EC-CAP II, implemented by CHAA, strengthens prevention efforts and places emphasis on community-level engagement and structural issues, gender inequalities, stigma, discrimination and human rights abuses. It incorporates the cross-cutting areas of strategic information and capacity building, and represents a sustainable, country-specific response for PLHIV and those most at risk of infection in 7 countries Antigua/Barbuda, Barbados, Dominica, Grenada, St. Lucia, St. Kitts/Nevis and St. Vincent/Grenadines.

The project is designed to increase reach and access to services for MARPs, employing a combination prevention approach. EC-CAP II also expands interventions for those living with HIV using a holistic approach to improve quality of life, promote healthy living and reduce risky behavior.

Because of rampant stigma and discrimination and the illegality of sex work and homosexuality, CSOs are often better placed to respond to the needs of MARPs, however, many CSOs are in the early stages of development. Most are characterized by: visions, missions and goals focused on the short-term and organizational survival; project-level strategies; project-grounded organizational structures; limited human and financial resources; systems, policies and procedures based only on project requirements: and an absence of monitoring and evaluation expertise. CHAA will work to strengthen CSOs to contribute to the development of sustainable community systems for MARP HIV programs and improve community-based program delivery.

CHAA will work closely with its partners PSI/C and CRN+ to expand services and reach to previously underserved populations. CHAA will work closely with NAPs and MoH on all islands to ensure appropriate, feasible, well implemented and sustainable country initiatives.

Collaborating with national stakeholders on a minimum package of services, CHAA will promote and support the provision of sensitive palliative care for PLHIV. In partnership with NAPs, CHAA will train CSOs and FBOs in case management and provide small grants for home based care, psychosocial and spiritual support for PLHIV and their families. Positive living peer support workers will help in empowering newly diagnosed individuals in dealing with access, disclosure and adherence issues. A clinic-based program, which involves the placement of at least one CA, will be implemented in partnership with MOH/NAP in all countries. Coordinating with MOH/NAPs, the establishment of a bi-directional referral system will facilitate understanding service coverage through: comparing the number of PLHIV reached with those diagnosed and living with HIV; and in annual changes in the number of individuals who do not access care & treatment after testing positive, or are lost to follow up.

With research and scripting conducted with PLHIV participation, participatory drama development will be carried out to reflect life concerns and challenges and opportunities relating to prevention with positives. Social activities for PLHIV will be funded through existing support groups. These groups will help to build social capital and overcome isolation. If sufficient numbers of PLHIV are interested and willing to participate in group activities, evidence-based group interventions, e.g. Healthy Relationships, can be adapted or reinvented for the Caribbean by working with CDC Master Trainers. FBOs will be key partners for care and support and will receive small grants for activities, including the development of tailored sermons and bible study materials to support a more enabling environment for testing, disclosure and access to services. Expected Result: PLHIV have improved quality of life through access to care, referrals, and peer psychosocial support and counseling.

Aiming to Increase access to stigma free prevention, treatment and care services for MARP and PLHIV in target countries, strategies include developing and promoting approaches to increase uptake of CBHCT and implementing bi-directional referral systems. Partnering with CDC and in line with the PF, EC-CAP II will scale up efforts to provide greater access for MARP in both client-initiated and PICT in 7 countries. This will be achieved through peer educator training, technical support to NAPs, small grants to CBI and supporting & seconding non-medical personnel, including community-based and peer counselors, to NAPs. NAPs will be assisted to establish policies on decentralized HIV rapid testing, including quality assurance, and to involve key populations, CA, and community stakeholders in policy development. EC-CAP II drawing on experience under the first phase of EC-CAP, will assist in identifying sites for HCT, support expansion of HCT through mobile testing and testing within relevant service providers. CA trained in HCT will continue to provide group and pre-counseling in the field, accompany clients for testing, provide testing at certified sites, and promote HCT services. The USG will support NAPs to: develop quality-monitoring systems at facility and community levels to sensitize staff and laypersons to provide non-discriminatory, non-stigmatizing, confidential HCT services for MARP; ensure quality of community HCT services through periodic supervision of counseling sessions. CHAA and CDC will build capacity of program sites and stakeholders to collect and analyze client-reported risk behavior data and to develop an HIV prevalence monitoring system for HCT using CDCs Risk Assessment Form.

CHAA and PSI/C will support the implementation of an innovative, MARP-friendly referral network at national and regional levels, integrating CA into the system. Active referrals (identifying relevant services, accompaniment, following up on use of services) will increase access to services for STI testing and treatment, HCT, FP, GBV, primary health care and social services. Expected Results: Increased access to counseling and testing at community sites; Increased access to sensitive services for MARP and PLHIV.

EC-CAP II will address numerous, complex, and intertwined causes of increased vulnerability for MARPs and inadequate care and support for PLHIV in 7 countries. A concentrated epidemic in the region; HIV transmission is primarily sexual with groups engaging in high-risk behaviors including multiple-concurrent partners and frequent unprotected vaginal or anal sex. Social and economic circumstances, gender inequalities/norms and the criminalization of sex between men further increase vulnerability. EC-CAPII seeks to decrease vulnerability to HIV through Increased Equitable Access to HIV Prevention, Treatment and Care Services for MARPS and PLHIV in the Eastern Caribbean. Objectives include: Reducing vulnerabilities to HIV through access to comprehensive prevention services; Increasing access to stigma-free prevention, treatment and care services for MARP and PLHIV; Strengthening capacity of national partners & CSOs to improve quality service delivery. Two main strategies for addressing behavior change among MARPs will be used: Building national capacity for combination prevention and a comprehensive package of services; and Promoting and implementing evidence-based interventions informed by strategic information.

Central to EC-CAP II is the CA or peer-educator program and development of an accredited network of MARP peers. This regional, professionally-trained network will be guided by a standardized and certified training package. CHAA will facilitate and support the integration of CA into the NAPs through relationships and internships with CSOs and national entities. This integration will catalyze greater acceptance and sustainability of MARP in the national response. The application of the CA model and a targeted combination prevention approach will seek to: Increase knowledge of HIV and ways of preventing STIs among MARP; Increase correct and consistent condom use by MARP and PLHIV; and Improve behavior change interventions for MARPs and PLHIV through peer based networks. CHAA and PSI/C will implement innovative behavior change approaches such as: using social media and other technologies; using edutainment and using existing local structures to promote community involvement in the HIV response.