PEPFAR may pull HIV funding from hard-hit Caribbean countries ..........

The United States is terminating its funding to several of the Caribbean countries hardest hit by the HIV/AIDS epidemic. Directors of the US President’s Emergency Fund for AIDS Relief (PEPFAR), America’s global fund to fight AIDS around the world, said that they could no longer justify supporting the upper middle-income countries of the Caribbean, and have ordered fund terminations from as early as this year.

 President Reagan AIDSGATE years

I saw a series of reports out there recently on the decrease of PEPFAR to the Caribbean and it came to me that this is starting to feel like the US President Reagan years when the White House then simply ignored the calls for proper funding for research for a relatively new disease being HIV then known as SIDS and which was pegged as a gay disease or gay plague. 

Thanks to the Act UP campaign and vigorous advocacy in those days.

Upon the rumours and fears expressed by mostly American AIDS experts that funding for HIV prevention work and treatment and care it has come home to action by the Trump administration, obviously playing to his base as he is the most unpopular president in years.

The Bahamas — which has the highest population prevalence of HIV in the English-speaking Caribbean, at just over 3% — will have its funding cut entirely in September 2017, followed by Barbados in 2018. Meanwhile, Guyana, Suriname and Trinidad & Tobago will have their funding slashed to historic lows for two years, before their allocations end in 2019.

Of the middle-income Caribbean countries, only Jamaica will be spared from cuts, but under strict conditions. Far fewer people living with HIV in Jamaica receive treatment than in the other upper-middle income Caribbean countries, and estimates are that more than 3 in 10 Jamaican men who have sex with men are HIV positive. 

To address this, PEPFAR will move 67-75% of its Caribbean regional budget to the island between 2017 and 2019. In exchange, Jamaica will have to meet ambitious targets to curb its epidemic, or PEPFAR will leave the English-speaking Caribbean region entirely, including the member countries of the Organisation of Eastern Caribbean States.

In the Caribbean, PEPFAR contributes to the cost of HIV prevention programmes, drug procurement, and the treatment, care and psychosocial support of people living with HIV and AIDS. The Fund also works with community organisations to target HIV prevention and care to LGBT people and commercial sex workers who are on the periphery of direct government programmes. PEPFAR’s interventions are further supported by health experts at US diplomatic missions, where some vacant posts have already been frozen as a result of the clawback.

PEPFAR’s moves now increase the burden on regional governments to bring their HIV/AIDS epidemics under control, even as public finances in several of the affected countries are already stretched. With the exception of Haiti, which will retain its PEPFAR funding entirely, a complete regional pullout would leave a US$9m gap¹ in financing for the Caribbean’s response to HIV and AIDS, based on PEPFAR’s 2014/15 expenditure levels.

Despite some progress, the picture of the Caribbean’s HIV/AIDS response is mixed. Prevention messages that focus on abstinence and condom use are mainstays of national health campaigns, and costly interventions such as drug prophylaxis to prevent HIV infection are off the radar for most. Moralistic views and discrimination against the LGBT community are effective barriers to healthcare, and the prevalence of HIV among these marginalised groups can often run times higher than in the general population.

Strong progress and adoption of international best practices, such as Barbados’ decision to treat all people living with HIV, regardless of the stage of their disease, have been largely supported by PEPFAR funds. Central governments will now have limited time to ensure sustainability of these gains and to finance gaps after the departure of US aid.

While PEPFAR’s Directors made no explicit link between their decisions and President Trump’s dictates to cut America’s levels of foreign aid, the repeal of PEPFAR’s reach in the Caribbean follows the administration’s decisions to cut funding to the United Nations Food and Population Fund, as well as its removal of federal dollars from Planned Parenthood and other international development programmes.

The US Congress recently passed the US-Caribbean Strategic Engagement Act, which an analysis featured in this publication deemed to be an important opportunity for advancing the Caribbean’s interests to the Trump administration. As at press time, sources tell Antillean that health and social development imperatives were not among the priorities advanced by CARICOM for the shaping of the future US engagement policy, despite CARICOM’s ambassadors in Washington and New York being briefed on PEPFAR’s decisions.

Thanks to the Antillean Media Outlet for this one (photos added for this post), in a another related story see: Trump administration cuts all future US funding to UNFPA

Funding for Programme to Reduce Aids-Related Deaths

The Ministry of Health will continue its implementation of a programme to reduce AIDS-related morbidity and mortality this year, through effective biomedical and supporting interventions.

A sum of approximately $624 million has been allocated in the 2016/17 Estimates of Expenditure, tabled in the House of Representatives on April 14, for the project.

The project, titled ‘Support to the National HIV/AIDS Response in Jamaica’, is also aimed at reducing new HIV infections among key populations, through behavioural and structural interventions.

It is funded by the Government, with support from the Global Fund to Fight AIDS, Tuberculosis and Malaria.

The project, which started in January 2016, is expected to run until December 2018.

