Source document: https://docs-lawep.s3.us-east-2.amazonaws.com/1697629177791.pdf (Antigua and Barbuda)
Country progress report - Antigua and Barbuda Global AIDS Monitoring 2018 Contents Overall - Fast-track targets HIV testing and treatment cascade - Ensure that 30 million people living with HIV have access to treatment through meeting the 90-90-90 targets by 2020 Prevention of mother-to-child transmission - Eliminate new HIV infections among children by 2020 while ensuring that 1.6 million children have access to HIV treatment by 2018 HIV prevention; Key populations - Ensure access to combination prevention options, including pre-exposure prophylaxis, voluntary medical male circumcision, harm reduction and condoms, to at least 90%% of people by 2020, especially young women and adolescent girls in high-prevalence countries and key populations—gay men and other men who have sex with men, transgender people, sex workers and their clients, people who inject drugs and prisoners Gender; Stigma and discrimination - Eliminate gender inequalities and end all forms of violence and discrimination against women and girls, people living with HIV and key populations by 2020 Knowledge of HIV and access to sexual reproductive health services - Ensure that 90%% of young people have the skills, knowledge and capacity to protect themselves from HIV and have access to sexual and reproductive health services by 2020, in order to reduce the number of new HIV infections among adolescent girls and young women to below 100 000 per year Social protection - Ensure that 75%% of people living with, at risk of and affected by HIV benefit
 from HIV-sensitive social protection by 2020 Community-led service delivery - Ensure that at least 30%% of all service delivery is community-led by 2020 HIV expenditure - Ensure that HIV investments increase to US$ 26 billion by 2020, including a quarter for HIV prevention and 6%% for social enablers Empowerment and access to justice - Empower people living with, at risk of and affected by HIV to know their rights and to access justice and legal services to prevent and challenge violations of human rights AIDS out of isolation - Commit to taking AIDS out of isolation through people-centred systems to improve universal health coverage, including treatment for tuberculosis, cervical cancer and hepatitis B and C Overall Fast-track targets Progress summary Antigua and Barbuda continues to strive toward the achievement of the 90/90/90 targets set by UNAIDS and adopted by the Organisation of the Eastern Caribbean States (OECS) and success toward reaching the Sustainable Development Goals.
The process to decentralise HIV care and treatment into Primary Health care continues in an effort to help the country augment the HIV intervention with strengthening of the prevention initiatives.

In addition to routine HIV-related activities, a number of Cross-cutting measured have been taken to increase the intensity of the HIV response in the country.
The interventions included activities that were carried out to mitigate the transmission of HIV through Community Mobilisation and partnership between government and non-governmental Organisations as well as a wide cross-section of individuals and agencies, inclusive of organisations reaching key populations with HIV prevention services.
This narrative will show some of the innovative measures that have been used to ensure that HIV-related service reach key population as well as people in the general population that may have unrealised risk of contracting HIV with HIV prevention knowledge and skills and other relevant services.
HIV testing and treatment cascade Ensure that 30 million people living with HIV have access to treatment through meeting the 90-90-90 targets by 2020 Progress summary ARVs are available in the country, free of charge and are accessible at the Mount St. John Medical Centre Pharmacy.

Antigua & Barbuda has commenced the Treat ALL Initiative and is working feverishly with Key Civil Society Organizations to ensure the achievement of the 90 90 90 targets.
This partnership is critical and building the capacity of CSOs in the Clinical Management of PLHIV with emphasis on Adherence is priority as their role in not only reaching Key populations and initiate them into care but sustainability of their efforts to ensure retention in Care of persons within their scope of influence.
Policy questions (2017) Is there a law, regulation or policy specifying that HIV testing: a) Is solely performed based on voluntary and informed consent Yes b) Is mandatory before marriage No c) Is mandatory to obtain a work or residence permit No d) Is mandatory for certain groups No What is the recommended CD4 threshold for initiating antiretroviral therapy in adults and adolescents who are asymptomatic, as per MoH guidelines or directive, and what it the implementation status?
No threshold; TREAT ALL regardless of CD4 count; Implemented countrywide Does your country have a current national policy on routine viral load testing for monitoring antiretroviral therapy and to what extent is it implemented?
a) For adults and adolescents Yes, fully implemented b) For children Yes, fully implemented Prevention of mother-to- child transmission Eliminate new HIV infections among children by 2020 while ensuring that 1.6 million children have access to HIV treatment by 2018 Progress summary All pregnant women are offered an HIV test, free of charge during their pregnancy with the emphasis on 1st trimester or initial visit and repeat testing in the 3rd Trimester.
All pregnant mothers tested positive for HIV are treated following the National HIV and AIDS care, Treatment and Prevention Guidelines (Option B+).

