US embassy cable - 05NASSAU1827

UNCLAS SECTION 01 OF 04 NASSAU 001827 
 
SIPDIS 
 
STATE FOR WHA/CAR WBENT, S/GAC AMBASSADOR TOBIAS 
 
E.O. 12958: N/A 
TAGS: PREL, EAID, TBIO, OVIP, KHIV, XL, BF, Human Rights 
SUBJECT: CARIBBEAN CONFERENCE ON HIV/AIDS CONFRONTS STIGMA 
AND PROMOTES REGIONAL COOPERATION 
 
 
1.  Summary:  On October 3 and 4, Post hosted international 
HIV/AIDS experts and 10 Caribbean mission representatives for 
the 4th Caribbean Chiefs of Mission Conference on HIV/AIDS. 
Ambassador Rood opened the conference with an appeal to 
reduce the 2.3 percent Caribbean infection rate by 
compassionately attending to the suffering of each individual 
and leading by example in the fight against stigma. 
Ambassador Tobias challenged the world's lack of outrage over 
8,000 AIDS deaths every day, asking whether more would be 
done to solve a problem causing 20 airline crashes every day, 
killing these same 8,000 persons. He asked COMs to use 
positions of leadership to fight the stigma of HIV/AIDS, and 
agreed to increase funding for Ambassador's Fund grants from 
$20,000 to $30,000.  While recognizing U.S. efforts to combat 
HIV/AIDS in poor countries, PM Christie expressed frustration 
with international aid strategies that do not recognize the 
challenges of migration or the needs of small, mid-income 
nations.  Echoing this theme, local and regional leaders 
called for better regional cooperation, noted the challenges 
of Caribbean migration and geography, and criticized current 
funding as too focused in limited countries.  In response, 
Ambassador Tobias agreed to review the role of regional 
funding in the Caribbean.  To reduce stigma and develop a 
coordinated regional approach, all agreed that development of 
sustainable programs, improved local capacity for self-help, 
public/private partnerships and the sharing of best practices 
were vital.  Mission representatives concluded the conference 
by sharing successes from 2005, developing program ideas for 
2006, pledging more personal involvement to model 
stigma-reducing behavior, and agreeing to continue to focus 
on Ambassador's Fund grant programs.  End Summary. 
 
2.  COMs and representatives from Port-au-Prince, Kingston, 
Georgetown, Port of Spain, Bridgetown, Paramaribo, Belize, 
Santo Domingo, Havana and Nassau attended the conference. 
Ambassador Randall Tobias, Global AIDS Coordinator, 
representatives of USAID, health professionals, 
representatives of HIV/AIDS NGOs and local government 
officials also participated. 
 
Opening Session 
--------------- 
 
3.  Ambassador Rood opened the conference with a snapshot of 
the regional HIV/AIDS pandemic, including the 2.3 percent 
prevalence rate in the Caribbean, second only to Sub-Saharan 
Africa.  He challenged leaders to move beyond the numbers and 
reduce stigma through bold leadership, compassionately 
focusing on the suffering of each person in need.  He said, 
"by focusing on the human dignity of each individual, we can 
see how this battle will be fought and eventually won." 
 
4.  Dr. Rony Francois, Secretary of Health for the State of 
Florida, emphasized the need for close regional cooperation 
because of the high incidence of HIV/AIDS in immigrant 
populations.  He specifically discussed high infection rates 
of Caribbean immigrants in Florida and New York.  Dr. 
Francois, a Haitian-American, noted the "close family ties" 
between the U.S. and its Caribbean neighbors, and said that 
HIV/AIDS in Caribbean should matter in the U.S. because it 
directly impacts the U.S. 
 
5.  In his opening remarks, Ambassador Tobias called for a 
sense of outrage at 8,000 AIDS deaths worldwide every day. 
He asked whether governments, and the general public, would 
do more to solve a problem that caused 20 airline crashes 
every day, killing those same 8,000 people.  He said that the 
stigma of HIV/AIDS was a main reason that more is not being 
done.  He discussed the President's Emergency Program for 
AIDS Relief (PEPFAR), which has provided $75 million in 
Caribbean aid, with a focus on Guyana and Haiti.  Ambassador 
Tobias challenged COMs to fight stigma through leadership, to 
promote a multisectoral response to HIV/AIDS and to empower 
women in the fight against HIV/AIDS.  He suggested that COMs 
work with Guyana and Haiti to learn their best practices and 
to coordinate regional strategies.  He also congratulated 
COMs on their work with the Ambassadors' Fund for HIV/AIDS, 
and announced a 50 percent increase in grant funding. 
 
6.  Bahamian PM Christie concluded the opening session by 
requesting additional HIV/AIDS assistance for middle-income 
countries.  Emphasizing the regional nature of problems in 
the Caribbean, the PM noted the heavy burden Haiti places on 
its Caribbean neighbors.  The PM requested that policymakers 
and international donors consider the unique nature and 
burdens of migration in the Caribbean, and the strong 
challenges faced by island nations in developing health 
infrastructure in remote areas.  He said that per capita GDP 
is an inadequate measure of the burdens placed on small 
economies for regional problems that require international 
assistance.  The PM said that a lack of U.S. action in 
middle-income countries has caused many Caribbean nations to 
rely upon Cuba for medical care and training.  He contrasted 
Cuba's open medical schools, provision of doctors and 
acceptance of low income patients into Cuba with limited U.S. 
efforts in many Caribbean nations.  The PM requested 
additional funding, a change in standards for aid awards and 
better access to U.S. medical schools by Caribbean students. 
 
