Our biggest challenge is that the Caribbean has not moved beyond the colonial framework of stratification and class interests to the notion that all people are born with human rights, and that we are building truly democratic societies where people have equal citizenship. As a result, very little progress has been made in implementing the greater involvement of people with HIV and AIDS. People living with HIV and communities most at risk are not at the centre of our HIV response.
Another huge challenge is that our interventions do not focus upstream of risk behaviour, at the core of what makes people vulnerable. We are also more prone to jargon than action when it comes to issues like stigma and discrimination and capacity-building. Our non-governmental organisation (NGO) infrastructure is weak. Funding and initiatives in the region to capacitate civil society responses by affected communities have mainly benefitted third party providers and not built strong indigenous civil society organisations. CSOs responding to HIV are not deeply rooted in local communities; and the NGOs that are well-rooted have been slow to address HIV as an issue.
Political leaders have shown extraordinary timidity in speaking and standing up against discrimination related to HIV. In Trinidad and Tobago, leaders have tried to create distinctions between protecting people from stigma and discrimination based on having HIV and stigma and discrimination related to being part of the social groups most vulnerable to HIV. We need to create more conversation about the humanity of people living with HIV and affected communities. To do so, people in these communities need to become more visible, and that requires creating a safe environment for them to do so.
Finally, we have to convert resources into outcomes. We have had a lot of money invested in the region, but key barriers remain bureaucracy and under spending – so-called “absorptive capacity”. There is a need to foster more innovation, to get resources more quickly behind promising ideas and to be able to evaluate them.