South-to-South Learning Exchange to Dominican Republic Learning from Centro de Orientación e Investigación Integral

On June 4-8, the PANCAP-K4Health partnership hosted a south-to-south learning exchange in Santo Domingo, Dominican Republic. The learning exchange included nine individuals representing national AIDS programs and civil society organizations (CSOs) from four countries in the region - Guyana, Jamaica, Suriname, and Trinidad & Tobago. The goal of the learning exchange was to share the successful HIV programming being applied at Centro de Orientación e Investigación Integral (COIN), specifically in reaching and delivering care to key populations.


In 2016, the Dominican Republic reports an HIV prevalence of 1% with an estimated 67,000 persons living with HIV and AIDS and 2500 new infections. Prevalence is significantly higher for key populations - men who have sex with men(MSM) at 7.1% (2013) and female commercial sex workers at 3.7% (2013). Further, the MSM population is estimated at 120,000 (2012) and transgender, 8900 (2012). In 2017, on the 90-90-90 continuum of care, the Dominican Republic reported 77% of persons living with HIV knowing their status, 52% receiving antiretroviral therapy, and 43% achieving viral suppression.


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, and trafficking in persons in the Dominican Republic, COIN has concentrated its efforts on implementing educational programs.

The programs focus on prevention and health care and social discrimination, as a way to implement strategies of innovative approaches, effective with these groups, and in turn contribute to the empowerment of them. 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.


Mr. Santo Rosario, Executive Director of COIN, welcomed participants and expressed his commitment and support in ensuring a successful learning exchange.

Ms. Julia Henn, Director, Health and HIV/AIDS Office, USAID/Eastern and Southern Caribbean, expressed her gratitude for being a part of the learning exchange. She applauded the work of the PANCAP-K4Health partnership and emphasized the important role of knowledge management in achieving the regional goals of 90-90-90 and ending AIDS. She urged participants to closely examine the DR’s program, take away applicable best practices, and to continue to innovate for success.


The participants of the learning exchange met with Dr. Luís E. Feliz Báez, Managing Director, General Directorate of Infection Control of Sexual Transmission and AIDS (DIGECITSS), Ministry of Health and Social Assistance. Dr. Baez shared examples of the regulatory activities of the Ministry such as the development of HIV guidelines, protocols, standard operating procedures, and their monitoring for compliance. He also shared extensively on the work that the Ministry has done in relation to HIV, the law, and how this is impacting stigma and discrimination.


The team met with Dr. Víctor Manuela Terrero Enacarnación, Executive Director, and the team of CONAHIVSIDA, who shared their work in coordinating the HIV response at the highest level and reporting to the Minister of Health and cabinet. The CONAVIHSIDA team shared extensively on the work that has been done to create an enabling environment to increase access to services for all Dominicans. The team also shared their strategies in reaching key populations and emphasized the role of data in programming.

Human Rights Observatory

COIN shared their work in prevention, HIV testing, stigma and discrimination, and care, treatment and support. Specifically, the team met with the staff of the Human Rights Observatory and had an in-depth discussion on how the observatory is organized, resourced (financial and human), and the referral system.

Mobile Clinic

The learning exchange participants were also able to experience a mobile outreach activity to observe how COIN delivers HIV prevention and testing to sex workers at a specific venue outside the clinic, in this case a local bar.

Visit to a mobile clinic.

Caribbean Vulnerable Communities Coalition

Participants met with Dr. John Waters and team of Caribbean Vulnerable Communities Coalition (CVC) and learned about their national initiatives in working with young persons, including economic empowerment through farming and goat rearing. They emphasized the role of data and research in supportive policies and programs.


COIN works closely with Trans Siempre Amigas (TRANSSA), an organisation that prioritizes services to transgender persons. The participants met with staff and the beneficiaries of TRANSSA services. The TRANSSA team shared their experience in serving the transgender community, noting that stigma and discrimination and violence towards the community remain significant hurdles. They noted that in many cases, HIV is not the top priority for transgender persons. Rather, they are more concerned about having an income, food and housing, substance abuse, and violence- more of the social determinants of health and predictors of HIV infection.

