Director’s Message | August – September 2018

The 15th Caribbean Cytometry and Analytical Society (CCAS) Expert Summit, which was convened on 26th – 30th August in Saint Lucia, provided a platform for PANCAP to share Test Treat Defeat – Caribbean Advocacy for Ending AIDS as a public health threat. The presentation focused on PANCAP’s high-level advocacy for the reduction of stigma and discrimination, the provision of affordable medicines and commodities, and adequate domestic financing for increasing the level of testing, treatment and viral suppression required to end AIDS as a public health threat in the Caribbean, and the successes to date.

Caribbean public health practitioners also presented on the process and challenges for achieving the elimination of mother-to-child transmission of HIV and Congenital Syphilis, shared country experience implementing Pre Exposure Prophylaxis (PrEP), the OECS Pharmaceutical Procurement System, a best practice for the region, and reported on the laboratory strengthening support, which is being provided by the Caribbean Med Lab Foundation in the OECS.  The CCAS also received presentations from Cuba in relation to EMTCT and GHESKIO in Haiti in relation to HIV Treatment.

However, while CCAS provided an opportunity for Caribbean public health practitioners to be updated on new technologies and to share best practices and experiences in HIV, the absence of National AIDS Programme Managers was glaring. In response, I would like to urge our member states to support the participation of these managers. NAP managers are ideally positioned to contribute by sharing best practices and experiences. NAP managers will also be exposed to the technological developments and strategies for ending AIDS. The PANCAP Coordinating Unit (PCU) will advocate for such support for our valued NAP managers to attend the annual CCAS.

I would like to congratulate the Caribbean Med lab Foundation on the occasion of its 10th Anniversary which was celebrated at a dinner hosted by the organization on 30th August at the end of CCAS 2018. CMLF promotes and supports the achievement of quality laboratory services in accordance with appropriate standards, through advocacy, resource mobilization, collaboration, research, and education. CMLF has provided invaluable services to the Caribbean region over the last 10 years and must be lauded for its stellar work. The work they do is even more important as we strive to achieve the UNAIDS 90-90-90 Targets given the crucial role of laboratory services for achieving each of these targets.

The PCU supported the PACC in preparing for the 34th Meeting of the PACC and 28th Meeting of the PANCAP Executive Board, which were held on 4-6 September in Georgetown, Guyana. The meetings provided an opportunity to discuss progress and challenges as well as programmatic and policy guidance. These meetings received and discussed the draft report on the evaluation of the CRSF and made policy recommendations for the Council for Human and Social Development (COHSOD) – Ministers of Health meeting scheduled for the third week in September in Washington D.C. USA.

A joint PANCAP – CVC – COIN Multi-country proposal was submitted to the Global Fund in August for funding in the amount of USD$6.5 million for the period 1 October 2019 to 30 September 2022. The conceptual framework for this proposal builds on the top-down and bottom-up strategies of the current Global Fund grants to more effectively work towards integrating these approaches into strengthened national programs that benefit from the inclusion of civil society and communities as equal partners in decision-making, planning, implementation, and oversight. This approach is indicative of a broader commitment of the regional response to stronger integration of community, civil society and government efforts as equal partners and stakeholders in the HIV response, and to more effectively link progress at the regional level to actions and tangible results at the national level. The proposal provides a unique opportunity to institutionalize partnerships between civil society and governments and to develop effective and sustainable programs to meet the needs of key populations and thereby diminish the HIV epidemic. The Partnership awaits the outcome of the Technical Review Panel, which is currently reviewing proposals submitted in August 2018.

Health Finance and Governance project helping to improve understanding of national funding and spending on health

By Sarah Goddard, Abt Associates

Guyana has achieved significant progress in funding the national response to HIV but faces challenges related to scaling up of Treat All in an environment of declining donor funding. The USAID-funded Health Finance and Governance (HFG) project, in collaboration with PAHO/WHO, has supported a National Health Accounts (NHA) estimation exercise in Guyana to improve understanding of national funding and spending on health. A National Health Accounts dissemination meeting was held in Georgetown on 3 August, at which it was revealed that the Government’s share of HIV spending increased from 25 percent in 2015 to 64 percent in 2016, indicating increasing domestic resource mobilization for HIV.

