The experience of the Caribbean HIV/AIDS Alliance

The region's HIV prevalence is second only to that of sub-Saharan Africa, with limited epidemiological data guiding interventions. HIV transmission is driven by complex factors, including socio-cultural and religious norms, complexity of sexual norms, stigma and discrimination, and gender inequities. The national and regional response to HIV/AIDS in the Caribbean has undergone significant changes since 2000. The establishment of the Pan Caribbean Partnership Against HIV/AIDS (PANCAP) in 2001 marked a major shift towards a multi-sectoral approach. This led to an increase in resources at both regional and national levels, resulting in the establishment of National AIDS Programs (NAPs). However, the focus on community engagement and marginalized populations, such as sex workers, men who have sex with men (MSM), and people living with HIV (PLHIV), has been limited. The HIV/AIDS Alliance conducted a needs assessment in August 2002, which identified marginalized groups not served well in the regional and national responses. The assessment highlighted the need to involve these groups in the national response and build their capacity. The Alliance promoted the importance of community engagement and the need to contribute to the national response. In response to these findings, the Alliance established a Country Office in Port of Spain, with the goal of becoming a local organization (LO). The programme start-up was supported by USAID regional funding through a central grant mechanism. The Alliance's Community HIV/AIDS Action (CHAA) strategy was launched in 2004, with support from USAID-Barbados. The strategy aimed to work with marginalized populations, including sex workers, MSM, and PLHIV, to increase their participation in the response. The CHAA objectives were to improve coverage of effective community-focused HIV prevention efforts, strengthen leadership and capacity of civil society to respond to HIV, and improve the institutional, organizational, and policy environment for community HIV responses. The programme implementation involved building the capacity of community-based organizations (CBOs) to provide prevention and care support to marginalized populations. Small grants were provided to support this effort. The programme also aimed to increase the participation of marginalized populations in decision-making bodies through policy changes. The programme scope was focused on nine islands in the Eastern Caribbean, with a small team based in Trinidad.