End-of-term evaluation
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- Evaluation Findings
LimitationsThere were several challenges in completing the evaluation of this NSP. These may have affected the final findings presented and need consideration when reviewing this report. They are as follows: Some key informants were not available for interview during the EET’s in-country mission. However, the EET was able to interview a large number of key informants representing a broad range of stakeholders, in addition to reviewing a large of number of documents from various sources. Epidemiological and behavioural data especially related to key populations was limited or unavailable for review by the EET. This meant that the evaluation could not delve deeper into the statistical nuances of these groups. The evaluation sought to draw out information from key populations through focus group discussions and interviews with key informants to counter for this. Male sex workers and ‘bougie’1 Men who have Sex with Men (MSM) groups were not accessible for focus groups as part of the evaluation. These groups were unattached to existing programming, and there was no method for accessing these largely ‘underground’ groups in a timely manner. Consequently, the voice of these groups was limited in the evaluation findings. The EET members were aware of this and took this into consideration when developing their findings and recommendations. The majority of focus group participants and key informants were implementers or beneficiaries of programmes. This skewed the testimonies received by the EET. Again, the EET members were aware of this and took it into consideration when developing their findings and recommendations. Additionally, testimonies were cross-referenced with empirical data as much as possible. Evaluation Findings
Findings Over the past five years, Barbados appears to have made some progress in attaining key elements of the Goal, and Strategic Objectives stated in the NSP 2008-2013. However, the ability of the national response to clearly demonstrate successes and identify shortcomings has been hampered by several issues. The most significant of which are weaknesses in strategic information and the broad definitions of key populations in the NSP and associated documents. Many of the key populations identified in these documents are not supported by epidemiological evidence. The focus group discussion participants, essentially agreed with the goals and objectives stated in the NSP, but expressed a desire for more ‘practical’ activities that reached them at the community-level, especially through peer educators. During the period 2004 and 2012 there has been a decline in the number of persons newly diagnosed with HIV and AIDS in Barbados (See Figure 2). This trend has largely continued from the start of the NSP period in 2008 until 2012, indicating that this element of the NSP Goal was achieved during the NSP period based on the available data. Overall, the rate of new diagnoses decreased by approximately 12% across the country during this period. Figure 2: Decline in people diagnosed with HIV and AIDS 
Source: Barbados GARPR 2014 According to the national health records, the percentage of young people (aged 15-24) who are living with HIV also decreased from 0.11% in 2010 to 0.10% in 2011. However, data beyond 2011 was not available at the time of the evaluation limiting the evaluation team’s ability to note whether this trend has continued. Additionally, no sero-prevalence studies of the key populations were completed during the NSP period. This means that there is currently no data available on the prevalence of HIV among commercial sex workers (CSWs), MSM, prisoners or drug users from 2008 onwards. There was also no data available to the evaluation team on the percentage of pregnant women aged 15-19 who were HIV infected or the percentage of infants born to HIV-infected mothers who were infected. According to the 2014 Global AIDS Response Progress Report (GARPR) for Barbados, there were no reported cases of transmission of HIV from an infected mother to her child in the last five years. Thus, the estimated number of child HIV infections from HIV-positive women delivering between 2012 and 2013 was zero. This is a major achievement for the national response. While there are several promising trends, the lack of data related to the Goal and Strategic Objectives of the NSP are a missed opportunity for the national programme to demonstrate its performance in key areas. The broad range of key populations articulated in the NSP is also problematic for the national response. Under the NSP, 14 separate groups are identified as vulnerable populations. Additional groups are also identified in other key documents. The targeting of many of these groups - such as female single heads of households or tourism workers – appears not to have been based on the available epidemiological data. This led to a situation where programmes, especially by partner Government Ministries, were being implemented with groups that would likely have minimal impact on the overall rates. These issues are discussed in more detail under the findings of Strategic Objective 1 that addresses prevention programming. Given the limited resources available, more targeted efforts with groups most vulnerable to HIV and AIDS will be required to sustain the gains made in the HIV response over the last 20 years. In the eyes of key populations, this could be better achieved through more community-based, and peer-led activities. This is highlighted by the comments of one young female sex worker who stated ‘We want [name of outreach worker] back and we want more people like her’ and the consensus amongst the MSM group in the need for an HIV-positive MSM safe space. Thus, it appears that for key populations, the implementation of NSP Goals and Objectives is the most important factor. Recommendations Establish robust indicators for the Goals and Strategic Objectives of the new NSP supported by clear and well aligned M&E plan. Assistance for this may be accessed through CARPHA or another agency with expertise in M&E. Adopt a High-Impact Prevention2 approach to reducing new HIV infections by targeting populations driving the epidemic (MSMs) using the available epidemiological data. Download 0.92 Mb. Share with your friends:
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