: Organisation Planning Institute of Jamaica : Name/Position Mr. Walter James A.I

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1 Custom analysis extract of: UNGASS - National Composite Policy Index (NCPI) 2007 Caribbean Jamaica COUNTRY: Jamaica Name of the National AIDS Committee Officer in charge: Dr. Sharlene Jarrett Postal address: Ministry of Health, 2-4 King Street, Kingston, Jamaica Tel: ext Fax: Jarrettsh@moh.gov.jm; duncanj@moh.gov.jm Date of submission: 1/31/2008 : Organisation National HIV/STI Program/Ministry of Health : Name/Position Dr. Peter Figueroa/ Chief Epidemiology and AIDS, Director, National HIV/STI program : respondents to Part A : respondents to Part A : Organisation Ministry of Education (Formerly) : Name/Position Hon. Maxine Henry-Wilson/Former Minister of Education Page 1 A.I / A.II / A.III / A.IV / A.V : Organisation Planning Institute of Jamaica : Name/Position Mr. Walter James A.I

2 : respondents to Part A : Organisation National HIV Programme, Ministry of Health : Name/Position Ms. Lovette Byfield/Prevention Coordinator : respondents to Part A : Organisation National HIV Programme, Ministry of Health : Name/Position Dr. Sharlene Jarrett/M&E Officer : respondents to Part A : Organisation Ministry of Water and Housing : Name/Position Ms. Monica Dystant : respondents to Part A : Organisation Ministry of Education : Name/Position Mr. Christopher Graham : respondents to Part A : Organisation Ministry of Labour and Social Security : Name/Position Mr Robert Chung/ Mr. Neville Moodie : Organisation National HIV/STI Coordinator/Ministry of Health : Name/Position Dr. Kevin Harvey/ HIV/STI Senior Medical Officer : respondents to Part A : Organisation ILO : Name/Position Ms. Nasolo Jacobs : respondents to Part B B.I / B.II / B.III : Organisation UNAIDS A.II A.III A.V A.I / A.III : Organisation National HIV Programme, Ministry of Health : Name/Position Dr. Debbie Carrington/ Treatment Care and Support Coordinator : respondents to Part A A.IV A.III A.I / A.II / A.III / A.IV / A.V Page 2

3 : Name/Position Mrs. Miriam Maluwa/Country Coordinator for Jamaica, The Bahamas and Cuba/ Mrs. Stephanie Watson Grant/ M&E Advisor : respondents to Part B : respondents to Part B : Organisation UNICEF : respondents to Part B : Name/Position Ms vette Dougherty and Ivan Cruishank : respondents to Part B : respondents to Part B B.I / B.II / B.III : Organisation Jamaica Council for Person with Disabilities : Name/Position Ms Valerie Spence B.II / B.III : Name/Position Ms via Condell B.I / B.II / B.III : Organisation Jamaica Network of Seropositives : Name/Position Ms Olive Edwards : respondents to Part B : respondents to Part B : Organisation Arts Ensemble : respondents to Part B B.I / B.II / B.III / B.IV : Organisation McNeil & McFarlene -Attorneys : Name/Position Ms Carlene McFarlane : Name/Position Mr Conroy Wilson : Organisation Jamaica AIDS Support for Life B.I / B.II / B.III / B.IV : Organisation Hope World Wide : Name/Position Ms Claudette Patterson and Dr. Sandra Swaby B.III / B.IV : Organisation Cable & Wireless : Name/Position Mrs. Mauleen Haynes B.I B.III Page 3

4 : respondents to Part B : respondents to Part B : Organisation UNESCO : Name/Position Ms Janelle Babb : respondents to Part B : respondents to Part B Position: Position: Position: Full time/part time Full time Position: Since when? 2/2007 Position: M&E Director Position: Full time/part time Full time Position: Since when? 9/2004 M&E Officer Biostatistician Position: Full time/part time Full time Position: Since when? 9/2005 Position: Position: Full time/part time Full time Position: Since when? 12/2004 Position: B.II / B.III : Organisation Constella Futures, LLC : Name/Position Mrs. Kathy McClure B.II / B.III B.I / B.II / B.III : Organisation Jamaica Employer Federation : Name/Position Ms. Lydia Ali : respondents to Part B : Organisation National AIDS Committee : Name/Position Mr. Vivian Gray : respondents to Part B : Organisation Jamaica Business Council : Name/Position Ms Pat Donald B.I / B.II Database Officer Position: Full time/part time Full time Position: Since when? 10/2002 B.II B.II Database Manager Page 4

