The MOH's National HIV/STI Programme (NHP) leads the national response to HIV & AIDS. It advocates for and coordinates the input of all sectors of the Jamaican society, including the private and public sectors, NGOs, and FBOs. Coordination of the multi-sectoral response to HIV and AIDS is also supported by the National AIDS Committee, a non-governmental organization representing over 100 governmental, private sector, non-governmental, community and faith-based organizations. The goal of the NHP with support from PEPFAR aims to reduce the sexual transmission of HIV by targeting interventions towards MARPs. This will be achieved by improving the attitudes and behaviors among vulnerable high-risk groups, reducing stigma and discrimination while protecting the rights of selected groups, expanding and scale up of HIV in the work place, and supporting the capacity of stakeholders (PLHIV, CBOs, NGOs) involved in policy making, program design, implementation and M&E.

The MOH is the preeminent government organization who together with the Regional Health Authorities and related organizations make up the public health system. The NHP is located in the Ministry of Health as the entity responsible for championing the response to the HIV pandemic in Jamaica. The national response to HIV/AIDS is a Government- led approach and interventions are pursued to reach MARPs while strengthening the capacity of MOH personnel to lead and sustain the programme. This is achieved through external technical assistance, workshops, conferences and systems strengthening. The NHP has traditionally adopted an evidence-based approach to their programs and activities. Under the PEPFAR approved workplan, a PMP is in place to monitor the activities with clear indicators, targets, and deliverables.

There are a number of barriers to effective health systems delivery in the National HIV/STI programme (NHP) which is located in the Ministry of Health. Among these is that the NHP has operated largely as a vertical programme which allows resources to be consumed in financing duplicative, independent administration and operational systems. This approach has been inefficient in addressing the holistic Sexual and Reproductive health needs of the client. In addition there is a tenuous relationship between the health systems within the wider governance objectives that would optimize rationalizing resources and transforming service.

USAID/Jamaica seeks to address this barrier by supporting the MOHs efforts to establish integrated and cohesive sexual and reproductive health services by incorporating the National HIV/STI Programme within the National Family Planning Board. By integrating SRH and HIV programmes, the MOH aims to facilitate greater use of services, ease of access to a catalogue of services, reduced travelling and down time costs for the clients. In addition it will facilitate an increased uptake of services and greater efficiency in programme operations, resulting in a healthier population.

The MOH targets key MARPs which include MSM, male and female sex workers, at-risk adolescents (ages 10-14), at-risk youth (ages 15-24), homeless, inmates and drug users. All 14 parishes in Jamaica are affected by the HIV epidemic but the most urbanized parishes have the highest cumulative number of reported AIDS cases (St. James 1,176 AIDS cases per 100,000 persons and Kingston & St. Andrew 822 cases per 100,000 persons). Both client initiated and provider initiated testing is conducted across the island. With respect to the outreach testing, HIV tests are administered with pre and post-test counseling and informed oral consent. Both the blood test (UniGold) and the Oral test (OraQuick) HIV rapid testing methods are used. In relation to referral of patients, a fast-track system is used to ensure successful referrals of patients who test positive through outreach testing. Personnel are in place to monitor linkages from HTC to appropriate services systems and systems are in place to evaluate successful linkages. There is a National Surveillance Officer, Hospital Active Surveillance Nurses, Parish Surveillance Coordinators and Contact Investigators. Quality Assurance for testing involves using control specimens (positive and negative) to ensure proper device performance; ensuring that the relevant information is correctly recorded on the result log; and confirming that the Standard Operating Procedures for testing is followed at all times.

USAID/Jamaica through a grant with the NHP focuses on reducing sexual transmission of HIV/AIDS among MARPs. The NHP supports interventions to reach MARPs by improving the use of strategic information for evidence based programs, policies, and decision-making, reducing stigma and discrimination, and providing HIV prevention education and services. It is expected that over time, progress in these areas will reduce the prevalence rate of HIV/AIDS and reduce discrimination against persons living with HIV/AIDS, both goals in the Caribbean Partnership Framework. This activity supports the National Strategy for HIV/AIDS Prevention, Care and Treatment and aims to coordinate closely with Global Fund and other USG agencies under PEPFAR. The NHP includes work through the Regional Health Authorities, NGOs and FBOs by capitalizing on their ability to reach vulnerable groups. Jamaica has one of the highest prevalence rates in the region among the MSM and SW and this activity seeks to make an impact on reducing new infections in these populations. There will also be a focus on adolescents who practice high risk behaviors especially those who are part of the MSM and SW community. USAID/Jamaicas grant to the MOH will be used primarily to scale up existing HIV prevention services for MARPs, which include conducting risk reduction conversations and empowerment workshops, increasing the availability of condoms and lubricants, outreach HIV testing at MSM parties, SW venues and bars and other MARP sites, and referral to clinical and community services. As a strategy to reduce discrimination in the workplace setting, the MOH supports the Ministry of Labour and Social Services in the sensitization of companies and their employees and in the drafting of HIV Regulations to enhance compliance and conformity. In a bid for sustainability, the Jamaica Business Council on HIV and AIDS will receive support to scale-up efforts to increase enrollment and solicit financial support from the private sector for the National HIV response. Supportive supervision and quality assurance will be the responsibility of the MOH who will play a key role in establishing a national minimum package of service for MARPs.