7.  Comment:  Post received an advance copy of a more 
positive speech focused on regional HIV/AIDS cooperation and 
the Bahamian successes in treatment.  The PM scrapped the 
speech in favor of an aggressive challenge to current models 
of funding for aid and a call for the U.S. to match Cuba's 
medical diplomacy.  The PM's presentation reflected his 
ongoing concerns regarding use of per capita GDP as a measure 
of need in a small country facing overwhelming challenges of 
migration and geography.  End Comment. 
 
Key Challenges in the Caribbean: Stigma, Migration and Funding 
--------------------------------------------- ----------------- 
 
8.  In a discussion session entitled "What Makes the 
Caribbean Epidemic Unique?" Dr. Nicholas Adomakoh, Director 
of the Barbados CHART Center, and Dr. Perry Gomez, Director 
of the Bahamas National HIV/AIDS Program, addressed the 
specific challenges of HIV/AIDS in the Caribbean context. 
While treatment advances have made HIV a chronic, treatable 
condition instead of a death sentence, only 10 percent of 
those infected worldwide have been tested and are aware of 
their infection, a statistic Dr. Adomakoh called "truly 
frightening in the implication that we cannot treat an 
undiagnosed disease."  The speakers emphasized the role of 
stigma in keeping persons from testing and treatment, noting 
a recent survey in which 80 percent of HIV/AIDS infected 
respondents reported being the target of malicious comments, 
56 percent reported that medical help was denied them because 
of their status and 65 percent reported that they avoided 
treatment out of fear of stigma.  Dr. Adomakoh also cited 
migration as a key Caribbean challenge, noting high rates of 
infection in migrants and questioning whether current funding 
models adequately address the problem. 
 
9.  The next session, "The Caribbean Landscape - What is 
Being Done" focused on coordinated regional approaches 
through CARICOM.  Carl Browne, Coordinator of the 
Pan-Caribbean Partnership on HIV/AIDS (PANCAP) discussed 
PANCAP's funding and priorities, including its work to 
support passage of HIV/AIDS legislation, provide training 
through Caribbean HIV/AIDS Regional Training (CHART) centers, 
negotiate low cost anti-retroviral drugs, and build 
institutional capacity in member nations.  Like other 
speakers, Browne emphasized that the Caribbean problem 
requires a coordinated regional approach.  Dr. Edward Green, 
Assistant Secretary General of CARICOM, assessed the impact 
of the Caribbean Single Market and Economy (CSME) on 
HIV/AIDS, focusing on the problems created by free movement 
of persons in the Caribbean, and noting that poverty drives 
both migration and HIV/AIDS.  Because migrants are at 
increased risk for HIV/AIDS, he cautioned that reduction in 
barriers to migration in CSME will reduce barriers to the 
movement of HIV/AIDS in the region.  Green recommended that 
HIV/AIDs policy should be coordinated regionally, that policy 
be standardized, and that regional efforts focus on enhancing 
local institutional capacity. 
 
10.  The session "HIV/AIDS Care and Treatment -- Three 
Perspectives" presented success stories in Barbados, Haiti 
and The Bahamas.  Dr. Nicholas Adomakoh of Barbados CHART, 
Dr. Jean Pape of GHESKIO Centers Haiti, and Dr. Percival 
McNeil of the HIV/AIDS Center Bahamas each discussed the 
successful treatment and prevention approaches in their 
countries.  All three cited the benefits derived from the 
availability of low-cost medication, while highlighting 
concerns about the development of resistant strains, the need 
for more medication, and the need to better identify persons 
needing treatment.  For their successes, they credited lower 
cost care, the development of local infrastructures, strong 
collaboration with international and private partners, and 
training provided through CHART centers. 
 
11.  In the final session focusing on Caribbean issues, 
Ambassador Tobias and Dr. Carol Jacobs, Chair of the Global 
Fund to Fight AIDS, discussed HIV/AIDS funding in the 
Caribbean.  Both emphasized the role of the Global Fund as a 
monetary, but not a technical support, mechanism.  Each 
discussed the need to focus on sustainability of Global Fund 
projects by building local capacity.  To ensure effective 
Global Fund projects, they urged COMs to help identify and 
address needs for infrastructure development and technical 
support.  Dr. Jacobs expressed frustration that PEPFAR 
focuses too heavily on target countries and does not 
sufficiently account for heavy migration in the region.  She 
also echoed the comments of PM Christie by noting the lack of 
grant funding for middle income nations that serve as 
destination points for infected persons.  In response, 
Ambassador Tobias agreed to review the possibility of 
increasing the role of regional funds in PEPFAR. 
 
