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2005-10-21 16:06:00
Embassy Nassau
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						UNCLAS SECTION 01 OF 04 NASSAU 001827 



E.O. 12958: N/A

1. Summary: On October 3 and 4, Post hosted international
HIV/AIDS experts and 10 Caribbean mission representatives for
the 4th Caribbean Chiefs of Mission Conference on HIV/AIDS.
Ambassador Rood opened the conference with an appeal to
reduce the 2.3 percent Caribbean infection rate by
compassionately attending to the suffering of each individual
and leading by example in the fight against stigma.
Ambassador Tobias challenged the world's lack of outrage over
8,000 AIDS deaths every day, asking whether more would be
done to solve a problem causing 20 airline crashes every day,
killing these same 8,000 persons. He asked COMs to use
positions of leadership to fight the stigma of HIV/AIDS, and
agreed to increase funding for Ambassador's Fund grants from
$20,000 to $30,000. While recognizing U.S. efforts to combat
HIV/AIDS in poor countries, PM Christie expressed frustration
with international aid strategies that do not recognize the
challenges of migration or the needs of small, mid-income
nations. Echoing this theme, local and regional leaders
called for better regional cooperation, noted the challenges
of Caribbean migration and geography, and criticized current
funding as too focused in limited countries. In response,
Ambassador Tobias agreed to review the role of regional
funding in the Caribbean. To reduce stigma and develop a
coordinated regional approach, all agreed that development of
sustainable programs, improved local capacity for self-help,
public/private partnerships and the sharing of best practices
were vital. Mission representatives concluded the conference
by sharing successes from 2005, developing program ideas for
2006, pledging more personal involvement to model
stigma-reducing behavior, and agreeing to continue to focus
on Ambassador's Fund grant programs. End Summary.

2. COMs and representatives from Port-au-Prince, Kingston,
Georgetown, Port of Spain, Bridgetown, Paramaribo, Belize,
Santo Domingo, Havana and Nassau attended the conference.
Ambassador Randall Tobias, Global AIDS Coordinator,
representatives of USAID, health professionals,
representatives of HIV/AIDS NGOs and local government
officials also participated.

Opening Session


3. Ambassador Rood opened the conference with a snapshot of
the regional HIV/AIDS pandemic, including the 2.3 percent
prevalence rate in the Caribbean, second only to Sub-Saharan
Africa. He challenged leaders to move beyond the numbers and
reduce stigma through bold leadership, compassionately
focusing on the suffering of each person in need. He said,
"by focusing on the human dignity of each individual, we can

see how this battle will be fought and eventually won."

4. Dr. Rony Francois, Secretary of Health for the State of
Florida, emphasized the need for close regional cooperation
because of the high incidence of HIV/AIDS in immigrant
populations. He specifically discussed high infection rates
of Caribbean immigrants in Florida and New York. Dr.
Francois, a Haitian-American, noted the "close family ties"
between the U.S. and its Caribbean neighbors, and said that
HIV/AIDS in Caribbean should matter in the U.S. because it
directly impacts the U.S.

5. In his opening remarks, Ambassador Tobias called for a
sense of outrage at 8,000 AIDS deaths worldwide every day.
He asked whether governments, and the general public, would
do more to solve a problem that caused 20 airline crashes
every day, killing those same 8,000 people. He said that the
stigma of HIV/AIDS was a main reason that more is not being
done. He discussed the President's Emergency Program for
AIDS Relief (PEPFAR), which has provided $75 million in
Caribbean aid, with a focus on Guyana and Haiti. Ambassador
Tobias challenged COMs to fight stigma through leadership, to
promote a multisectoral response to HIV/AIDS and to empower
women in the fight against HIV/AIDS. He suggested that COMs
work with Guyana and Haiti to learn their best practices and
to coordinate regional strategies. He also congratulated
COMs on their work with the Ambassadors' Fund for HIV/AIDS,
and announced a 50 percent increase in grant funding.

6. Bahamian PM Christie concluded the opening session by
requesting additional HIV/AIDS assistance for middle-income
countries. Emphasizing the regional nature of problems in
the Caribbean, the PM noted the heavy burden Haiti places on
its Caribbean neighbors. The PM requested that policymakers
and international donors consider the unique nature and
burdens of migration in the Caribbean, and the strong
challenges faced by island nations in developing health
infrastructure in remote areas. He said that per capita GDP
is an inadequate measure of the burdens placed on small
economies for regional problems that require international
assistance. The PM said that a lack of U.S. action in
middle-income countries has caused many Caribbean nations to
rely upon Cuba for medical care and training. He contrasted
Cuba's open medical schools, provision of doctors and
acceptance of low income patients into Cuba with limited U.S.
efforts in many Caribbean nations. The PM requested
additional funding, a change in standards for aid awards and
better access to U.S. medical schools by Caribbean students.

