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A supportive or enabling environment, including policies and legislation that address discrimination, socio-cultural inequalities and psycho-social variables and vulnerabilities, is critical to achieving universal access to HIV prevention, treatment, care and support. In the Caribbean, several factors, including the nature of the political and social environments, hinder access to HIV prevention, treatment, care and support programmes.
“ We must work harder to empower people of all ages whose life circumstances place them at increased risk of HIV. As of 2009, only 26% of countries had established HIV prevention goals for reaching sex workers, only 30% had set targets for reaching people who use drugs and just 18% had them for men who have sex with men.” UNAIDS 2012 Letter To Partners, Michel Sidibé
This means that treatment not only saves lives but prevents new infections. We must prevent drug resistance and increase antiretroviral treatment coverage from just under 50 percent to more than 80 percent of our people living with HIV. But if we want people to present themselves for testing and treatment we must also address stigma and discrimination. Prejudice can discount the investments we make in this response. Many of our attitudes and actions amount to a disincentive to others to get tested, to access treatment or to disclose their status. When we discriminate the virus wins.” Dr Ernest Massiah, World AIDS Day, 2011
"It is well recognized that for the HIV and AIDS response to be effective it must include both private and public actors working effectively together and supporting each other. This is a critical role of the PANCAP Partnership. The nature of the PANCAP means that every partner has to work within its own mandate and area of comparative advantage, while fostering an environment for all partners to pursue their respective programmes in a harmonized and coordinated fashion.” Hon. Dr. Denzil Douglas, World AIDS Day 2011
Almost three decades into the Caribbean HIV epidemic, stigma and discrimination continue to be key drivers of the epidemic. While much has been done to address their impact, including public education campaigns, the training of health care and legal aid providers, regional consultations, and institution of the novel Champions for Change Initiative, stigma and discrimination continue to hamper the HIV regional response.
“The call for … the reduction of stigma and discrimination cannot be overemphasised.” H. E. Dr. Edwin Carrington, Secretary-General, CARICOM
(World AIDS Day Message 2009)
The Pan Caribbean Partnership against HIV and AIDS recognises these issues and has committed to address the multiple layers of stigma and discrimination, and thus to promote an enabling environment. The Caribbean Regional Strategic Framework on HIV and AIDS 2008-2012, which defines the strategic direction and programmatic orientation of the Partnership and was developed through a collaborative process involving countries, regional and international partners, identifies its first priority as Promoting an Enabling Environment. It undertakes to:
- Develop policies, programmes and legislation that promote human rights including gender equality, and reduce socio-cultural barriers in order to achieve universal access.
- Reduce the stigma and discrimination associated with HIV and vulnerable groups.
- Reduce the economic and social vulnerability of households.
It also identifies a number of regional public goods and services which are to be delivered. These include:
- The development and advocacy of the adoption of regional model policies and legislation for social protection, improved access to prevention and treatment services, and HIV-related migration issues.
- Advocacy for regional policies addressing HIV-related migration issues.
- The establishment of a regional Stigma and Discrimination Unit (Regional Stigma and Discrimination Unit (RSDU)) that will, among other things, provide technical support for country programmes addressing stigma and discrimination and disseminate best practices and tested methodologies on reducing stigma and discrimination. See Stigma Unit booklet
- Technical assistance to increase country capacity for conducting gender analysis, sensitivity studies and programmes; and
- The conduct of socio-economic impact and cost-effectiveness studies and national HIV spending assessments, to advise governments on appropriate HIV-related policies and programmes.
Building on earlier accomplishments to promote an enabling environment, including assessments of the legal frameworks of Grenada, Guyana, Saint Lucia, St. Kitts and Nevis, and St. Vincent and the Grenadines, as the well as the development of a Regional Communication Strategy to Address HIV and AIDS-Related Stigma and Discrimination. The following is a summary of some key accomplishments in PANCAP’s efforts to promote an enabling environment:
- PANCAP Regional Model Anti-Discrimination Policy.
- PANCAP Regional Model Anti-Discrimination Legislation.
- PANCAP Regional Model Anti Discrimination Policy & Legislation - Desk Review.
- Model Code of Practice for Psychosocial Practitioners in HIV and AIDS care.
- Model Code of Practice on HIV and AIDS for Caribbean Medical Practitioners / Associations.
- Model Workplace Policy on HIV and AIDS.
- Development of anti-stigma toolkits for six sectors: faith-based organisations, people living with HIV and AIDS, the tourism sector, health workers, the private sector and educators.
- Establishment of the Stigma and Discrimination Unit, headquartered in Barbados.
Complementing these regional goods and services are partner initiatives aimed at promoting an enabling environment at the national and regional levels, including programmes and campaigns designed to get rid of Myths and Misconceptions (e.g., Jamaica’s Getting on with Life campaign),
“break the silence” and promote respect for people living with HIV (the Caribbean Broadcast Media Partnership's
Heroes campaign. Initiatives are also ongoing to incorporate stigma and discrimination in all prevention and care programmes and to redevelop mechanisms to document and provide redress for HIV-related human rights violations.
Media campaign targeting youth
From July – October 2012, PANCAP’s Caribbean Regional Social Marketing Project (CARISMA) conducted a media campaign in five English speaking Caribbean countries Antigua and Barbuda, Dominica, Grenada, Guyana and Saint Lucia aimed at reducing stigma & discrimination among youth, age 16-24. The campaign sought to generate more compassion and respect for individuals living with HIV. And built on past Regional efforts by increasing awareness of how HIV-related stigma and discrimination is perpetuated.
The multimedia campaign included television spots, a music video, radio, print and social media that communicate the campaign's key messages: True Friends Don’t Discriminate and “I will stand up for friends with HIV and stand against Stigma and Discrimination!” Following the launch of the campaign,–youth was able to access media material and linkages to resources in their respective countries on a dedicated website www.facebook.com/truefrenz4life
PANCAP’s tools in this effort are:
- A dedicated regional partnership - PANCAP - supported by CARICOM.
- Deep stakeholder commitment.
- Partnerships with people living with HIV and AIDS CRN+.
- Links with expertise in academic, technical, faith-based organisations, as well as the private and public sectors. See Guidlines for Faith Based Organisations
- Synergy of national and regional programmes.
- Wide-reaching national and regional partnerships with similar priorities.
- UK OT Policy Report
- Proposal for Formative Research for BCC Programming
- International development partners, commitments, declarations, conventions and guidelines.
- Jamaica Declaration of Committment (2011)
A DECLARATION of COMMITMENT to reduce stigma and discrimination against people living
with HIV and AIDS, issued on the occasion of Champions for Change III: Conference to Accelerate
the Media’s Role in Helping to Reduce Stigma and Discrimination. – December 2008