Thursday, February 22, 2018

Killer diseases

The final climb to the end of...


representative: Prime Minister of St Kitts and Nevis and chair of PANCAP, Dr Denzil Douglas also spoke at the conference.

Mark Fraser

 Key messages/lessons for the Caribbean  from the Caricom Secretariat, Turkeyen, Greater Georgetown, Guyana.  

The 20th International AIDS conference is over. Far from over, however, is what must be done on this “last climb” to end the epidemics of AIDS, tuberculosis and malaria by 2030, “leaving no one behind”. This is an even of more pressing concern, given the fact of an almost gone MDG era and, in this context, the “small window of opportunity to make big changes”.

Despite the “distance”, the Caribbean made its presence known. Of the conference’s approximately 15,000 participants, Caribbean (regional) representatives included the Prime Minister of St Kitts and Nevis and chair of PANCAP, Dr Denzil Douglas; UN Secretary-General Envoy for HIV and AIDS in the Caribbean, Professor Edward Greene; PANCAP Coordinating Unit Director, Dereck Springer; co-founder of the Caribbean Regional Network for People living with HIV and AIDS, Yolanda Simon and Director of the Caribbean Drug Programme, Dr Marcus Day. 

In a post-conference interview, Professor Greene, a former Caricom Secretariat assistant secretary-general for Human and Social Development was asked to share his reflections and to sum up what he believes to be some key messages and lessons for the Caribbean.  

For him, the 20th International AIDS Conference (IAC) was distinctive in terms of its context, content and composition. Greene noted that while the Malaysia Airline disaster which killed at least six delegates to the conference including Joep Lange, a former IAC president cast a sombre mood on the conference, it seemed to have “imbued the proceedings with a resolve to immortalise the departed colleagues by outcomes designed to bring an end to the AIDS epidemic. He noted also that the messages emanating from many of the sessions were that science was poised to create that breakthrough in support of  the aspiration for an AIDS free generation. Greene drew attention to the fact that it was clear that the Conference focussed on Asia Pacific Region as well as promoted universal access to global health. He highlighted the Asia Pacific Sustainable Funding model for HIV and AIDS in collaboration between UNAIDS and the World Bank, in this context.

The following are some key messages from the Conference which includes lessons for the Caribbean:

The resolve to end the AIDS epidemic represents a momentus opportunity for broader health and development efforts

The AIDS movement has demonstrated what can be achieved through global solidarity, evidenced based action and multisectoral partnerships. In the Caribbean, the Caricom initiatives through PANCAP and more recently,  CARPHA  provide the basis for meeting the post 2015  development challenges to strengthen the convergence of HIV, TB, malaria, NCDs and other health emergencies into an overall health goal. In so doing, this could fulfil the vision of  Caricom Heads in the Nassau Declaration (2001) that the health of the region is the wealth of the region.


HIV treatment  is critical to ending AIDS and making HIV transmission rare

The region must increase the present  number of  PLHIV having access  to ARVs from just under 50 per cent to the 90 per cent To do so, there is need to find a formula for more people to come forward for testing , and ‘’to know their status’’ and therafter for sustainable financing and universal access to treatment. In this regard, Caribbean governments must join the international lobby to challenge the TRIPS agreement and assert that access to affordable medicines is a human right.

Sustainable financing is essential to support research, training and outreach required to end AIDS, yet the sources are drying up, especially for middle income countries. At the same time, governments are generally looking at other priorities  sometimes under the false impression that AIDS is over.

The most expedient response for Caribbean countries that  are classified in the middle/upper income category, but mainly lack capacity to respond individually,  is through collaboration provided by PANCAP and CARPHA . Donor partners are increasingly reluctant to fund countries which individually have small number of cases. It is therefore necessary to strengthen  the governance arrangements and foster alliances with agencies such as UNAIDS, PAHO and WHO. In this regard, Caribbean governments and especially Ministers of Health should support the proposal for a Caribbean Foundation for HIV and Sustainable Health aimed at promoting research and training of critical public health leadership in the region as well as supporting the annual scientific conference of CARPHA. 


Ending AIDS and ending extreme poverty are interrelated

The data for the Caribbean fully illustrate this feature. It is particularly alarming to note that new infections are highest among adolescents and youth, especially young women, sex workers and men who have sex with men. These are the sectors that are most marginalised, stigmatised and do not present for early testing. A multisectoral response, led for example, through Caricom’s  Council for Human and Social Development — education, health, culture, youth, gender and labour — programmes,  can most likely highlight the links between improving health outcomes and sustainable development in the post 2015 development agenda.

The role of faith leaders is vital to the mission of leaving no one behind. This was the conclusion of a dialogue among a cross-section of faith leaders at the conference.

The continuing national consultations in the Caribbean on Justice for All may wish to take into consideration  some voices from Melbourne 


• Sara Speicher, the interim executive director of the Ecumenical Advocacy Alliance (EAA), who chaired the session,  aptly summarised the sentiments by stating that while there are divisions among faith leaders on the way forward,  controversy must not be replaced with silence — “If we’re going to make sure that faith-based groups can continue our struggle that nobody gets left behind in the response to HIV, we’re also going to have to make sure our own voices are heard. That’s something we will have to work on, as we look towards AIDS 2016 in Durban, South Africa”, she said. 

• The Rev Michael Schuenemeyer, a pastor in the United States and executive director of the United Church of Christ HIV and AIDS Network, said “responsible faith leaders need to put their religious houses in order if nobody is going to be left behind... we need to create spaces where we can engage in dialogue, and appeal to the sense of empathy and compassion that almost every faith community carries. We need to hold each other accountable, and that may require some of us to more boldly confront the negative rhetoric that causes harm, puts people at risk, and supports laws that criminalise HIV, sexuality and gender identity,” he said.