1. Serving Communities and Vulnerable Populations throughout the Caribbean Region Increasing Access to HIV&AIDS Services through Evidence Based Programming: The Case of the Eastern Caribbean Community Action Project. December 2009 This project was made possible by support from the U.S. Agency for International Development (USAID) International HIV/AIDS Alliance/Caribbean HIV&AIDS Alliance University of California, San Francisco Presented by Rosemary Lall, Senior Research Officer, Caribbean HIV&AIDS Alliance

2. Serving Communities and Vulnerable Populations throughout the Caribbean Region Background Adult HIV prevalence in the Caribbean region estimated to be 1.1%. Barbados 1.2% (UNAIDS 2008) Main mode of transmission is heterosexual contact. Reported declines in incidence (new cases) of HIV in some countries of the Caribbean such as Barbados (UNGASS 2008). However, certain populations may be disproportionately impacted.

3. Serving Communities and Vulnerable Populations throughout the Caribbean Region Data Background: Limited data on effective approaches for preventing HIV transmission among different populations in the region. Limited best practice experiences with MARPs re: prevention, community based counselling and rapid testing or palliative care models Response Need to collect reliable data about 1) population dynamics, 2) the context of HIV risk behaviours, 3) what works in the Caribbean context (best practices/lessons learned) to develop (among others) evidence- based approaches to HIV prevention, efficient models for CBCRT and palliative care

4. Serving Communities and Vulnerable Populations throughout the Caribbean Region EC CAP Overview

5. Serving Communities and Vulnerable Populations throughout the Caribbean Region About CHAA… CHAA is a linking organization of the International HIV/AIDS Alliance based in Brighton, UK. CHAA’s headquarters are currently in Trinidad CHAA aims to contribute to the reduction of HIV and AIDS in the Caribbean Region through the active involvement of the most vulnerable and stigmatized populations. It currently implements programs in five Caribbean countries: St Kitts and Nevis, St Vincent and the Grenadines, Antigua and Barbuda, Jamaica and Barbados. CHAA works specifically to mobilize communities to carry out HIV prevention, AIDS care and education activities in three key populations: men who have sex with men, sex workers and people living with HIV. Current areas of focus include the Eastern Caribbean Community Action Project which works in four countries of the Eastern Caribbean; accelerating the private sector response to HIV&AIDS within the tourism sector; development of six S&D toolkits for the Caribbean ; SRH/HIV integration among Spanish speaking sex workers in Antigua and St Kitts.

6. Serving Communities and Vulnerable Populations throughout the Caribbean Region EC CAP Objective Overall objective: Increase access to HIV and AIDS services in St Kitts and Nevis, Antigua and Barbuda, St Vincent and the Grenadines and Barbados for most at risk groups (including MSM, SW, PWH and PLWA) through evidence based programming Strategy: Building a strong multi-level partnership with: International partners (IntraHealth, UCSF), national programs, Ministries (MOH, NAC), community stakeholders and civil society organizations.

7. Serving Communities and Vulnerable Populations throughout the Caribbean Region Expected Results 2 main expected results which are closely linked through a pivotal reliance on evidence based programming which: assists in managing the integration and scope of the project activities Enables EC CAP and the target countries to respond to the evidence (≠ from anecdotal information)

8. Serving Communities and Vulnerable Populations throughout the Caribbean Region Expected Result 1-To increase the use of strategic information to promote sustainable, evidence-based, HIV/AIDS community services in the Eastern Caribbean Strategies: Strengthen the regional data base of M&E and strategic information on most at risk populations (through various studies and surveys) in collaboration with local and regional bodies, including NGOs. Making available Technical Assistance on M&E and strategic information Documenting lessons learned and best practices Informing program design and re-planning