5 1. Has the country developed a national multisectoral strategy/action framework to combat AIDS? IF YES, period covered: How long has the country had a multisectoral strategy/action framework? Which sectors are included in the multisectoral strategy/action framework with a specific HIV budget for their activities? Health: strategy/action framework Health: earmarked budget Education: strategy/action framework Education: earmarked budget Labour: strategy/action framework Labour: earmarked budget Transportation: strategy/action framework Transportation: earmarked budget Military/Police: strategy/action framework Military/Police: earmarked budget Women: strategy/action framework Women: earmarked budget Young people: strategy/action framework Young people: earmarked budget Justice: strategy/action framework Justice: earmarked budget Tourism: strategy/action framework Other*:: strategy/action framework Other*:: earmarked budget Page 5

6 1.3 Does the multisectoral strategy/action framework address the following target populations, settings and cross-cutting issues? a. Women and girls: b. Young women/young men: c. Specific vulnerable subpopulations[3]: d. Orphans and other vulnerable children: e. Workplace: f. Schools: g. Prisons: h. HIV, AIDS and poverty: i. Human rights protection: j. Involvement of people living with HIV: k. Addressing stigma and discrimination: l. Gender empowerment and/or gender equality: 1.4 Were target populations identified through a process of a needs assessment or needs analysis? IF YES, when was this needs assessment /analysis conducted? Year: What are the target populations in the country? Target populations include: SWs, male clients of SWs, MSM, Prison inmates, In- and out-of-school adolescents (10 14 years old) and youth (15-24 years old), Crack/cocaine users, PLWHIV and STI clinic attendees in the public sector. The general population is also reached through programmes in the workplace, hotels, and sites where persons go to meet sex partners (e.g. fast-food restaurants, bus stops, clubs, etc.), and Media campaigns. 1.6 Does the multisectoral strategy/action framework include an operational plan? 1.7 Does the multisectoral strategy/action framework or operational plan include: a. Formal programme goals? : b. Clear targets and/or milestones? : c. Detailed budget of costs per programmatic area? : d. Indications of funding sources?: e. Monitoring and Evaluation framework? : Page 6

7 1.8 Has the country ensured full involvement and participation of civil society[4] in the development of the multisectoral strategy/action framework? Active involvement IF active involvement, briefly explain how this was done: Active involvement and participation of civil society was accomplished through several actions. The National Program facilitated islandwide multisectoral consultations and workshops, for which a consultant was hired for a period of 1 year. Consultations included targetted stakeholder workshops and consultations(with young people, women, etc). 1.9 Has the multisectoral strategy/action framework been endorsed by most external Development Partners (bi-laterals; multi-laterals)? 1.10 Have external Development Partners (bi-laterals; multi-laterals) aligned and harmonized their HIV and AIDS programmes to the national multisectoral strategy/action framework?, all partners 2. Has the country integrated HIV and AIDS into its general development plans such as: a) National Development Plans, b) Common Country Assessments/United Nations Development Assistance Framework, c) Poverty Reduction Strategy Papers, d) Sector Wide Approach? 2.1 IF YES, in which development plans is policy support for HIV and AIDS integrated? a) National Development Plans: b) Common Country Assessments/United Nations Development Assistance Framework: c) Poverty Reduction Strategy Papers: d) Sector Wide Approach: Page 7

8 2.2 IF YES, which policy areas below are included in these development plans? HIV Prevention: development Plans a) / b) / c) / d) Treatment for opportunistic infections: development Plans a) / b) / c) / d) Antiretroviral therapy: development Plans a) / b) / c) / d) Care and support (including social security or other schemes): Reduction of gender inequalities as they relate to HIV prevention/treatment, care and/or support: Reduction of income inequalities as they relate to HIV prevention/ treatment, care and /or support: Women s economic empowerment (e.g. access to credit, access to land, training): 3. Has the country evaluated the impact of HIV and AIDS on its socio-economic development for planning purposes? development Plans a) / b) / c) / d) AIDS impact alleviation: development Plans a) / b) / c) / d) development Plans a) / b) / c) / d) development Plans a) / b) / c) / d) Reduction of stigma and discrimination: development Plans a) / b) / c) / d) development Plans a) / b) / c) / d) 3.1 IF YES, to what extent has it informed resource allocation decisions? 2 4. Does the country have a strategy/action framework for addressing HIV and AIDS issues among its national uniformed services such as military, police, peacekeepers, prison staff, etc? 4.1 IF YES, which of the following programmes have been implemented beyond the pilot stage to reach a significant proportion of one or more uniformed services? Behavioural change communication: Condom provision : HIV testing and counselling(*): STI services : Treatment: Care and support : (*)If HIV testing and counselling has been implemented for uniformed services beyond the pilot stage, what is the approach taken? Is it voluntary or mandatory (e.g. at enrolment)? Briefly explain: HIV testing remains voluntary except for the purposes of Canadian and US oveseas employment, for which they are mandatory. HIV testing may occur through walk-in at both private and public sector sites; there is also VCT outreach by various NGOs and the NHP. Provider initiated opt-out VCT occurs for ANC, STI, hospital admissions, police and military recruits. Page 8

