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

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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.


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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

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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