ALL HIV diagnosed and exposed babies are monitored at the Medical Outpatient Paediatric Clinic and treated according to the National HIV and AIDS Care, Treatment and Prevention Guidelines, free of charge.
All children diagnosed with HIV attend the Medical Outpatient Paediatric HIV Clinic and are monitored and treated until the age of 18yrs, while All exposed babies are monitored until they are cleared (Negative ELIZA by 24mths).

The Government of Antigua & Barbuda continues to provide Free Formula for all exposed and confirmed cases for a period of 6 months with possibility for continuation of supply due to economic situation.

This program is closely monitored by the EMTCT Coordinator.
In order to meet this Commitment a partnership was established and sustained between the Maternal and Child Health Nurses and the EMTCT Coordinator.

Policy questions (2016) Does your country have a national plan for the elimination of mother-to-child transmission of HIV?

No Do the national guidelines recommend treating all infants and children living with HIV irrespective of symptoms and if so, what is the implementation status of the cut-off?
Treat All; Implemented countrywide HIV prevention; Key populations Ensure access to combination prevention options, including pre-exposure prophylaxis, voluntary medical male circumcision, harm reduction and condoms, to at least 90%% of people by 2020, especially young women and adolescent girls in high-prevalence countries and key populations—gay men and other men who have sex with men, transgender people, sex workers and their clients, people who inject drugs and prisoners Progress summary Post exposure prophylaxis, male and female condoms and others HIV prevention commodities are offered to the public, inclusive of key population, free of charge.
Key population are reached in collaboration with civil society.

Strategic interventions geared towards target populations are executed by Civil Society Organizations with support by the National AIDS Secretariat.

These targeted interventions roll out at community levels have proven to be impactful and include persons from key population in their prevention team from design to execution.
Policy questions: Key populations (2016) Criminalization and/or prosecution of key populations Transgender people Neither criminalized nor prosecuted Sex workers Selling sexual services is criminalized Men who have sex with men Yes, imprisonment (14 years - life) Is drug use or possession for personal use an offence in your country?
Possession of drugs for personal use is specified as a criminal offence Legal protections for key populations Transgender people No Sex workers No Men who have sex with men - People who inject drugs No Policy questions: PrEP (2017) Has the WHO recommendation on oral PrEP been adopted in your country's national guidelines?
No, guidelines have not been developed Gender; Stigma and discrimination Eliminate gender inequalities and end all forms of violence and discrimination against women and girls, people living with HIV and key populations by 2020 Progress summary The elimination of violence and discrimination against women and girls are mainly addressed through the efforts of the Directorate of Gender Affairs while key population are reach in partnership with civil society.
Therefore, the government through the Directorate of Gender Affairs and Civil Society continue to advocate for the elimination of all forms of violence and discrimination against women and girls, people living with HIV and key population.

One of the greatest accomplishment for 2017 was the opening of the Support and Referral Centre (SARC).

The unit is committed to effectively responding to various types of gender inequality through education, advocacy, and the provision of quality care and services.
The programme offers a range of prevention, intervention, and responsive services that will encourage and promote a holistic approach to treatment, healing and an individual’s overall mental and physical health.

All the services are available to individuals directly affected by gender-based violence (GBV) and trafficking, their families, and the community.
Policy questions (2016) Does your country have a national plan or strategy to address gender-based violence and violence against women that includes HIV No Does your country have legislation on domestic violence*?

Yes What protections, if any, does your country have for key populations and people living with HIV from violence?
General criminal laws prohibiting violence Programmes to address intimate partner violence* Interventions to address police abuse Interventions to address torture and ill-treatment in prisons Does your country have policies in place requiring healthcare settings to provide timely and quality health care regardless of gender, nationality, age, disability, ethnic origin, sexual orientation, religion, language, socio-economic status, HIV or other health status, or because of selling sex, using drugs, living in prison or any other grounds?
Yes, policies exists and are consistently implemented Knowledge of HIV and access to sexual reproductive health services Ensure that 90%% of young people have the skills, knowledge and capacity to protect themselves from HIV and have access to sexual and reproductive health services by 2020, in order to reduce the number of new HIV infections among adolescent girls and young women to below 100 000 per year Progress summary HIV Prevention Education activities are held in schools in collaboration with the Ministry of Education, Youth and Sports and the Barbuda Council.
These activities are conducted in varying primary and secondary schools.

The students are informed about HIV and strategies to prevent transmission in appropriate language.

