldest regional mechanism comprising 35 independent states of the Americas—has adopted a bold new Resolution on the Promotion and Protection of Human Rights of People Vulnerable to or Living With or Affected by HIV.

Meeting at its 43^rd General Assembly, delegates approved the Resolution which puts human rights, gender equality and social justice at the heart of the region’s HIV response. The new agreement emphasizes the importance of the greater involvement and participation of the most affected populations in the response to the epidemic.

In spite of progress addressing HIV in the region—treatment coverage is high, and new HIV infections have begun to decline in parts of the Caribbean—the Resolution recognizes the still significant challenges that remain to ensure equitable access to HIV services, particularly among most at risk groups as well as women and girls.

Opening the Assembly, Secretary General of the OAS, Jose Miguel Insulza noted the frequent ‘disregard’ of the rights of minorities but highlighted the critical opportunity the OAS provides "for frank, open policy dialogue on these issues in the Hemisphere".

Deeply rooted stigma and discrimination is still all too pervasive among community and religious leaders, service providers and state agents. This impedes access to services, employment, and in some cases, leads to social exclusion for people most vulnerable to HIV, including sex workers, men who have sex with men, transgender people, drug users and indigenous populations. The Resolution calls for specific measures to promote gender equality and address the needs of women, adolescents and girls, noting the strong inter-relation between gender-based violence as both a cause and consequence of HIV.

As discussions continue globally around the sustainability of the AIDS response, the Resolution flags the ‘exorbitant’ cost of antiretroviral treatment in some countries and the challenge of securing generic alternatives. Furthermore, despite increases in domestic funding for the AIDS response, the Resolution notes that resources are still not being sufficiently invested in programmes that support and sustain education, behavior change and other HIV prevention strategies.

The Resolution looks at ways to strengthen collaboration with international bodies such as the Inter-American Commission on Women and the Inter-American Commission on Human Rights to advocate for greater protective laws and policies. These include the exchange of experiences and best practices, the organization of joint activities, and the coordination of efforts and capacities to attain the greatest possible impact.

OAS Member States called upon UNAIDS and the Pan American Health Organization (PAHO) to join efforts in the implementation of the Resolution as well as to provide countries with support to eliminate new HIV infections among children, to ensure access to affordable treatment, to end stigma and discrimination and to promote gender equality.

"This Resolution comes at an opportune time, when global discussions on development and health are shifting, but also demonstrates that new opportunities are emerging to maintain the momentum to reach UNAIDS vision of zero discrimination, zero new HIV infections, and zero AIDS-related deaths," said UNAIDS Executive Director Michel Sidibé.

Mr Sidibé met with Secretary General Insulza in Washington DC, prior to the OAS General Assembly where he remarked that "The OAS has been a leader in driving forth discussions around affordable medicines, and is breaking new ground in terms of addressing stigma and discrimination, and recognizing the intersection between gender-based violence and HIV".

The United Nations Secretary-General’s Special Envoys for AIDS are committed individuals selected by the United Nations Secretary-General to help advance the AIDS agenda at global level and to ensure that AIDS is kept high as a political priority in their respective regions. In a series of interviews with Unaids.org, the Special Envoys for AIDS share their views on the state of the AIDS epidemic and their own role in the global effort to end the epidemic.

John Edward Greene, United Nations Secretary-General’s Special Envoy for AIDS in the Caribbean

John Edward Greene was appointed the United Nations Secretary-General’s Special Envoy for AIDS in the Caribbean in November 2011, following his role as Assistant Secretary-General for Human and Social Development at the Caribbean Community (CARICOM) Secretariat.

Professor Greene has a long regional and international career in the fields of academia, social sector development, poverty alleviation, organizational development and AIDS. During his time at CARICOM, he crafted the blue-print for the establishment of the Pan-Caribbean Partnership against HIV and AIDS (PANCAP) which was recognized in 2004 as an international best practice in the response to HIV.

In 2010 he was honored by the Government of Suriname, which named him Grand Officer in the Order of the Yellow Star for his contributions to social development and health in the Caribbean, and particularly to the response to AIDS. He was also awarded the Lifetime Youth Award by the Caribbean Youth Ambassadors Corp for his pioneering role in the region’s youth and development agenda.

As one of the Secretary General’s Special Envoys for AIDS, what do you consider to be your role in the response to AIDS?

My role as Special Envoy is to advocate for the targets and commitments laid out in the 2011 Political Declaration on HIV/AIDS. In particular, I aim to promote the concepts of shared responsibility and sustainability of the AIDS response, and putting human rights at the centre of the response. These concepts have been identified as priorities by the Caribbean constituency.