9 5. Has the country followed up on commitments towards universal access made during the High-Level AIDS Review in June 2006? 5.1 Has the National Strategic Plan/operational plan and national AIDS budget been revised accordingly? 5.2 Have the estimates of the size of the main target population sub-groups been updated? 5.3 Are there reliable estimates and projected future needs of the number of adults and children requiring antiretroviral therapy? Estimates only 5.4 Is HIV and AIDS programme coverage being monitored? (a) IF YES, is coverage monitored by sex (male, female)? (b) IF YES, is coverage monitored by population sub-groups? IF YES, which population sub-groups? Currently, programme coverage is monitored by the following subgroups: MSM, SW, Prison inmates, Age groups, Urban/Rural, Sex. (c) IF YES, is coverage monitored by geographical area? IF YES, at which levels (provincial, district, other)? Coverage is monitored by the following geographical areas: Parish, Regional, National 5.5 Has the country developed a plan to strengthen health systems, including infrastructure, human resources and capacities, and logistical systems to deliver drugs? Overall, how would you rate strategy planning efforts in the HIV and AIDS programmes in 2007 and in 2005? 2007: : 8 Comments on progress made in strategy planning efforts since 2005: In 2005 and 2007 the country has developed a multisectoral strategy/action plan to combat HIV and AIDS, and this plan is being implemented. This is reflected in the increase in ARV coverage, pmtct, and VCT. The country has also evaluated the impact of HIV and AIDS on its economic development for planning purposes. Page 9

10 1. Do high officials speak publicly and favourably about AIDS efforts in major domestic fora at least twice a year? President/Head of government : Other high officials : Other officials in regions and/or districts : 2. Does the country have an officially recognized national multisectoral AIDS management/coordination body? (National AIDS Council or equivalent)? 2.1 IF YES, when was it created? Year: IF YES, who is the Chair? Name: Title/Function: Howard Hamilton, QC Chairman 2.3 IF YES, does it: have terms of reference? : have active Government leadership and participation? : have a defined membership?: include civil society representatives? (*): include people living with HIV?: include the private sector?: have an action plan?: have a functional Secretariat? : meet at least quarterly?: review actions on policy decisions regularly?: actively promote policy decisions?: provide opportunity for civil society to influence decision-making?: strengthen donor coordination to avoid parallel funding and duplication of effort in programming and reporting?: 3. Does the country have a national AIDS body or other mechanism that promotes interaction between government, people living with HIV, civil society and the private sector for implementing HIV and AIDS strategies/ programmes? Page 10

11 3.1 IF YES, does it include? Terms of reference : Defined membership : Action plan : Functional Secretariat : Regular meetings (*): (*)If it does include regular meetings, what is the frequency of the meetings: Quarterly IF YES, What are the main achievements? The main achievements include: Capacity building for various NGOs Taken on the role of the CCM and have submitted two successful Global Fund proposals Has a legal committee that addresses relevant legislation to reform stigma and discrimination Advocating for the rights of PLWHIV and other key populations at high risk 4. What percentage of the national HIV and AIDS budget was spent on activities implemented by civil society in the past year? 10-15% 5. What kind of support does the NAC (or equivalent) provide to implementing partners of the national programme, particularly to civil society organizations? Information on priority needs and services : Technical guidance/materials: Drugs/supplies procurement and distribution : Coordination with other implementing partners : Capacity-building : 6. Has the country reviewed national policies and legislation to determine which, if any, are inconsistent with the National AIDS Control policies? 6.1 IF YES, were policies and legislation amended to be consistent with the National AIDS Control policies? 6.2 IF YES, which policies and legislation were amended and when? : policy/law Labour Laws : year 2004 : policy/law Education Laws : year 2004 Page 11

12 Overall, how would you rate the political support for the HIV and AIDS programmes in 2007 and in 2005? 2007: : 7 Comments on progress made in political support since 2005: There is increased support from high official, evidenced in them speaking publicly and favorably about HIV efforts. Most recently, the Prime Minister underwent public HIV testing on World AIDS Day, There is also evidence of increased effort to ensure the sustainability of the National response by creating HIV posts in various Ministries. 1. Does the country have a policy or strategy that promotes information, education and communication (IEC) on HIV to the general population? 1.1 IF YES, what key messages are explicitly promoted? Be sexually abstinent: Delay sexual debut: Be faithful: Reduce the number of sexual partners: Use condoms consistently: Engage in safe(r) sex: Abstain from injecting drugs: Greater acceptance and involvement of people living with HIV: Greater involvement of men in reproductive health programmes: 1.2 In the last year, did the country implement an activity or programme to promote accurate reporting on HIV by the media? 2. Does the country have a policy or strategy promoting HIV-related reproductive and sexual health education for young people? 2.1 Is HIV education part of the curriculum in primary schools? : secondary schools? : teacher training? : 2.2 Does the strategy/curriculum provide the same reproductive and sexual health education for young men and young women? 2.3 Does the country have an HIV education strategy for out-of-school young people? Page 12