Among the anticipated targets for this fiscal year are: the delivery of the HIV Prevention Programme’s defined package of services for 10,000 men-who-have-sex-with men (MSM) and 2,500 transgender; and the delivery of HIV and syphilis test results to 4,000 MSM and 1,800 transgender.

Some 3,247 MSM will also be reached with HIV prevention activities, while over 18,000 female sex workers will either be reached through the HIV prevention programme, or receive HIV or syphilis test results.

A total of $361.58 million has been earmarked for a project aimed at promoting safer sex practices among groups at high risk for HIV transmission.

The allocation, to the HIV prevalence in Most-at-Risk Population Reduced Project in the Ministry of Health, is contained in the 2016/17 Estimates of Expenditure, now before the House of Representatives.

The initiative, which started in 2009, was initially scheduled to end in 2014, but has been extended to 2017.

It seeks to increase safer sex practices and improve attitudes and behaviours among vulnerable groups; reduce HIV transmission by delaying sexual initiation, promote abstinence and increasing condom use among sexually active adolescents; reduce stigma and discrimination surrounding HIV/AIDS; and finalise and disseminate the National HIV/AIDS Workplace Policy.

Other objectives include: supporting the capacity-building of community-based organisations, Ministry of Health staff, and people living with HIV/AIDS.

For the 2016/17 fiscal year, the project is expected to reach 1,810 men-who-have-sex-with-men (MSM) and 3,239 female sex workers.

Some 907 HIV and counselling test results for MSM will also be returned, as well as for 1,621 female sex workers. A total of 6,334 HIV-positive adults and children will receive clinical assessment, blood count or viral load tests. An additional 1,184 adults and children are to be enrolled for antiretroviral treatment (ART).

As at December 2015, HIV preventative interventions were provided for over

1,800 persons in key populations. In addition, more than 840 persons were provided with HIV test and counselling results; and 1,845 HIV-positive adults and children received ART.

The project is funded by the Government of Jamaica and the United States Agency for International Development (USAID).

Caribbean Sees Progress on HIV/AIDS, Fears Funding Cuts

Ian McKnight, executive director of the Caribbean Vulnerable Communities Coalition (CVCC), used one word – “tokenistic” – to sum up his perspective on the 19th International AIDS Conference that ended here over the weekend.

Addressing the final session of the six-day event, McKnight said while “hubs” were important for allowing delegates to voice their opinions in small gatherings, these same delegates were not given the same opportunity at gatherings attended by scientists, officials and other major stakeholders.


The Caribbean has the second highest incidence of HIV/AIDS after sub-Saharan Africa. McKnight said he was disappointed that the conference had excluded vulnerable populations, such as drugs users and sex workers, from making their position known.


U.S. President Barack Obama lifted a travel ban on HIV-positive travelers, but some sex workers say they were denied visas to attend the conference. “It is nothing short of an abomination that they have been excluded from this conference …we need their voices and their issues here with us at this conference.


“So these half baked attempts at including people who use drugs and sex workers are tokenistic and it must stop now,” he said to loud applause.


Prior to the official start of the conference, the executive director of the Barbados-based Caribbean Media Broadcast Partnership (CMBP), Dr. Allyson Leacock, said that while the Caribbean media had adopted a significant role in educating and informing the public about the HIV/AIDS epidemic, she was also fearful that the conference would sideline Caribbean concerns.


She said the challenge for the Caribbean is that its population is so small and donors and other agencies “tend to use these numbers when HIV has the same potential to decimate the region”. Jamaica’s health minister, Dr. Fenton Ferguson also appealed to the international community not to cut back on aid to the region as it deals with the HIV/AIDS epidemic.


“The move to make funding decisions based on limited criteria such as World Bank country rankings without wider economic and potential impact assessments will be judged as an error by history if allowed to stand. “These decisions threaten the very lives of the people we have just saved, “he said, adding that Jamaica, and the region as a whole, “cannot go it alone from here”.


“We need the continued support of our international development partners, who if they abandon us now, in the words of Michele Sidebe (UNAIDS executive director) would be making a decision to let HIV regain a foothold and flourish in Jamaica and they would be making a decision to abandon the next generation of children to HIV,” he said.


Ferguson said a recent study indicates that Jamaica would need 30 million dollars annually by 2030 compared to 15 million annually today to sustain its HIV programmes. “We could therefore see a doubling of the cost to the response if the investments to mitigate its impact are not made now,” he said, adding “today Jamaica, like many other countries, is concerned about the potential impact of the global financial crisis on the sustainability of its national response to HIV”.


McKnight said cutting back was not an option, adding that all the progress being touted at the conference “would be doomed to failure if we do not have the funding to do this work”. “None of it, none of it can ever happen without serious commitments and so we call again on our governments and say renew your calls to take ownership for this response and to make the investment necessary and to end AIDS,” he said.


U.S. Secretary of State Hillary Clinton said more than 150 million dollars in new U.S. spending initiatives geared toward leveraging progress against AIDS already achieved through new drug treatments, programmes to stop mother-to-child transmission of HIV and the preventive effect of expanded voluntary male circumcision.


