THE VULNERABLE GROUP COMPONENT OF THE PANCAP R9 GLOBAL FUND PROJECT
The Vulnerable Groups (VG’s) component of the PANCAP Regional Proposal is built on a core partnership between COIN and CVC.
The Caribbean Vulnerable Communities Coalition (CVC) is a coalition of civil society actors providing frontline services to marginalized groups, including sex workers, men who have sex with men, drug users, and prisoners- has been building its capacity over the past four years. Operating out of its hub in Kingston, Jamaica, it brings together under one umbrella both leading and emerging civil society experts in rights-based prevention, care, treatment and support from across the Caribbean. (Link: www.cvccoalition.org)
The Centro de Orientación e Investigación Integral (COIN) is an NGO based in the Dominican Republic with twenty five years experience working in HIV prevention and care and treatment with most at risk populations. Since 2003, COIN has participated in more than 40 HIV projects and activities across the Caribbean and is a active member of CVC. (Link www.coin.org.do)
Another crucial partnership that falls within the CVC membership is the Caribbean Drug and Alcohol Research Institute (CDARI). CIDARI is a private not for profit research institute registered in Saint Lucia . It has a strong track record in implementing a number of regional and sub-regional training, research, policy and advocacy projects and is a key partner within the CVC family.
There are two underlying methodological approaches inherent in the VGs component of the VG’s project.
The first emphasizes mobilization and community development to foster collective commitment in prevention. It is secured through partnering with CVC member organizations (lead in-country NGOs and CBOs) throughout the Caribbean.
The second approach stresses the added value of combining the forces of civil society with those of government. National AIDS Programmes often have little knowledge regarding effective interventions for preventing HIV infection among VGs, and encouraging them to access and adhere to treatment.
Whilst epidemiologic studies and surveillance data make it clear that VGs should be a focus of national HIV prevention efforts, the connection between the risk of disease and the unique circumstances that VGs face is much less well established. In the absence of scientific data, we must rely on the experience and expertise of those working on the ground with VGs to bridge this gap.
The CVC/COIN partnership in the PANCAP Global Fund proposal is about tapping into a wealth of information to help document and disseminate the components of a sound strategy seeking to prevent HIV infections among VGs and assist transferring this “know how” to National programmes so that they can assume the work more effectively.
These approaches of community involvement, and harnessing the combined strength of government and non-government institutions, also define the broader partnership relationships in the project.
The VG Project identifies five key vulnerable populations to be targeted in countries throughout the Caribbean, namely - Sex Workers (SWs), both local and mobile; Men who have Sex with Men (MSM); Marginalized Youth (MY); Drug Users (DUs); and Prisoners (Ps).
Although the specifics of each programme vary, there are some central themes common to all of them.
These include:
Creation of an Enabling environment
A supportive environment is essential for successful prevention work. This involves ensuring an enabling environment at the policy level, as well as encouraging more positive attitudes towards vulnerable groups at the ground level by reducing discrimination and stigma.
HIV is not just a public health issue, but a human rights issue, and therefore addressing VGs human rights is paramount. This includes the right to protection from infection. Throughout the Caribbean, addressing the attitudes of health personnel and the armed forces is particularly important, as discrimination against VGs from these sectors still prevails and affects their security and access to health services.
The programme also identifies the media as having a vital role to play and has programmed activities with the Caribbean Broadcast Media Partnership on HIV/AIDS to help change the mindset of leaders, the general public and the society through information dissemination and communication through building the capacity of a cadre of media workers to produce and disseminate rights-infused coverage of issues affecting VGs together with local NGO partners.
Providing Empowerment, Opportunities and Options for VGs.
VGs themselves are integral to the response to AIDS, but they need to be supported to do so in an environment in which they feel safe and are free from violence, intimidation, stigma and discrimination. Empowerment is about the capacity to make informed choices, to be heard and meaningfully involved in decisions that affect one’s life.
The VG component of the PANCAP proposal takes a bottom-up approach. VGs themselves are experts in their own situation. The programme focuses on building the capacity of VGs and the CBOs that work with them. An important part of this strategy is to use the different vulnerable groups as peer educators (PEs), both for spreading the prevention message and for building the capacity of the VGs themselves.
Addressing Sexual and Reproductive Health (SRH) Needs of VGs
Vulnerable groups require specific attention as decision makers and program planners develop interventions. Effective strategies for reaching VGs to encourage HIV testing, regular condom use, and other harm reduction behaviours can differ and need to consider the many nuances, social constraints, and prejudices (both external and internal) that define the realities of these groups. The proposal includes funding for model, tailor-made programmes that are designed to capture all the shades of grey and build them into the programming.
Scaling-up the scope of interventions
Activity 2.1 involves an approach to scaling- up efforts to curtail HIV infection in VGs that supports and empowers community-driven HIV/AIDS programming. New strategies are combined with a scaling up of traditionally effective interventions that are tailored for local epidemiology and context to maximize public health impact despite resource constraints.
The scaling-up is envisaged as a sequenced approach where best practices are determined and supported, local partners are engaged to pilot and refine, and finally transference of “know how” occurs to National AIDS Programmes for sustainability and amplification.
A similar pattern is repeated across each of the target groups - mobilizing of community leaders, organizing the community for action, examining the particular HIV/AIDS issues of each sub-population, focusing and setting priorities for action, joint planning and community implementation.
With all this in place the approach creates sustainable and wider-ranging impacts by mobilizing communities, and giving them the tools to become agents of their own development.