13 3. Does the country have a policy or strategy to promote information, education and communication (IEC) and other preventive health interventions for vulnerable sub-populations? 3.1 IF YES, which sub-populations and what elements of HIV prevention do the policy/strategy address? Targeted information on risk reduction and HIV education: Targeted information on risk reduction and HIV education: Targeted information on risk reduction and HIV education: Targeted information on risk reduction and HIV education: Targeted information on risk reduction and HIV education: Stigma & discrimination reduction: Stigma & discrimination reduction: Stigma & discrimination reduction: Stigma & discrimination reduction: Condom promotion: Condom promotion: Condom promotion: HIV testing & counselling: HIV testing & counselling: HIV testing & counselling: HIV testing & counselling: HIV testing & counselling: Clients of sex workers Prison inmates HIV testing & counselling: Other sub-populations (*) Reproductive health, including STI prevention & treatment: Reproductive health, including STI prevention & treatment: Reproductive health, including STI prevention & treatment: Reproductive health, including STI prevention & treatment: Reproductive health, including STI prevention & treatment: Vulnerability reduction (e.g. income generation): Vulnerability reduction (e.g. income generation): MSM Sex workers Clients of sex workers Prison inmates Other sub-populations (*) MSM Sex workers Clients of sex workers Prison inmates MSM Sex workers Clients of sex workers Condom promotion: Other sub-populations (*) IDU MSM Sex workers MSM Sex workers Clients of sex workers Prison inmates Other sub-populations (*) Sex workers Other sub-populations (*) Page 13

14 (*)If Other sub-populations, indicate which sub-populations Positive Prevention efforts with PLWHIV Condom Promotion with Parolees Targeted information on risk reduction and HIV education, Condom promotion, HIV testing and counselling, Reporoductive health services, an d Vulnerability reduction strategies are in place for At-risk youth. Overall, how would you rate policy efforts in support of HIV prevention in 2007 and in 2005? 2007: : 6 Comments on progress made in policy efforts in support of HIV prevention since 2005: There has been a signigicant increase in supportive policies bentween 2005 and Education policies have been revised (the policy for the management of HIV and AIDS in schools) and there is also an HFLE policy and the HFLE programme has been implemented in over 200 schools. The Ministry of Educationi has developed its own strategic plan for HIV and AIDS, which will be guided by the NSP. Overall, there is a comprehensive framework to guide HIV prevention in the education sector. This effort will be funded by the NHP. There has been an increase in workplace programs and policies in both public and private sector. Despite this, there remains policies that hinder the overall effort to create a supportive environment. For example, although there is a policy guaranteeing access to contraceptives by minors, there is the law that states the legal age of consent in Jamaica is16. This law discourages many health care providers from implementing this policy. 4. Has the country identified the districts (or equivalent geographical/ decentralized level) in need of HIV prevention programmes? IF YES, to what extent have the following HIV prevention programmes been implemented in identified districts* in need? Blood safety: the activity is available in Universal precautions in health care settings: Prevention of mother-to-child transmission of HIV: Risk reduction for men who have sex with men: Risk reduction for sex workers: the activity is available in Programmes for other vulnerable subpopulations: Reproductive health services including STI prevention & treatment: School-based AIDS education for young people: Programmes for out-of-school young people: the activity is available in the activity is available in the activity is available in the activity is available in the activity is available in the activity is available in the activity is available in Page 14 IEC on risk reduction: the activity is available in IEC on stigma and discrimination reduction: the activity is available in Condom promotion: the activity is available in HIV testing & counselling: the activity is available in most districts* in need HIV prevention in the workplace: the activity is available in most districts* in need

15 Overall, how would you rate the efforts in the implementation of HIV prevention programmes in 2007 and in 2005? 2007: : : : 7 Comments on progress made in the implementation of HIV prevention programmes since 2005: Several prevention programmes have seen significant expansion. Of note are the HIV testing programme, HFLE programme and the Prison programme/correctional Services. While there has been progress in the work with MSM, this aspect needs further improvement. Programmes are unable to reach this key population due to entrenched stigma and discrimination by health care workers. MSM programmes must also enhance efforts to reach influential peers/gatekeepers. Sex workers are also difficult to reach, as they appear to be increasingly discrete, particularly with the rise in new institutions, such as 'massage parlours'. 1. Does the country have a policy or strategy to promote comprehensive HIV treatment, care and support? (Comprehensive care includes, but is not limited to, treatment, HIV testing and counselling, psychosocial care, and home and community-based care). 1.1 IF YES, does it give sufficient attention to barriers for women, children and most-at-risk populations? 2. Has the country identified the districts (or equivalent geographical/decentralized level) in need of HIV and AIDS treatment, care and support services? IF YES, to what extent have the following HIV and AIDS treatment, care and support services been implemented in the identified districts* in need? Antiretroviral therapy: Nutritional care: Paediatric AIDS treatment: Sexually transmitted infection management: Psychosocial support for people living with HIV and their families: Home-based care: most districts* in need Palliative care and treatment of common HIV-related infections: HIV testing and counselling for TB patients: most districts* in need TB screening for HIV-infected people: some districts* in need TB preventive therapy for HIV-infected people: TB infection control in HIV treatment and care facilities: most districts* in need most districts* in need Page 15

