Caribbean

(from left) Miguel Bustos, Senior Program Manager at the Levi Strauss Foundation; John Hassell, UNAIDS Caribbean Senior Adviser for Regional Partnerships; Ernest Massiah, UNAIDS Caribbean Regional Support Team Director; Maurice Tomlinson, AIDS Free World attorney and advocate; Miriam Edwards, Guyana Sex Worker Coalition President; Edward Greene, UN Special Envoy on HIV/AIDS for the Caribbean.
Credit: UNAIDS/Daniel Volmy

The UNAIDS Caribbean Regional Support Team launched the Caribbean Coalition for Social Justice (CCSJ) during the 2011 Caribbean HIV Conference, held in the Bahamas in November. The Barbados-based Coalition will pool resources and provide legal services for people in the region who have been victims of arbitrary acts of discrimination but do not have access to the courts.

“The most vulnerable groups of Caribbean society often have no access to the justice system when their rights are violated based on race, gender, sexual orientation, or HIV status,” said Dr Ernest Massiah, Director of the UNAIDS Caribbean Regional Support Team. “This new organisation will address legitimate human rights violations in courts of law as well as regional and international human rights tribunals.”

United Nations Special Envoy on HIV/AIDS for the Caribbean, Dr Edward Greene, welcomed the newly formed Coalition, saying that it was a significant step for the region toward fulfilling its obligations to protect human rights and fundamental freedoms. “The creation of the Caribbean Coalition for Social Justice will give us hope that we can eliminate discrimination,” said Dr Greene.

The Caribbean HIV Conference brought together researchers, policy-makers and advocates to discuss ways to scale-up the HIV response in the Caribbean. “We’ve reached the peak in resources and probably global interest,” said Alan Whiteside, professor at the Health Economics and HIV/AIDS Research Division of the University of KwaZulu-Natal in South Africa, speaking at the conference. Prof Whiteside said the Caribbean urgently needed to scale up effective prevention methods and find effective approaches for fostering behaviour change, including fewer sexual partners, fewer concurrent partners and reduced substance abuse.

Amalia Del Riego, Senior Adviser at the Pan American Health Organisation HIV Caribbean Office, highlighted several of the region’s successes - progress in eliminating mother-to-child HIV transmission, mortality reduction, and increased access to HIV testing and treatment services.

Despite this progress, several gaps need to be addressed in the region. Ms Del Riego noted that in some countries between 30 and 40 percent of funds assigned to the HIV response are spent on administrative costs. Men who have sex with men (MSM), sex workers and young people continue to have limited access to services. Furthermore, many of the activities under the HIV prevention umbrella cannot be linked to concrete results.

The Caribbean continues to have one of the highest regional HIV prevalence rates after sub-Saharan Africa, although the epidemic has slowed considerably since the mid-1990s.

To contribute to or learn more about the Caribbean Coalition for Social Justice, email hassellj@unaids.org.

Observatorio VIH y Cárceles de LatinoaMÉrica y el Caribe

Mounting an effective challenge to HIV in prison settings is a key part of the AIDS response at national, regional and global levels. To define standards for HIV prevention and treatment and the protection and promotion of prisoners’ human rights, it is important to consolidate as much data as possible about the epidemic in this environment. The newly established Monitoring Centre for HIV and Prisons in Latin America and the Caribbean is set to become the key regional repository for such vital information. 

The Monitoring Centre—called the Observatorio VIH y Cárceles de LatinoaMÉrica y el Caribe in Spanish—gathers data from 23 countries which is accessible via a web site. Its primary aim is to help governments and civil society define and implement national HIV prison policies based on international standards. Up and running in Spanish since mid-February, an English language version will be launched 30 April 2011.

The United Nations Office on Drugs and Crime (UNODC) is spearheading the initiative with support from the UN Educational, Scientific and Cultural Organisation (UNESCO), the Pan American Health Organization (PAHO), the World Bank, the UN Development Programme (UNDP) and UNAIDS.

According to José Vila del Castillo, UNODC Regional Advisor, “The Monitoring Centre shows the United Nations system ‘delivering as one’. Addressing HIV in the region’s prisons has become a priority. The centre is an important tool to catalyze prison reform processes and HIV penitentiary programmes.” 

