AMBASSADORS TO THE CARIBBEAN DISCUSS HIV/AIDS AND

UNCLAS SECTION 01 OF 04 PORT OF SPAIN 000535 SIPDIS SENSITIVE DEPT FOR S/GAC - MARK DYBUL DEPT PASS TO HHS FOR SECRETARY DEPT FOR WHA/EX, WHA/CAR, WHA/PD, GAC DEPT FOR USAID LAC/AA, GH/AA, GM/OMA ALSO FOR USAID MISSION DIRECTORS E.O. 12958: N/A TAGS: KHIV EAID PREL OVIP TBIO KPAO TD XL SUBJECT: AMBASSADORS TO THE CARIBBEAN DISCUSS HIV/AIDS AND PARTNERSHIPS COMPACT SENSITIVE BUT UNCLASSIFIED; PLEASE PROTECT ACCORDINGLY ¶1. (SBU) SUMMARY: At the Seventh Annual Chiefs of Mission Conference on HIV/AIDS in the Caribbean, eight U.S. Ambassadors discussed the future of U.S. regional assistance in the fight against HIV/AIDS. Focusing on the Partnership Compacts envisaged under PEPFAR II legislation, the Ambassadors asked the Office of the Global AIDS Coordinator for guidance on the role of Chiefs of Mission in developing the Compacts and the designation of someone to lead the process. The Ambassadors also emphasized the importance of bilateral engagement on HIV/AIDS in non-PEPFAR focus countries, as opposed to a strictly regional approach. In addition to offering the Ambassadors an opportunity to make recommendations about the Compact development process, the conference included a number of presentations from local and regional experts and officials, including Prime Minister Manning. END SUMMARY ¶2. (U) On October 22-23, Embassy Port of Spain hosted the Seventh Annual U.S. Chiefs of Mission Conference on HIV/AIDS in the Caribbean. The conference brought together U.S. ambassadors and officials from eight embassies, as well as U.S. Agency for International Development (USAID),Centers for Disease Control (CDC),and Department of State representatives from Washington and the wider Caribbean region. The conference was open to officials from the GOTT and local NGOs on the first day. During the second day, USG participants engaged in small group discussions about Partnership Compacts and the future of USG support for the fight against HIV/AIDS in the region. Speaker presentations from day one are posted on the conference website at http: http:// www.conference- registration.state.gov/caribbeancom/index.cfm . ¶3. (U) The conference theme was "Maintaining the Momentum in HIV/AIDS Prevention, Care & Treatment in the Caribbean." Conference goals were three-fold: to give participants an understanding of the progress in the region to date; to pinpoint the key challenges remaining; and to begin a dialogue that will ensure continued collaboration in the fight against HIV/AIDS under the recently re-authorized President's Emergency Plan for AIDS Relief (PEPFAR II). The conference included remarks by Prime Minister Patrick Manning, UNAIDS Caribbean Regional Director Dr. Karen Sealey, State's Assistant Global AIDS Coordinator Michele Moloney-Kitts, T&T-based Medical Research Foundation Director Dr. Courtenay Bartholomew, Dr. Amalia Del Reigo of the Pan American Health Organization's HIV/AIDS Caribbean Office, as well as presentations on vulnerable populations, PEPFAR, and regional priorities. Regional Progress, But No Room for Complacency -------------- - ¶4. (U) Ambassador Austin opened the conference on a positive note by spotlighting the progress in the fight against HIV/AIDS, including the fact that the prevalence rate in the region appears to have stabilized at 1.1 percent, according to UNAIDS. Heralding the 50 percent reduction in the number of HIV/AIDS related deaths in T&T due to the national antiretroviral program, Prime Minister Manning also emphasized the positive and thanked the U.S. for its leadership in the fight against HIV/AIDS. He also noted the importance of international cooperation on issues of global significance, such as HIV/AIDS, citing the recent multilateral efforts to tackle the global financial situation as a good example. ¶5. (U) The Prime Minister and the speakers that followed him, though, emphasized there is no room for complacency, as the epidemic continues to take a significant toll. Sealey helped put this message in perspective by noting that 38 Caribbean citizens died of AIDS everyday in 2007 and 55 were newly infected. Sealey called not only for efforts to "maintain the momentum," but to "intensify" it in order to "turn off the tap of infections." Echoing Prime Minister Manning's call for collaboration, Sealey suggested collective action would help the Caribbean maintain its momentum and address ongoing challenges. She commended the Pan