Guyana’s Health Accounts will play an important role in the country’s health policy and future decision making for health expenditures. Ms. Julia Henn, Director of Health and HIV/AIDS Office, USAID/Eastern and Southern Caribbean, described the National Health Accounts as a “goldmine of information for policymakers.” One key recommendation is for Guyana to better leverage the private sector in order to diversify domestic funding sources for health and HIV. According to Mr. Tesfaye Dereje, Senior Health Finance Specialist of the HFG project, “Guyana is off to a great start.”

CRN+ seeks to improve access to public health services by People Living with HIV 

Image: (L-R) Mr. Winfield Tannis-Abbott, CRN+ Chair presenting Dr Rhonda Moore, National AIDS Programme Manager, Guyana with a token of appreciation at the culmination of the dialogue. 

The Caribbean Regional Network of People Living with HIV and AIDS (CRN+) facilitated a dialogue with health care providers and People Living with HIV (PLHIV) in Georgetown, Guyana in August.  The dialogue encompassed discussions on the procedures of accessing services (testing, treatment, and care) in Guyana.

The event brought together representatives from the public treatment sites, Ministry of Health, National AIDS Programme Secretariat, National PLHIV Networks, Joint United Nations Programme on HIV/AIDS (UNAIDS), the Pan American Health Organization (PAHO) and CRN+.

The National AIDS Programme Secretariat opened the discussions with brief presentations on accessing services at treatment sites across Guyana and the importance of creating an Enabling Environment. Participants praised the initiative for focusing on the improvement of the system for accessing health services at public treatment sites.

The initiative forms part of a series of regional capacity building meetings by CRN+ which are intended to improve access to care and treatment by PLHIV. 

Successful Expert Summit, From Care to Cure – Towards the elimination of HIV, held in Saint Lucia

Image:  (L-R) CCAS Chairman Clive Landis, RTI International founder Dr. Wendee Wechsberg, CCAS President Vera Layne, Saint Lucia Health and Wellness Minister Mary Isaac, Caribbean Med Labs Foundation Director, Valerie Wilson, Director of PANCAP, Dereck Springer.

The 15th Annual Caribbean Cytometry & Analytical Society’s (CCAS) Expert Summit, “From Care to Cure – Towards the Elimination of HIV”, was held in Saint Lucia from 26 to 30 August. The summit brought together regional and international HIV experts to explore scientific innovations and social interventions that will accelerate progress toward ending the AIDS epidemic as a public health threat.

Present was Senator The Hon. Mary Isella Isaac, Minister for Health and Wellness, Saint Lucia.  View an interview with the Senator here.

PANCAP Director, Dereck Springer delivered a well-received presentation on Test, Treat, Defeat in Caribbean Advocacy and the Caribbean Regional Strategic Framework: beyond 2018.  He provided an illustration of the Barbados Treat All Programme, documented in a case study and animated video by PANCAP (View here). The Director advocated that the 2030 goal of ending AIDS can be realized with the region utilizing the Barbados Treat All experience as a best practice to improve the HIV response and to achieve better health outcomes for People Living with HIV and AIDS (PLHIV).
CCAS Chairperson, Professor Clive Landis pointed to successes of the Caribbean HIV response including the validation of seven countries for the elimination of Mother-to-child transmission of HIV and Syphilis.

He noted that while the region has embraced the power of antiretroviral treatment and viral suppression to prevent HIV infections in newborns, there is an inadequate understanding among the public about how successful treatment can also reduce sexual transmission.

View Professor Landis’ remarks here.

UNAIDS Director for Latin America and the Caribbean, Dr. César Núñez, noted that through the 2016 Political Declaration on ending AIDS, United Nations members states have agreed to adopt a Fast-Track strategy that involves increasing prevention, testing, and treatment services while working to eliminate stigma and discrimination. Dr. Núñez shared the latest HIV data, which indicates that the Caribbean must accelerate progress if it is to meet the targets to end the AIDS epidemic by year 2030.

