AIDS 2014: Key Messages/Lessons for the Caribbean

(CARICOM Secretariat, Turkeyen, Greater Georgetown, Guyana) The Twentieth International AIDS conference is over. Far from over, however, is what must be done on this “last climb” to end the epidemics of AIDS, Tuberculosis and Malaria by 2030, “leaving no one behind”. This is even of more pressing concern, given the fact of an almost gone MDG era and, in this context, the “small window of opportunity to make big changes”.

Despite the “distance”, the Caribbean made its presence known. Of the Conference’s approximately 15,000 participants, Caribbean (regional) representatives included the Prime Minister of St. Kitts and Nevis and Chair of PANCAP, the Rt. Hon. Dr. Denzil Douglas, UN Secretary-General Envoy for HIV and AIDS in the Caribbean, Prof. Edward Greene; PANCAP Coordinating Unit Director, Dereck Springer; Co-founder of the Caribbean Regional Network for People living with HIV and AIDS, Yolanda Simon and Director of the Caribbean Drug Programme, Dr. Marcus Day.
In a post-conference interview, Prof. Greene, a former CARICOM Secretariat Assistant Secretary-General for Human and Social Development was asked to share his reflections and to sum up what he believes to be some key messages and lessons for the Caribbean.

For him, the 20th International AIDS Conference (IAC) was distinctive in terms of its context, content and composition. Dr Greene noted that while the Malaysia Airline disaster which killed at least six delegates to the conference including Joep Lange, a former IAC President cast a sombre mood on the conference, it seemed to have “ imbued the proceedings with a resolve to immortalise the departed colleagues by outcomes designed to bring an end to the AIDS epidemic. He noted also that the messages emanating from many of the sessions were that science was poised to create that breakthrough in support of the aspiration for an AIDS free generation. Dr. Greene drew attention to the fact that it was clear that the Conference focussed on Asia Pacific Region as well as promoted universal access to global health. He highlighted the Asia Pacific Sustainable Funding model for HIV and AIDS in collaboration between UNAIDS and the World Bank, in this context.

The following are some key messages from the Conference which includes lessons for the Caribbean:
The resolve to end the AIDS epidemic represents a momentus opportunity for broader health and development efforts

The AIDS movement has demonstrated what can be achieved through global solidarity, evidenced based action and multisectoral partnerships. In the Caribbean, the CARICOM initiatives through PANCAP and more recently, CARPHA provide the basis for meeting the post 2015 development challenges to strenghten the convergence of HIV, TB, Malaria, NCDs and other health emergencies into an overall health goal. In so doing, this could fulfil the vision of CARICOM Heads in the Nassau Declaration (2001) that the health of the region is the wealth of the region.

HIV treatment is critical to ending AIDS and making HIV transmission rare

The region must increase the present number of PLHIV having access to ARVs from just under 50% to the 90%. To do so, there is need to find a formula for more people to come forward for testing , and ‘’to know their status’’ and therafter for sustainable financing and universal access to treatment. In this regard, Caribbean governments must join the international lobby to challenge the TRIPS agreement and assert that access to affordable medicines is a human right.

The science is evolving in a dramatic fashion leading to biomedical prevention strategies, resulting in the scientific conclusion of ‘’treatment as prevention’’ i.e early initiation of treatment saving lives and money.

Caribbean scientists and researchers must be aligned with the major centers and global networks for randomised clinical trials thereby transfering knowledge gained from AIDS to other health emergencies.

Sustainable financing is essential to support research, training and outreach required to end AIDS, yet the sources are drying up, especially for middle income countries. At the same time, governments are generally looking at other prioirites sometimes under the false impression that AIDS is over.