What motivates you in this role?

I am working with UNAIDS to strengthen the Pan Caribbean Partnership  Against HIV and AIDS (PANCAP), a unique partnership between governments, the private sector, NGOs and development agencies across the English, French, Dutch and Spanish-speaking Caribbean.

Many of the small states that make up the Caribbean lack the capacity to respond to AIDS effectively at a national level. PANCAP brings together national HIV programmes with international and regional organisations to achieve collective success in all areas of the AIDS response.

At the community level, the challenge of reducing stigma and discrimination is being supported by the Champions for Change, a group of committed and well-respected individuals who act as project advocates and work to address these issues in their countries.

In addition, the Caribbean could be the first region in the World to achieve the elimination of new HIV infections among children and this is an exciting prospect.

What improvements are you seeing in the response to AIDS in the Caribbean?

Governments in the Caribbean are becoming increasingly aware of the need to invest in the AIDS response to avoid a regression on the progress that has been made in providing access to HIV treatment and prevention. They are also increasingly receptive to advancing the human rights agenda, and especially to removing punitive laws from the books.

What key issues and challenges remain in the region?

The biggest challenges we face in the region revolve around sustainability of HIV programmes, to sustain and scale up access to antiretroviral drugs as well as advancing the human rights agenda to reduce stigma and discrimination. The latter involves not only promoting the elimination of punitive laws, but also changing overall values and attitudes. This involves sustaining a dialogue for building on the concept of basic rights for all, based on the Universal Declaration of Human Rights.

In addition, while taking AIDS out of isolation has become a recurrent theme in the post-2015 agenda, it is important to stress the fact that AIDS is the only disease so strongly affected by stigma and discrimination.

During your time at CARICOM you actively supported and encouraged youth involvement in AIDS programmes. What is the role of young people in today’s AIDS response?

I am happy to say that young people are engaged in the development and implementation of HIV policy within the framework of PANCAP. The CARICOM Youth Ambassadors Programme has been very effective in engaging youth in the decision-making process in the region. As Special Envoy, I will work passionately with youth leaders and their groups to identify more creative approaches to discouraging risky behaviour, such as drug use and having multiple sexual partners, among young people.

Young people are the new generation of leaders. They are the essence of the change that we are promoting to achieve the goal of an AIDS-free generation.

UNAIDS Executive Director Michel Sidibé (left) participates in a World AIDS Day event in Pétionville, Haiti, along with United States Ambassador to Haiti, Pamela White, and Haiti’s First Lady, Sophia Martelly.

On one level, Haiti’s HIV response parallels its earthquake recovery. Although the task is far from over, national and international stakeholders have collaborated to confront the challenge and important gains have been made.

During a World AIDS Day commemoration in Pétionville, Haiti, hosted by the Ministry of Health, UNAIDS Executive Director Michel Sidibé congratulated the country on its progress toward the vision of “getting to zero:” zero new HIV infections, zero discrimination and zero zero AIDS-related deaths.

Over the past decade, the rate of new HIV infections in Haiti fell by 54%. From 2005 to 2011, there was a 47% national decline in AIDS-related deaths. By 2011, 58% of Haitians living with HIV were accessing antiretroviral therapy. Mr Sidibé expressed optimism that this positive trajectory would continue.

“I was honoured yesterday to meet the President of the Republic and I can tell you that during our conversation, it was obvious that he wanted to put AIDS at the centre of his efforts to ensure that all people have access to the information and support systems necessary for life,” Sidibé said.

These efforts, said Mr Sidibé, must focus on the country’s most vulnerable. An estimated 18% of men who have sex with men and 8% of sex workers in Haiti are living with HIV.  Nearly half of young Haitians living in camps do not have adequate knowledge about HIV.

Mr Sidibé urged Haiti’s leaders to boost efforts to reach populations at high risk of HIV infection with prevention and treatment services. He called for the passage of an HIV law that would signal zero tolerance for stigma and discrimination.

Mr Sidibé also urged the leadership of Haiti to increase domestic investments for the HIV response. Currently, more than 75% of funding for Haiti’s HIV response comes from external sources. By taking greater ownership of its national AIDS response, Haiti would join the worldwide paradigm shift “from charity to global solidarity,” said the UNAIDS Executive Director.

