World AIDS Day

The Network of Guyanese Living with and Affected by HIV-AIDS (G+) and Society Against Sexual Orientation Discrimination (SASOD) join the Caribbean Vulnerable Communities Coalition (CVC) and the Caribbean Treatment Action Group (CTAG), two regional groups bringing together organisations working in HIV and AIDS, in calling for greater access to HIV medication, care and support for all persons infected with HIV in the Caribbean, particularly for those from socially marginalised groups. Among these groups are sex workers, men who have sex with men, drug users, prisoners, youth in especially difficult circumstances, and children who have lost one or more parent to AIDS-related illnesses.

Through the United Nations General Assembly Special Session plus Five (UNGASS+5) Political Declaration on HIV-AIDS, all governments, including the Guyana government:

Commit to intensify efforts to enact, strengthen or enforce, as appropriate, legislation, regulations and other measures to eliminate all forms of discrimination against and to ensure the full enjoyment of all human rights and fundamental freedoms by people living with HIV and members of vulnerable groups… and develop strategies to combat stigma and social exclusion connected with the epidemic.

At a November meeting in Bayahibe in the Dominican Republic, the groups concluded that while access to care and treatment for HIV has improved in the Caribbean, it has been limited or non-existent for members of socially marginalised groups who are especially vulnerable to the impact of HIV because of stigma and discrimination. CVC and CTAG have released a joint statement outlining the framework within which effective and meaningful HIV treatment and support might take place in Caribbean countries.

Dubbed the "˜Bayahibe Declarationâ", the document calls on Caribbean governments, regional and international health authorities, and international donors to take immediate action to redress the problem of access to drugs and support faced by members of marginalised groups infected with or affected by HIV. It also provides a roadmap by which national governments, civil society actors, service providers and human rights defenders can assure all persons living with HIV in the Caribbean of proper care, treatment and support. CVC and CTAG believe that in this way, members of these groups can realise their fundamental human rights to life and health.

Among the elements the groups present as essential to improving access to treatment and support for HIV positive persons, especially those who are socially marginalised, are the assurance that all persons in detention, including foreign nationals, are informed of their right to obtain HIV-related information and services; the assurance that health care providers treat drug users with respect, and provide appropriate and non-discriminatory health care services; the education and sensitisation of children and youth regarding their human rights and the steps to take to report physical, sexual and other cases of abuse; the training of health care workers to provide effective services for men who have sex with men; the execution of programmes that aim to eradicate homophobia and heterosexism; the training of service providers at treatment sites in the human rights of sex workers; and the building or expansion of outreach facilities in areas where sex work is common.

The declaration was signed by individuals and agencies working in different speech communities across the Caribbean including representatives of both G+ and SASOD.

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Bayahibe Declaration

November 2006

Caribbean Vulnerable Communities Coalition

&

Caribbean Treatment Action Group

In recent years, the international community has taken important initiatives to scale up access to lifesaving antiretroviral therapy, especially in the developing world. Although these initiatives have fallen short of their targets, in the Caribbean, the region with the second highest infection rate in the world, they have generated essential political and financial support for making medication available at no or reduced cost, which has been critical to increasing the life expectancy of people living with HIV in the region.

The benefits, however, have not been equitably distributed. The widespread discrimination and abuse faced by members of socially marginalised groups -- sex workers, men who have sex with men, drug users, prisoners, young people in especially difficult circumstances, children who have lost one or more parent to AIDS -- heighten their risk of HIV infection, and impede their access to care and treatment where they are living with the disease. In this regard, their marginalised status compounds the stigma and discrimination they face because of HIV, and compromises or effectively bars their access to treatment.

This declaration, made in Bayahibe, Dominican Republic, in November 2006, calls for immediate action by Caribbean governments, regional and international health authorities, and international donors to correct the situation. This declaration also provides a roadmap for national governments, civil society actors, service providers and human rights defenders to ensure that all people living with HIV in the Caribbean can obtain proper care, treatment and support, and therefore realise their fundamental human rights to life and health.

