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.
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 basis.
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 organizations; --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.
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. ROOD