Leadership as Key to Stigam Reduction 
------------------------------------- 
 
12.  In the session "Engaging the Private Sector", David 
Greeley of Merck & CO, Camille Barnett of the Bahamas AIDS 
Foundation, and W. Edward Wood, COO of the Clinton Foundation 
HIV/AIDS Initiative each discussed the importance of 
public/private partnerships in the fight against HIV/AIDS. 
There was agreement regarding the value of a business 
approach to the provision of health services, with special 
recognition of the role that private organizations have 
played in negotiations for lower cost HIV/AIDS medications. 
COMs were encouraged to use their positions to educate the 
private sector about the need for involvement and the 
benefits of control of HIV/AIDS to business.  COMs were also 
advised to encourage businesses to develop programs for 
worker testing, to develop workplace policies to reduce 
stigma, to participate in local HIV/AIDS foundations, and to 
provide medical support to infected workers in employer-paid, 
confidential health programs. 
 
SIPDIS 
 
13. The need for COM leadership was also discussed in the 
session "Stigma and Discrimination: How to Be a Champion for 
Change."  Sir George Alleyne, UN Special Envoy on HIV/AIDS 
for the Caribbean encouraged COMs to be national leaders in 
the fight against stigma, and recommended that COMs: publicly 
attack HIV/AIDS prejudices; support legislation to protect 
HIV/AIDS infected persons from discrimination; work with 
children regarding HIV/AIDS dangers; demystify the disease 
through regular public discussion; and, embrace those living 
with HIV/AIDS to set a positive example of the need for 
respect and care.  He further recommend that "Champions for 
Change" develop local capacity and inspire others while 
remaining personally committed and publicly involved. 
Suzette Moses-Burton, President of the Caribbean Regional 
Network for HIV Positive Persons, provided inspiration by 
sharing her personal story as a person living with HIV/AIDS. 
She discussed the fear of stigma that discourages testing and 
the open discrimination against those living with HIV/AIDS. 
She demanded action, more than words, and challenged COMs to 
stand out as inspirational leaders. 
 
Sustaining Projects and Sharing Best Practices 
--------------------------------------------- - 
 
14.  Dr. Marcus Bethel, Bahamian Minister of Health, led the 
concluding remarks by reiterating the need for public/private 
partnerships, thanking the COMs for directing Ambassador's 
Fund grants to needy organizations, and challenging 
participants to work towards a coordinated regional approach. 
 Ambassador Tobias focused his comments on the need for 
sustainability in HIV/AIDS programs, stating that one-time 
projects that are not sustained and do not develop local 
capacity lack the ability to make transformational changes. 
He asked COMs to help their countries build their capacity 
for self-help, to be visible in the fight against HIV/AIDS 
and to provide a good example with strong HIV/AIDS programs 
in their embassies. 
 
15.  The discussion sessions concluded with a review of 
HIV/AIDS projects and activities in each of the participating 
countries and a discussion of best practices.  COMs nominated 
Jamaica to host the conference in 2006.  COMs agreed that 
Ambassadors' Fund grants were very successful, with results 
that exceeded the size of the grants.  COMs also agreed to 
focus on the development of local capacity, to provide 
leadership by example and to better coordinate efforts 
regionally.  USAID agreed to serve as a clearinghouse for 
sharing HIV/AIDS initiatives and best practices on an ongoing 
basis. 
 
16.  COMs discussed the following specific steps to advance 
efforts to combat HIV/AIDS in the region: 
 
--Use local contacts in government and business to ensure 
strong representation of community leaders in local HIV/AIDS 
organizations; 
--Work more closely with schoolchildren in HIV/AIDS education; 
--Pursue licenses for local broadcast of "A Closer Walk", a 
moving documentary regarding HIV/AIDS issues; 
--Develop a regional newsletter on HIV/AIDS issues; 
--Coordinate grant applications regionally, making model 
grant applications available to NGOs seeking funding; 
--Continue strong Ambassadors' Fund programs, considering 
programs that have long-term resonance, such as musical and 
theater programs; 
--Use resources and programs from individual countries 
throughout the region, including plays, films and songs, 
gathering past embassy projects for regional distribution; 
--Plan an HIV/AIDS event to coincide with potential Secretary 
of State visit to Nassau in February 2006 for a meeting with 
Caribbean counterparts on the future of the Caribbean. 
 
Site Visits 
----------- 
 
17.  The conference concluded with a visit to the HIV/AIDS 
Resource Center in the Royal Victoria Gardens.  Dr. Perry 
Gomez, Director of the National HIV/AIDS Program, and Mrs. 
Bernadette Saunders, the Bahamas Regional Training 
Coordinator, led conference participants on a tour of the 
facility.  The COMs met with staff and volunteers involved in 
the daily work of HIV/AIDS. 
 
18.  Several participants also visited the Bahamas AIDS 
Foundation.  They met with the head of BNN , a local group of 
people living with AIDS, to hear first-hand about the 
challenges of living with AIDS in the Bahamas.  They 
discussed the importance of public figures, like the 
Ambassador and the PM, taking a leadership role to speak 
publicly, reduce stigma and advance discussion.  They also 
considered various ways embassies could support the work of 
volunteer caregivers. 
ROOD