7. Comment: Post received an advance copy of a more
positive speech focused on regional HIV/AIDS cooperation and
the Bahamian successes in treatment. The PM scrapped the
speech in favor of an aggressive challenge to current models
of funding for aid and a call for the U.S. to match Cuba's
medical diplomacy. The PM's presentation reflected his
ongoing concerns regarding use of per capita GDP as a measure
of need in a small country facing overwhelming challenges of
migration and geography. End Comment.

Key Challenges in the Caribbean: Stigma, Migration and Funding



8. In a discussion session entitled "What Makes the
Caribbean Epidemic Unique?" Dr. Nicholas Adomakoh, Director
of the Barbados CHART Center, and Dr. Perry Gomez, Director
of the Bahamas National HIV/AIDS Program, addressed the
specific challenges of HIV/AIDS in the Caribbean context.
While treatment advances have made HIV a chronic, treatable
condition instead of a death sentence, only 10 percent of
those infected worldwide have been tested and are aware of
their infection, a statistic Dr. Adomakoh called "truly
frightening in the implication that we cannot treat an
undiagnosed disease." The speakers emphasized the role of
stigma in keeping persons from testing and treatment, noting
a recent survey in which 80 percent of HIV/AIDS infected
respondents reported being the target of malicious comments,
56 percent reported that medical help was denied them because
of their status and 65 percent reported that they avoided
treatment out of fear of stigma. Dr. Adomakoh also cited
migration as a key Caribbean challenge, noting high rates of
infection in migrants and questioning whether current funding
models adequately address the problem.

9. The next session, "The Caribbean Landscape - What is
Being Done" focused on coordinated regional approaches
through CARICOM. Carl Browne, Coordinator of the
Pan-Caribbean Partnership on HIV/AIDS (PANCAP) discussed
PANCAP's funding and priorities, including its work to
support passage of HIV/AIDS legislation, provide training
through Caribbean HIV/AIDS Regional Training (CHART) centers,
negotiate low cost anti-retroviral drugs, and build
institutional capacity in member nations. Like other
speakers, Browne emphasized that the Caribbean problem
requires a coordinated regional approach. Dr. Edward Green,
Assistant Secretary General of CARICOM, assessed the impact
of the Caribbean Single Market and Economy (CSME) on
HIV/AIDS, focusing on the problems created by free movement
of persons in the Caribbean, and noting that poverty drives
both migration and HIV/AIDS. Because migrants are at
increased risk for HIV/AIDS, he cautioned that reduction in
barriers to migration in CSME will reduce barriers to the
movement of HIV/AIDS in the region. Green recommended that
HIV/AIDs policy should be coordinated regionally, that policy
be standardized, and that regional efforts focus on enhancing
local institutional capacity.

10. The session "HIV/AIDS Care and Treatment -- Three
Perspectives" presented success stories in Barbados, Haiti
and The Bahamas. Dr. Nicholas Adomakoh of Barbados CHART,
Dr. Jean Pape of GHESKIO Centers Haiti, and Dr. Percival
McNeil of the HIV/AIDS Center Bahamas each discussed the
successful treatment and prevention approaches in their
countries. All three cited the benefits derived from the
availability of low-cost medication, while highlighting
concerns about the development of resistant strains, the need
for more medication, and the need to better identify persons
needing treatment. For their successes, they credited lower
cost care, the development of local infrastructures, strong
collaboration with international and private partners, and
training provided through CHART centers.

11. In the final session focusing on Caribbean issues,
Ambassador Tobias and Dr. Carol Jacobs, Chair of the Global
Fund to Fight AIDS, discussed HIV/AIDS funding in the
Caribbean. Both emphasized the role of the Global Fund as a
monetary, but not a technical support, mechanism. Each
discussed the need to focus on sustainability of Global Fund
projects by building local capacity. To ensure effective
Global Fund projects, they urged COMs to help identify and
address needs for infrastructure development and technical
support. Dr. Jacobs expressed frustration that PEPFAR
focuses too heavily on target countries and does not
sufficiently account for heavy migration in the region. She
also echoed the comments of PM Christie by noting the lack of
grant funding for middle income nations that serve as
destination points for infected persons. In response,
Ambassador Tobias agreed to review the possibility of
increasing the role of regional funds in PEPFAR.