During the World AIDS Day ceremony, Haiti’s First Lady, Sophia Martelly, acknowledged the complex network of social issues that increase people’s risk of HIV. “Wherever educating children is problematic, there will be AIDS. Wherever basic social needs are not met, there will be AIDS. Wherever there is violence and rape, there will be AIDS. That is why there must be an in-depth approach to prevention,” said the First Lady.

“I am proud to be working alongside the President of the Republic to guarantee education for all, the strengthening of our health care system, women's empowerment and improved living conditions for the whole population,” she added.

Haiti President Michel Martelly (left) and UNAIDS Executive Director Michel Sidibé at the Ministry of Planning in Port-au-Prince.
Credit: UNAIDS

The President of Haiti ushered in World AIDS Day 2012 commemorations with a note of hope. “It would be a very beautiful success story if we could pull off an HIV-free generation,” declared President Michel Martelly, in a meeting on 30 November with UNAIDS Executive Director Michel Sidibé.

In 2011, an estimated 77% of pregnant women living with HIV in Haiti had access to services that prevent mother-to-child transmission (PMTCT) of HIV. Between 2009 and 2011 the country secured a 25% decrease in the number of children born with HIV.

“Getting to zero HIV infections in children should be the legacy of this administration,” said Mr Sidibé. “It would be a very powerful accomplishment. Two children are born with HIV in Haiti each day. Think of what it would mean if we could leave behind a generation that was born HIV-free,” he added.

President Martelly noted the moral and economic imperatives of preventing HIV in children, saying that while it costs only US $150 to prevent a child being born with HIV, it would cost hundreds of thousands of dollars to treat a person living with the virus over the course of their lives. “If you can save a mother,” he added, “you prevent a child from becoming an orphan.”

In separate meetings with Haiti’s First Lady, Sophia Martelly, and the Minister of Health, Florence Guillaume Duperval, Mr Sidibé stressed that Haiti has the potential to eliminate HIV in children and dramatically reduce AIDS-related deaths in mothers. The First Lady pointed to national efforts geared toward achieving these twin goals, including a campaign to ensure that more pregnant women—particularly those living in rural areas—access HIV testing and treatment services.

Haiti First Lady Sophia Martelly (left) and UNAIDS Executive Director Michel Sidibé at Haiti's National Palace in Port-au-Prince.
Credit: UNAIDS

The Caribbean has the highest PMTCT coverage of any developing region. Many smaller Caribbean countries are already close to eliminating new HIV infections among children. Further scale-up of PMTCT services in Haiti—one of the region’s most populous countries—will help the entire Caribbean reach closer to the goal of eliminating new HIV infections among children, a key target of the 2011 Political Declaration on HIV/AIDS.

In addition to PMTCT scale-up, Haiti has progressed in other areas of its national HIV response.  Between 2001 and 2011, for example, new HIV infections in the country declined by 54%. Haiti also attained a 47% decline in AIDS-related deaths from 2005 to 2011.

L to R: Luiz Loures, UNAIDS Director of the Political and Public Affairs branch; César Antonio Núñez, Director of the Regional Support Team for Latin America; Dr Carissa Etienne, Director elected of the Pan American Health Organization; Michel Sidibé, Executive Director of UNAIDS; and Ernest Massiah, Director of the Regional Support Team for the Caribbean.

UNAIDS Executive Director Michel Sidibé met on 7 November with the recently appointed Director of the Pan American Health Organization (PAHO) Dr Carissa Etienne at the UNAIDS Headquarters in Geneva to strengthen collaboration towards putting an end to AIDS in the Americas.

"We can build on the successes of the Americas, a region that was one of the first to eliminate measles and polio,” said Mr Sidibé. “There is no reason why this region cannot be the first to end AIDS.”

During the meeting, they exchanged ideas on how to increase joint efforts to achieve the Millennium Development Goals by 2015 and to ensure that health and HIV are part of the post 2015 agenda.

"As we look forward, HIV and health are key for the region, and for global development,” said Dr Etienne. “PAHO will play a key role in moving this agenda forward and with UNAIDS, the Americas can be the first region to see the end of AIDS.”

Dr Carissa Etienne, a native of Dominica, was elected as the new PAHO Director during the 28th Pan American Sanitary Conference that took place from 17-21 September 2012 in Washington D.C. and will begin her five-year term on 1 February 2013. Dr Etienne is currently Assistant Director General, Health Systems and Services, of the World Health Organization (WHO) in Geneva.

