Background and Objectives
PANCAP, with funding from USAID, will facilitate a South-South a learning exchange in Santo Domingo, Dominican Republic from 17-21 February 2020. The objectives of the South-to-South Learning Exchange are:
- To understand successful models of care delivery used to reach key populations with prevention, ART and support services at the national level and understand their intersection with community-based models.
- To learn about successful interventions that have been used to advance human rights and reducestigma and discrimination among key populations.
- To understand the components of a Pre-Exposure Prophylaxis programme which serves as a highly effective prevention modality, and Index-based Testing as a successful testing Strategy when used in conjunction with Assisted Partner Notification.
- To understand the degree and mechanisms of coordination and collaboration between COIN, Dominican Republic Ministry of Public Health and Social Assistance, other civil society organisations and stakeholders in supporting the scale-up of HIV prevention, care and treatment services to the key populations.
- To facilitate knowledge sharing and exchange among the participants in relation to 90-90-90 and Treat All.
- To develop country-specific action plans to enhance in-country collaboration among members of the multidisciplinary team participating in the learning exchange.
Participating countries: Antigua and Barbuda, Dominica, Grenada, Saint Lucia, St. Kitts and Nevis, St. Vincent and the Grenadines.
The Dominican Republic HIV response
In 2018, the Dominican Republic with an estimated 10.4 million people reported an HIV prevalence of 0.9% with 70,000 persons living with HIV and AIDS and an incidence of 0.4 per 1000 population with 2,700 new infections. In 2018, the prevalence was significantly higher for key populations- transgender persons-27.7%, men who have sex with men (MSM)- 4% and commercial sex workers- 4.2%. Further in 2018, the MSM population was estimated at 132,000, commercial sex workers, 97,800 and transgender, 9,400.
With regard to the treatment cascade, in 2018 the Dominican Republic reported that 82% of persons living with HIV knew their status, 56% received antiretroviral therapy and 37% achieved viral suppression. As of June 2019, 33,291 persons were receiving antiretroviral therapy, 1912 new persons were initiated on treatment with a twelve-month retention of 81%. Importantly, their HIV response has pivoted as evidenced by thesignificant gains made in testing and treating key populations. Innovative strategies implemented by grassroots community organisations such as Este Amor, Transsa, CEPROSH, Grupo Clara, IDEV, REDOVIH and Clínica la Familia la Romana in reaching and testing men who have sex with men, young marginalized sex workers and transgender persons complemented the work done in the formal health care system to achieve a comprehensive response. Several of these CSOs worked with the PEPFAR Linkages programme on Index-Based Testing and Assisted Partner Notification. REDOVIH and Este Amor have experience delivering comprehensive treatment and care to HIV positive persons from among key populations and have has excellent results with viral suppression. Additionally, the Dominican Republic is a pioneer Caribbean country for implementing a Pre-exposure prophylaxis programme and has gathered significant experience in PrEP programming which can be shared with other Caribbean countries.. The Ministry of Public Health and Social Assistance leads the multi-sectoral response in collaboration with other governmental, non-governmental, civil society, donors and technical partners.
About COIN
COIN has been a key partner to the Ministry of Public Health and Social Assistance and grassroots community-based organisations in service delivery.
COIN is a private, social interest institution of the Dominican Republic, created on November 28, 1988, by a multidisciplinary team of people with shared experience in community and health work. Born as a result of the emergence of the HIV / AIDS epidemic, trafficking in persons in the Dominican Republic, COIN has concentrated its efforts on implementing educational programmes.
COIN’s programmes focus on prevention and health care and social discrimination, to implement innovative strategies and approaches that serve to empower these groups. In their work with marginalized populations, COIN promotes the integration of the community in the identification of their needs and problems and works with them to define policies and execute solutions to these needs and problems.
Opening of the Event
Mr. Santo Rosario, Director of COIN, welcomed participants to the Dominican Republic and to COIN, encouraged everyone to make maximum use of the learning exchange and expressed his commitment and support in ensuring a highly successful learning exchange
DIGECITSS
The team met with Dr. Luís E. Feliz Báez, Director, General Directorate of Infection Control of Sexual Transmission and AIDS (DIGECITSS), Ministry of Health and Social Assistance. Dr. Baez welcomed the team and shared an update on HIV situation in the Dominican Republic.
Dr. Jose Ledesma, Technical Advisor of Intervention Strategies, DIGECITSS shared their experiences in moving PrEP from pilot to a national programme and stressed the importance of understanding your communities. He also shared the benefits of PrEP in addressing other sexually transmitted infections and spoke of the dual testing done for Hepatitis and Syphilis.