Thus, cognisant of the urgent need to ensure effective and meaningful access to antiretroviral treatment for people in the Caribbean whose immune systems have been compromised by HIV;

Firmly resolved that states must take immediate steps to ensure equal access to treatment for all persons living with HIV as part of their obligations to protect the human right to health; and

Calling on duty-bearers mandated to provide health care and to protect the health and human rights of all people in the Caribbean,

We declare the following to be essential steps to be taken:

For people in Caribbean correctional facilities or other places of detention

1. Ensure all persons in detention, including foreign nationals, are informed of their right to obtain HIV-related information and services in a language they understand (this should include training and other assistance for family and community members who are part of an individual’s support system);
2. Ensure that all persons in detention, including detained foreign nationals, have prompt, adequate medical assessment on entry into custody, and access to essential medical treatment (patients should receive at least the same standard of care that could be expected for persons outside of the prison system) and guarantee a continuation of any medical treatment that began prior to incarceration;
3. Ensure the development, dissemination and adoption of written HIV policies that address

i. confidentiality

ii. attitudes of prison staff

3. staff training on HIV and
4. scheduled access by civil society groups;

4. Promote “through care” by allowing access to the prison by civil society groups;

5. Ensure that community boards monitoring prisoners’ rights include at least one person knowledgeable about HIV-related issues;
6. Ensure access to appropriate services for women (including gynaecological health services);
7. Ensure confidentiality and privacy with respect to all medical services;
8. Ensure adequate nutrition for all detainees and inmates.

For drug users in the Caribbean

1. Ensure that health care providers treat drug users with respect, and provide appropriate and non-discriminatory health care services;
2. Ensure that rehabilitation and other support centres for people who use drugs incorporate HIV-related services such as prevention and testing;
3. Provide support services for pregnant women who use drugs and their children, including post-delivery services and programmes for the prevention of mother to child transmission of HIV;
4. Sensitise and educate all service providers at addiction treatment sites about HIV- prevention and testing and the need to incorporate such services into their drug treatment programme;
5. Ensure that programmes and policies for people who use drugs are informed by research and other evidence (including research on barriers to access to health care services for drug users; use of peer educators to provide education and information) and are not driven by condemnatory, moralistic attitudes;
6. Identify, support and pay peer educators to facilitate access to treatment;
7. Ensure access for drug users to public health facilities;
8. Promote a harm reduction and public health approach to addressing drug use, including support for alternatives to incarceration for drug users;
9. Promote continuity of treatment and social assistance for drug users (e.g., on entry into and exit from custody).

For young people in especially difficult circumstances, including orphans and other children made vulnerable by HIV in the Caribbean

1. Incorporate representatives of the youth community who are recommended and approved by local youth organisations at all levels of decision-making related to HIV/AIDS policy and implementation;
2. Establish children/youth advisory boards that will identify the needs and issues of concern to children/youth and that will guide programme development, including training for all children and youth in preparation for meaningful employment;
3. Conduct sensitisation, education and life skills training programmes about the process of disclosure for parents/caregivers of children who are HIV positive;
4. Educate and sensitise children and youth about their human rights and empower them to take necessary the steps to report physical, sexual and other cases of abuse;
5. Create an awareness of the need for redress for children and youth who have been denied access to treatment;
6. Ensure the legal system adequately addresses issues of abuse of youth and children;
7. Train children and youth to become adherence counsellors, peer educators, and advocates for the rights of children, and create opportunities for the utilisation of their skills;
8. Sensitise and educate all legal service providers about how to provide adequate legal services to children and youth;
9. Train children and youth to interact and effectively communicate with the media;
10. Engage children and youth in all areas of decision- and policy-making that affect their lives.

For men who have sex with men in the Caribbean

1. Incorporate representatives of the Caribbean men who have sex with men (MSM) community who are recommended and approved by local MSM organisations at all levels of decision-making related to HIV/AIDS policy and implementation;
2. Train health care personnel to effectively and affectively provide services for MSM;
3. Develop an internal MSM-community referral system to friendly health care facilities and service providers;
4. Execute programmes that aim to eradicate homophobia and heterosexism;
5. Repeal ‘sodomy’ laws to create a policy environment that is conducive for MSM to access all health care services;
6. Ensure access to treatment for HIV-positive MSM who are incarcerated, young or from rural areas;
7. Establish support groups for HIV-positive MSM which include their partners, families and friends to promote adherence;
8. Sensitise faith-based organisations, religious leaders, politicians, policy makers and legislators about the destructive impact of homophobia;
9. Incorporate these recommendations as part of national and regional level policies which promote human rights and the exercise of citizenship without stigma and discrimination of any kind, in particular for sexual orientation and/or gender identity.