Providing a permanent public space for informed reflection and dialogue, the virtual centre develops methodologies for collecting, processing, analysing and validating the scientific data gleaned on what works, and how best to proceed, in addressing HIV in prisons. It will highlight existing information and encourage ongoing research. Training and technical support are also offered through reference directories, online consultations, discussion forums and virtual classrooms.

In Latin America and the Caribbean, as elsewhere, many prisoners are vulnerable to HIV due to a number of factors, including the relative lack of knowledge about the virus among this population, overcrowding, lack of access to protection and good quality health services and violent conditions.

Across the region, where data are available, several countries have higher HIV prevalence in the prison population than in the general population. For example, according to data collected by UNODC this year, in Peru there are more than eight times as many people living with HIV in prison than outside (4.03% versus 0.4%). In Bolivia the situation is even starker; the same source documents show that in nine prisons in the country, 10% of prisoners are reported as HIV positive, compared to 0.2% prevalence in the wider society. 

César Antonio Núñez, Director of UNAIDS’ Latin America Regional Support Team, believes the Monitoring Centre will provide a valuable insight into the lives of a neglected population, “The Centre will really help us to know the true HIV situation in the penitentiary system, and shed light on human rights-related issues. It is probably in the environment of HIV and prisons where UNAIDS’ commitment to being ‘the voice of the voiceless’ is most needed and appropriate.”

(L to R): UNAIDS Deputy Executive Director, Management and External Relations, Ms Jan Beagle; Hon Rodger Samuel, Minister in the Office of the Prime Minister responsible for HIV; Dr Ernest Massiah, Director, UNAIDS Caribbean; Mr Sam Condor, Deputy Prime Minister and Minister of Foreign Affairs of St Kitts and Nevis; Mr Ainsley Reid, GIPA, Jamaica; Ms Angelica Hunt, Ag UN Resident Coordinator; and Ms Izola Garcia, UNAIDS Coordinator for Trinidad and Tobago.

Representatives from government, civil society, people living with HIV, UN agencies and development partners from across the Caribbean met in Port of Spain, Trinidad and Tobago, to review progress made towards achieving universal access to HIV prevention, treatment, care and support targets. The two-day meeting held from 23-24 March was convened by UNAIDS in collaboration with partners in the lead up to the UN High Level Meeting on AIDS, which will take place in June 2011.

“This is a unique opportunity for everyone who is part of the AIDS response day after day to reflect and take stock of where we are on our shared journey,” said UNAIDS Deputy Executive Director, Management and External Relations, Jan Beagle.

Political leaders were candid about the challenges and underscored the need to engage young leaders and do things differently as the AIDS response enters a new era and moves towards reaching zero new infections, zero discrimination, and zero AIDS-related deaths.

“Fear, denial, ignorance, stigma and discrimination are still very prominent in the region. It is a barrier to condom use, even accessing HIV treatment and care,” said Rodger Samuel, Minister in the Office of the Prime Minister, Trinidad and Tobago. “The old approaches do not seem to be working, especially with the new generation. If we do not get our youth involved, ‘getting to zero’ will be an immensely hard task.”

There are an estimated 260 000 people living with HIV in the Caribbean. Close to half of people in need of antiretroviral treatment are receiving it. Overall, HIV now affects more women than men in the region. However, there is considerable variation between countries. For example, 60% of people living with HIV in the Bahamas are women. But in Cuba and Suriname, 69% of people living with HIV are men. AIDS remains the leading cause of death in people aged 20-59 years old.

Participants acknowledged important progress in the region to date, including a 43% reduction in AIDS-related mortality between 2001 and 2008, and an 18% reduction in new HIV infections among children during the same time period. There has been significant expansion of programmes to prevent mother-to-child HIV transmission of HIV, with four countries that reaching 95% coverage.

But stigma and discrimination, homophobia and a punitive legal environment continue to undermine efforts to reach universal access goals towards HIV prevention, treatment, care and support across the Caribbean. There are 11 countries in the region that criminalize sex between people of the same sex, and 13 that criminalize sex work. Five countries, territories and areas continue to impose restrictions on the entry, stay and residence of people living with HIV.

“The HIV response shines a spotlight on inequality and violations of human rights, and compels us to act,” said Ms Beagle. “We must remove punitive laws that are blocking access to critical HIV services. The law should work for the HIV response, not against it.”

