This will be a new TBD mechanism that will focus on providing more data and designing activities to address gender norms, stigma, and sexual and gender-based violence which impede the effectiveness of HIV prevention and care efforts in Jamaica.

Stigma and discrimination discourage those who are infected with and affected by HIV from seeking needed services. Ideas about the lifestyles of people living with HIV contribute to a sense that the disease is a problem that affects "others," which may undermine individuals' estimation of their own risk and reduce their motivation to take preventive measures. Additionally, there are a number of social, economic, and cultural factors such as gender roles which impact the health outcomes of individuals. Sexual and gender-based violence (SGBV) is a major public health concern in Jamaica. Women often experience violence from men they know, often husbands or male family members. In addition to violating the human rights of women, sexual and gender-based violence poses significant risks to women's health, including immediate physical and psychological injury, as well as less obvious risks such as unsafe abortions, unwanted pregnancy, and sexually transmitted infections, including HIV. Jamaica recently completed a 2008 Reproductive Health Survey which included a component on GBV and HIV/AIDS. This new national data will be used to inform the design of this new program.

This program will complement the work already begun under PANCAP on stigma and discrimination (S&D). PANCAP will continue to focus on addressing S&D through policy reform and legislation. This activity will work more with civil society organizations, private sector, universities, faith-based partners, and the Ministry of Labor & Social Services to target the general population in high prevalence urban areas, such as Kingston & St. Andrew and Montego Bay. This activity supports the cross-cutting area under gender reducing violence and coercion as well as addressing male norms and behaviors. The program will strive for greater cost-effectiveness through partnerships with the public and private sectors involvement in the data collection, design, and implementation. The activities begun under this program can be adopted and easily replicated by other HIV prevention programs in Jamaica and across the Caribbean region to ensure quick scale-up and greater reach.

This program will begin by implementing an evidence-based pilot focused on assessing the impact of providing support and services to communities with high levels of violent sexual crimes. The Implementer will select a rural and an urban community which is plagued by high crime rates to introduce a number of support services, including strengthening community centers to provide sports, recreation, cultural events, and referrals to health services. The Implementer would administer a baseline survey of 100 individuals from each community to measure their psycho-social profile of their attitudes and high risk behaviors. Then over the course of the intervention a number of community activities and services will be provided, including HIV prevention education and referrals to counseling and testing. At the end of the first year, the Implementer will conduct an endline survey to measure any changes in behavior and attitudes. The results of this pilot will be broadly disseminated across the Caribbean region and will inform future programming through this mechanism and the At-Risk Youth APS.

There are a number of proven approaches that can be undertaken to address stigma, negative gender norms, and SGBV including providing information, counseling, skills acquisition, and increasing the opportunities for contact with people living with HIV. This activity will aim to assist in reducing new HIV infections by collecting new data and designing activities and messages that can be adopted by a wide variety of organizations working in HIV prevention, care, and reproductive health. The specific types of interventions will be determined following the baseline assessment and data collection. One example of a possible activity might be to work with disadvantage out-of school male youth through sports and social gatherings to address male norms. There has been a great deal of work done under the Male Norms Initiative under PEPFAR that can lend input into such a program. All activities and interventions would include linkages to health services and counseling and testing.

The selected partner would oversee program implementation and monitoring to ensure that lessons learned are captured and shared. The program should aim to reach an estimated 1,500 individuals through individual, small-group, and community-level activities that explicitly address norms about masculinity and 3,000 individuals reached with gender-based violence and coercion messaging.