Additionally, education sessions are held in collaboration with government and non- governmental organisation in an effort to continue to raise HIV awareness throughout Antigua and Barbuda.
Policy questions (2016) Does your country have education policies that guide the delivery of life skills-based HIV and sexuality education, according to international standards, in: a) Primary school Yes b) Secondary school Yes c) Teacher training Yes Social protection Ensure that 75%% of people living with, at risk of and affected by HIV benefit from HIV-sensitive social protection by 2020 Progress summary A government funded subsistence programme is available through AIDS Secretariat and all PLHIV are referred to others social programmes as the need arises.
The government has in place a Clinical Care Team, which comprises of a HIV Case Manager with responsibilities of ensuring the social protection of All clients are realized and attached to the National AIDS Secretariat is the Human Rights Desk for PLHIV and social protection is one of its mandate.

The National Program also engages in the planning, development and policing of the Nations’ Social Protection Policy.
Additionally, the National AIDS Secretariat provides a monthly food package for all deserving PLHIV, free formula for babies diagnosed with HIV or babies of supposedly exposed mothers until confirmed Negative ELIZA test, assistance with purchasing gas, medication and needed specialised medical services.

This program is made possible by an annual budgeted subsidy by the Government of Antigua & Barbuda.

Policy questions (2016/2017) Yes and it is being implemented a) Does it refer to HIV?
Yes b) Does it recognize people living with HIV as key beneficiaries?

Yes c) Does it recognize key populations (sex workers, gay men and other men who have sex with men, people who inject drugs, transgender people, prisoners) as key beneficiaries?

Yes d) Does it recognize adolescent girls and young women as key beneficiaries?

Yes e) Does it recognize people affected by HIV (children and families) as key beneficiaries?

Yes f) Does it address the issue of unpaid care work in the context of HIV?
Yes What barriers, if any, limit access to social protection programmes in your country?

Social protection programmes do not include people living with HIV, key populations and/or people affected by HIVComplicated proceduresFear of stigma and discriminationLack of documentation that confers eligibility, such as national identity cardsHigh out-of-pocket expensesAll laws are general regarding access to social protection.
Community-led service delivery Ensure that at least 30%% of all service delivery is community-led by 2020 Progress summary Through partnership with community groups, civil society and others agencies, HIV prevention activities are offered.

The government is currently working towards the de- centralisation of HIV treatment and care services into primary health care.
This initiative is being strengthen under the present Global Fund Grant as CSOs are being equipped to take ownership and a decisive role in the national response.

The strengthening of CSOs in the areas of legal literacy, advocacy and development and implementation of service delivery directory for key populations under this Global Fund Grant is well-timed and CSOs are engaged in the creation of a sustainability plan.
To further strengthen this commitment, a renewed partnership now exist between the National AIDS Secretariat and CSOs as CSOs are now poised to offer HIV Rapid Testing at their sites and participate in HIV Care and Treatment Services.

To ensure that HIV Rapid Testing is accessible by key population CSOs have been offering HIV Rapid Testing in the brothels, clubs and private homes for the FSW at a time convenient to them.
Policy questions (2017) Does your country have a national policy promoting community delivery of antiretroviral therapy?

Yes What safeguards in laws, regulations and policies, if any, provide for the operation of CSOs/CBOs in your country?
Services to key populations can be provided by CSOs/CBOs Reporting requirements for CSOs/CBOs delivering HIV services are streamlined Number of condoms and lubricants distributed by NGOs in the previous year a) Male condoms: - b) Female condoms: - c) Lubricants: - HIV expenditure Ensure that HIV investments increase to US$ 26 billion by 2020, including a quarter for HIV prevention and 6%% for social enablers Progress summary The Government of Antigua and Barbuda had invested 1.3 M ECD in HIV Treatment, Care and Support.
The Pam American Health Organisation (PAHO) provided Antigua and Barbuda HIV related activities with financial support, as follows: 1.Integration of HIV into PHC US$5,193.87 (Jan 18-20,2017) 2.HIV Testing Equipment/Supplies 6 Nov 2017 (arrived Dec 2017) US$7,780.00 Empowerment and access to justice Empower people living with, at risk of and affected by HIV to know their rights and to access justice and legal services to prevent and challenge violations of human rights Progress summary There is a human rights desk attached to the AIDS Secretariat, Ministry of Health, Wellness and the Environment.
The HR Desks serves as the focal point on all aspects of Human Rights violations relevant to Persons Living with HIV and performs the following functions: a.
Oversee the implementation of human rights program and Initiate various human rights projects and activities c. Monitor and maintain records/files of cases involving violation of human rights allegedly committed by State and non-State actors, as reported by PLH groups and individuals through any means (news reports, walk-in complaints, electronic communications, etc.)
d. Receive and consolidate reports/complaints on violation of human rights allegedly committed and assist in the referral of complaints to appropriate investigating offices/bodies; e. Enhance partnerships and cooperation with concerned government entities, local community organizations, NGOs, and private and or civic oriented groups towards advancing the cause of human rights; f. Represent the MoH in dialogues, meetings, conferences, consultations and the like, on human rights concerns; g. Work in collaboration with other Human Rights organizations locally, regionally and internationally h. Serve as focal person in the implementation, monitoring and accomplishment of plans and activities on the promotion and protection of human rights; i.
Receive complaints on violation of human rights and make all necessary referrals j.