But there were suggestions here that the US funds were geared more towards Africa than the Caribbean. In a report titled “Together We Will End AIDS” released ahead of the conference, UNAIDS noted that AIDS-related deaths in the Caribbean have declined by almost 50 percent in 10 years.


AIDS-related deaths fell to about 10,000 in 2011, nearly half of the figure for 2001, in the almost 30 years since the start of the AIDS epidemic. “This is in large part due to the relatively high antiretroviral treatment coverage of 67 percent for the Caribbean as a whole. At present 230,000 people are living with HIV in the Caribbean. The estimated number of persons who were newly infected with the virus last year was 13,000,” the report said.


UNAIDS said that about 1,100 children became infected with HIV in the Caribbean in 2011, the majority in the Dominican Republic and Haiti, which together comprise 68 percent of the region’s HIV epidemic. UNAIDS said that many of the member countries of the Organisation of Eastern Caribbean States (OECS) “are close to achieving elimination targets for the prevention of mother to child transmission (PMTCT).”


But there is need for caution. “We don’t want people to think that the AIDS epidemic is over because we have eight million people in treatment,” UNAIDS deputy executive director Paul De Lay told IPS after participating in a panel discussion on “HIV/AIDS and the News Agenda – Implications for Ending the Epidemic”.


“We need to work with the media to ensure that we are putting the right spin on the data,” De Lay said, noting that while it is important to note that eight million people were receiving medical treatment for the virus, “underneath that figure is a lot of people who are not getting treatment”.

USAID to launch LGBT Global Development Partnership Initiative

The event seems to have been rescheduled for the fall according to sources.

Few details are publicly available but this is something big.

On Monday, the United States Agency for International Development(USAID) was to hold a gathering at the Ronald Reagan Building in Washington, DC, to celebrate LGBT pride month and to launch their Global LGBT Equality Partnership.

USAID was launched by President John F. Kennedy in 1961 to handle civilian foreign aid. It operates based on guidelines from the U.S. President, the U.S. Secretary of State and the National Security Council and its goal is to provide "economic, development and humanitarian assistance around the world in support of the foreign policy goals of the United States."

The Partnership would make it current USAID policy to make federal foreign aid available to agencies working to strengthen LGBT rights throughout the world although I assume it would limit it to a number of nations that meet certain diplomatic standards and to organizations that have the infrastructure to handle federal grants from the United States.

From the event press announcement:

Eighty-five countries and territories criminalize LGBT behavior, seven countries have a death penalty for same-sex sexual activity, and fewer than 50 countries punish anti-gay discrimination in full or in part. The partnership will enhance LGBT equality through providing a greater voice in civil society and political processes, increased access to services including police and justice systems and improved economic security.


The Partnership will cast a worldwide net but, speaking specifically about Latin America, a lot of the limited funding that LGBT-rights organizations get comes from local and European sources. One of the few exceptions when it comes to U.S. foundations has been the work of the Astraea Lesbian Foundation for Justice which has long recognized the benefit of supporting international LGBT work.

I know from sources that USAID has been laying the groundwork and already granted some awards. Details will have to wait another day.

The initiative follows a presidential directive last year to use U.S. foreign aid money to secure and protect LGBT rights throughout the world and the exemplary work done by the State Department under Secretary of State Hillary Clinton on these same issues.

On a related matter, today the U.S. Department of State released the following pride month message from Hillary in which she addresses several of the Department of State's international achievements.

Non Discrimination

Foreign assistance agencies will work toward a goal of ensuring that USG implementing partners mirror USG non-discrimination practices for both employees and beneficiaries in the implementation of their programs. We issued a hortatory policy on October 11 for non-discrimination on the bases of sexual orientation, gender identity, pregnancy, marital status, parental status, political affiliation. USAID’s policy supports the human rights of all individuals. USAID’s inclusive policy simultaneously ensuring that faith-based implementing partners retain an exemption from the Federal prohibition on employment discrimination on the basis of religion when the organization receives financial assistance from USAID.

Protection

USAID/OFDA promotes non-discrimination among disaster-affected populations as a core component of protection by recognizing LGBT individuals for their distinct needs among vulnerable groups within an affected population. USAID/OFDA has issued an Annual Program Statement (APS) for sexual and gender based violence, in humanitarian assistance settings, that includes sexual orientation and gender identity, in the areas for which organizations may submit proposals.

USAID has included LGBT concerns in our discussions regarding our programs in the following regions:
LAC (Colombia, Honduras, Jamaica)
AFR (Uganda, Mali, Malawi)
Asia (Pakistan through the film “Bol”)
E&E (Macedonia)


Through email conversations, meetings with civil society activists, and reading cable traffic, we are aware of LGBT concerns in the following USAID-presence countries:
Africa (Zimbabwe, Nigeria, Ghana, Uganda, Namibia, Malawi)
Asia (India, Nepal)
E&E (Russia)
LAC (Haiti, Jamaica, Honduras, Colombia, Nicaragua, regionally through a conference in St. Lucia through ARC International)