Panelists in the opening ceremony of the 6th Latin American and Caribbean Forum on HIV/AIDS and Sexually Transmitted Infections, including Dr Luiz Loures of UNAIDS (pictured second from right). Credit: UNAIDS

More than 4000 delegates—including government officials, health experts, community leaders, scientists, indigenous populations, youth and people living with HIV—convened from 28-31 August in Sao Paulo, Brazil, for the 6th Latin American and Caribbean Forum on HIV/AIDS and Sexually Transmitted Infections (STIs).

Hosted by the Government of Brazil in collaboration with the Horizontal Technical Cooperation Group, PAHO, UNAIDS, UNDP, UNESCO, UNICEF and civil society regional networks, the forum provided an opportunity to take stock of progress, challenges and lessons learned in HIV responses across the region. Participants engaged on a range of issues, from AIDS financing and new HIV prevention technologies to strategies for closing treatment access gaps.

Brazil widens treatment access

As delegates gathered in Sao Paulo, Brazil’s Ministry of Health announced that it will expand its national AIDS treatment programme to include at least 35 000 more people. Brazil currently provides free antiretroviral treatment to 223 000 people living with HIV—a coverage of 69%—according to government estimates.

Prior to this week’s announcement, Brazilians with a CD4 count of 350 cells per cubic millimeter were eligible for antiretroviral treatment. Under Brazil’s new policy, treatment eligibility will start at an earlier stage of HIV infection—at a CD4 count of 500. In a statement issued on 28 August, Brazil’s Minister of Health, Alexandre Padilha, explained that this decision was based on recent studies that have shown improvement in the quality of life of people living with HIV and a reduction of adverse effects in the immediate and long term.

“Brazil’s AIDS programme sets an example not only for Latin America, but for the world,” said Dr Luiz Loures, Director of the UNAIDS Political and Public Affairs branch and a participant in the opening ceremony of the forum. He noted that Brazil’s decision to provide earlier treatment for people living with HIV may trigger a “snowball effect” and influence health policies in other countries around the world.

Progress and gaps

Many other countries in Latin America have scaled up access to HIV treatment in recent years. According to the latest data from UNAIDS, an estimated 70% of people eligible for antiretroviral treatment in the region were receiving it at the end of 2011. Wide access to treatment has helped reduce the annual number of AIDS-related deaths: from 63 000 a decade ago to 57 000 in 2011.

Despite progress, key populations across the region, particularly men who have sex with men (MSM) and transgender people, continue to be disproportionately impacted by the epidemic and have limited access to HIV prevention and treatment services—a message that resonated throughout the forum in Sao Paulo.

An estimated half of all HIV infections in Latin America result from unprotected sex between men. According to national estimates, the reported HIV prevalence among transgender people in Argentina (34%) and Peru (20.8%) stands in sharp contrast to that of the general population: 0.4% and 0.23% in these two countries, respectively.

“AIDS is no longer seen as a major problem, especially in Latin America, where we have high treatment coverage,” noted Violeta Ross, Co-founder and Chair of the Bolivian Network of People with HIV and AIDS, in an article posted on the Brazilian Ministry of Health web site. “But the data are misleading because treatment is expensive. Several countries still have enormous difficulties in ensuring access for everyone," she added.

Voices of civil society

More than 4000 delegates convened at the forum in Sao Paulo from 28-31 August. Credit: UNAIDS

Advocates at the forum emphasized the importance of community mobilization in accelerating HIV responses among vulnerable populations. “Evidence-based strategies presented at the forum show that strengthening community work—including among sexual minorities—can transform national HIV responses,” said Simon Cazal, Executive Director of Somosgay, an organization that works to promote the human rights of lesbian, gay, bisexual, transgender and inter-sex (LGBTI) people. “The LGBTI movement has set priorities, giving rise to stronger activism. We have shown that with few resources, we can accomplish a lot if we are strategic and if we work alongside communities.”

Many delegates underscored the need to bridge the AIDS response with other social movements. "We have to evolve. We cannot just fight for more condoms and medicines,” said activist Enrique Chaves, Director of Advocacy for the non-profit organization AID for AIDS International. “We must acknowledge that the struggle for access to health and HIV services is also a matter of access to employment, housing and education. We have to connect our agenda with the broader agenda of development, the struggle for social justice,” he added.

Image from an initiative by people living with HIV in the Dominican Republic launched to draw attention to the fact that the availability of generic drugs has significantly reduced treatment prices in the global market.

The Dominican Republic is one step closer to ensuring that all people living with HIV access treatment. The country’s National Social Security Council has established a commission to look into the technical, financial and operational implications of including antiretroviral therapy (ART) in the Basic Health Plan.

