The Third Annual General Meeting of the Pan-Caribbean Partnership Against HIV/AIDS (PANCAP) was held in Georgetown, Guyana on 12-13 November 2003, under the Chairmanship of the Hon. Dr. Leslie Ramsammy, Minister of Health, Republic of Guyana, assisted by Deputy Chairperson, H.E. Ms. Dolores Balderamas Garcia, Ambassador/Chairperson National AIDS Commission, Belize.
OPENING CEREMONY
The Opening Ceremony was chaired by Dr. Edward Greene, Assistant Secretary-General, Human and Social Development, Caribbean Community (CARICOM) Secretariat.
Dr. Leslie Ramsammy extended a warm welcome to Delegates on behalf of the Government and People of Guyana. He stressed that the Pan Caribbean Partnership (PANCAP) represents a crucial step in moving towards a coordinated and effective effort to mitigate the impact and halt the spread of HIV/AIDS in the Caribbean. In this regard, he underscored the importance of the Meeting for the Region. Minister Ramsammy pointed to some of the social and economic effects of the HIV/AIDS epidemic on the Region, and expressed his sincere hope that the Meeting would achieve its goals to the benefit of the Region.
Remarks were offered by Ms. Yolanda Simon, Founder and Coordinator of the Caribbean Regional Network of People Living with HIV/AIDS (CRN+), who expressed her appreciation for the association between PANCAP and CRN+. She noted the progress of PANCAP since its inception in 2001, and affirmed the commitment of CRN+ to PANCAP and its mission.
Representing Dr. Yitades Gebre, Chairman of the Caribbean Coalition of National AIDS Programme Coordinators (CCNAPC), was Ms. Renee West Mendoza, Chief Operations Officer of CCNAPC. Ms. West Mendoza, in a statement from Dr. Gebre, pointed out that the HIV/AIDS epidemic already had, and would continue to have, crippling effects and that it was one of the most formidable challenges faced by the Region. She cited PANCAP as an important forum to address the issues related to an effective regional response in a more coordinated manner. She highlighted the importance of focussing on policy and advocacy in the context of the Caribbean Regional Strategic Framework on HIV/AIDS. She affirmed CCNAPC’s support for greater cooperation between national programmes and territories, which would ensure uniformity of programme implementation across the Caribbean. She also affirmed the commitment of CCNAPC to PANCAP and its partners in positioning HIV/AIDS as a social, human rights and health priority in the region.
In a video address to the PANCAP Meeting Dr. Peter Piot, Director of UNAIDS, expressed his pleasure at seeing PANCAP evolve from a concept to a reality, and expressed hope that this body would rise to the challenge of the successful implementation of its mandate. He suggested that, in an effort to scale up the response to the epidemic in the Caribbean, PANCAP needs to address the issue of prevention and treatment, and to measure the deliverables in the school, workplace and the home. Dr. Piot singled out the need to work towards the elimination of HIV/AIDS-related stigma and discrimination, noting that a human rights approach is a critical component rather than an optional extra in this effort. He wished PANCAP success in breaking barriers.
In a telephone message, the Hon. Dr. Denzil Douglas, Prime Minister of St. Kitts and Nevis and Chair of PANCAP characterized PANCAP as a very special mechanism endorsed by the Heads of Government as a pillar of the Nassau Declaration. He highlighted the diminishing effect of HIV/AIDS on the Region’s vital human resources, especially among the young (including young mothers and babies). He indicated that the lack of availability of affordable anti-retroviral drugs had resulted in inequalities in access to treatment and care.
Dr. Douglas mentioned that since the signing of the Partnership Agreement in February 2001, several agencies had contributed to the strengthening of PANCAP. These include: Caribbean Epidemiology Centre (CAREC), Caribbean Community (CARICOM) Secretariat, Caribbean Health and Research Centre (CHRC), CRN+, Joint United Nations Programme on HIV/AIDS (UNAIDS) and University of the West Indies(UWI). He thanked the Canadian International Development Agency (CIDA) and Unites States Agency for International Development (USAID) for their contributions towards the development of PANCAP. He indicated that he was happy that the Meeting would focus on implementing the new structure and functions suggested in the Second Annual Meeting in 2002. He also signalled that he was pleased with the involvement of and active role played by the Caribbean Network of People Living with AIDS in the decision making structure.