The opening ceremony’s distinguished Speaker was Dr. Wendee Wechsberg of RTI International. She shared a gender-sensitive model for offering care to women living with HIV.  It extends beyond treatment to develop structural interventions that increase education and economic development and improve access to sexual and reproductive health.

What is CCAS? 

The Caribbean Cytometry & Analytical Society (CCAS) is a registered HIV Charity comprised of volunteers from the University of the West Indies, the Barbados Ministry of Health and the private sector. The mandate of the CCAS is to train and educate healthcare providers for improved diagnosis, monitoring and treatment of HIV and AIDS in the Caribbean region by removing technical and social barriers to care. CCAS’s annual HIV/AIDS regional workshop rotates through the region and has trained more than 1250 HIV/AIDS specialists from over 20 countries.

New Team Lead and Senior Advisor appointed to UNAIDS Caribbean Sub-Regional Office

The Partnership extends a warm welcome to Mr. James M. Guwani, recently appointed Team Lead and Senior Advisor at the UNAIDS Caribbean Sub-Regional Office, based in Kingston, Jamaica. He will be responsible for leading the Sub-regional Team and overseeing support for the implementation of the Sub-Regional Programmes and working closely with UNAIDS Country Offices in the Region to strengthen national and partner capacities for fast-tracking the AIDS response.

Mr. Guwani recently joined the Caribbean Sub-regional Team, effective 1 August 2018, from the UNAIDS Regional Support Team for Eastern and Southern Africa (UNAIDS RST ESA) based in Johannesburg, where he served as Regional Strategic Information Advisor and later Regional Programme Advisor.

He has been with UNAIDS since 2004 and has served as the Global Monitoring and Evaluation (M&E) Capacity Building Coordinator in Geneva, M&E Advisor in Uganda, Zambia, Guyana and Suriname, and the M&E Technical Advisor to Barbados. Prior to joining UNAIDS, James worked as a Monitoring and Evaluation Specialist at the Centres for Disease Control and Prevention (CDC) in the US. Before joining the CDC, he worked with the American Red Cross in Washington DC, as the Senior Program Evaluator for the Red Cross HIV and AIDS Education and Prevention Programs. He has a Doctorate in Medical Epidemiology from The Pennsylvania State University. Prior to attending Penn State, he received a joint MPH and International Development Studies Degree from Ohio University.

The Partnership anticipates a fruitful collaboration with Mr. Guwani at this critical stage of the Region’s HIV response. 

SCLAN receives grant funding for key initiatives 

The Spouses of CARICOM Leaders Action Network (SCLAN) received grant funding from Gilead Sciences Inc. for initiatives under the theme “Transforming Lives through Innovation: Implementation of high-impact prevention programs for adolescents, young men and women”.  The image depicts Mrs. Kim Simplis Barrow, First Lady of Belize and a representative of Gilead Sciences Inc during the presentation of the grant.

Faith leaders play a vital role in sustaining achievements of the health sector – Minister Karen Cummings, Guyana

Image: Hon. Dr Karen Cummings, Minister within the Ministry of Public Health, Guyana  

Participants of the Guyana National Faith Leaders Consultation in August, including faith leaders and leaders of key populations, were privileged to hear from Hon. Dr Karen Cummings, MP, Minister within the Ministry of Public Health, Guyana.

While Minister Cummings reflected on the progress made in the region’s HIV response, including the seven Caribbean territories being validated for the elimination of mother-to-child transmission of HIV and syphilis, she spoke of some “hard truths” regarding the challenges related to the response.

Minister Cummings warned that stigma and discrimination threaten the laudable gains made and can be considered a primary barrier to vulnerable populations accessing HIV prevention and other health care services.

“From fears of contagion to negative social judgment, many persons in society often unwittingly engage in and encourage varying degrees of stigma and discrimination against persons living with HIV,” stated the Minister.