The establishment of the commission comes after a financial feasibility study about covering people living with HIV under the country’s family health insurance. The study was done in 2011 by the United Nations Development Programme (UNDP), United Nations Children’s Fund (UNICEF), Pan American Health Organisation (PAHO) and the Joint United Nations Programme on HIV/AIDS (UNAIDS).

The newly-established commission—whose membership includes several national health system offices in addition to regional and global partners such as PAHO and UNAIDS—is set to complete its work during the last quarter of 2012.

According to UNAIDS Country Coordinator, Ana Maria Navarro, the development comes at a critical time and is a direct consequence of a feasibility study elaborated by United Nations agencies in the Dominican Republic. “This resolution brings us nearer to securing the sustainability of the AIDS response,” said Dr Navarro.

The Dominican Republic is classified as a middle-income country even though there are marked inequalities in income distribution. At present access to HIV treatment is completely financed by international donor agencies. While more than 20 000 people are currently receiving HIV treatment, more than 2 500 individuals known to be living with AIDS do not have access to life-saving drugs.

This is despite a guarantee of universal access to treatment for people living with HIV made in the country’s 2007 – 2015 National Strategic Plan on HIV and AIDS. The treatment gap also contradicts the principles of universality and equity that informed the 2001 reform of the Social Security System. Moreover, a new HIV law introduced last year provides for the comprehensive healthcare of people living with HIV.

But a 2002 regulation for the operationalization of the Basic Health Plan excludes coverage of antiretroviral drugs on the basis of their high cost. A primary objective of the feasibility study was to provide evidence that HIV treatment is not as expensive as local authorities believed.

“This is one giant step for the Dominican Republic,” said UNAIDS Caribbean Director, Ernest Massiah. “It is a step towards ensuring that treatment is maintained, and lives of Dominicans living with HIV are saved. People living with HIV can continue to work, support their families and participate in the simple joys of life to which we are all entitled. This is about respect, dignity and life.”

In April 2012, people living with HIV in the Dominican Republic launched an initiative to draw attention to the fact that the availability of generic drugs has significantly reduced treatment prices in the global market. The Dominican Network of People Living with HIV (REDOVIH+), Alianza Solidaria de Lucha contra el SIDA (ASOLSIDA), Fundación Grupo Paloma and Grupo Clara jointly launched a petition which called for the 2012 presidential candidates to address the financial sustainability issues related to their treatment ahead of elections at the end of May.

Dane Richardson (left), Programme Development Manager, and Kandasi Levermore, Executive Director of Jamaica AIDS Support for Life (JASL) discuss the use of the Human Rights Costing Tool while participating in the pilot project.

Jamaica’s new National HIV Strategic Plan (NSP) 2012-2017 focuses on an enabling environment and human rights. The plan was developed in 2011 through a highly consultative process involving the government, private sector, faith-based organizations, youth, people living with HIV and international development partners. 

The Jamaica NSP makes human rights real. NSPs often include human rights as guiding principles or cross-cutting priorities. However, the Jamaica NSP includes concrete and costed programmatic actions to support human rights, reduce stigma and create an enabling legal environment for the HIV response. This was made possible with the use of the new UNAIDS Human Rights Costing Tool (HRCT).

The costing of the NSP was undertaken by the National HIV/STI Programme (NHP) with the technical support of UNAIDS and involved the use of UNAIDS financial tools including the National AIDS Spending Assessment (NASA), Resource Needs Model (RNM) and the HRCT.

According to Dr. Pierre Somse, UNAIDS Country Coordinator for Jamaica, the Bahamas, and Belize: “The Human Rights Costing Tool is a powerful connector which brings together all stakeholders working on human rights and facilitates effective dialogue among them while providing measurable targets. It allows people to see what the human-rights-based approach is in reality. It therefore makes it a tangible component of strategic planning while better articulating what the human-rights-based campaign is.”

The Human Rights Costing Tool was included in the process of costing of the NSP for three reasons: to estimate both spending and the resource needs on human rights more precisely so as to inform the Resource Needs Model (RNM); to promote the use of the tool by the civil society and stakeholders working on human right; and to facilitate the participation of civil society and stakeholders working on Human Rights in the development of the NSP.

