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DE RUEHSP #0535/01 3291724
ZNR UUUUU ZZH
R 241724Z NOV 08
FM AMEMBASSY PORT OF SPAIN
TO RUEHC/SECSTATE WASHDC 9529
RUEHWN/AMEMBASSY BRIDGETOWN 7932
RUEHAO/AMCONSUL CURACAO 0073
RUEHGE/AMEMBASSY GEORGETOWN 1429
RUEHKG/AMEMBASSY KINGSTON 0436
RUEHBH/AMEMBASSY NASSAU 3797
RUEHPO/AMEMBASSY PARAMARIBO 1982
RUEHPU/AMEMBASSY PORT AU PRINCE 1298
RUEHDG/AMEMBASSY SANTO DOMINGO 2634
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RUEHPH/CDC ATLANTA GA
RHMFISS/HQ USSOUTHCOM MIAMI FL//HQ USSOUTHCOM JS MIAMI FL

UNCLAS SECTION 01 OF 04 PORT OF SPAIN 000535 
 
SIPDIS 
 
SENSITIVE 
 
DEPT FOR S/GAC - MARK DYBUL 
DEPT PASS TO HHS FOR SECRETARY 
DEPT FOR WHA/EX, WHA/CAR, WHA/PD, GAC 
DEPT FOR USAID LAC/AA, GH/AA, GM/OMA 
ALSO FOR USAID MISSION DIRECTORS 
 
E.O.  12958:  N/A 
TAGS: KHIV EAID PREL OVIP TBIO KPAO TD XL
SUBJECT: AMBASSADORS TO THE CARIBBEAN DISCUSS HIV/AIDS AND 
PARTNERSHIPS COMPACT 
 
SENSITIVE BUT UNCLASSIFIED; PLEASE PROTECT ACCORDINGLY 
 
¶1.  (SBU) SUMMARY: At the Seventh Annual Chiefs of Mission 
Conference on HIV/AIDS in the Caribbean, eight U.S. Ambassadors 
discussed the future of U.S. regional assistance in the fight 
against HIV/AIDS.  Focusing on the Partnership Compacts envisaged 
under PEPFAR II legislation, the Ambassadors asked the Office of the 
Global AIDS Coordinator for guidance on the role of Chiefs of 
Mission in developing the Compacts and the designation of someone to 
lead the process.  The Ambassadors also emphasized the importance of 
bilateral engagement on HIV/AIDS in non-PEPFAR focus countries, as 
opposed to a strictly regional approach.  In addition to offering 
the Ambassadors an opportunity to make recommendations about the 
Compact development process, the conference included a number of 
presentations from local and regional experts and officials, 
including Prime Minister Manning.  END SUMMARY 
 
¶2.  (U) On October 22-23, Embassy Port of Spain hosted the Seventh 
Annual U.S. Chiefs of Mission Conference on HIV/AIDS in the 
Caribbean.  The conference brought together U.S. ambassadors and 
officials from eight embassies, as well as U.S. Agency for 
International Development (USAID), Centers for Disease Control 
(CDC), and Department of State representatives from Washington and 
the wider Caribbean region.  The conference was open to officials 
from the GOTT and local NGOs on the first day.  During the second 
day, USG participants engaged in small group discussions about 
Partnership Compacts and the future of USG support for the fight 
against HIV/AIDS in the region.  Speaker presentations from day one 
are posted on the conference website at http: http:// 
www.conference- registration.state.gov/caribbeancom/index.cfm . 
 
¶3.  (U) The conference theme was "Maintaining the Momentum in 
HIV/AIDS Prevention, Care & Treatment in the Caribbean."  Conference 
goals were three-fold: to give participants an understanding of the 
progress in the region to date; to pinpoint the key challenges 
remaining; and to begin a dialogue that will ensure continued 
collaboration in the fight against HIV/AIDS under the recently 
re-authorized President's Emergency Plan for AIDS Relief (PEPFAR 
II).  The conference included remarks by Prime Minister Patrick 
Manning, UNAIDS Caribbean Regional Director Dr. Karen Sealey, 
State's Assistant Global AIDS Coordinator Michele Moloney-Kitts, 
T&T-based Medical Research Foundation Director Dr. Courtenay 
Bartholomew, Dr. Amalia Del Reigo of the Pan American Health 
Organization's HIV/AIDS Caribbean Office, as well as presentations 
on vulnerable populations, PEPFAR, and regional priorities. 
 
