Stigma & Discrimination (S&D) have been described as key drivers of the HIV epidemic in the Caribbean. In fact, they have been identified as major barriers to the universal access to care treatment and support services, which is a critical millennium development goal for the Caribbean and particularly for persons living with HIV as well as most affected and most at risk populations. These "vulnerable groups" bear the brunt of the epidemic and often have rates of infection which are many times higher than the general population. Discrimination makes it difficult to reach these groups with the much needed services and programs which the Caribbean has already mobilized to scale up, in order to address the challenge of HIV on our small region.

The Pan Caribbean partnership against HIV/AIDS (PANCAP), regional leaders and policy makers recognized these barriers and in response have largely agreed to pursue a responsive human rights agenda. The new Caribbean Regional Strategic Framework (CRSF) 2008 2012 which guides the response of the region to the challenge of the HIV epidemic over the next four years, recognizes this barrier and puts an emphasis on developing and "enabling environment" which focuses on the "development of policies, programs and legislation that affirm human rights and counter deep underlying social barriers&". The need for the rights based approach was underscored in the work of PANCAP under the previous CRSF 2002-2007 which highlighted the need for "advocacy, policy development and legislation" around HIV. Research conducted in the region thus far, including national assessments of legal frameworks in several countries and explorations of the ways in which stigma and discrimination are being manifested, underscore the fact that "discrimination against PLHIV" is indeed a critical policy issue. Research also emphasizes a need for a variety of approaches to dealing with S&D.

CARICOM/PANCAP, as the leading regional entity tasked with leading the efforts on HIV/AIDS related policy reform, has embarked upon a mutli-pronged approach to addressing this issue of stigma and discrimination and has secured funding from other sources to cover some aspects of the response. This strategy involves: Legislative & Policy Reform; operationalization of Stigma & Discrimination Unit; development of national level recourse mechanisms; development of tools to measure S&D; research on S&D; development of behavior change and empowerment initiatives and the national level.

While S&D is not in and of itself a separate goal area under the PF, it has been recognized that the high incidence of S&D across this region greatly hinders the success and investments in other areas of the response, especially the provision of prevention, care, treatment and support services. Given its cross-cutting importance, the USG has committed to addressing S&D as an overarching issue. Under the PF, the USG will work closely with CARICOM/PANCAP with the goal to pursue policy reform and behavioral change initiatives to address the pervasive reality of stigma and discrimination in the region, two areas where gaps exist in the technical assistance and financial resources needed to support the response. Efforts in this regard will be for the benefit of all PF countries, with the development of models and best practices that can be shared with all CARICOM/PANCAP member countries.

It is envisioned that by the end of the PF, the USG inputs would have assisted in enabling the countries in the region to enact many of the supporting policies and legislative changes needed to ensure that vulnerable and marginalized persons and groups become much less so and are in fact better supported as productive and valuable members of the Caribbean community. The policy reform efforts should also support simultaneous efforts to strengthen the health systems across the region as they seek to better integrate HIV care and treatment services into primary health care services. Behavior change efforts targeting health care providers, other service providers and the community at large will compliment these efforts.

USAID Barbados will continue to provide technical assistance to enhance the regional and national agendas with respect to the promotion of the Human Right Agenda in support of a reduction of HIV related stigma and discrimination. Efforts will be made to leverage USG resources with other resources from the Global Fund and other donors in support of policy and legislative reform and the more meaningful engagement of PLWHA in the advocacy efforts. Efforts will be made to ensure that effective technical assistance is brought to bear on this process, drawing on lessons learned and best practices from across the world. Efforts will also be made to ensure that national level interests are also addressed.