Caribbean Partnership Against HIV/AIDS (PANCAP) for its leadership and heralded it as the only sustained regional partnership against this scourge in the world. She further emphasized the need to continue PORT OF SP 00000535 002 OF 004 such resource and knowledge sharing to improve surveillance systems, encourage behavior modification, and manage the growing financial burden of care and treatment. ¶6. (U) Similarly, Dr. Morris Edwards of PANCAP, delivering remarks on behalf of Denzil Douglas, the Prime Minister of St. Kitts and Nevis and the CARICOM Minister with responsibility for health, pointed to two critical challenges facing the region -- preventing new infections and reducing stigma and discrimination. PANCAP's Second Strategic Framework, he noted, focuses on using education and other means to change attitudes towards people living with AIDS and encouraging behavior modification. ¶7. (U) Speaking about vulnerable populations, several panelists expressed concern about the level of stigma and discrimination in Caribbean societies, often abetted by public policies that fail to protect basic human rights. Stigma and discrimination seriously hinder efforts to improve surveillance, care, treatment, and prevention. Further, the stigma surrounding HIV/AIDS undercuts efforts to promote awareness and modify behavior, while perpetuating discrimination. Local participants encouraged audience members and U.S. government officials to expand their definition of vulnerable populations and consider deportees as well as the prison population in their plans to fight HIV/AIDS. With respect to deportees, the question was raised as to which government should take responsibility for testing and treating these individuals (who may have been infected in the U.S.). Sharon Mottley, Chief Operations Officer for the Caribbean Coalition of National AIDS Program Coordinators (CCNAPC),called for high-level support for policies to protect vulnerable populations and improve access to treatment. Mainstreaming testing, treatment and care into public health facilities, as opposed to establishing separate HIV/AIDS clinics, was raised as one way to improve access to care in countries where stigma discourages persons from seeking assistance. The Future of USG Assistance -------------- ¶8. (U) Audience members were pleased to learn about PEPFAR from U.S.-based officials charged with administering it. Moloney-Kitts and Dr. Deborah Birx, Director of the Centers for Disease Control's Global AIDS Program, talked about PEPFAR, its accomplishments to date and goals for the future. Chandra Baier and Julia Roberts, PEPFAR coordinators in Haiti and Guyana respectively, discussed specific successes targeting vulnerable populations under the PEPFAR program despite the lack of surveillance data to guide programming. ¶9. (U) Moloney-Kitts noted that the second phase of PEPFAR will usher in a new era in assistance. Managing that assistance through bilateral and regional Partnership Compacts, the U.S. government will collaborate with host country officials, regional entities and civil society organizations to identify key issues and strategic initiatives that build sustainable local capacity to fight the HIV/AIDS epidemic. According to Moloney-Kitts, the Compacts will provide a means of increasing the visibility and strengthening the voice of civil society in the fight against HIV/AIDS. Once local support systems are strong enough to provide treatment and care as well as to conduct prevention activities, U.S. assistance will decrease. Local participants welcomed the news about PEPFAR II and were particularly pleased to learn that the new legislation lifts the U.S. immigration ban on immigrant visa applicants who are HIV positive. ¶10. (SBU) In a more detailed presentation delivered only to USG participants, Moloney-Kitts outlined the key principles, financial framework, and policy goals of the Partnership Compacts. In order to advance the Compact development process, she noted a number of critical elements need to be determined by USG personnel working in the region in collaboration with local counterparts. Specifically, she also suggested that issues of accountability, partnership, bilateral versus regional engagement and policy reform should be addressed by regional staff. PORT OF SP 00000535 003 OF 004 ¶11. (SBU) Using the National Issues Forums model, which encourages dialogue about complex issues and helps participants find common ground, the