Tackling stigma is key to HIV prevention

Minister Cummings further reflected on the early history of the epidemic when the late Jonathan Mann, former Head of the World Health Organization’s Global Programme on AIDS, had identified AIDS-related stigma and discrimination as a third epidemic following the accelerated spread of HIV infection and the visible rise in AIDS cases.

Minister posited that Mann recognized that stigma, discrimination, blame, and denial are potentially the most difficult aspects of HIV to address. However, she affirmed that tackling the factors that were outlined by Mann continues to be the key to preventing HIV transmission and mitigating the impact of the disease on individuals, families, and communities.

Minister Cummings noted that since its detection in 1983, HIV has been associated with aspects of religion such as “moral failings” and “sinful behaviour”. She underscored that this was a misguided view, stating, “We need to recognize, acknowledge and embrace all people, regardless of their beliefs, political persuasion, and sexual orientation.”

The Public Health Minister said that an essential part of the Fast Track Initiative to end AIDS is the inclusion of key populations who are being left behind in the HIV response. This mainly occurs, the Minister noted, because of stigma and discrimination, which severely impact negatively on vulnerable groups who hesitate to be tested because of fear.  These persons are ultimately left untreated.

“As healthcare providers responsible for the health and wellbeing of our fellow human beings, we cannot be blinded by prejudice and insular judgment. If we are truly committed and determined to take the fight to end AIDS, then we must demonstrate that resolve by working with persons with HIV, including the key population component,” Minister Cummings emphasized.

Faith leaders are integral to the response

Addressing the participants of the consultation, Minister Cummings highlighted that religious leaders play a vital role in helping to further the achievements of the health sector.  “Through your perspective, you have expanded programmes in partnership with the Ministry of Public Health. Further, you have support from international funding to help track the epidemic in a multi-sectoral, multi-level, multi-dimensional effort that simultaneously reduces stigma, shame, denial, discrimination, inaction, and misinformation still attached to HIV.”

Minister recommended that faith leaders intensify their efforts to support public health initiatives by promoting the SAVE model – Safe practices, available medicines, voluntary testing and empowerment through education – at the individual, family, local, community and national level.

She challenged Guyana’s faith community to work closer with the public health sector on removing barriers of stigma and discrimination and underscored that partnership and collaboration are integral to achieving the 2030 goal of ending AIDS.

World AIDS Day 2018 Theme Announced – “Know Your Status”

Tuesday, 11 September 2018 (PANCAP Coordinating Unit, CARICOM Secretariat):  The theme for the 2018 observance of World AIDS Day is “Know your status”.

The 30th anniversary of World AIDS Day will be marked on 1 December 2018. Since 1988, the AIDS response has made significant progress and today millions of people living with HIV are leading healthy and productive lives. But we still have miles to go, as the latest UNAIDS report shows, and one of the challenges remaining is knowledge of HIV status.

HIV testing is essential for expanding treatment and achieving the 90-90-90 Targets. It also empowers people to make choices about HIV prevention, so that they can protect themselves and their loved ones.

Many barriers to HIV testing remain and UNAIDS estimates that more than 9.4 million people living with HIV still do not know their status. Stigma and discrimination deter people from taking an HIV test. Access to confidential HIV testing remains an issue of concern. Many people get tested only after becoming ill and symptomatic. This leads to HIV treatment being initiated late, undermining its many benefits for both treatment and prevention. At the same time, there are many new opportunities to expand access to HIV testing. Self-testing, community-based testing services, and multi-disease testing are helping people to know their HIV status.

HIV testing programmes must be expanded. For this, we need political will and investment, as well as novel and innovative approaches to HIV testing that are fully leveraged and taken to scale.

In the coming weeks and months, we will be sharing more campaign ideas and materials via PANCAP.org.

PANCAP anticipates a highly successful World AIDS Day 2018.  Join us! 