Dr. Douglas pointed out that on behalf of PANCAP, he had signed the agreement in principle with six pharmaceutical companies in Barcelona (July 2002), and that this represents a landmark as the Caribbean is the first regional entity, along with the South West African States, to arrive at a collective price for Anti-Retroviral Drugs (ARVs). With regard to ARVs, Dr. Douglas noted the work of partners such as WHO, PAHO, UNAIDS and the William Jefferson Clinton Foundation. He suggested that the Meeting was also important because it comes at a time when the region is celebrating the recent announcement of grant awards from the Global Fund for Tuberculosis, HIV/AIDS and Malaria (GFTAM). He stressed that even though the Region was a recipient of the resources from the Global Fund, there remains a large gap to be filled. In this regard, he expressed the hope that the Meeting, and especially its engagement with donor partners, would yield positive responses.
In his closing remarks to the opening ceremony, Dr Greene placed PANCAP within the context of the Millennium Development Goals (MDG). He observed that the MDG emphasised issues such as reduction in child mortality rates, reduction of maternal mortality and reduction in HIV/AIDS, Malaria, Tuberculosis and other diseases.
Dr Greene noted that one per cent of the entire Caribbean or 500,000 persons were infected with HIV/AIDS. Furthermore, in almost every country, 40 per cent of the infected adult population are women and there is a higher HIV rate among girls than boys. In this context, PANCAP is a regional umbrella body essential for a consolidated, cooperative and collaborative approach to a problem which has become insurmountable within individual countries.
He took the opportunity to introduce the staff of PANCAP and highlighted some achievements, including the production of a monthly electronic newsletter, a bi-monthly production of PANCAP News, and collaboration with PAHO/WHO, UNAIDS and the W.J. Clinton Foundation vis-à-vis ARVs. He stated that the PANCAP Coordinating Unit had completed the architecture of the PANCAP structure and functions. He also took the opportunity to congratulate Belize, Guyana, Haiti, Jamaica and the OECS which had been awarded grants in the third round competition of the Global Fund. He pointed out that this would bring new challenges with regard to management and collaboration.
In closing, Dr Greene asked delegates to dedicate time to working towards a formula for accelerating the implementation of the Regional Strategic Framework since the lives of many depended on collective efforts in the fight against HIV/AIDS.
STRUCTURE AND FUNCTION OF THE PAN-CARIBBEAN PARTNERSHIP AGAINST HIV/AIDS
Bearing in mind that the overarching goal of PANCAP is to curtail the spread of HIV/AIDS and to significantly reduce the impact of AIDS on human suffering and on the development of the Caribbean’s human, social and economic capital, the Meeting noted the actions taken and the progress made in respect of the Caribbean Regional Strategic Framework on HIV/AIDS for 1999-2004 and the seven priority areas which had been identified for action. These areas are: Advocacy, Policy Development and Legislation; Care and Support for People Living with HIV/AIDS; Prevention of HIV Transmission among Young People; Prevention of HIV Transmission among Vulnerable Populations; Prevention of Mother-to-Child HIV Transmission; Strengthening of Regional and National Response Capabilities and Resource Mobilisation.
The Meeting considered a proposal for the structure and functions of PANCAP, which reflected a refinement of proposals from the Second Annual General Meeting of PANCAP, held in October 2002, and set out the inter-locking relationship between the various groups/committees/bodies and their respective roles and responsibilities. It was agreed that the Steering Committee, which held its inaugural meeting during this Meeting, will perform an executive function placing special emphasis on the initiation of appropriate programmes, methods of improving linkages among partners and the implementation of priorities. The Steering Committee comprises twenty members representing the various constituent groups that make up the PANCAP Partnership. These include representatives from CARICOM and Non-CARICOM countries in the Caribbean, the Private Sector, NGOs, the donor Community, Civil Society and People Living With HIV/AIDS (PLWHAs).
PROGRESS REPORT ON THE IMPLEMENTATION OF PANCAP ACTIVITIES
The Meeting received reports on the implementation of various PANCAP activities.
It noted the activities undertaken under the PANCAP Law, Ethics and Human Rights (LEHR) Programme, which is based on the Action Plan on Law, Ethics and Human Rights and is funded by CIDA and the USAID. The objective of the LEHR Programme is the reduction of the stigma and discrimination against persons infected and affected by HIV/AIDS by enhancing awareness, building capacity, introducing law reforms and policies, and enhancing legal services.
The Meeting agreed that during the current year a Special Sub-Committee of PANCAP should be established to accelerate programmes at the country level designed to protect the rights of PLWHAs and their families. The main elements of such a programme would include initiatives for reducing stigma, increasing and strengthening the participation of regional and national networks of PLWHA in the response to HIV/AIDS, and promoting a safe work environment free of stigma and discrimination.
Among the donor agencies that have committed themselves to collaborate in these initiatives are CIDA, International Labour Organisation (ILO), UNAIDS, United Nations Population Fund (UNFPA), United Nations Children Fund (UNICEF), and USAID.
