VZCZCXRO8389
PP RUEHGR
DE RUEHKG #0358/01 1161749
ZNR UUUUU ZZH
P 251749Z APR 08
FM AMEMBASSY KINGSTON
TO RUEHC/SECSTATE WASHDC PRIORITY 6247
INFO RUCNCOM/EC CARICOM COLLECTIVE

UNCLAS SECTION 01 OF 02 KINGSTON 000358 
 
SIPDIS 
 
SIPDIS 
 
STATE FOR WHA/CAR (JTILGHMAN)(VDEPIRRO) 
STATE FOR USAID GLOBAL HEALTH 
STATE FOR USAID/LAC 
STATE FOR OGAC (MARK DYBUL) 
 
 
E.O. 12958:  N/A 
TAGS: EAID SOCI TBIO KHIV JM XL
SUBJECT: JAMAICA REQUESTS INCREASE IN HIV AIDS FUNDS 
 
SUMMARY 
------- 
 
¶1. (SBU) The U.S. Mission is requesting to increase HIV/AIDS funding 
for Jamaica from USD 1.25 million to USD 2.5 million beginning in FY 
¶2008.  An estimated 2/3 of Jamaicans infected with HIV do not know 
their status.  The highest rate of growth in transmission is among 
youth aged 10-19. 
 
Background 
---------- 
 
¶2. (SBU) With prevalence at an estimated 1.5 percent, the HIV/AIDS 
epidemic in Jamaica has features of both a low-level generalized 
epidemic and a concentrated epidemic.  For example, Jamaica has an 
HIV prevalence rate of 1.3 percent in public sector antenatal clinic 
attendees but 9 percent among commercial sex workers (prostitutes) 
and an estimated 25-30 percent among men who have sex with men. 
According to sentinel surveillance, there has been no significant 
change in HIV prevalence among the general population over the last 
decade.  This is quite remarkable in a country that has all of the 
main risk factors for an explosive epidemic including: 
 
- Sexual debut at an early age (often forced); 
- Multiple concurrent sex partners for both men and women; 
- High rates of commercial, transactional and cross-generational 
sex; 
- Extreme stigmatization of homosexuality making men who have sex 
with men very hard to reach. 
 
¶3. (SBU) Counterbalancing these factors is a relatively high rate of 
condom use at last sexual encounter (53 percent among women; 67 
percent among men).  Yet, there has been little change in reported 
safer sexual behaviors in the past ten years.  In sum, the HIV 
situation in Jamaica reflects either a major success story, 
particularly as it relates to condom ("C") use, or a serious problem 
with the statistics. 
 
¶4. (SBU) A recent USAID assessment team that visited Jamaica in 
March to conduct a situational analysis and make future 
recommendations for USG programming, concluded that it is probably a 
bit of both.  E.g. condom use is indeed high; however, little 
progress has been made on abstinence ("A") among youth or being 
faithful ("B") to one partner.  The high risk behaviors cited above 
are widespread. The team also suspects that there are gaps in the 
sentinel surveillance system that lead to underreporting of the true 
magnitude of the epidemic. 
 
¶5. (SBU) The USAID HIV/AIDS assessment recommends, and the Mission 
concurs, that USAID should focus its resources on providing 
technical assistance to: 
a. support the civil society response to the HIV/AIDS epidemic, 
including outreach and behavior change related to "A" and "B"; 
b. support a coordinated private sector response to HIV/AIDS to 
eliminate stigma and discrimination; and 
c. work with other donors to consolidate the Ministry of Health's 
monitoring and evaluation system and improve data for decision 
making. 
 
¶6. (U) The 6th Annual Chiefs of Mission (COM) Conference on HIV/AIDS 
was held in Kingston in October 2007.  This conference--organized by 
U.S. Embassy Kingston, USAID, and the Centers for Disease Control's 
Caribbean Regional Program--addressed the role of regional 
cooperation in fighting HIV/AIDS in the Caribbean. U.S. Ambassadors 
and Chiefs of Missions from The Bahamas, Barbados, Belize, Haiti, 
Trinidad and Tobago, Guyana, Jamaica, Cuba, Suriname, and the 
Dominican Republic participated, along with experts and activists 
from across the Caribbean region.  The conference provided American 
Chiefs of Mission in the Caribbean with an overview of successes and 
lessons learned in supporting HIV/AIDS efforts in the region, while 
allowing conference participants to share perspectives on how 
Ambassadors could best use their leadership roles to advocate a 
continued focus on the disease. 
 