Health Finance and Governance project helping to improve understanding of national funding and spending on health

Guyana has achieved significant progress in funding the national response to HIV but faces challenges related to scaling up of Treat All in an environment of declining donor funding. The USAID-funded Health Finance and Governance (HFG) project, in collaboration with PAHO/WHO, has supported a National Health Accounts (NHA) estimation exercise in Guyana to improve understanding of national funding and spending on health. A National Health Accounts dissemination meeting was held in Georgetown on 3 August, at which it was revealed that the Government’s share of HIV spending increased from 25 percent in 2015 to 64 percent in 2016, indicating increasing domestic resource mobilization for HIV.

Guyana’s Health Accounts will play an important role in the country’s health policy and future decision making for health expenditures. Ms. Julia Henn, Director of Health and HIV/AIDS Office, USAID/Eastern and Southern Caribbean, described the National Health Accounts as a “goldmine of information for policymakers.” One key recommendation is for Guyana to better leverage the private sector in order to diversify domestic funding sources for health and HIV. According to Mr. Tesfaye Dereje, Senior Health Finance Specialist of the HFG project, “Guyana is off to a great start.”

Faith leaders play a vital role in sustaining achievements of the health sector – Minister Karen Cummings, Guyana

Participants of the Guyana National Faith Leaders Consultation in August, including faith leaders and leaders of key populations, were privileged to hear from Hon. Dr Karen Cummings, MP, Minister within the Ministry of Public Health, Guyana.

While Minister Cummings reflected on the progress made in the region’s HIV response, including the seven Caribbean territories being validated for the elimination of mother-to-child transmission of HIV and syphilis, she spoke of some “hard truths” regarding the challenges related to the response.

Minister Cummings warned that stigma and discrimination threaten the laudable gains made and can be considered a primary barrier to vulnerable populations accessing HIV prevention and other health care services.

“From fears of contagion to negative social judgment, many persons in society often unwittingly engage in and encourage varying degrees of stigma and discrimination against persons living with HIV,” stated the Minister.

Tackling stigma is key to HIV prevention

Minister Cummings further reflected on the early history of the epidemic when the late Jonathan Mann, former Head of the World Health Organization’s Global Programme on AIDS, had identified AIDS-related stigma and discrimination as a third epidemic following the accelerated spread of HIV infection and the visible rise in AIDS cases.

Minister posited that Mann recognized that stigma, discrimination, blame, and denial are potentially the most difficult aspects of HIV to address. However, she affirmed that tackling the factors that were outlined by Mann continues to be the key to preventing HIV transmission and mitigating the impact of the disease on individuals, families, and communities.

Minister Cummings noted that since its detection in 1983, HIV has been associated with aspects of religion such as “moral failings” and “sinful behaviour”. She underscored that this was a misguided view, stating, “We need to recognize, acknowledge and embrace all people, regardless of their beliefs, political persuasion, and sexual orientation.”

The Public Health Minister said that an essential part of the Fast Track Initiative to end AIDS is the inclusion of key populations who are being left behind in the HIV response. This mainly occurs, the Minister noted, because of stigma and discrimination, which severely impact negatively on vulnerable groups who hesitate to be tested because of fear.  These persons are ultimately left untreated.

“As healthcare providers responsible for the health and wellbeing of our fellow human beings, we cannot be blinded by prejudice and insular judgment. If we are truly committed and determined to take the fight to end AIDS, then we must demonstrate that resolve by working with persons with HIV, including the key population component,” Minister Cummings emphasized.

Faith leaders are integral to the response

Addressing the participants of the consultation, Minister Cummings highlighted that religious leaders play a vital role in helping to further the achievements of the health sector.  “Through your perspective, you have expanded programmes in partnership with the Ministry of Public Health. Further, you have support from international funding to help track the epidemic in a multi-sectoral, multi-level, multi-dimensional effort that simultaneously reduces stigma, shame, denial, discrimination, inaction, and misinformation still attached to HIV.”

Minister recommended that faith leaders intensify their efforts to support public health initiatives by promoting the SAVE model – Safe practices, available medicines, voluntary testing and empowerment through education – at the individual, family, local, community and national level.

She challenged Guyana’s faith community to work closer with the public health sector on removing barriers of stigma and discrimination and underscored that partnership and collaboration are integral to achieving the 2030 goal of ending AIDS.