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Civil society still in denial about HIV/AIDS

By Pauline Ngunjiri

Stakeholders agree the Federation of St.Kitts and Nevis has done a “marvellous” job in meeting the deadlines for UNGASS targets. However, it appears very little is being done by civil society to deal with the HIV/AIDS situation in the country.

More than 20 years since the AIDS epidemic loomed and five years since the first United Nations General Assembly Special Session on HIV/AIDS, it is still not a priority issue for civil society organisations and the general population in St. Kitts.

Stigma and discrimination continue to push persons who test HIV positive underground. There are hardly any public appearances of persons living with HIV.

AIDS workers are convinced that until persons living with HIV/AIDS give a human face to the epidemic, civil society will remain in denial,

“The revolution will be driven by greater involvement of People Living with HIV,” Dr Kathleen Ferdinand a private doctor who is also the Chairperson of the HIV/AIDS Advisory Council in St. Kitts said in an interview conducted at her private clinic.

Yet, civil society role is crucial in catalysing national action and, “their full involvement and participation in the design, planning, implementation and evaluation of programmes is crucial to the development of effective responses to the HIV/AIDS epidemic.” (UNGASS Declaration para 33, 2001).

One of the major objectives outlined in the General Assembly’s Resolution that describes the 2006 high-level meeting to be held in New York from 31 st May to June 2 nd is the active participation of the civil society.

The Federation’s National Strategic Plan created an enabling environment under which civil society would operate through the creation of the National Advisory Council for HIV/AIDS in St Kitts and the Nevis HIV/AIDS Committee (NEHAC) in Nevis . Both entities were launched in 2001 but they are non-functional.

Leaders of the agencies that from the Council for HIV/AIDS in St. Kitts and NEHAC in Nevis did not respond to questions directed to them regarding their current ‘non-functional’ status.

PRIVATE SECTOR APATHY

 Investigations reveal that various sectors look at HIV/AIDS as an issue to be dealt with by the MOH.

“The private sector wants to wait until they see people dead on the streets. This will be too late,” a health educator, who chose not to be named noted. “We are always reactionary. We only function when we are in a crisis. The sectors are waiting to see the physical manifestations before they address the issue.”

A cross section of health workers interviewed testified to the fact that some private entities only wish to be involved in combating AIDS to help track down employees living with the virus and potential employees who may be positive. But there are some concerns. The health workers claim that the private sector does not have the capacity to respond to the epidemic and recommended that the MOH train them. They also called for quicker and simple procedures that would enable Community Based Groups (CBOS) to access AIDS funds.

The Na tional AIDS Coordinator in St. Kitts Marlene Liburd and her counterpart in Nevis , Andrea Nisbett confirmed MOH has increased funding. In the period under review (UNGASS 2001 to 2006) the Federation successfully negotiated a US$4.04 million loan from the World Bank to be repaid over a period of five years. Funds also came from the local treasuries, Global Fund, DFID and USAID, Family Health International (FHI) among others.

The increased funding has enabled MOH to sensitise and mobilise sectors but what has not become a reality are sustainable in-house programs at work places, a life skills program infused to the school curriculum, sustained Home Based Care programs by Community Based Organisations (CBOS) such as faith-based groups and other stakeholders. Focused programs tailored to meet needs of vulnerable groups such as Men Having Sex with Men (MSM) and Sex Workers do not exist.

A self-support group for persons living with HIV, FACTS (Facilitating Access to Confidential Testing, Treatment and Support) formed in 1999 is now stagnant.

“I have packed the office equipment and it is sitting in my house,” Juletta Henderson who coordinates the organisation said in an interview.

The cumulative number of people living with HIV in St. Kitts is 252 since 1984. The prevalence rate is 1%. St. Kitts has a population of 35,000 while Nevis has a population of 11,000. It is difficult to determine deaths caused by HIV/AIDS in the Federation because the death certificates do not state cause of death.

WAKING UP CIVIL SOCIETY

In order for the national response to HIV/AIDS to succeed, civil society must buy into the programmes spearheaded by government to ensure sustainability. Liburd said the political will is there.

“Significant political commitment has been demonstrated by the Prime Minister Dr. Denzil Douglas locally, at the regional level and at the international level. However maintaining sustained interest remains a challenge. Leaders should be more visibly associated with HIV/AIDS and with people living with HIV.”

Liburd is concerned that the involvement of leaders has not included other ministers of government, religious leaders and social celebrities.

In Nevis , Andrea Nisbett confirmed the Premier of the island participates at all major HIV/AIDS forum. However, she also admitted that focused training is crucial if leaders in all sectors will include HIV/AIDS in their constituencies and portfolios.

“We failed to target the leadership initially,” she said, but noted activities to sensitise the leaders were in the pipeline.

Outspoken private medical practitioner Dr Kathleen Ferdinand who heads the National Advisory Council for HIV/AIDS, is satisfied with the MoH efforts: “the Ministry of Health has streamlined its role and performed marvellously well but other sectors have not grasped that HIV/AIDS is a social and an economic issue.”

One of the notable successes in St Kitts and Nevis HIV/AIDS response is the 80 trained Voluntary Counselling and Testing (VCT) counsellors. Fifty-two persons living with HIV in St. Kitts and the 14 living with the virus in Nevis are on free ARV treatment through the government programme whether they receive treatment through government facilities or through private doctors.”

The Permanent Secretary Ministry of Health Elvis Newton confirmed free ARVS are available even for those getting treatment through private health facilities as long as health care workers make referrals.

A cross-section of the civil society confirmed they have been consulted. Father Ernest Fleming Chairman of the Nevis Christian Council (NCC) said members of his council have been mobilised but he noted stigma and discrimination remains the major barrier to successful HIV/AIDS interventions.

“This affects VCT and self-disclosure. I believe as more people change attitudes, we will begin to see a change,” he said.

The St. Kitts and Nevis Media Association (MAS) is a member of the St. Kitts HIV/AIDS Advisory Council and so is the Government Information Services department. Stakeholders interviewed confirm when called upon to cover HIV/AIDS activities, the media houses have been responsive.

Pemberton, Chief Labour Officer Nevis confirmed NEHAC set up to offer an advocacy forum under which civil society can make their needs known is not functional, “but a lot of work has been done by the MOH in Nevis .”

The Federation’s Chief Labour Commissioner Clifford Thomas disclosed that only one company in St. Kitts has an in-house work place HIV/AIDS intervention. There is a current initiative coordinated by the Labour Department in collaboration with International Labour Organisation (ILO), where technical support is provided to companies to develop work place HIV/AIDS policies.

“Twenty two years into the epidemic, there is only a MOH response. Other sectors are at goal level but not at the implementation level. HIV/AIDS is not perceived as a major development issue that could have tremendous impact on social and economic life of the population…we need a national response by all sectors. Some sectors see HIV/AIDS as a threat. Some feel talking about HIV/AIDS is not good for business. The private sector does not see HIV/AIDS as an urgent problem,” Ferdinand said.

As St. Kitts and Nevis prepares to send a delegation to the UGASS meeting end of the month, The Permanent Secretary St. Kitts MOH, Elvis Newton, is optimistic, “we plan to address issues of stigma through legislation and policing of that legislation.”

The article above is part of a five country series on the Caribbean ’s HIV/AIDS response since individual governments signed the United Nations General Assembly Special Session on HIV/AIDS Declaration of Commitment in 2001. It is now five years since those promises were made and time to assess the progress made. The project is done under the supervision of Panos Caribbean.