The most expedient response for Caribbean countries that are classified in the middle/upper income category, but mainly lack capacity to respond individually, is through collaboration provided by PANCAP and CARPHA . Donor partners are increasingly reluctant to fund countries which individually have small number of cases. It is therefore necessary to strengthen the governance arrangements and foster alliances with agencies such as UNAIDS, PAHO and WHO. In this regard, Caribbean governments and especially Ministers of Health should support the proposal for a Caribbean Foundation for HIV and Sustaianble Health aimed at promting research and training of critical public health leadership in the region as well as supporting the annual scientific conference of CARPHA.

Ending AIDS and ending extreme poverty are interrelated

The data for the Caribbean fully illustrate this feature. It is partiuclarly alarming to note that new infections are highest among adolecents and youth, especially young women, sex workers and men who have sex with men . These are the sectors that are most marginalised, stigmatised and do not present for early testing. A multisectoral response, led for example, through CARICOM’s Council for Human and Social Development – education, health, culture, youth, gender and labour — programmes, can most likely highlight the links between improving health outcomes and sustaianble development in the post 2015 development agenda.

The Melbourne Declaration highlights eliminating stigma and discrimination as an essential element of ‘’leaving no one behind’’. While scientific, logistic and financial solutions are relevant to addressing one of the worse epidemics in human history, if large elements of the population remain isolated through fear, ignorance and discriminatory policies, then an effective response to HIV is impossible

The Caribbean will need to pursue the Justice for All programme which proposes an inclusive range of strategies between now and 2018 . Among them are eliminating mother to child transmission of HIV, increasing access to sexual and reproductive health, adopting innovative ways to introduce age appropriate health and family life education and abolishing laws that discriminate against homosexuals, sex workers and other marginalised groups.

The role of faith leaders is vital to the mission of leaving no one behind. This was the conclusion of a dialogue among a cross-section of faith leaders at the conference .

The continuing national consultations in the Caribbean on Justice for All may wish to take into consideration some voices from Melbourne

• Sara Speicher, the interim Executive Director of the Ecumenical Advocacy Alliance (EAA), who chaired the session, aptly summarised the sentiments by stating that while there are divisions among faith leaders on the way forward, controversy must not be replaced with silence – “If we’re going to make sure that faith-based groups can continue our struggle that nobody gets left behind in the response to HIV, we’re also going to have to make sure our own voices are heard. That’s something we will have to work on, as we look towards AIDS 2016 in Durban, South Africa”, she said.

• The Rev. Phumzile Mabizela, a South African Presbyterian minister and the Executive Director of the International Network of Religious Leaders Living with or Personally Affected by HIV and AIDS (INERELA+) said the anti-gay legislation is setting back the struggle against AIDS.“The new laws and even the discussion of the new laws have promoted a lot of fear. People are scared of going to clinics or hospitals. They don’t know whom to trust,” said Mabizela

• The Rev. Michael Schuenemeyer, a pastor in the United States and executive director of the United Church of Christ HIV and AIDS Network, said “responsible faith leaders need to put their religious houses in order if nobody is going to be left behind… we need to create spaces where we can engage in dialogue, and appeal to the sense of empathy and compassion that almost every faith community carries. We need to hold each other accountable, and that may require some of us to more boldly confront the negative rhetoric that causes harm, puts people at risk, and supports laws that criminalize HIV, sexuality and gender identity,” he said.

Dr Greene called especial attention to the Special Session dealing with HIV, Small Island States and the post 2015 development agenda, in which CARICOM Prime Minisister for Human Resource, Health and HIV expressed concern that the SAMOA Declaration include a stronger statement calling for the retention of AIDS in the post 2015 development agenda; ensuring HIV sensitive targets are aligned with other goals in areas such as gender and youth and on the social, economic and environmental determinants of HIV, poor health, poverty and inequality, environmental and sustainable development. The Prime Minister highlighted making Justice for All a fundamental requirement for getting to Zero discrimination; noting that while the July Conference of CARICOM Heads of Government deferred the PANCAP Justice for All Declaration, pending further consultations at the national level, Heads reaffirmed their support for efforts to eliminate HIV and AIDS stigma and discrimination to effectively combat the spread of AIDS.

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