As regards the CIDA-supported Strengthening PANCAP Communications and Information Sharing Project, the Meeting noted that the Project aimed to increase knowledge and awareness among its members and the media. In this context, it considered actions taken and proposed and approved the emphasis that is placed on the expansion of the existing programme to enhance communication with members using various information technologies.
In respect to access of ARVs, the Meeting noted that notwithstanding the successful negotiations in July 2002 in Barcelona, Spain for reduced prices, many people living with HIV/AIDS (PLWHAs) still cannot afford or did not have access to them. The William Jefferson Clinton Foundation was recognised for its partnership with PANCAP in pursuing other options for treatment, which had resulted in the successful implementation of an ARV programme in The Bahamas and the initiation of similar programmes for the Organisation for Eastern Caribbean States (OECS) and Haiti. The Meeting commended the contributions of the Pan American Health Organisation/World Health Organisation (PAHO/WHO), USAID and the Eastern Caribbean Drug Procurement Agency, which had assisted PANCAP to develop a strategic plan for care and treatment.
The Meeting agreed with the recommendation of the Working Group on Care and Treatment that efforts should be placed on further seeking lower prices for ARVs, coordinating the procurement and distribution process and strengthening Voluntary Counselling and Training (VCT).
RESOURCE MOBILISATION
The Meeting recognised the constant and major challenge of securing adequate financing for regional and national HIV/AIDS Programmes. It noted the reports of country-specific programmes with multilateral agencies and considered projections for financing regional and national HIV/AIDS programmes, as well as proposals for future strategies and coordination of approaches. In this regard, the Meeting also noted with appreciation the award from the Global Fund in the sum of approximately US$112M to be disbursed over the next five years to projects from PANCAP countries. It approved the recommendations from the Steering Committee to establish a working group to discuss and implement activities that could ensure rationalisation in the use and impact of GFATM resources.
The Meeting also noted that approval of the proposals for grant resources from KFW GTZ and the World Bank would result in additional resources.
The Meeting considered initiatives undertaken with respect to special programmes, notably, World Bank Support for the Prevention and Control of HIV/AIDS; the Regional Proposal submitted to the Global Fund to Fight HIV/AIDS, Tuberculosis and Malaria; and the German (KFW) Government-Caribbean Social Marketing Programme. The Meeting agreed with the proposal from the Steering Committee to establish a group to deal with policy-making recommendations on the rationalisation of resources and to collaborate with the efforts for donor coordination.
THE GLOBAL FUND TO FIGHT HIV/AIDS, TUBERCULOSIS AND MALARIA (GFATM)
The Meeting noted the information provided by the Director for Latin America and the Caribbean (LAC) at the Global Fund to Fight HIV/AIDS, Tuberculosis and Malaria (GFATM) regarding the conditions for grant implementation.
The Meeting expressed concern that for Round Four of the Global Fund submission process the World Bank Income Classification would apply. As a consequence several CARICOM Member States would be disqualified due to the fact that they fall within the middle-income category.
The Meeting endorsed the view that it was unfair that some countries in the Caribbean were being disqualified from receiving money from the Global Fund due to an income classification based mainly on GDP criteria.
The Meeting also endorsed the view that the Global Fund criteria ignores the fact that HIV/AIDS and other catastrophic diseases reinforce the poverty trap especially in circumstances like the Caribbean where poverty levels are relatively high, structural unemployment is also high, and the income distribution is skewed. It was agreed that this notion should be challenged on the basis of empirical evidence that the Caribbean countries especially the Organisation of Eastern Caribbean States (OECS), are highly vulnerable to natural disasters that reek havoc on physical and human resources with implication for public finance and the burden of increasing debt.
The Meeting requested PANCAP to take all action necessary to have this decision reversed.
The Meeting welcomed the appointment of Dr Carol Jacobs to the Board of the Global Fund, replacing Brazil as the Latin America and the Caribbean Representative.
STRENGTHENING THE INSTITUTIONAL RESPONSE TO HIV/AIDS/STI IN THE CARIBBEAN (SIRHASC)
The Meeting received a report on the main achievements of the CARICOM-European Union (EU) Project on Strengthening the Institutional Response to HIV/AIDS/STI in the Caribbean (SIRHASC), which has the objective to reduce the spread and impact of HIV/AIDS/STI in CARIFORUM Member States, especially the worst affected countries. It noted that the Project had been implemented in July 2001 and was scheduled to come to an end on 30 June 2004.
It also noted the nature and scope of the Project, which focus is on strengthening the capacity of premier regional institutions, viz., the Caribbean Epidemiology Centre (CAREC); the Caribbean Regional Network of People Living with HIV/AIDS (CRN+); the Caribbean Health Research Council (CHRC); the United Nations Joint Programme on AIDS (UNAIDS); and the University of the West Indies (UWI), as well as the role of the CARICOM Secretariat in the management and coordination of this Project.