Regional Progress, But No Room for Complacency 
--------------------------------------------- - 
¶4.  (U) Ambassador Austin opened the conference on a positive note 
by spotlighting the progress in the fight against HIV/AIDS, 
including the fact that the prevalence rate in the region appears to 
have stabilized at 1.1 percent, according to UNAIDS.  Heralding the 
50 percent reduction in the number of HIV/AIDS related deaths in T&T 
due to the national antiretroviral program, Prime Minister Manning 
also emphasized the positive and thanked the U.S. for its leadership 
in the fight against HIV/AIDS.  He also noted the importance of 
international cooperation on issues of global significance, such as 
HIV/AIDS, citing the recent multilateral efforts to tackle the 
global financial situation as a good example. 
 
¶5.  (U) The Prime Minister and the speakers that followed him, 
though, emphasized there is no room for complacency, as the epidemic 
continues to take a significant toll.  Sealey helped put this 
message in perspective by noting that 38 Caribbean citizens died of 
AIDS everyday in 2007 and 55 were newly infected.  Sealey called not 
only for efforts to "maintain the momentum," but to "intensify" it 
in order to "turn off the tap of infections."  Echoing Prime 
Minister Manning's call for collaboration, Sealey suggested 
collective action would help the Caribbean maintain its momentum and 
address ongoing challenges.  She commended the Pan Caribbean 
Partnership Against HIV/AIDS (PANCAP) for its leadership and 
heralded it as the only sustained regional partnership against this 
scourge in the world.  She further emphasized the need to continue 
 
PORT OF SP 00000535  002 OF 004 
 
 
such resource and knowledge sharing to improve surveillance systems, 
encourage behavior modification, and manage the growing financial 
burden of care and treatment. 
 
¶6.  (U) Similarly, Dr. Morris Edwards of PANCAP, delivering remarks 
on behalf of Denzil Douglas, the Prime Minister of St. Kitts and 
Nevis and the CARICOM Minister with responsibility for health, 
pointed to two critical challenges facing the region -- preventing 
new infections and reducing stigma and discrimination.  PANCAP's 
Second Strategic Framework, he noted, focuses on using education and 
other means to change attitudes towards people living with AIDS and 
encouraging behavior modification. 
 
¶7.  (U) Speaking about vulnerable populations, several panelists 
expressed concern about the level of stigma and discrimination in 
Caribbean societies, often abetted by public policies that fail to 
protect basic human rights.  Stigma and discrimination seriously 
hinder efforts to improve surveillance, care, treatment, and 
prevention.  Further, the stigma surrounding HIV/AIDS undercuts 
efforts to promote awareness and modify behavior, while perpetuating 
discrimination.  Local participants encouraged audience members and 
U.S. government officials to expand their definition of vulnerable 
populations and consider deportees as well as the prison population 
in their plans to fight HIV/AIDS.  With respect to deportees, the 
question was raised as to which government should take 
responsibility for testing and treating these individuals (who may 
have been infected in the U.S.).  Sharon Mottley, Chief Operations 
Officer for the Caribbean Coalition of National AIDS Program 
Coordinators (CCNAPC), called for high-level support for policies to 
protect vulnerable populations and improve access to treatment. 
Mainstreaming testing, treatment and care into public health 
facilities, as opposed to establishing separate HIV/AIDS clinics, 
was raised as one way to improve access to care in countries where 
stigma discourages persons from seeking assistance. 
 
The Future of USG Assistance 
---------------------------- 
¶8.  (U) Audience members were pleased to learn about PEPFAR from 
U.S.-based officials charged with administering it.  Moloney-Kitts 
and Dr. Deborah Birx, Director of the Centers for Disease Control's 
Global AIDS Program, talked about PEPFAR, its accomplishments to 
date and goals for the future.  Chandra Baier and Julia Roberts, 
PEPFAR coordinators in Haiti and Guyana respectively, discussed 
specific successes targeting vulnerable populations under the PEPFAR 
program despite the lack of surveillance data to guide programming. 
 
 
¶9.  (U) Moloney-Kitts noted that the second phase of PEPFAR will 
usher in a new era in assistance.  Managing that assistance through 
bilateral and regional Partnership Compacts, the U.S. government 
will collaborate with host country officials, regional entities and 
civil society organizations to identify key issues and strategic 
initiatives that build sustainable local capacity to fight the 
HIV/AIDS epidemic.  According to Moloney-Kitts, the Compacts will 
provide a means of increasing the visibility and strengthening the 
voice of civil society in the fight against HIV/AIDS.  Once local 
support systems are strong enough to provide treatment and care as 
well as to conduct prevention activities, U.S. assistance will 
decrease.  Local participants welcomed the news about PEPFAR II and 
were particularly pleased to learn that the new legislation lifts 
the U.S. immigration ban on immigrant visa applicants who are HIV 
positive. 
 