Participants also discussed the need to increase investment in stigma and discrimination reduction programmes to secure the rights of people living with HIV. Ainsley Reid, Coordinator for the Greater Involvement of People Living with HIV, Jamaica, underscored this by highlighting that “people living with HIV need more than medicines.” 

“I know people who have died with the medicines in their hands. What we really need is social protection, including food, employment, housing, etc. This is what it takes to move beyond ‘victim mode’ and have empowerment and meaningful involvement,” he added. 

Participants during the universal access consultation that took place in Port of Spain, Trinidad and Tobago. 23-24 March 2011

Civil society reported on the outcomes and conclusions of a one-day meeting which they held prior to the universal access consultation. Representatives called for the removal of punitive laws that block HIV responses and violate human rights. The need for intensified political and community action to take on the continued taboo around issues related sexuality was also stated. Civil society also emphasized the need to train healthcare workers on ethics and confidentiality. A call was made for regional negotiations to drive down the price of medicines.

Changes in the development environment, including signs of reductions in funding flows, was a backdrop to the discussions during the two days. During the last decade the Caribbean region received more than US$ 1.3 billion in external funding for HIV. While some countries already fund their national HIV programmes entirely from domestic resources, others will be under increasing pressure to reduce programme delivery costs and secure new resources as current sources of funding decline.

“It will be imperative to clearly identify where we can make efficiencies in the region, and be ruthlessly honest about dropping what doesn’t yield us results,” said Ernest Massiah, Director of the UNAIDS Regional Support Team for the Caribbean in his remarks during the opening ceremony.

Kay Forde discusses HIV prevention with loggers
Credit: ILO

Kay Forde has been a sex worker in Guyana for more than 20 years. She is an AIDS activist too. As secretary of the One Love Organization, a non-governmental organization addressing the HIV needs of sex workers, Ms Forde is committed to making a difference in the Kwakwani region, Guyana.

This commitment involves not only advocating for the rights of sex workers to live free of stigma and discrimination, with access to good information about HIV, it also extends to working with their clients. Many of the clients earn their living in the wood logging industry.

There are some 13,000 loggers in Guyana and they are a significant segment of the migrant worker population. With forests generally found in isolated areas, there can be a lack of regular access to both condoms and correct knowledge of how HIV is transmitted, which increases vulnerability to infection. Sex workers themselves are disproportionally affected by the virus with an HIV prevalence of around 16%, compared to an adult HIV prevalence in Guyana of 1.2%.

With this in mind, in 2009 One Love joined forces with the International Labour Organization (ILO), the Government of Guyana, the US Department of Labour and the PEPFAR HIV/AIDS Workplace Education Programme. One of the principle aims is to encourage HIV prevention among loggers with a core package of services. This includes condom promotion, voluntary HIV counselling and testing, and referrals for sexually transmitted infections, which together aim to increase risk recognition and promote safer sex.

The work with loggers intensified in April 2010 when the ILO entered into a partnership with the Upper Berbice Forest and Agriculture Producers Association (UBFAPA) to educate its members. Fifteen of the One Love team and affiliate trainers travelled from camp to camp conducting interactive group discussions.  

Ms Forde believes that the loggers of Kwakwani have become more aware of HIV and are more willing to discuss intimate sexual issues. “They come and ask questions. They’re attentive and interactive and it’s very fulfilling to have them listen and get full explanations on health and sexual matters,” she said.

Charles Swaving, a logging camp supervisor working near Kwakwani, who attended a One Love discussion in July last year, agrees. He says he was grateful for the opportunity to find out correct information about HIV as well as the need to treat those living with the virus with dignity and respect. He vows to remain HIV-free.

According to Sean Wilson, ILO National Project Coordinator, this successful partnership demonstrates that sex workers can be powerful advocates for HIV prevention. “The strategy to use the One Love Organization is working well, since awareness is now being created among both the organization’s members and the loggers on the importance of adopting safer sexual practices.”

The project is ongoing and there are plans to re-engage loggers already reached and examine the impact of substance use on HIV transmission as well as how transmission risks can be reduced overall. There will also be greater efforts made to ensure a regular and reliable supply of condoms to loggers. There is also an issue of how loggers can access condoms in remote locations where transportation costs are high.

During the coming years, the project will continue working with the UBFAPA to engage more of its membership in what is seen as a vital education process. The ILO also intends to replicate this partnership with other sex workers’ organizations to reach different groups of workers across the country.