Leadership as Key to Stigam Reduction


12. In the session "Engaging the Private Sector", David
Greeley of Merck & CO, Camille Barnett of the Bahamas AIDS
Foundation, and W. Edward Wood, COO of the Clinton Foundation
HIV/AIDS Initiative each discussed the importance of
public/private partnerships in the fight against HIV/AIDS.
There was agreement regarding the value of a business
approach to the provision of health services, with special
recognition of the role that private organizations have
played in negotiations for lower cost HIV/AIDS medications.
COMs were encouraged to use their positions to educate the
private sector about the need for involvement and the
benefits of control of HIV/AIDS to business. COMs were also
advised to encourage businesses to develop programs for
worker testing, to develop workplace policies to reduce
stigma, to participate in local HIV/AIDS foundations, and to
provide medical support to infected workers in employer-paid,
confidential health programs.


13. The need for COM leadership was also discussed in the
session "Stigma and Discrimination: How to Be a Champion for
Change." Sir George Alleyne, UN Special Envoy on HIV/AIDS
for the Caribbean encouraged COMs to be national leaders in
the fight against stigma, and recommended that COMs: publicly
attack HIV/AIDS prejudices; support legislation to protect
HIV/AIDS infected persons from discrimination; work with
children regarding HIV/AIDS dangers; demystify the disease
through regular public discussion; and, embrace those living
with HIV/AIDS to set a positive example of the need for
respect and care. He further recommend that "Champions for
Change" develop local capacity and inspire others while
remaining personally committed and publicly involved.
Suzette Moses-Burton, President of the Caribbean Regional
Network for HIV Positive Persons, provided inspiration by
sharing her personal story as a person living with HIV/AIDS.
She discussed the fear of stigma that discourages testing and
the open discrimination against those living with HIV/AIDS.
She demanded action, more than words, and challenged COMs to
stand out as inspirational leaders.

Sustaining Projects and Sharing Best Practices



14. Dr. Marcus Bethel, Bahamian Minister of Health, led the
concluding remarks by reiterating the need for public/private
partnerships, thanking the COMs for directing Ambassador's
Fund grants to needy organizations, and challenging
participants to work towards a coordinated regional approach.
Ambassador Tobias focused his comments on the need for
sustainability in HIV/AIDS programs, stating that one-time
projects that are not sustained and do not develop local
capacity lack the ability to make transformational changes.
He asked COMs to help their countries build their capacity
for self-help, to be visible in the fight against HIV/AIDS
and to provide a good example with strong HIV/AIDS programs
in their embassies.

15. The discussion sessions concluded with a review of
HIV/AIDS projects and activities in each of the participating
countries and a discussion of best practices. COMs nominated
Jamaica to host the conference in 2006. COMs agreed that
Ambassadors' Fund grants were very successful, with results
that exceeded the size of the grants. COMs also agreed to
focus on the development of local capacity, to provide
leadership by example and to better coordinate efforts
regionally. USAID agreed to serve as a clearinghouse for
sharing HIV/AIDS initiatives and best practices on an ongoing

16. COMs discussed the following specific steps to advance
efforts to combat HIV/AIDS in the region:

--Use local contacts in government and business to ensure
strong representation of community leaders in local HIV/AIDS
--Work more closely with schoolchildren in HIV/AIDS education;
--Pursue licenses for local broadcast of "A Closer Walk", a
moving documentary regarding HIV/AIDS issues;
--Develop a regional newsletter on HIV/AIDS issues;
--Coordinate grant applications regionally, making model
grant applications available to NGOs seeking funding;
--Continue strong Ambassadors' Fund programs, considering
programs that have long-term resonance, such as musical and
theater programs;
--Use resources and programs from individual countries
throughout the region, including plays, films and songs,
gathering past embassy projects for regional distribution;
--Plan an HIV/AIDS event to coincide with potential Secretary
of State visit to Nassau in February 2006 for a meeting with
Caribbean counterparts on the future of the Caribbean.

Site Visits


17. The conference concluded with a visit to the HIV/AIDS
Resource Center in the Royal Victoria Gardens. Dr. Perry
Gomez, Director of the National HIV/AIDS Program, and Mrs.
Bernadette Saunders, the Bahamas Regional Training
Coordinator, led conference participants on a tour of the
facility. The COMs met with staff and volunteers involved in
the daily work of HIV/AIDS.

18. Several participants also visited the Bahamas AIDS
Foundation. They met with the head of BNN , a local group of
people living with AIDS, to hear first-hand about the
challenges of living with AIDS in the Bahamas. They
discussed the importance of public figures, like the
Ambassador and the PM, taking a leadership role to speak
publicly, reduce stigma and advance discussion. They also
considered various ways embassies could support the work of
volunteer caregivers.