9. Serving Communities and Vulnerable Populations throughout the Caribbean Region Expected Result 2: To increase Access to HIV/AIDS Community Services in the Eastern Caribbean Strategies: Expand the network of Community Animators (peer outreach workers) Develop and implement informed Behaviour Change Interventions Implement community-based rapid testing (pilot in A&B, to be replicated in Barbados and SKN), while making our experience available to strengthen referral systems across all islands Strengthen palliative care currently offered through FBOs and CBOs Strenghten our program monitoring and quality assurance capacity and provision of technical assistance and capacity building in this area Expand our support to grassroots organizations through the provision of small grants to NGOs and CBOs

10. Serving Communities and Vulnerable Populations throughout the Caribbean Region Evidence based programming: the EC CAP model

11. Serving Communities and Vulnerable Populations throughout the Caribbean Region BCI STI and SRH Condoms and lubricant Harm reduction PreventionContextual Interventions Human capacity development Community Leadership Resource mgmt. Care and Support Clinical mgmt. Referral network Palliative care Home-based care Nutrition Adherence Support Community based counseling and risk assessment Community based rapid testing National CBCT policy development Strategic Information, Monitoring and Evaluation Counseling and Testing

12. Serving Communities and Vulnerable Populations throughout the Caribbean Region Evidence based programming in action

13. Serving Communities and Vulnerable Populations throughout the Caribbean Region M&E DATA USE

14. Serving Communities and Vulnerable Populations throughout the Caribbean Region Using M&E feedback to enhance programs M&E system established to provide on- going feedback to outreach staff provided through systematic monitoring and evaluation of peer outreach data………and will soon benefit from a surveillance survey of clients Goal Enhancing the peer outreach model in all four islands Outcome Data on clients is systematically collected by outreach workers. This is checked and processed at a central location and collated data returned to the country offices who use the data to increase effectiveness of outreach strategies e.g. in one of our countries we were reaching twice as many men as women. Concerted efforts were therefore made to develop new strategies to reach women.

15. Serving Communities and Vulnerable Populations throughout the Caribbean Region SI DATA USE

16. Serving Communities and Vulnerable Populations throughout the Caribbean Region Assessing the Feasibility and Acceptability of Implementing Evidence- Based HIV Prevention Interventions for Women Working in Industrial Estates in St. Kitts Goal Gather strategic information to determine which of the Effective Behaviour Interventions (EBIs) recommended by the US Centers for Disease Control and Prevention, is feasible and acceptable for translation in this setting Outcomes Most appropriate EBI identified: Behaviour change intervention based on a combination of SISTA and POL being developed by EC CAP BCC advisor in conjunction with local stakeholders and international experts Study findings for reducing HIV risk among women in a small island state in the Caribbean were disseminated at national level with key stakeholders and through poster presentations and participation at international fora (United States Government's Implementer's Meetings in Namibia, and at the US CDC HIV Prevention Conference in Atlanta )

17. Serving Communities and Vulnerable Populations throughout the Caribbean Region Case study of community based counseling and rapid testing roll out Goal Document the process and implementation of the CBCT program in Antigua for application to roll out of CBCT in other target countries. Outcomes Highlight the key lessons learnt in implementing CBCRT including best practices that can be relevant to implementing CBCRT in other eastern Caribbean countries under EC CAP Disseminate findings to key stakeholders to allow for widespread circulation and adoption of best practice in non EC CAP CBCRT attempts in the Caribbean

18. Serving Communities and Vulnerable Populations throughout the Caribbean Region Data gaps analysis: HIV and AIDS programming and policy Goal: Assess priority data needs of target countries, particularly for MARPS, through consultation with key national stakeholders and country offices Outcomes: Report of critical data gaps in target countries Two studies designed and implemented to fill data gaps and tailored our on-going and future programs

19. Serving Communities and Vulnerable Populations throughout the Caribbean Region Thank You! For further information you may contact: Dr. Gaelle Bombereau-Mulot 1 868 623 9714 ext. 234 gbombereau@alliancecarib.org.tt Rosemary Lall 1 868 623 9714 ext. 239 rlall@alliancecarib.org.tt

20. Serving Communities and Vulnerable Populations throughout the Caribbean Region