16 April 2014
KINGSTON, Jamaica – Government representatives, civil society and technical partners from nine Caribbean countries held intense discussions on how new funding made available from the generous contributions of major donors to the Global Fund will support their efforts to bring the AIDS epidemic under control and build sustainable health systems.
Many countries in the region fund the majority of their own national programs, but additional resources can play a significant role.
There was agreement among many participants in the meeting that by using the new funding model to help target the most vulnerable they could achieve high impact and a sharper fall in infection rates, thereby helping to put health interventions on a firmer long-term footing.
"We want to use the new funding model as an opportunity to strengthen the health system and we have to emphasize a community-based approach," said Haiti's Health Minister Florence Guillaume. "By creating a foundation in countries like Haiti we can have a better health impact and maintain the results obtained."
"If we can prove that health investment is not a charity but an investment in access to services, people will be in good health. A good labor force is good for growth and that will reduce dependence on external donors," said Guillaume.
Among partners represented at the meeting were the Pan American Health Organization (PAHO), the Joint United Nations Programme on HIV/AIDS (UNAIDS), the United Nations Development Program (UNDP) and the U.S. President's Emergency Plan for AIDS Relief (PEPFAR).
The new funding model is designed to deliver on the promise of partnership that created the Global Fund in 2002, making more effective grants and with greater impact, so that more people can benefit from prevention, care and treatment. That includes strong country ownership and a focus on human rights.
More than 250,000 were living with HIV in the Caribbean in 2012, giving it the highest prevalence of the virus of any region in the world outside sub-Saharan Africa. Despite a fall of more than half in mortality rates over the past decade, HIV prevalence among men who have sex with men in some countries is running at more than 30 percent.
"The new funding model offers the opportunity for civil society to access the country dialogue that it offers, with the possibility to give input into the concept note," said Jaevion Nelson, head of advocacy at Jamaica Forum of Lesbians, All-Sexuals and Gays (J-FLAG). Nelson is an alternate member of the Global Fund Board, representing developing country NGOs.
"Given that funding may be drying up and that Jamaica could become an upper middle income country we must spend whatever we have to obtain a sustainable outcome, not just because the money is there," he said.
Countries are encouraged under the new funding model to engage in a robust dialogue with all stakeholders, including affected groups, civil society, technical partners and the private sector, before drafting a concept note for presentation to the Global Fund that details how to invest allocated money for maximum impact.
The Global Fund will allocate nearly USD$600 million for Latin America and the Caribbean during the 2014-2016 period under the news funding model. This exceeds the amount the region received in the last four years.
"There was a lot of dissatisfaction with the previous system which had a lot of bureaucratic hurdles," said Mirta Roses Periago, Global Fund Board member for Latin America and the Caribbean. "Now people see the rules of the game are clear from the allocation you are going to receive. In terms of simplicity, it's a very transparent process and you know what you are going to receive if you comply."
After the regional meeting, the Pan Caribbean Partnership against HIV and AIDS (PANCAP) held a consultation, led by Prime Minister of St Kitts and Nevis, Denzil Douglas, and the UN Special Envoy for HIV in the Caribbean, Professor Edward Greene, to drive forward a program to overcome stigma and discrimination in the region called "Justice for All. "
PANCAP, launched in 2001 by heads of government of the Caribbean Community (Caricom), helps coordinate national HIV programs with international and regional organizations involved in the fight against AIDS in the Caribbean.
Four Health Ministers also joined the consultation, held in collaboration with Jamaica's Health Ministry, UNAIDS and the University of the West Indies.
"We know what to do and we have the instruments to end the epidemic but we are starting to see an increasing contingent of people who are being left behind, " said Luiz Loures, Deputy Executive Director of Programme at UNAIDS. "We will not make it if we continue with business as usual."
Decriminalization of punitive laws against homosexual behavior is necessary, "but not sufficient on its own – efforts are also required to reduce associated stigma, discrimination and violence," said Mandeep Dhaliwal, Director of the HIV, Health & Development Practice at UNDP, in a presentation.
"Scientific tools alone are not sufficient to halt and reverse AIDS. Enabling legal environments are essential to a successful AIDS response," said Dhaliwal.
Delegates agreed to present a declaration for endorsement by Caribbean leaders calling for a raft of measures, including tougher laws on domestic violence and to prohibit job discrimination on grounds of HIV status, disability and sexual orientation by 2015 as well as reform of laws criminalizing men who have sex with men.
The Global Fund's Executive Director, Mark Dybul, who attended the launch of the consultation meeting, said: "We support Justice for all and the need for a human rights-based approach. We firmly believe that you are the Global Fund and that we are here to support and serve you."
A recent Health Ministry report on Jamaica's HIV epidemic said that discriminatory laws frustrated efforts to offer men who have sex with men access to quality health services "due to fear of criminal punishment as a consequence of disclosure."
Jamaica's Health Minister Fenton Ferguson said it would take time for social attitudes towards vulnerable people to evolve, even if discriminatory legislation is under review. "It is a very slow process and it is not going to change overnight," said Fenton. "If you look back in Jamaica to 30-40 years ago and where we are now, despite the discrimination, we have come a very long way."