The Eastern Caribbean Community Action Project II (EC-CAP II) is based on the premise that access to HIV services for most at risk populations can be achieved through evidence-based programming, community and civil society involvement, stronger engagement with national programs and enhanced behavior change interventions. This model has demonstrated how key elements of a structured HIV prevention, testing and care program based upon a peer-led strategy can come together as a strong collaborative endeavor between the national authorities and civil society. This type of approach will ultimately lend itself to a much more effective and sustainable approach for small island states. EC-CAP II will engage in both direct service delivery and the provision of technical assistance.

EC-CAP-II, is designed to the follow-on to EC-CAP and will continue and build upon the successes already achieved under EC-CAP within the scope of the Partnership Framework.

The strategies that guide project implementation include: 1) A combination prevention approach ensuring a comprehensive package of services; 2) Promoting and implementing evidence-based interventions informed by strategic (qualitative) information, including special studies and focused data collection; 3) Providing small grants and related capacity building to Non-Governmental Organisations, Community-Based Organisations, Faith Based Organisations and local entities; 4) Implementing community based rapid testing and bi-directional referral systems; and 5) Promoting access to care and support, including PWP.

The project will continue to address individual risk perception, promote individual behavior change to prevent HIV transmission, and increase individual health seeking behaviors (testing, care, treatment) through peer to peer interventions. EC-CAP-II is designed to allow for significant creativity and innovation within each activity. This is particularly important as efforts are made to expand and consolidate in the four islands which were part of the EC-CAP, while using lessons learned rolling activities in the three new countries. The project will complement and enhance the services provided by the public health care system by contributing to the implementation of following activities: community based behavior change interventions; community based HIV rapid testing; community based care and support, including Prevention with Positives; referrals to and from public clinics that provide HIV testing, care, and treatment, when appropriate.

This will be year two of this program and it is envisioned that the implementing partner would have developed a strategy for strengthening prevention with positive (PwP) services and that effective models of care and support services to PLHIV that that link facility and community based services will be replicated in Barbados and the six OECS countries.

The TBD partner will build capacity of civil society through grants to community-based organizations to increase the provision of palliative care to include holistic care and support for PLWHA, hospice care to terminally ill, and home-based care that includes nutritional and psychosocial support. The implementing partner will focus on increasing the CBOs' capacity to implement the program.

Review and update package of prevention for positives interventions.

The implementing partner will provide technical assistance and training to MoH staff and other suitably identified persons to use HIV rapid tests and to strengthen referrals between testing services, prevention services and community care and support services. This includes training health care providers and others to provide non discriminatory, non stigmatising confidential HIV CT Services to MARPS; training community members (and animators) to deliver HIV testing, and to promote CT to MARPS.

During FY 2011 the implementing partner will continue to collaborate with the Ministries of Health to expand the network of community-based testing sites where relevant. The implementing partner will work with the CDC and will continue to collaborate with the MOH and the NAP towards the decentralization of CT and the continued roll-out CBCT using the HIV rapid test at additional sites across each of the countries that EC-CAP II will be implemented in.

The EC-CAP II project is built upon a peer outreach or Animator model and will continue to utilize and adjust the selection, training, and support of the existing and new community-based Animators and groups who provide prevention, testing, care and support services, referrals, prevention with positives and/or adherence counseling, and advocacy for PLWHA to reduce stigma and discrimination in order to increase coverage and access to services.

As EC-CAP II steadily increases the number of persons reached with behavior change interventions, and more data are being collected including size estimation surveys, the issue of scaling up coverage and frequency of interventions will become a major concern. Different outreach approaches and different behavior change interventions will need to be tailored so that outreach and behavior change interventions can access persons who do not want to be identified as sex workers, MSM or any other high risk group due to desires for anonymity/confidentiality and concerns with stigma and discrimination. Interventions may need to focus not only at geographic sites, but also virtual sites where persons gather, such as internet chat rooms, and make use of pervasive technologies such as mobile telephony in order to facilitate follow-up and message reinforcement.