Caribbean Region – The coverage of the programme is over 22 countries with focus on Bahamas, Barbados, Belize, Guyana, Jamaica(high priority), Trinidad and Tobago and Suriname.
OVERVIEW
UNAIDS Global AIDS Response Progress Report (GARP) (2014) indicates that there are an estimated 250,000 [230,000–280,000] adults and children living with HIV in the Caribbean. The overall HIV prevalence in the region is 1.1% [0.9–1.2%], with the highest prevalence of 3.2% [3.1–3.5%] found in the Bahamas. Five countries account for 96% of all people living with HIV in the region: Haiti (55%), The Dominican Republic (18%), Jamaica (12%), Cuba (6%), [1]and Trinidadand Tobago (5%). Of note too are the Bahamas and Barbados with 3% and 1% respectively, of the total PLWH in the region.
Countries continue to grapple with political, cultural, social and programmatic barriers to eliminating new HIV infections, AIDS-related deaths and discrimination. Key issues such as stigma and discrimination, access to services and the protection of human rights persist. Gay men and other men who have sex with men and sex workers are among the most vulnerable key populations in the region that continue to suffer from systemic stigma, abject social exclusion and marginalization.
Collectively, there were an estimated 12,000 [9,400–14,000] new HIV infections in the Caribbean in 2013. Although this represents a significant reduction in new infections in the region, the trends vary among the countries. For example, Jamaica experienced a 42% decline in new infections while Trinidad and Tobago also experienced a notable decline of 32%. HIV estimates are not currently available for the small island countries.
The WHO Global School-Based Student Health Survey (GSHS) indicates that 56% of girls and 79% of boys on average had sex before the age of 14. In the most recent GSHS on average 38% of adolescents 13–15 years of age did not use a condom at last sexual intercourse. The number of young women living with HIV is 1.2 times higher than the number of young men living with HIV. Even with this reality, young people are consistently denied unfettered access to SRH services and commodities. On average in the Caribbean, one out of every three young people aged 15–24 are inadequately informed or unaware of the ways to prevent HIV. Youth in Antigua and Barbuda were able to demonstrate knowledge and awareness of HIV (86%); however, median awareness among youth in the region was 43% among girls and 42% among boys.
Gay men and other men who have sex with men experience high levels of HIV prevalence across the Caribbean. In Jamaica for example, one in three (or 33% of) gay men and other men who have sex with men is HIV-positive. HIV prevalence is also disproportionately high among gay men and other men who have sex with men in the Bahamas, Belize, Dominica, Guyana and Saint Vincent and the Grenadines. HIV prevalence among sex workers is alsodisproportionately high with prevalence rates ranging from 2.9% in Jamaica, to 5.5% in Guyana, 5.8% in Suriname and 8.4% in Haiti.
Uptake of antiretroviral therapy among all people living with HIV in the region increased from 5% [4–6%] to 41% [36–46%] between 2005 and 2013 (7 countries reporting). Barbados has the highest treatment coverage, 64% [48–83%].
Despite progress in reducing new infections and increasing access to services, HIV remains a significant cause of mortality in the Caribbean. In 2013, there were an estimated 11,000 [8,300–14,000] AIDS-related deaths in the Caribbean. In keeping with HIV prevalence in the region, AIDS-related deaths were highly concentrated with 98% occurring in five countries—the Bahamas, the Dominican Republic, Haiti, Jamaica and Trinidad and Tobago. Haiti alone accounted for 59% of all AIDS-related deaths in the region.
[1] Cuba, Dominican Republic and Haiti are covered by LACRO
HIV PROJECT GUIDING FRAMEWORKS
The following global and regional frameworks guided the development, review and implementation of UNFPA’s HIV programme.