One year ago, on 11 January 2010, the Haiti earthquake devastated large parts of the capital, Port-au-Prince, with surrounding areas. Credit: UNAIDS

One year after a devastating earthquake in Haiti, the delivery of HIV prevention and treatment services appears to be back on track.

Over the past 12 months, Haiti has engaged in intensive HIV prevention campaigns in temporary settlements, where an estimated 800 000 displaced people are living. With the support of partners and UNAIDS, youth-sensitization and condom distribution programmes are now reaching tens of thousands of people.

Before the earthquake, UNAIDS estimated that 68 000 people were living with HIV in the three departments that were later impacted by the tremor—57% of the national total of 120 000. Within three months of the January 2010 earthquake, 80% of people on HIV treatment in these departments were able to access their antiretroviral drugs again. However, national coverage of antiretroviral treatment (43%) remains far from the goal of universal access.

“Every crisis presents an opportunity to move forward,” said Ernesto Guerrero, the UNAIDS Country Coordinator in Haiti. “The challenges posed by the earthquake in Haiti are no exception.”

In the aftermath of the earthquake, for example, HIV centers in Haiti have made strides in preventing mother-child-transmission of HIV. According to the US Centers for Disease Control and Prevention, an estimated 156 000 pregnant women in Haiti were tested for HIV in the fiscal year of 2010, compared to 132 000 in fiscal 2009.

Despite progress, Haiti continues to face repeated challenges. Health services are stretched and the cholera epidemic has further hindered the country’s ability to deliver HIV services. Sexual and gender-based violence in the temporary settlements is placing women at high risk of HIV infection.

According to the latest estimates from UNAIDS, 1.9% of the adult population in Haiti is living with HIV. Nearly half (46%) of all people living with HIV in the Caribbean reside in Haiti.

Former UN Secretary-General Kofi Annan (left), UNAIDS Executive Director Michel Sidibé (centre) and Hon Sarah Wescot-Williams, Prime Minister of St Maarten. Credit: UNAIDS

At the 10th annual general meeting of the Pan-Caribbean Partnership Against HIV and AIDS (PANCAP), held in St Maarten, Netherlands Antilles, UNAIDS Executive Director Michel Sidibé joined former UN Secretary-General Kofi Annan and Caribbean leaders to take stock of progress, challenges and lessons learned in the regional response to the HIV epidemic over the past decade.

In his remarks at the opening of the meeting, Mr Sidibé congratulated leaders across the region for keeping HIV high on the development agenda and highlighted the critical role that PANCAP can play in accelerating the HIV response. “PANCAP is the tool for helping us make the call for social justice in the Caribbean,” he said.
According to a new UNAIDS report, The Status of the HIV epidemic in the Caribbean, there were between 210 000 and 270 000 people living with HIV in the Caribbean in 2008. Haiti and the Dominican Republic account for about 70% of all people living with HIV in the region. In the English-speaking Caribbean, Jamaica is the country most affected by the epidemic, with an estimated 27 000 people living with HIV.

The report cites a number of achievements in the regional HIV response. More than 90% of pregnant women in 11 Caribbean countries are now tested for HIV every year. About 52% of pregnant women receive services for the prevention of mother-to-child transmission of HIV, which led to an 18% reduction in new HIV infections among children in 2008.
Governments across the region provided antiretroviral treatment to 51% of people in need in 2008—up from just 1% in 2004.  Greater access to antiretroviral treatment is saving lives: since 2001, AIDS-related deaths have dropped by about 40% in the region.

Criminalization of homosexuality

Two-thirds of countries in the Caribbean continue to criminalize homosexuality. Where homophobia is institutionalized in the law, stigma and discrimination against men who have sex with men is pronounced. Homophobia blocks access to HIV prevention programmes and impacts the quality of care for people living with HIV.

“Imagine yourself as a gay man in such an environment. How confident would you feel about getting an HIV test, or asking for information on prevention or treatment?” asked Mr Sidibé. “Homophobia hurts wherever it haunts—from classrooms to courtrooms,” he added.