The process to cost human rights activities involved several stages. Two workshops were organized, the first one with a core group of technicians and the second one with a broader group of stakeholders including representatives from civil society, international NGOs, members of the UN Joint Team, members of the academic sector, leaders of networks of people living with HIV & AIDS, representatives of Key Populations, and the directors of the National HIV/STI Programme. These workshops provided an opportunity for discussion around the process for the incorporation of the tool into the national HIV response, to seek buy-in and to streamline its application to the human rights component of the Jamaica National HIV Strategic Plan 2012-2017. Participating institutions found the tool useful and user-friendly and made the commitment to streamline the use of the tool so as to have a real estimate of the level of human rights spending in their own organizations and also as part of a collective effort to estimate the level of human rights spending and resource needs in the Jamaican response generally.

Some challenges were however encountered in the application of the tool. These included the limited number of programmes and activities available for input within the tool. Although the composition of the programmes and activities is customizable, the restriction to 7 Programmes and 6 Activities per programme was found to be a hindrance in some instances as simply reformulating the title of the programme or activity did not always successfully encapsulate the scope of the institution’s programme or its corresponding activities. To overcome this, entities were encouraged to modify the ‘List Menu’ as much as possible so as to find the best fit for their respective Programmes and Activities and this is believed to have been the way to overcome this challenge.

Use of the HRCT also proved beneficial to the NASA process as well as the RNM process. It served as an incredibly useful data collection tool for the human rights costs of the response and facilitated the identification of significant gaps in resource estimates as well as informed the updates that were made to the NASA 2010-2011.

The HRCT was originally designed for use by individual organizations in the estimation of the cost of their human rights programmes. However, the stakeholders in Jamaica decided to adapt the tool to estimate costs of human rights activities at the national level by making a composite of costs. This was very useful in the NSP development process. Moving forward, there has been significant buy-in for the implementation of the tool for use by civil society stakeholders. This will involve the collection of data which will be aggregated and used to update the costing of the NSP. This process will culminate in a national validation meeting where the results will be shared and consensus will be reached on the national figure for costing human rights.

Members of the West Indies Cricket Team, photographed with children who participated in the Think Wise coaching clinic and Dr Ernest Massiah, Director of the UNAIDS Caribbean Regional Support Team.
Credit: UNAIDS

Hosting a group of local students at the Kensington Oval stadium in Bridgetown, Barbados, the West Indies Cricket Team expressed solidarity with the UNAIDS vision of zero new HIV infections among children. The coaching clinic was held as part of the Think Wise Campaign, a global partnership that uses the power and reach of cricket to address key HIV-related issues.

"We have the medicines, we have the knowledge. There is no need for any Caribbean child to be born with HIV,” said West Indies Captain Darren Sammy, who endorsed the call for preventing mother-to-child transmission (PMTCT) of HIV and ensuring access to life-saving treatment for HIV-positive women. “There is no need to treat anyone any differently because of their HIV status," he added.

The Think Wise Campaign—a partnership between UNAIDS, UNICEF, the International Cricket Council and the Global Media AIDS Initiative—places particular emphasis on HIV prevention as well as on the education and empowerment of children. Engaging young people in the HIV response was the focus of the coaching session in Bridgetown, which included a discussion around HIV.

"Through this event, the children have loved meeting their favourite players and learning some new skills. At the same time, they have gained awareness about HIV and the importance of treating all people with equal respect and compassion,” said Dr Ernest Massiah, Director of the UNAIDS Caribbean Regional Support Team. “Like the cricketers, these children can be agents of change in their families, communities and schools."

A regional Elimination Initiative—led by the Pan American Health Organization—aims to end mother-to-child transmission of HIV in Latin America and the Caribbean by 2015. The Eastern Caribbean, with its smaller disease burden, is expected to reach the target far sooner.

West Indies Cricket Captain, Darren Sammy, participates in media interviews with Dr Ernest Massiah, Director of the UNAIDS Caribbean Regional Support Team, at the Kensington Oval stadium in Barbados.
Credit: UNAIDS

At present, mother-to-child transmission of HIV accounts for between 8 and 10 per cent of all HIV infections in the Caribbean. However, some Caribbean countries have either achieved or are close to achieving elimination targets; between 2007 and 2010, for example, there were no new HIV infections recorded among babies in Barbados.

Widespread stigma and discrimination against people living with HIV remains a challenge for PMTCT programmes across the region. Stigma and the fear of unfair treatment prevent some HIV-positive mothers from accessing early antenatal care, abstaining from breastfeeding or making their babies available for follow-up testing and care.

"The Eastern Caribbean can eliminate mother-to-child transmission because we have the means to prevent it," Dr Massiah stressed. "West Indian people can play a part by addressing the negative attitudes and judgments associated with HIV. This would allow mothers across our region to feel safe and confident about accessing life-saving testing, treatment, care and support."