16 Cotrimoxazole prophylaxis in HIVinfected people: Post-exposure prophylaxis (e.g. occupational exposures to HIV, rape): HIV care and support in the workplace (including alternative working arrangements): Home-based care: most districts* in need Palliative care and treatment of common HIV-related infections: HIV testing and counselling for TB patients: TB screening for HIV-infected people: most districts* in need TB preventive therapy for HIV-infected people: TB infection control in HIV treatment and care facilities: Cotrimoxazole prophylaxis in HIVinfected people: Post-exposure prophylaxis (e.g. occupational exposures to HIV, rape): 4. Does the country have access to regional procurement and supply management mechanisms for critical commodities, such as antiretroviral drugs, condoms, and substitution drugs? HIV treatment services in the workplace or treatment referral systems through the workplace: HIV care and support in the workplace (including alternative working arrangements): HIV treatment services in the workplace or treatment referral systems through the workplace: Other services:: most districts* in need Antiretroviral therapy: Nutritional care: most districts* in need Paediatric AIDS treatment: Sexually transmitted infection management: Psychosocial support for people living with HIV and their families: 3. Does the country have a policy for developing/using generic drugs or parallel importing of drugs for HIV? N/A N/A most districts* in need most districts* in need most districts* in need most districts* in need most districts* in need some districts* in need N/A Page 16

17 Overall, how would you rate the efforts in the implementation of HIV treatment, care and support services in 2007 and in 2005? 2007: : 8 Comments on progress made since 2005: In an effort to achieve Universal Access, there as been islandwide scale-up in treatment as evidenced in the increase in numbers of treatment sites. Coverage with ARVs have moved from approximately 30% to 60% from 2005 to Does the country have a policy or strategy to address the additional HIV- or AIDS-related needs of orphans and other vulnerable children (OVC)? 5.1 IF YES, is there an operational definition for OVC in the country? 5.2 IF YES, does the country have a national action plan specifically for OVC? 5.3 IF YES, does the country have an estimate of OVC being reached by existing interventions? Overall, how would you rate the efforts to meet the needs of orphans and other vulnerable children? 2007: : 7 Comments on progress made in efforts to meet the needs of OVC since 2005: Close collaboration with UNICEF and other relevant stakeholders has increased between 2005 and 2007.Through financial support from UNICEF there is now an officer assigned to OVCs. This officer works with the Child Development Agency. There is also a steering committee in place to guide a situational analysis focused on OVCs. This analysis will be conducted in 2008, and the results from this analysis will inform new strategies to address the needs of OVCs. 1. Does the country have one national Monitoring and Evaluation (M&E) plan? IF YES, Years covered: IF YES, was the M&E plan endorsed by key partners in M&E? 1.2. IF YES, was the M&E plan developed in consultation with civil society, including people living with HIV? Page 17

18 1.3. IF YES, have key partners aligned and harmonized their M&E requirements (including indicators) with the national M&E plan?, most partners 2. Does the Monitoring and Evaluation plan include? a data collection and analysis strategy : behavioural surveillance : HIV surveillance : a well-defined standardized set of indicators : guidelines on tools for data collection : a strategy for assessing quality and accuracy of data : a data dissemination and use strategy : 3. Is there a budget for the M&E plan? 3.1 IF YES, has funding been secured? 4. Is there a functional M&E Unit or Department? 4.1 IF YES, is the M&E Unit/Department based in the NAC (or equivalent)? : 4.2 IF YES, how many and what type of permanent and temporary professional staff are working in the M&E Unit/Department? Number of permanent staff: IF YES, are there mechanisms in place to ensure that all major implementing partners submit their M&E data/reports to the M&E Unit/Department for review and consideration in the country s national reports? IF YES, does this mechanism work? What are the major challenges? The major challenged faced by the M&E Unit in receiving reports from all major implementing partners is with the timeliness and completeness of reports submitted to the M&E Unit. Often reports are late. 4.4 IF YES, to what degree do UN, bi-laterals, and other institutions share their M&E results? 4 Page 18