SUSTAINABLE DEVELOPMENT GOALS (SDGs), 2016 - 2030
· SDG Action Area 1: Ensure healthy lives and promote well-being at all ages
Target 3 – 90% of countries provide access to integrated health services for HIV, TB, HPV B/C, SRHR & NCDs;
Output 1 – Governments supported to implement activities for bi-directional linkages and integration of HIV and SRH programmes;
· SDG Action Area 2: Reduce inequality in access to services and commodities
Target 4 – 90% of SWs, MSM, PWID, TG, prisoners, adolescents and young people have access to HIV prevention services and commodities tailored to their needs;
Output 2 – Enhanced capacity of regional and national systems to safeguard the sexual health of sex workers;
Output 3 – Universal access to SRH commodities including condoms and lubricants for young people and sex workers promoted and improved;
· SDG Action Area 3: Achieve gender equality and empower women and girls
Target 8 – 90% of adolescents and young people have the relevant knowledge, skills and agency to protect their health;
Output 4 – Enhanced national capacities to improve young people’s access to SRH&R services and commodities;
Target 10 - 90% of women and children live a life free from gender-based violence, and women can protect themselves from intimate partner violence and HIV;
Output 5 – Stakeholders mobilized to mitigate the impact of Gender Based Violence on HIV;
UNPFA STRATEGIC PLAN, 2014 -2017
Outcome 1: Increased availability and use of integrated sexual and reproductive health services (including family planning, maternal health and HIV) that are gender-responsive and meet human rights standards for quality of care and equity in access
Output 4: Increased national capacity to deliver HIV programmes that are free of stigma and discrimination, consistent with the UNAIDS unified budget results and accountability framework (UBRAF) commitments
Output Indicators
· SP Output Indicator 4.1: Number of countries supported by LACRO that have implemented social behaviour change communication (SBCC) strategies for adolescent and youth including those from key populations.
· SP Output indicator 4.2: Number of countries supported by LACRO that have reached the implementation stage of the UNFPAs 10 step strategic approach to comprehensive condom programming.
UNFPA SROC Multi-Country Programme for the English and Dutch Speaking Caribbean 2012 - 2016
Output 3: Strengthened capacity of national and sub-regional institutions and organizations to advocate and scale up integrated interventions to prevent sexually transmitted infections and HIV; particularly for young people and vulnerable groups
Output Indicator(s):
• Number of countries that have completed an assessment of the linkages between SHR and HIV policies, systems and service delivery
• Number of countries using a comprehensive condom programming approach as part of their sexually transmitted infections and HIV-prevention strategies
• Number of organizations advocating and implementing HIV prevention strategies for young people and most-at-risk groups
UNAIDS Division of Labour, 2010
UNFPA has co-convener responsibilities for oversight and delivery of the following areas under the UNAIDS Division of Labour:
· DoLArea 1: Reduce sexual transmission of HIV
· DoLArea 6: Empower men who have sex with men, sex workers and transgender people to protect themselves from HIV infection and to fully access antiretroviral therapy
· DoLArea 8: Meet the HIV needs of women and girls and stop sexual and gender-based violence
· DoLArea 9: Empower young people to protect themselves from HIV
UNAIDS UBRAF, 2016 - 2017
· Output A1.1.1. Strengthened capacity of young people, youth-led organizations, key service providers and partners to develop, implement, monitor and evaluate HIV prevention programmes.
· Output A1.2.1. Informed vocal and capable organizations of men who have sex with men, sex workers and transgender people engaged as partners to advance universal access to HIV prevention, treatment, care and support, in major municipalities, and at least one comprehensive HIV programme in place providing non-judgemental, non-stigmatizing and relevant services.
· Output A1.3.2. Strengthened capacity to plan, implement and evaluate combination prevention programmes that meet the needs of individuals and communities.
· Output C4.1.1. Evidence on GBV and HIV linkages is collected, shared and used to address GBV within national HIV strategies and/or to review or develop new strategies, and range of actors linking GBV and HIV is increased.
PANCAP Caribbean Regional Strategic Framework (CRSF) 2014 - 2018
· Strategic Objective 1.2. Promote the development and acceptance of positive social norms and behaviours that support healthy and equitable societies
· Strategic Objective 3.1. Expand access to high quality evidence-based and appropriately targeted packages of prevention services (combination prevention)
· Strategic Objective 5.1. Integrate HIV services into national health systems.
PROGRAMME IMPLEMENTATION
Comprehensive Condom Programming (CCP): The capacity of National AIDS Programmes, Sexual and Reproductive Health Units, Civil Society Organizations and other affiliates of the Ministries of Health has been strengthened to improve universal access to male and female condoms and lubricants in 19 Caribbean territories through the promotion and implementation of a comprehensive approach to condom programming as per the CCP framework.
HIV and Sex Work :UNFPA supported capacity building and empowerment of sex workers and sex worker led organizations to advocate for the sexual and reproductive health and rights. UNFPA also actively promote the adaptation, dissemination and implementation of the Sex Worker Implementation Tool (SWIT).
Comprehensive Sexuality Education:HIV prevention has been an entry point for comprehensive sexuality education.UNFPA provided strategic support to Ministries of Education, Universities and other allied institutions to improve the planning and implementation of programmes for comprehensive Sexuality Education (CSE) in the Caribbean region. Six countries received support to strengthen the delivery of the key programme for delivery of CSE called Health and Family Life Education (HFLE). This involved the development of strategies for improving systems and human resource capacities for CSE and HFLE delivery.