USG representatives then broke into three small groups to discuss the Partnership Compact concept. Specifically, the groups were asked to make recommendations on how to form effective partnerships with regional and/or host country governments and NGOs that would build local capacity and encourage policy change to advance the fights against HIV/AIDS. Participants reviewed three different partnership approaches, discussed their merits, sought common ground, and worked to develop a best practice recommendation for both Washington and the compact development teams. ¶12. (SBU) At the conclusion of the small group sessions, participants reconvened to discuss their conclusions in plenary. Three key recommendations were made to help drive the Compact development process forward. First, while regional cooperation is important, bilateral support for the fight against HIV/AIDS is paramount. In their meeting with Ambassador Dybul and separately in meetings with the region's Ambassadors, Caribbean health ministers expressed a preference for bilateral assistance. Given the increase in funding under PEPFAR II, expectations in the region are high that U.S. assistance levels will increase. It was agreed that any regional approach must have a substantial bilateral component, to include a uniform, minimum level of assistance which would be made available to each partner nation in the Regional Caribbean Compact, regardless of that nation's size. The regional elements could function as an "umbrella" or "chapeau," guiding bilateral efforts, but the bilateral piece of the Compact is critical to demonstrate the USG's commitment. ¶13. (SBU) Second, participants called for greater involvement by Chiefs of Mission in the Compact development process. The Ambassadors, in particular, were concerned about the perceived lack of communication about the Compact process and the seeming lacuna involving the need to clearly articulate the role of the Ambassadors in gaining host country buy-in. Further, few understood who had overall responsibility for the Compact process. There was a clear call for technical agencies to engage Chiefs of Mission more effectively on this issue. Only through improved communication will the Ambassadors be able to promote the Compact agenda and help build effective partnerships to support it. One group suggested that the Office of the Global AIDS Coordinator develop a briefing paper and talking points to assist the Ambassadors as they reach out to host governments and potential partners. ¶14. (SBU) Third, a regional steering committee should be formed to guide the development and implementation of the Caribbean Compact. The committee would have national and regional representation and, ideally, Ambassadorial leadership. In discussing CARICOM's involvement in such a committee and in the regional Partnership Compact more broadly, several participants raised concerns how CARICOM could be held accountable for the Compact's results. Comment: Many Successes, Much to Do -------------- ¶15. (SBU) The Chiefs of Mission Conference on HIV/AIDS succeeded on many fronts. For the local audience, it offered an opportunity to engage with the key U.S. government agencies and to learn about the future of U.S. assistance under PEPFAR II. Given the high level USG participation, the conference visibly demonstrated the U.S. commitment to the fight against HIV/AIDS in the Caribbean, generating favorable coverage in local media and press commentary on the need to control the spread of the disease. ¶16. (SBU) The conference also importantly afforded the first opportunity for CDC, USAID, and State Department officials involved in drafting the Partnership Compact documents to hold direct talks on a number of critical issues. Ambassadors were able to raise their concerns to key personnel from the Office of the Global AIDS Coordinator, CDC's Global AIDS Program, and USAID's Office of HIV/AIDS. The dialogue initiated at the conference will help move the regional Partnership Compact forward. The U.S. Chiefs of PORT OF SP 00000535 004 OF 004 Mission Conference on HIV/AIDS offers a critical venue for dialogue on a regional level and an opportunity for USG personnel to meet about key issues that require substantial interagency coordination. As an indication of the conference's value to U.S. engagement in the region, Santo Domingo offered to host the Eighth Annual U.S. Chiefs of Mission Conference on HIV/AIDS in the Caribbean in 2009. AUSTIN