19 5. Is there an M&E Committee or Working Group that meets regularly to coordinate M&E activities?, meets regularly IF YES, Date last meeting: May Does it include representation from civil society, including people living with HIV? IF YES, describe the role of civil society representatives and people living with HIV in the working group The role of civil society representatives and PLWHIV in the working group include, but is not limited to the following: Participants contribute to multi-sectoral discussion on national indicators. Present and share the current knowledge on the status and trends of the HIV/AIDS epidemic in Jamaica. Review the various epidemiological and behaviour patterns in the HIV/AIDS affected communities and to explore current issues Generate information needed to guide the National HIV/STI Program. Review and tailor the M&E system for the program Review the resource need to develop effective and integrated M&E systems in the Health regions Meet program requirements in reporting 6. Does the M&E Unit/Department manage a central national database? 6.1 IF YES, what type is it? Web based HIV and AIDS tracking system; rapid test database; and an HIV electronic register 6.2 IF YES, does it include information about the content, target populations and geographical coverage of programmatic activities, as well as their implementing organizations? 6.3 Is there a functional Health Information System (HIS)? National level : Sub-national level (*): 6.4 Does the country publish at least once a year an M&E report on HIV, including HIV surveillance data? 7. To what extent are M&E data used in planning and implementation? 4 What are examples of data use? M&E data are used in setting targets for scale up of ARV treatment based on surveillance data of PLWHIV population; prioritizing prevention efforts based on data on risk behaviours and vulnerable groups; Setting targets for prevention activities based on population estimates of vulnerable groups. Page 19

20 What are the main challenges to data use? The main challenges to data use are that 1) the M&E system does not have adequate data on hard-to- reach key populations, which limits the information that can be shared with stakeholders; and 2) because of delays in getting data from all health regions, reports are not always available for all regions to use in planning. 8. In the last year, was training in M&E conducted At national level? : At national level? : IF YES, Number of individuals trained: 30 At sub-national level? : At sub-national level? : IF YES, Number of individuals trained: 50 Including civil society? : Overall, how would you rate the M&E efforts of the AIDS programme in 2007 and in 2005? 2007: : 7 Comments on progress made in M&E since 2005: Since 2005, the M&E Unit has experienced tremendous growth. The M&E Plan, which was revised in 2007 after consultations with various stakeholders, complements the new National HIV Strategic Plan. Many elements of the M&E system are well established and provide information for program planning and decision-making. The M&E system is steadily taking the necessary steps to move towards an electronic rather than a paper-based system. These include a web-based HIV/AIDS Tracking System (HATS), a rapid test database, and an HIV electronic register. These are important for tracking output indicators such as number of HIV tests done, number of persons on treatment and general HIV surveillance. Much progress has been made in this aspect since Although there remains room for growth, the M&E sytem has also continued to improve on the timeliness of publications such as AIDS quarterly epidemic update. Since 2005, the M&E unit have also accomplished the important milestone of convening the Monitoring and Evaluation Reference Group, which met twice in 2006 and twice in In 2006, data collection tools were designed, tested and implemented for stakeholders such as line ministries, sub-recipients, and parish AIDS associations. Currently a number of data collection toolsare processed by the M&E unit. 1. Does the country have laws and regulations that protect people living with HIV against discrimination? (such as general non-discrimination provisions or provisions that specifically mention HIV, focus on schooling, housing, employment, health care etc.) 2. Does the country have non-discrimination laws or regulations which specify protections for vulnerable sub-populations? Page 20

21 2.1 IF YES, for which sub-populations? Women: Young people : IDU: MSM: Sex Workers : Prison inmates : Migrants/mobile populations : IF YES, Briefly explain what mechanisms are in place to ensure these laws are implemented: The Child Care and Protection Act, which protects children from exploitation and abuse, is monitored and enforced by the Child Development Agency, an agency of the Ministry of Health. The Government of Jamaica is committed to addressing all forms of discrimination against women and girls and, through the Bureau of Women's Affairs, continues advocacy efforts to support human rights initiatives in order to attain gender equality goals. The Government's programmes and policies in this regard are guided by the principles of specific international charters relating to women/gender issues. IF YES, Describe any systems of redress put in place to ensure the laws are having their desired effect: The current systems of redress which exist to ensure laws are having their desired effect are weak. This combined with stigma and discrimination poses a serious problem. 3. Does the country have laws, regulations or policies that present obstacles to effective HIV prevention, treatment, care and support for vulnerable sub-populations? 3.1 IF YES, for which sub-populations? Women : Young people : IDU: MSM: Sex Workers: Prison inmates : Migrants/mobile populations : Page 21