Sex workers in the Caribbean

1. Incorporate representatives of the sex work community who are recommended and approved by local sex work organisations at all levels of decision-making related to HIV/AIDS policy and implementation;
2. Train service providers at treatment sites in human rights of sex workers;
3. Offer comprehensive services, including VCT, to sex workers at all clinics;
4. Build and expand outreach facilities in areas where sex work is common;
5. Establish comprehensive referral system for adherence support;
6. Provide language assistance to foreign sex workers at clinic sites;
7. Provide confidential counselling for HIV positive sex workers;
8. Ensure HIV-positive sex workers who are sick have access to social services, education, and condom distribution regardless of residency status;
9. Provide equal access to services for brothel and street sex workers;
10. Ensure the non-disclosure of the sero-status of sex workers to others, including brothel owners;
11. Scale up treatment and care for sex workers beyond the brothel;
12. Ensure human rights protection for sex workers, including protection against sexual exploitation;
13. Decriminalise sex work.

Signed,

Carlos Adón

Instituto Dominicano de Estudios Virológicos

Dominican Republic

Moisés Agosto

Tides Foundation

Puerto Rico

Juanita Altenberg

Maxi Linder Association

Suriname

Harry Beauvais

Foundation for Reproductive Health and Family Education

Haiti

Robert Best

United Gays and Lesbians Against AIDS Barbados

Barbados

Dusilley Cannings

Network of Guyanese Living With and Affected by HIV/AIDS

Guyana

Robert Carr

Caribbean Centre for Communication for Development

Caribbean Institute for Media and Communication

University of the West Indies

Jamaica

Milton Castelen

National AIDS Program

Suriname

Veronica Cenac

AIDS Action Foundation

Saint Lucia

Rachel Charles

Hope PALS Network

Grenada

Marcus Day

Caribbean Drug Abuse Research Institute

Saint Lucia

Joan Didier

AIDS Action Foundation

Saint Lucia

Novlet Dougherty-Reid

Jamaica AIDS Support for Life

Jamaica

Olive Edwards

Jamaica Network of Seropositives

Jamaica

Keenan Ferreira

Life Goes On

Dominica

Patricia Figueroa

Caribbean Treatment Action Group

Puerto Rico

Devon Gabouriel

United Belize Advocacy Movement

Belize

Philipa García

Alianza Solidaria para el VIH/SIDA

Dominican Republic

Tamico Gilbert

Bahamas Human Rights

Amnesty International

Bahamian Friends of the Cuban Five

Bahamas

Mario Kleinmoedig

Orguyo

Curaçao

Steeve Laguerre

SeroVie

Haiti

Rohan A. Lewis

Board Member

Caribbean Vulnerable Communities Coalition

Jamaica

Rosáura Lopez

Puerto Rico Concra

Puerto Rico

Deborah Manning

Board Member,

Caribbean Vulnerable Communities

Jamaica

Ian McKnight

Jamaica AIDS Support for Life

Jamaica

Aimé Charles Nicholas

Formation Interventions Recherche sur le Sida et les Toxicomanies Caraïbe

Départements français d’Amérique (Martinique, Guadeloupe and Guyane)

Caleb Orozco

United Belize Advocacy Movement

Belize

Ricky Pascoe

Board Member

Caribbean Network of Seropositives

Ethel Pengel

Mamio Namen Project

Suriname

Johane Philogène

Foundation for Reproductive Health and Family Education

Haiti

Sissaoui Pierre

Entr’aides Guyane

French Guyana

Nastassia Rambarran

Society Against Sexual Orientation Discrimination

Guyana

Leonardo Sánchez

Amigos Siempre Amigos

Dominican Republic

Joel Simpson

Society Against Sexual Orientation Discrimination

Guyana

Yvonne Sobers

Families Against State Terrorism

Jamaica

Jonathan Waters

Red Voluntarios de Amigos Siempre Amigos

Dominican Republic

Solomon Wedderley

AIDS Foundation of The Bahamas

Bahamas National Network for Positive Living (BNN+)

Bahamas

Gareth Williams

Jamaica Forum for Lesbians, All-sexuals and Gays

Jamaica
Tags: WADHIV/AIDSCaribbeanDeclarationHigh Risk PopulationsStigma