Maintain records/data/statistics of HR violation/s within area of responsibility Reports of Human Rights Violations can be made to the Human Rights Desk for the purpose of reporting a complaint of HIV–related Stigma and Discrimination for the purpose of information or seeking redress for the act of Discrimination.

Complaints may remain anonymous for information if so desired by the client.
The process entails the completion of an Initial Human Rights Complaint Form followed by a Detailed Complaint Form.

Clients or anyone witnessing an act of discrimination can contact the HR Office and file a complaint.

Additionally, clients or persons witnessing an act of discrimination can send text advising of complaint and request an in-person interview to have complaint process.
Following Case submission to the Human Rights Desk all relevant persons, institutions or organizations are contacted within 14 working days.
All Human Rights Complaints are examined under a three-step process of mediation, investigation and adjudication under strict privacy and confidentiality Policy questions (2016) In the past two years have there been training and/or capacity building programmes for people living with HIV and key populations to educate them and raise their awareness concerning their rights (in the context of HIV) in your country?
Yes, one-off activities Are there mechanisms in place to record and address cases of HIV-related discrimination (based on perceived HIV status and/or belonging to any key population)?

Reports of Human Rights Violations can be made to the Human Rights Desk for the purpose of reporting a complaint of HIV–related Stigma and Discrimination for the purpose of information or seeking redress for the act of Discrimination.

Complaints may remain anonymous for information if so desired by the client.
The process entails the completion of an Initial Human Rights Complaint Form followed by a Detailed Complaint Form.

Clients or anyone witnessing an act of discrimination can contact the HR Office and file a complaint.

Additionally, clients or persons witnessing an act of discrimination can send text advising of complaint and request an in-person interview to have complaint process.
Following Case submission to the Human Rights Desk all relevant persons, institutions or organizations are contacted within 14 working days.

All Human Rights Complaints are examined under a three- step process of mediation, investigation and adjudication under strict privacy and confidentiality.

What accountability mechanisms in relation to discrimination and violations of human rights in healthcare settings does your country have, if any?
Complaints procedure Procedures or systems to protect and respect patient privacy or confidentiality What barriers in accessing accountability mechanisms does your country have, if any?
Mechanisms do not function Affordability constraints for people from marginalized and affected groups Awareness or knowledge of how to use such mechanisms is limited AIDS out of isolation Commit to taking AIDS out of isolation through people- centred systems to improve universal health coverage, including treatment for tuberculosis, cervical cancer and hepatitis B and C Progress summary The process of integrating HIV services into primary health care has commenced.
Through support from PAHO and the Global fund we have completed the training of health care providers and CSO in HIV Care and treatment, HIV counselling and Rapid testing for HIV and Syphilis.
The training of Midwives in the offering of services to ensure all pregnant women are tested for HIV, STI and Hepatitis B. Additionally, we are working with three Civil Society organisation Antigua Planned Parenthood Association, Women Against Rape and Health, Hope and HIV Network to offer HIV Care and treatment as a part of their baskets of services All PLHIV are tested for TB, Hepatitis B as well as cervical cancer among women as part of our baseline testing.
Efforts to increase representation of the affected population in decision making continues as Key populations are given every opportunity to express their thoughts on matters specific to theirs and also at national and policy levels.
Policy questions (2016) Is cervical cancer screening and treatment for women living with HIV recommended in: a) The national strategy, policy, plan or guidelines for cancer, cervical cancer or the broader response to non-communicable diseases (NCDs) No b) The national strategic plan governing the AIDS response Yes c) National HIV-treatment guidelines Yes What coinfection policies are in place in the country for adults, adolescents and children?
Intensified TB case finding among people living with HIV TB infection control in HIV health-care settings Co-trimoxazole prophylaxis Hepatitis B screening and management in antiretroviral therapy clinics