22 IF YES, briefly describe the content of these laws, regulations or policies and how they pose barriers: There are no specific legislation on HIV or any general legislation that expressly protects the rights of vulnerable groups such as SW, MWM, IDU, prisoners, or migrants. Examples of policies and legislation that pose barriers are: The Ministry of Education has policies that prevent access to condoms in schools The Offences against the Person Act, makes sex between men the criminal offence of 'buggery' Sex work is a criminal offence and illegal Though the law and policy are silent, prison authorities are reluctant to develop full fledged HIV prevention and treatment programs. This barrier to condom in prisons, prevents incarcerated MSM from protecting themselves. In general these laws make it difficult to access these populations with targetted prevention messages, commodities and services. It is equally difficult for these populations to access health services, disclose their status and seek relevant treatment, care and support. 4. Is the promotion and protection of human rights explicitly mentioned in any HIV policy or strategy? 5. Is there a mechanism to record, document and address cases of discrimination experienced by people living with HIV and/or most-at-risk populations? IF YES, briefly describe this mechanism There is a national reporting system that is being developed to record HIV-related discrimination. JN+ manages this database under the guidance of a multisectoral steering committee. When reports are received, the information is codified and a case administration process commences. Investigation is then conducted and based on findings and the complainants wishes, appropriate redress is sought. The system is in the process of being standardized, and will involve advocacy, investigative teams comprising lawyers, social workers, and others with training in the area of HIV. 6. Has the Government, through political and financial support, involved most-at-risk populations in governmental HIV-policy design and programme implementation? IF YES, describe some examples Examples of the involvement of most at risk populations include: 1) NHP/Global Fund support to Jamaican network of seropositives (JN+); 2) Through NAC and the CCM, groups that work with key populations are involved in policy design and implementation; 3)JN+, (Jamaica AIDS Support for Life) JASL, Children First, Hope WorldWide were involved in developing the NSP 4)JN+ active participant in project advisory board for ILO Despite the high level of involvement, there remain groups that could be further involved in governmental HIV-policy design and programme implentation. These include: 1) Military personnel 2) Disabled communities 3) Prison inmate groups Page 22

23 7. Does the country have a policy of free services for the following: HIV prevention services : Anti-retroviral treatment : HIV-related care and support interventions : IF YES, given resource constraints, briefly describe what steps are in place to implement these policies: In respect of ARV there is a needs test. While the majority of PLWHIV in need of ARV receive this service without paying a fee of any sort, and none are denied care on this basis, this poverty designation may cause PLWHIV to feel doubly discriminated against. At this time, medications for opportunistic infections are not included here. 8. Does the country have a policy to ensure equal access for women and men, to prevention, treatment, care and support? In particular, to ensure access for women outside the context of pregnancy and childbirth? 9. Does the country have a policy to ensure equal access for most-at-risk populations to prevention, treatment, care and support? 9.1 Are there differences in approaches for different most-at-risk populations? IF YES, briefly explain the differences: There are a number of targetted prevention interventions that are designed to specifically address the needs of the identified key populations at high risk. In addition, some clinics have special hours for treating SWs who are patients. In general, there is a need for more tailored approaches for MSM and youth. 10. Does the country have a policy prohibiting HIV screening for general employment purposes (recruitment, assignment/relocation, appointment, promotion, termination)? 11. Does the country have a policy to ensure that AIDS research protocols involving human subjects are reviewed and approved by a national/local ethical review committee? 11.1 IF YES, does the ethical review committee include representatives of civil society and people living with HIV? Page 23

24 12. Does the country have the following human rights monitoring and enforcement mechanisms? - Existence of independent national institutions for the promotion and protection of human rights, including human rights commissions, law reform commissions, watchdogs, and ombudspersons which consider HIVrelated issues within their work: - Focal points within governmental health and other departments to monitor HIV-related human rights abuses and HIV-related discrimination in areas such as housing and employment: - Performance indicators or benchmarks for compliance with human rights standards in the context of HIV efforts: - Performance indicators or benchmarks for reduction of HIVrelated stigma and discrimination: IF YES, on any of the above questions, describe some examples: Some examples of institutions for the promotion and protection of human rights include: -Independent Jamaican Council for Human right -Public Defenders office which is restricted to the public sector Performance indicators or Benchmarks include: Human rights standards are included in the NSP and performance indicators are inicluded in the M&E framework. The development of the HIV-related discrimination and redress system will facilitate monitoring of such discrimination. 13. Have members of the judiciary (including labour courts/employment tribunals) been trained/sensitized to HIV and AIDS and human rights issues that may come up in the context of their work? 14. Are the following legal support services available in the country? Legal aid systems for HIV and AIDS casework: Private sector law firms or universitybased centres to provide free or reduced-cost legal services to people living with HIV: Programmes to educate, raise awareness among people living with HIV concerning their rights: 15. Are there programmes designed to change societal attitudes of stigmatization associated with HIV and AIDS to understanding and acceptance? Page 24