¶7. (U) In early April 2008, the U.S. Congress voted to expand the 
President's Emergency Plan for AIDS Relief (PEPFAR) by authorizing 
USD 50 billion (USD 20 billion more than the White House requested). 
 PEPFAR has provided USD 15 billion during its first five years, and 
this bill will triple the funding for PEPFAR programs.  This could 
be called the largest foreign aid initiative meant to combat a 
single disease in U.S. history.   The new bill includes 14 Caribbean 
countries, which will benefit from PEPFAR along with 15 African 
countries. 
 
Government of Jamaica Commitment 
-------------------------------- 
 
 
KINGSTON 00000358  002 OF 002 
 
 
¶8. (SBU) The National HIV/STI control Program has drafted a National 
Strategic Plan for 2007-2012.  The plan has been budgeted at USD 201 
million by the World Bank, but is only 40 percent funded by the 
Global Fund, the World Bank, and the GOJ itself.  Sufficient funding 
to close this gap is not likely to be forthcoming, making 
prioritization of strategic interventions essential. 
 
¶9. (SBU) The new Prime Minister, Bruce Golding, has been vocal in 
his support of HIV/AIDS prevention efforts, including the National 
Program and the work of the Jamaica Business Council on HIV/AIDS and 
has made public statements regarding previously taboo subjects, such 
as multiple concurrent partners.  At the COM Conference on HIV/AIDS, 
Prime Minister Golding delivered the opening remarks and stated that 
only with strong support from parents and schools, and cooperation 
from the community, would the topic of HIV/AIDS education and the 
issue of new HIV/AIDS infections be successfully addressed. 
 
¶10. (SBU) Jamaica has just been awarded a Round 7 Global Fund 
against TB and Malaria grant of USD 15 million with a lifetime 
budget of USD 44 million, with disbursements contingent upon 
continued good performance in prevention, treatment, care and 
support, and enabling environment and human rights.  The World Bank 
is also preparing another USD 10 million loan; however, it is 
important to note that due to problems of absorptive capacity, only 
2/3 of the current USD 15 million loan has been drawn down. 
 
USAID Funded Programs 
--------------------- 
 
¶11. (SBU) USAID support, currently capped at USD 1.25 million, has 
been devoted to prevention programs directed at vulnerable 
populations using peer educators, adolescents through community 
networks, providing technical assistance to strengthen the National 
HIV/STI Control programs monitoring and evaluation system, special 
studies (youth resiliency, behaviors among men who have sex with men 
and commercial sex workers) as well as support for the Jamaica 
Business Council on HIV/AIDS.  Except for this support, USAID 
funding has been given directly to the GOJ national program in the 
form of a grant.  Performance has been acceptable, if lackluster, 
and Mission Management believes that the modest USG contribution is 
being dispersed too widely-in essence lost among larger pots of 
donor funding also directly transferred to the GOJ. 
 
Proposal For Additional Funds 
----------------------------- 
¶12. (SBU) The U.S. Mission/Jamaica requests a total FY 2008 
allocation of USD 2.5 million.  The Mission would then negotiate a 
new public/private sector compact with the GOJ national program to 
begin implementation in 2008.  USAID/Jamaica is seeking additional 
funding from PEPFAR, with proposed goals: 
a. strengthen the capacity of the Country Coordinating Mechanism to 
help the GOJ to better manage other donor funds; 
b. work with the private sector and civil society to reduce stigma 
and discrimination; and 
c. expand technical assistance from another USG partner (such as CDC 
or the University of North Carolina) to strengthen the sentinel 
surveillance system and conduct key population-based studies. 
JOHNSON