HIV prevention not reaching key populations

Among men who have sex with men, HIV prevalence varies from an estimated 6.1% in the Dominican Republic to 32% in Jamaica. HIV prevalence among female sex workers—another key affected population in the region—varies from 2.7% in the Dominican Republic to 27% in Guyana.
According to the UNAIDS report, HIV prevention programmes reach less than 40% of men who have sex with men and less than 50% of female sex workers in the region. Meeting participants agreed that expanding HIV services for those most vulnerable to infection would be critical to an effective regional HIV response.

High-profile cricketers including Graeme Smith, Kumar Sangakkara, Mahendra Singh Dhoni and Stafanie Taylor team took time out from the Twenty20 World Cup being held at Barbados to help support cricket’s global response to HIV.

A series of community activities have been organized during the tournament by the Think Wise partnership. While Sri Lanka’s captain Sangakkara visited a school in Barbados to deliver an HIV prevention session, the Indian team hosted community groups and carried out cricket training sessions.

The South African squad invited a group of children aged 12-15 to visit a training session followed by a 15-minute question and answer session with skipper Smith. The children then showcased their cricketing skills to Rob Walter, the South Africa fitness trainer.

Stafanie Taylor and Stacy-Ann King, both of the West Indies women's cricket team, visited Project Viola in St Kitts which aims to provide services and support to teen mothers in school.

Think Wise, a partnership programme between UNAIDS, the International Cricket Council, UNICEF and the Global Media AIDS Initiative, was established to use the power of cricket to help tackle key issues around AIDS and encourage informed decision making by children and young adults.

The advocacy work carried out by the partnership and leading international cricketers delivers key information about HIV through public service announcements, event publications and online at international, regional and national levels. The partnership also provides information resources to young people and volunteers, coaches, as well as commentators and broadcasters about the AIDS epidemic.

Talking about the campaign, Graeme Smith said, “As a Think Wise Champion, I believe that it is very important to use my profile to encourage young people to protect themselves from HIV.

“By having the chance to meet young people from the region, I have been able to understand the important work that organizations such as UNAIDS and UNICEF, working with local agencies, do in providing young people with education on HIV in the Caribbean,” he added.

UNICEF Representative for Barbados and the Eastern Caribbean, Tom Olsen, added: “We are extremely proud of this partnership and value it highly. We talk a lot of sports for development and know the value of using sports to effect positive behavioural change."

Sri Lankan skipper Sangakkara said, “Hopefully more players and umpires will join in with this project in the future so we can continue to spread the word.”

A Caribbean Broadcast Media Partnership on HIV/AIDS public service announcement campaign, featuring Taylor alongside other leading Caribbean celebrities, is also being played on the big screen at matches and by CBMP broadcasters across the region.

Tickets have been donated to local community groups who run HIV prevention programmes, umpires are wearing Think Wise logos on their shirts and players in the semi-finals and the final on May 16 will wear red ribbons as a show of support for people living with HIV.

The partnership between UNAIDS and ICC began in September 2003 when they first teamed up to bring messages of HIV prevention to young people across cricket playing nations. In 2006 UNICEF also joined the partnership which now also supports the “Unite for Children, Unite against AIDS” campaign.

West Indies cricketer Ramnaresh Sarwan Credit: Getty Images

In conjunction with the International Cricket Council (ICC), West Indies cricketer Ramnaresh Sarwan was unveiled as a new Think Wise Champion on 26 April as part of a global cricket partnership to raise awareness of HIV.

He joins high profile cricketers Graeme Smith, Kumar Sangakkara and Virender Sehwag, as well as West Indies colleague Stafanie Taylor, in becoming a Champion for the ICC’s partnership with UNAIDS, UNICEF and the Global Media AIDS Initiative.

The global partners are also working with the Caribbean Broadcast Media Partnership on HIV/AIDS as part of the ‘Live UP’ campaign to coincide with the cricket tournament ICC World Twenty20 2010, which takes place from 30 April-16 May. This initiative encourages young people in the region to take positive action by informing themselves about the facts about HIV, getting tested and protecting themselves.

Sarwan (29) is one of the leading batsmen in the West Indies team, having made 83 Test and 154 ODI appearances to date. In that time, he has scored 15 Test centuries and four ODI hundreds to date.

“The issue of HIV is an important one for young people in the Caribbean and hopefully I can use my profile as an international cricketer to have a positive impact on people’s behavior within the region,” said Ramnaresh Sarwan.

“It is important young people are aware of resources that exist for them, such as the Live UP website, www.iliveup.com where they can find out about HIV, learn the importance of protection, and understand how to talk about these issues to their partner and friends.