¶10.  (SBU) In a more detailed presentation delivered only to USG 
participants, Moloney-Kitts outlined the key principles, financial 
framework, and policy goals of the Partnership Compacts.  In order 
to advance the Compact development process, she noted a number of 
critical elements need to be determined by USG personnel working in 
the region in collaboration with local counterparts.  Specifically, 
she also suggested that issues of accountability, partnership, 
bilateral versus regional engagement and policy reform should be 
addressed by regional staff. 
 
 
PORT OF SP 00000535  003 OF 004 
 
 
¶11.  (SBU) Using the National Issues Forums model, which encourages 
dialogue about complex issues and helps participants find common 
ground, the USG representatives then broke into three small groups 
to discuss the Partnership Compact concept.  Specifically, the 
groups were asked to make recommendations on how to form effective 
partnerships with regional and/or host country governments and NGOs 
that would build local capacity and encourage policy change to 
advance the fights against HIV/AIDS.  Participants reviewed three 
different partnership approaches, discussed their merits, sought 
common ground, and worked to develop a best practice recommendation 
for both Washington and the compact development teams. 
 
¶12.  (SBU) At the conclusion of the small group sessions, 
participants reconvened to discuss their conclusions in plenary. 
Three key recommendations were made to help drive the Compact 
development process forward.  First, while regional cooperation is 
important, bilateral support for the fight against HIV/AIDS is 
paramount.  In their meeting with Ambassador Dybul and separately in 
meetings with the region's Ambassadors, Caribbean health ministers 
expressed a preference for bilateral assistance.  Given the increase 
in funding under PEPFAR II, expectations in the region are high that 
U.S. assistance levels will increase.  It was agreed that any 
regional approach must have a substantial bilateral component, to 
include a uniform, minimum level of assistance which would be made 
available to each partner nation in the Regional Caribbean Compact, 
regardless of that nation's size.  The regional elements could 
function as an "umbrella" or "chapeau," guiding bilateral efforts, 
but the bilateral piece of the Compact is critical to demonstrate 
the USG's commitment. 
 
¶13.  (SBU) Second, participants called for greater involvement by 
Chiefs of Mission in the Compact development process.  The 
Ambassadors, in particular, were concerned about the perceived lack 
of communication about the Compact process and the seeming lacuna 
involving the need to clearly articulate the role of the Ambassadors 
in gaining host country buy-in.  Further, few understood who had 
overall responsibility for the Compact process.  There was a clear 
call for technical agencies to engage Chiefs of Mission more 
effectively on this issue.  Only through improved communication will 
the Ambassadors be able to promote the Compact agenda and help build 
effective partnerships to support it.  One group suggested that the 
Office of the Global AIDS Coordinator develop a briefing paper and 
talking points to assist the Ambassadors as they reach out to host 
governments and potential partners. 
 
¶14.  (SBU) Third, a regional steering committee should be formed to 
guide the development and implementation of the Caribbean Compact. 
The committee would have national and regional representation and, 
ideally, Ambassadorial leadership. In discussing CARICOM's 
involvement in such a committee and in the regional Partnership 
Compact more broadly, several participants raised concerns how 
CARICOM could be held accountable for the Compact's results. 
 
Comment: Many Successes, Much to Do 
----------------------------------- 
 
¶15.  (SBU) The Chiefs of Mission Conference on HIV/AIDS succeeded on 
many fronts.  For the local audience, it offered an opportunity to 
engage with the key U.S. government agencies and to learn about the 
future of U.S. assistance under PEPFAR II.  Given the high level USG 
participation, the conference visibly demonstrated the U.S. 
commitment to the fight against HIV/AIDS in the Caribbean, 
generating favorable coverage in local media and press commentary on 
the need to control the spread of the disease. 
 
¶16.  (SBU) The conference also importantly afforded the first 
opportunity for CDC, USAID, and State Department officials involved 
in drafting the Partnership Compact documents to hold direct talks 
on a number of critical issues.  Ambassadors were able to raise 
their concerns to key personnel from the Office of the Global AIDS 
Coordinator, CDC's Global AIDS Program, and USAID's Office of 
HIV/AIDS.  The dialogue initiated at the conference will help move 
the regional Partnership Compact forward.  The U.S. Chiefs of 
 
PORT OF SP 00000535  004 OF 004 
 
 
Mission Conference on HIV/AIDS offers a critical venue for dialogue 
on a regional level and an opportunity for USG personnel to meet 
about key issues that require substantial interagency coordination. 
As an indication of the conference's value to U.S. engagement in the 
region, Santo Domingo offered to host the Eighth Annual U.S. Chiefs 
of Mission Conference on HIV/AIDS in the Caribbean in 2009. 
 
AUSTIN