25 IF YES, what types of programmes? Media : School education : Personalities regularly speaking out : Other:: Overall, how would you rate the policies, laws and regulations in place to promote and protect human rights in relation to HIV and AIDS in 2007 and in 2005? 2007: : 5 Comments on progress made in promoting and protecting human rights in relation to HIV and AIDS since 2005: The policies, laws and regulations have not been adequately institutionalized. While anecdotal evidence suggests that there is increased public awareness of the importance of human rights in the HIV response, there is a need for greater focus on gender and key populations at high risk through policy, laws and regulations. Overall, how would you rate the effort to enforce the existing policies, laws and regulations in relation to human rights and HIV and AIDS in 2007 and in 2005? 2007: : 3 Comments on progress made in enforcing existing policies, laws and regulations in relation to human rights and HIV and AIDS since 2005: The absence of a legislative framework hampers progress. Further, there is not much effort to test the laws or framework. 1. To what extent has civil society contributed to strengthening the political commitment of top leaders and national policy formulation? 2 2. To what extent have civil society representatives been involved in the planning and budgeting process for the National Strategic Plan on AIDS or for the current activity plan (e.g. attending planning meetings and reviewing drafts) 2 3. To what extent are the services provided by civil society in areas of HIV prevention, treatment, care and support included a. in both the National Strategic plans and national reports?: b. in the national budget?: 2 4. Has the country included civil society in a National Review of the National Strategic Plan? IF YES, when was the Review conducted? Year: Page 25

26 5. To what extent is the civil society sector representation in HIV-related efforts inclusive of its diversity? 2 List the types of organizations representing civil society in HIV and AIDS efforts: Jamaican Network of Seropositives Organizations of vulnerable subpopulations (MSM and Youth) Faith based organization Community Based Organizations Human rights organizations Workers organizations (e.g. Unions, Medical Association of Jamaica) Employers federation Insurance Industry 6. To what extent is civil society able to access a. adequate financial support to implement its HIV activities?: b. adequate technical support to implement its HIV activities?: 2 2 Overall, how would you rate the efforts to increase civil society participation in 2007 and in 2005? 2007: : 8 Comments on progress made in increasing civil society participation since 2005: The effort to increase participation of civil society is noted, in light of efforts such as a number of conferences and seminars that have been held islandwide to encourage participation and to inform civil society. The inclusiveness of the consultattion process for the development of NSP is one such example. Despite these efforts, there still remains a strong need for more involvement from civil society. 1. Has the country identified the districts (or equivalent geographical/decentralized level) in need of HIV prevention programmes? Page 26

27 IF YES, to what extent have the following HIV prevention programmes been implemented in identified districts in need? Blood safety: Universal precautions in health care settings: Prevention of mother-to-child transmission of HIV: Risk reduction for men who have sex with men: Risk reduction for sex workers: most districts* in need Programmes for other vulnerable subpopulations: Reproductive health services including STI prevention & treatment: School-based AIDS education for young people: Programmes for out-of-school young people: IEC on risk reduction: IEC on stigma and discrimination reduction: HIV testing & counselling: Harm reduction for injecting drug users: Condom promotion: some districts* in need some districts* in need most districts* in need some districts* in need HIV prevention in the workplace: some districts* in need Other programmes:: some districts* in need Other programmes:: some districts* in need 1. Has the country identified the districts (or equivalent geographical/decentralized level) in need of HIV and AIDS treatment, care and support services? Overall, how would you rate the efforts in the implementation of HIV treatment, care and support services in 2007 and in 2005? 2007: : 9 N/A Page 27

28 2. What percentage of the following HIV programmes or services is estimated to be provided by civil society? Prevention for youth : 25-50% Prevention for MSM : 51-75% Prevention for sex workers : >75% Counselling and Testing : 25-50% Clinical services (OI/ART)* : 3. Does the country have a policy or strategy to address the additional HIV and AIDS-related needs of orphans and other vulnerable children (OVC)? <25% Home-based care : >75% Programmes for OVC** : 51-75% 3.1 IF YES, is there an operational definition for OVC in the country? 3.2 IF YES, does the country have a national action plan specifically for OVC? 3.3 IF YES, does the country have an estimate of OVC being reached by existing interventions? IF YES, what percentage of OVC is being reached? 50% Overall, how would you rate the efforts to meet the needs of orphans and other vulnerable children? 2007: : 8 Comments on progress made since 2005: A significant number of Orphans are placed in children's homes through which they receive all necessary support including ARVs. In addition, the majority have been reintegrated into the public school system where they receive free education. Uniting the world against AIDS Page 28

: Organisation basic life skills : Name/Position M.Gilds-Mullen/Coordinator

: Organisation basic life skills : Name/Position M.Gilds-Mullen/Coordinator Custom analysis extract of: UNGASS - National Composite Policy Index (NCPI) 2007 Caribbean Suriname COUNTRY: Suriname Name of the National AIDS Committee Officer in charge: Milton Castelen Postal address: