Combating HIV/AIDS in the region-
CARICOM signs MOU with Clinton Foundation By Shirley Thomas
Guyana Chronicle
August 27, 2002

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The Caribbean has cut a deal. It has a plan, but insufficient resources. Let us find out what the deficit is, and go and get the money' - former U.S. President Bill Clinton

AS THE Caribbean Community seeks to address the critical HIV/AIDS pandemic, a Memorandum of Understanding has been signed between the Community and the William J. Clinton Presidential Foundation.

The Memorandum of Understanding (MOU), signed last week, lays the basis for collaboration and support for CARICOM's efforts at stemming the spread of the disease.

Signing the MOU, which paves the way for the Foundation to assist CARICOM and its member states to chart The 'Road Map' for Implementing the Regional HIV/AIDS Treatment and Care Plan, was Dr. Carla Barnett, Deputy Secretary General of CARICOM.

The signing, which took place at the Georgetown-based CARICOM Secretariat, was witnessed by a three-member team from the Clinton Foundation, headed by Mr. Ira C. Magaziner, who will be leading the Clinton Foundation AIDS initiative. Others were Ms. Lynn M. Margherior and Ms. Maureen A. Bisognano.

Mr. Magaziner told reporters at the ceremonial signing: "Our hope is to assist you in mobilising the resources, both human and financial, and to help those people get treatment that they need and to help in prevention programmes that can ensure that the number of persons who are being infected with HIV/AIDS goes down dramatically."

"In concrete terms," he said, "we are looking to try to assist in the development of the delivery systems and the public health infrastructure that's necessary to support the delivery of treatments. Simply having the drugs is not sufficient without appropriate delivery systems to make sure that the drugs are delivered properly and treatment is delivered properly to people who need it."

Magaziner said the Foundation also plans to help build the human resource infrastructure the Caribbean Community needs. "We need to support that system; the quality infrastructure that's necessary to ensure that as you scale off rapidly in the delivery of treatment, that it is delivered with high quality," he stressed.

He pointed to statistics emanating from the region, which show that there are more than 500,000 people in the Caribbean now living with HIV/AIDS. He also noted that of a total of about 43 million people living with HIV/AIDS globally, 41 million live in developing countries, and at most - about 30,000 of those are receiving treatment.

Magaziner said that it is the team's intention to begin work to benefit the Caribbean Community immediately.

"This is an urgent problem; there are hundreds of people dying every day. It's a problem that you can't wait and say we'll have our next meeting six months from now. You have to start right away and work very intensively."

Among the wide range of benefits for CARICOM outlined in the MOU are:

** Making available technical experts to work at country, sub- regional and regional levels to assist relevant officials to prepare integrated treatment, care and prevention plans that can be submitted and used in discussions with potential donors, and with pharmaceutical companies;

** the facilitation of the development of quality management and information sharing mechanisms that will allow treatment and care programmes to "scale up" rapidly while continuously improving quality;

** assistance in the development and implementation of pharmaceutical procurement strategies including assistance in negotiations with pharmaceutical companies that produce patented and generic drugs.

Magaziner said the intention is to help the Caribbean people get those drugs at the most economic levels as possible, so that they are affordable to the societies of the Caribbean. The Foundation will also try to help marshal global resources, both human and financial, in support of those goals.

"The key factor as we start to roll treatment out to people, is to make sure it works and it's organised well, because those who are giving the money hopefully, are most concerned that the money is spent in a way that is effective," he said.

He continued: "The worst thing we could to do is try to start treating people with antiretroviral drugs and have the drug treatment stop. That will mean that the virus will develop immunity to those drugs, and we will be facing yet a different problem where we have to develop new drugs when the old drugs don't work."

Magaziner explained that while money is important for the procurement of the drugs, equally important is the organisation to deploy the treatment and the drugs in ensuring that the disease is controlled.

''President William J. Clinton has made the global battle against HIV/AIDS a major area of focus for his Foundation, which is committed to assisting developing countries to develop plans, mobilise international resources and develop their internal human resources to defeat the epidemic."

The MOU states that President Clinton has recognised the efforts in the Caribbean to arrest and eliminate the HIV/AIDS epidemic, and the importance of these efforts to the United States, given the proximity of the Caribbean to the United States, and the frequent interface of their populations.

Therefore, Clinton responded willingly to an invitation by CARICOM for the Clinton Foundation to enter into a Partnership with the Pan Caribbean Partnership.

Magaziner recalled that when former President Clinton was in Barcelona, Spain, he was tremendously impressed with the CARICOM report put forward by the Prime Minister of St. Kitts and Nevis, Dr. Denzil Douglas.

Dr. Douglas has quasi Cabinet responsibility for Health, including HIV/AIDS and Human Resource Development in CARICOM.

Magaziner said that against this background, Mr. Clinton asked him directly at the meeting in Barcelona to immediately get in touch with the CARICOM Secretariat and Dr. Douglas with the view of assisting the region.

Magaziner commented: "The teams that you have working at CARICOM have understood the dimension of this (HIV/AIDS) problem. You have mobilised your leadership in a very forceful way, and you have advanced beyond most theories in the world in really developing both the resolve and the plans to confront this crisis."

He acknowledged that there are other groups and foundations working similarly in the fight against HIV/AIDS, and said that the Clinton Foundation is working with all of those groups to try to bring assistance.

"This is a crisis where there is more than enough work for everybody, and the important thing is to follow the lead," he noted.

He said that what is required is collaboration among many groups.

"We will look to you to tell us how we could be of help...It should be done under your leadership because you know the problems best in the Caribbean, and we could help mobilise resources for you, but it should be at your direction," the team, leader told CARICOM officials at the opening ceremony.

Dr. Barnett, in welcoming the team from the Clinton Foundation, said that the Secretariat was very pleased to receive them. She said that through the discussions between the representatives of the Foundation and the Secretariat, CARICOM is seeking to establish a firm footing for its relationship with the Foundation, thus the signing of the Memorandum of Understanding by the Secretariat.

"This MOU will lay the basis for collaboration and support as the region seeks to address the HIV/AIDS pandemic which is threatening the socioeconomic fabric of our society," she said.

Barnett noted that HIV/AIDS represents the single most important challenge to the well being and development of the Caribbean region. Moreover, due to the scale, the scope and the complexities involved in addressing the situation, Caribbean Heads of Government had adopted a regional approach involving a significant number of regional and international partners under what is known as the Pan Caribbean Partnership.

The partnership, signed in Bridgetown, Barbados, in February, 2001, includes the Pan American Health Organisation (PAHO), the Caribbean Epidemiology Centre (CAREC), the Caribbean Network of People Living with AIDS, the University of the West Indies, the World Health Organisation, UNAIDS, the United States Agency for International Development (USAID), the Canadian International Development Agency (CIDA), the European Union, and the British Department for International Development.

Barnett said the support and collaboration of all these entities are really critical in addressing the issue.

"It is therefore with the greatest of pleasure that we welcome the representatives of the Clinton Foundation, and invite them to work with us, to support us, as the Caribbean region seeks to address this crisis of global proportions."

She was of the view that the current economic circumstance constrains the ability of Caribbean countries to expand their capacity, operationalise facilities, and to procure the drugs and other technologies necessary to deal comprehensively and effectively with the HIV/AIDS crisis and its effects on their societies.

"We are very pleased that Former President Bill Clinton, a known supporter of the peoples of the Caribbean, has decided to join us at this time, when assistance is so desperately needed," Barnett declared.

She explained that the Barcelona pledge by Clinton was followed by a meeting of the Clinton Foundation with the Prime Minister of St. Kitts and Nevis in St. Kitts on July 20. The ceremony last week was a result of the July 20 discussion.

Noting that the efforts of the Pan Caribbean Partnership are guided by the Regional Strategic Plan and HIV/AIDS, Barnett said that one specific priority area of this plan is the treatment and care for people living with AIDS.

In support of this, the region has been engaged in a process to negotiate, at affordable prices, access to the antiretroviral drugs, which are critical to the treatment of persons living with AIDS.

This effort was led by Dr. Douglas, who reported that the drug companies have agreed to make these drugs available to Caribbean nations at significantly reduced prices.

"But even at these reduced prices, these drugs which are so essential to treatment, are still very costly, particularly when set against the real economic difficulties facing the region at this time," Barnett said.

To this end, the forms of assistance to be made available to the Caribbean Community by the Clinton Foundation, in keeping with the MOU, will respond ideally to the present dilemma of CARICOM countries.

Barnett quoted President Clinton as saying: "The Caribbean has cut a deal. It has a plan, but insufficient resources. Let us find out what the deficit is, and go and get the money."