CONAHIVSIDA
The team met with Dr. Victor Manuela Terrero Enacarnacion, Executive Director, and the team of the National Council for HIV and AIDS (CONAHIVSIDA), who shared their work in coordinating the HIV response at the highest level and reporting to the Minister of Health and cabinet. Dr. Enacarnacion and team shared extensively on the work done creating an enabling environment to increase access to services for all. They shared the importance of engaging civil society organisations for advocacy and community service delivery. CONAHIVSIDA coordinates the implementation of the civil society implementing under the Global Fund project focused on addressing the key populations epidemic. The team also shared examples of their advocacy for policy and programmes- including the full transition of all antiretrovirals from the Global Fund to government’s budget.
Dominican Republic Institute of Virological Studies (IDEV)
IDEV Founder and Director Dr Ruth Ellen Levy Koenig shared the history of IDEV, noting that the institute started as a clinical research site in 1999 and shortly after, was incorporated into the national programme and commenced the provision of comprehensive care, including antiretroviral therapy to people living with HIV particularly key populations and Haitian migrant populations. IDEV serves primarily key populations, implements Treat All and is managing more 4000 persons on antiretroviral therapy.
Dr. Carlos Adon, Deputy Director led participants on a tour of the clinic. He described the comprehensive services provided to the people living with HIV including antiretroviral therapy, adherence, disclosure and other forms of counselling, psychological and nutritional services, contact tracing and more. He also shared the menu of preventative and support services provided to key populations including anal health services for men who have sex with men, counselling and referral hormone therapy for transgender persons.
COIN's Response
COIN shared their work in prevention, HIV testing, stigma and discrimination, and care, treatment and support and described the following responses:
- Human Rights Observatory: addressing human rights violations towards key populations and successful redress initiatives.
- Pre-Exposure Prophylaxis(PrEP) : experience in implementing a PrEP program, including the design of the initiative, eligibility for PrEP, monitoring, and follow up.
- Migrant Response: model that includes a bottom-up approach where collective health interventions are deemed most appropriate and the clinical governance approach where collective health decision making is based on the best available evidence.
- Harm Reduction Programme: needle syringe programme and other strategies geared towards reducing vulnerability to HIV
- Sex Worker Response: strategies to reduce stigma and discrimination, enhance human rights and address HIV prevention, care, treatment and support for sex workers.
- HIV treatment: COIN provides comprehensive services to PLHIV including laboratory support for CD4 and viral load testing that is conducted on-site and is considered a one-stop shop approach.
TRANSSA
Trans Siempre Amigas (TRANSSA) prioritises services to transgender persons. Christina King and members of TRANSSA team shared their experiences in serving the transgender community, noting that hate crimes, stigma and discrimination and violence towards the community remain significant hurdles. Further, they shared that in many cases, HIV is not the top priority for transgender persons. Rather, members of the community are more concerned about having an income, food and housing and addressing substance use, and violence. TRANSSA is actively involved with the Shared Incident Data Base (SID) that contributes to the understanding of Human Rights violations in the Dominican Republic and Caribbean. The SID initiative is led by Caribbean Vulnerable Communities with support from the Global Fund. Through this initiative, TRANSSA also builds capacity for the community to serve as paralegals to identify, provide initial support and refer clients who face human rights violations. TRANSSA also works closely with COIN Human Rights Observatory. TRANSSA shared their strategy of engaging persons of transgender orientation in their communities and applauded the role that COIN has played in delivering services in a safe space to their community.
Caribbean Vulnerable Communities Coalition (CVC)
Dr. John Waters shared their initiatives in working with young persons, including economic empowerment through farming and goat rearing. They emphasised the role of data and research in supportive policies and programs. He shared their work in building the community response to human rights violations and reporting to the Shared Incident Data Base.
Country Team Collaboration
Participating country teams were given the opportunity to share on their HIV responses. As part of the visioning board exercise, countries developed their continuum of care, highlighting and sharing strengths and gaps in relation to their national response to the 90-90-90, Treat All, and stigma and discrimination. Antigua and Barbuda St. Kitts and Nevis, Saint Lucia and St. Vincent and the Grenadines described best practices in their response. Participants used the visioning board to develop and present their workplan of at least two activities that they will implement on returning to their countries.
Thank you
Dr. Shanti Singh – Anthony expressed her appreciation on PANCAP’s and the participants behalf to COIN for making the learning exchange highly successfully. She thanked Santo Rosario for his leadership, for his commitment to PANCAP and the Regional response.
Credits:
Timothy Austin