Primary Health Clinic

COIN conducts training of health care workers at three government HIV treatment sites to enhance their capacity to provide friendly services to key populations. We visited the HIV treatment site which is integrated in primary health care services and serves more than 4,000 persons living with HIV (PLHIV). The clinic 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.


COIN supports the El Movimiento Socio-Cultural de los Trabajadores Haitianos (MOSCHTA) clinic in delivering HIV services to Haitian migrants and Dominicans of Haitian descent. This venue provides healthcare services, legal assistance, empowerment assistance, and elementary and secondary education to approximately 500,000 migrants in more than 30 bateyes (poor districts that were established to house sugar plantations labourers and their families). In 2014, MOSCHTA formed a strategic alliance with COIN and added HIV services to their package of services. In that regard, MOSCHTA provides HIV prevention services, including mobile outreaches, to the bateyes and offers HIV treatment to PLHIV.

Country Coordinating Mechanism

A special session was convened with members of the Country Coordinating Mechanism (CCM) who shared their experience in working together to coordinate and provide oversight to The Global Fund HIV project. Civil society organizations in the CCM represent a coalition of 15 CSOs. Key population representatives in the CCM shared their process of selection to the CCM and their experience in representing their constituency at this level.


Participating country teams were given the opportunity to share on their HIV responses. As part of a visioning board exercise, countries developed their continuum of care, highlighting and sharing strengths and gaps around each 90 of the continuum, Treat All, and stigma and discrimination. Jamaica, Suriname, and Trinidad and Tobago described best practices in their response.

Jamaica focused on how the government and civil society collaborate in order to help achieve the 90-90-90 targets. Suriname discussed their patient-centered and community-specific approach in reaching the 90-90-90 goals. Trinidad and Tobago shared the benefits of a CSO partnership as well as their Government's decentralised model for effective delivery of treatment and care.


Participants were extremely satisfied with the learning exchange and expressed a great appreciation for the site visits and group work in enriching their learning experience.

Participants valued the progressive legislative agenda in creating an enabling environment for all Dominicans and not limited to addressing stigma and discrimination related to HIV.

Participants valued COIN's collaboration with other CSOs and the government (MoH, CCM, CONAHIVSIDA) and agreed that COIN was an extraordinary example of a CSOs leadership in the national response and in providing comprehensive community service delivery to key populations.

Participants felt that the national response was well coordinated, inclusive of key stakeholders (CSOs, technical partners, key populations, donors), and well advanced in the deliberations around sustainability.

Participants highly valued the holistic approach employed by COIN, Transsa, and other stakeholders in addressing the social determinants of health and vulnerabilities to HIV such as substance abuse and homelessness.

Participants were pleased with the PrEP experience, the work of the Human Rights Observatory, and the support COIN provides to key population organizations, such as TRANSSA and MOSCHTA.


Using a visioning board exercise, participants developed a country work plan to continue working as a team by bringing together government and civil society to advance specific aspects of their response. Learning from the experiences of COIN and Transsa, Guyana’s participant will work collaboratively with Guyana Trans United to better understand the barriers to transgender persons accessing services and provide daily nutritional support through a soup kitchen. Trinidad and Tobago will work to expand the scale and quality of HIV testing to key populations. Suriname will focus on capacity building of health care workers to delivery key population-friendly services. Jamaica will engage CSOs and key government partners around Global Fund transition and sustainability, resource needs, and key priority areas to be funded for the HIV/AIDS programme. Jamaica will also provide mentorship support to Adherence Counsellors around mental health and HIV to improve health outcomes.


Thank you to all of the learning exchange participants for their engagement! A special thanks to the COIN team for helping to organize a successful learning event so others can benefit from the successful programming in the Dominican Republic.



This publication is made possible by the support of the American People through the President’s Emergency Plan for AIDS Relief (PEPFAR) and the U.S. Agency for International Development (USAID) under the Knowledge for Health (K4Health) Project (AID-OAA-A-13-00068). The contents of this publication do not necessarily reflect the views of the U.S. Government, PEPFAR, USAID, or K4Health.

Photography courtesy of Jennifer Dayana Santos Goris

Report Abuse

If you feel that this video content violates the Adobe Terms of Use, you may report this content by filling out this quick form.

To report a Copyright Violation, please follow Section 17 in the Terms of Use.