HIV and SRH Promotion, Advocacy and Policy: UNFPA seized several strategic opportunities to promote the regional response to HIV and SRH and to advocate for the implementation of SRH and HIV programmes. These include presentations at strategic meetings of national and regional institutions.
PROGRAMME FOCUS 2016 - 2020
The activities for the UNFPA UBRAF programme are influenced by: consultations on national needs and priorities with national and regional partners including UN agencies in collaboration with the Liaison Offices; challenges and lessons learnt from UNFPA activities; and management priorities based on UNAIDS division of labour and results framework. Discussions and outputs from regional meetings (including UNFPA’s planning meetings) play a key role in informing the determination of programmatic priorities. The programme development actively considers the cluster approach to programming and utilizes the relevant global and regional frameworks mentioned earlier.
KEY PARTNERS
UN Agencies, CARICOM, PANCAP, Caribbean Vulnerable Community Coalition (CVC), Caribbean Sex Work Coalition (CSWC), Caribbean Public Health Agency (CARPHA), University of the West Indies (UWI),Population Services International (PSI), Ministries and Health, Education and Youth.
OPPORTUNITIES AND KEY CHALLENGES
· The main challenge to programme implementation stems from our conservative environment that discourages interventions in some populations, criminalize behaviours and sustains stigma and discrimination against some groups. Regional and national responses continue to be undermined by laws and policies that criminalize the behaviours of sexually active adolescent, sex workers and men in same sex relationships.
· Blind conservatism in the region and anti LGBT movements has engineered the conflation of comprehensive sexuality education with the LGBT agenda and thereby introducing new obstacles to implementing CSE and HFLE programmes region wide.
· Fiscal challenges faced by many countries in the region have prevented them from allotting sufficient resources to support implementation of critical programme activities.
· The upper middle income status classification of countries in the region has resulted in a depletion of donor resources available to deliver interventions with the general population and adolescents, thus limiting the countries’ ability to initiate needed programmes or to take current programmes to scale.
· Changes in the global funding landscape, reduced UBRAF funding and the inability to predict the level of future UBRAF support remains a challenge to effective programme planning and implementation.
· Changes in core and thematic funding along with related changes in the typology of the SROC have also undermined programme planning and the effectiveness of programme delivery.
PRIORITIES FOR 2016
In 2016, the programme continues interventions in response to the needs of the region in collaboration with other UN system agencies, with Jamaica as fast-tracing country absorbing more that 60% of the allocations for HIV prevention.
1. Sub-Activity: 3.1.1 ASRH STANDARDS
Provide technical assistance to the MoH for the dissemination and implementation of ASRH Standards for the provision of youth friendly services in health centres and clinics in Jamaica
2. Sub-Activity: 3.1.2 - HFLE PEER EDUCATION (Q3/4)
Provide technical assistance to the Ministry of Education for the pilot testing of a national peer education programme to support the delivery of sexual health and sexuality component of the HFLE in Jamaica and the Caribbean.
3. Sub-Activity: 3.1.3 - CSE/HFLE INSTRUCTION (Q3/4)
Provide technical assistance to the Ministries of Education and Health and NGOs to enhance national capacities in CSE instruction and delivery in 5 countries (Barbados, Guyana, Jamaica, Trinidad and Tobago, and Suriname).
4. Sub-Activity: 3.2.1 – Prevention with KP (Q2 - 4)
Provide technical support to the Ministry of Health and NGOs to build the capacities of health care providers and empower members of key populations to improve the delivery of SRH and services to KP in line with the SWIT & MSMIT & TRANIT guidance in 4 countries (Bahamas, Belize, Jamaica and Trinidad and Tobago)
5. Sub-Activity: 3.2.2 – FC, CCP
Provide technical assistance to synthesize assessment of the FC acceptability studies in 4 Caribbean countries and to develop FC advocacy strategy (Barbados, Guyana, Jamaica, and Suriname).
6. Sub-Activity: 3.2.3 – CCP, ST KITTS and NEVIS and Jamaica
Provide technical assistance to advance implementation of the CCP in 2 countries(St Kitts and Jamaica)
7. SROC Activity: 3.3 – M & E AND COORDINATION
Implement monitoring and evaluation activities, promotion of regional standards, networking and mobilization, national and regional coordination.