“By using this event to raise awareness of HIV and remind cricket supporters not to discriminate against people with the disease, hopefully we can play our role in educating young people.”

A series of awareness activities will take place during the course of the ICC World Twenty20 2010 including community interactions between leading players and local community groups in Barbados, Guyana, St Kitts and St Lucia. The players will wear red ribbons as a show of support for people living with HIV in the semi-finals and final and public service announcements will be played on the big screen at matches.

This public service announcement, which features leading Caribbean celebrities and Stafanie Taylor is part of the Caribbean Broadcast Media Partnership’s ‘Live UP’ campaign that is being aired by 95 top broadcast media houses across 24 countries in the Caribbean.

Top Caribbean musical artists Alison Hinds, Bunji Garlin, Claudette Peters, Fay Ann Lyons and Mr Vegas, as well as Kim Collins, the St Kitts sprinter who won 100m gold at 2003 World Athletics Championships in Paris, are among those who deliver a message about HIV in a 30-second advert which has been shown across the Caribbean since last month.

The partnership between UNAIDS and ICC began in September 2003 when they first teamed up to bring messages of HIV prevention to young people across cricket playing nations. In 2006 UNICEF also joined the partnership which now also supports the “Unite for Children, Unite against AIDS” campaign.

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

Haitian civil society representatives visited Washington, D.C. on 6 April to mobilize political support for reconstructing the AIDS response in Haiti.

The civil society delegation, with support from UNAIDS, gave a testimony of their experiences with the earthquake and highlighted the importance of reconstructing the AIDS response with direct involvement of affected communities, especially people living with HIV. The briefing was held at Capitol Hill during a US Congressional briefing sponsored by US Senator Kirsten Gillibrand (D-NY) and attended by congressional staff, AIDS advocates and US civil society representatives.

Later that same day, the delegation from Haiti visited US Global AIDS Coordinator Ambassador Eric Goosby and his colleagues from USAID. The US government team pledged its support to encourage the Haitian government to include the involvement of people living with HIV in planning the reconstruction of the AIDS response in Haiti.

On 24 March, US President Obama asked the US Congress to approve $2.8 billion as an emergency requirement for relief and reconstruction support for Haiti following the devastating earthquake of 12 January 2010. The request is now pending before US lawmakers who will very soon vote on the proposal.

There were an estimated 120 000 people living with HIV in Haiti before the earthquake. Most of the structural damage happened in the three departments (Ouest, Sud-Est and les Nippes) that accounted for nearly 60% of the population of people living with HIV.

Following an initial rapid assessment of the situation with the Ministry of Public Health and Population, UNAIDS released a concept note Helping Haiti rebuild its AIDS response. The report explains the current situation in Haiti and what may be required to meet the immediate and intermediate AIDS response needs.

Civil society networks of people living with HIV as well as many of the organizations providing HIV services have been affected by the earthquake and are in need to be strengthened.

Hon. Dr. Leslie Ramsammy, Minister of Health of Guyana launching the national HIV prevention, principles, standards and guidelines. 24 March 2010.

On Wednesday 24th March 2010, Guyana unveiled the country’s new national principles, standards and guidelines for the prevention of HIV as part of its efforts to achieving universal access to HIV prevention, treatment, care and support.

“By 2020 Guyana must be well on the road towards elimination of HIV as a major public health problem,” said Dr Leslie Ramsammy, Guyana’s Minister of Health.

The principles, standards and guidelines are the result of two years of work under the leadership of the Ministry of Health’s National AIDS Programme, in close collaboration with UNAIDS. Guyana’s HIV prevention quality standards are fully in line with the UNAIDS Executive Director’s call for a global “prevention revolution” to reduce the number of new HIV infections.

“Prevention is a key priority. We need to construct a compelling prevention narrative. One built upon equality and human rights. One that recognizes the importance of responses that are strategically tailored to local epidemics, that include biomedical, behavioural and structural approaches, and that meaningfully involves beneficiaries,” said UNAIDS Executive Director Michel Sidibé.

According to UNAIDS, the national HIV prevention principles, standards and guidelines represent an important step forward for intensifying HIV prevention activities in Guyana, and should serve as a model for other countries in the region. The guidelines feature a scorecard for rating the quality of prevention programmes being implemented.