The Meeting called on the European Union (EU) to consider a no-cost extension of this project beyond 2004 so as to ensure that on-going programmes funded by the project can be sustained while provision is being made for their incorporation into mainstream institutions. It endorsed a recommendation from the Steering Committee for consideration to be given by the European Union (EU) to permit the current EU/CARICOM Project Implementation Unit (PIU) to be merged into the PANCAP Coordinating Unit over the period 2004-2005 when the no-cost extension phase would be in operation. CARICOM was mandated to discuss these issues with the EU.
CARE AND TREATMENT PROGRAMME FOR THE ORGANISATION OF EASTERN CARIBBEAN STATES (OECS) AND THE BAHAMAS
The representative of the William Jefferson Clinton Foundation presented a report on the Foundation’s support for a comprehensive Care and Treatment Programme for the OECS.
The Meeting noted the progress made in negotiations for reduced prices for ARVs.
CARIBBEAN COMMISSION ON HEALTH AND DEVELOPMENT (CCHD)
The Meeting noted, with pleasure, the information that the Caribbean Commission on Health and Development (CCHD), which was established to meet the objectives of the Nassau Declaration – The Health of the Nation is the Wealth of the Nation adopted by CARICOM Heads of Government in July 2001, had been set up under the chairmanship of Sir George Alleyne, OCC. It expressed its thanks to the WHO Commission for Macro-Economics and Health for its support to the Commission, which was charged with advising on policy options to improve the financing and management of health systems in the Caribbean.
The Meeting noted the development and requested the CCHD to collaborate with PANCAP in sponsoring a Policy Round Table and Public Forum on HIV/AIDS.
CORE PARTNERS ON HIV/AIDS PREVENTION AND CONTROL ACTIVITIES
The Meeting received reports from the Caribbean Coalition of National AIDS Programme Coordinators (CCNAPC); the CARICOM Youth Ambassadors Programme; the Caribbean Epidemiology Centre; the Caribbean Regional Network for People Living with HIV/AIDS; the Caribbean Health Research Centre; the Joint United Nations Programme on HIV/AIDS; and the University of the West Indies – the Core Partners designated specific lead roles in the implementation of the Caribbean Regional Strategic Framework.
The Meeting considered the contributions of the partners and noted the progress made over the period 2002-2003 as well as the areas for strengthening programming.
The Meeting noted the following tools used by CAREC to re-characterise and monitor the epidemic: the Template for Standardisation of National Annual Reports on HIV/AIDS/STI and Regional HIV/AIDS/STI Reporting Forms as the best means to monitor the epidemic; and anonymous and unlinked surveys as the best strategy to re-characterise the HIV/AIDS epidemic.
In respect of the Caribbean Health Research Centre, the Meeting noted that proposals for the way forward involved the harmonisation of requests for Monitoring and Evaluation (M&E) data from agencies and the development of the Caribbean Indicators and Measurement Tools in four languages.
The Meeting welcomed the UNAIDS’ “new commitment towards a generation free of AIDS” with the goal to achieve three million PLWAs on ARVs by 2005. This will be achieved through the expansion of access to treatment; the continuation of the fight against discrimination; the empowerment of the most vulnerable; collaboration with the security and armed forces to address AIDS as a threat to national security; the fostering of social responsibility by forging stronger partnerships between Government and Civil Society; collaboration with PLWHAs as agents of change and the creation of equitable access for women.
DONOR PARTNERS
Donor partners agreed that they would continue to support the Caribbean Regional Strategic Framework (CRSF). Several specific commitments were made for collaboration with PANCAP in the areas of monitoring and evaluation, surveillance, care treatment and support, laboratory research, institutional strengthening, youth and HIV/AIDS, social and reproductive health and security programmes.
Donors identified the need for strategic coordination especially in light of the expected inflow of funds from the GFATM.
It was agreed that PANCAP, in consultation with the Donor Community, would discuss the modalities for developing coordinated donor strategies. USAID, GFATM and GTZ agreed to collaborate with CARICOM to support this activity.
APPRECIATION
The Meeting expressed its gratitude to the Secretary-General of the Caribbean Community and the Staff of the CARICOM Secretariat and in particular, the PANCAP Coordinating Unit for the excellent arrangements put in place, which had contributed to the success of the Meeting.
The Meeting also expressed its deep appreciation to DFID, UNICEF and USAID whose contributions made it possible for a number of participants to attend.
Pan Caribbean Partnership Against HIV/AIDS
13 November 2003
