End-of-term evaluation
Programme Area 3: Impact Mitigation and Support of PLHIV
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- Evaluation Questions
- What was done to address the structural and socio-cultural barriers that limit economic and educational opportunities for key populations
- What are the structural and socio-cultural factors that continue to contribute to educational and economic development of key populations
- Were the activities implemented in supporting the educational and economic development of key populations effective
- Recommendations
Programme Area 3: Impact Mitigation and Support of PLHIV
Findings Over the NSP period, the NHAC took a lead role in addressing the socio-cultural issues that affect key populations ability to access educational and economic opportunities. The main thrust of this work centred on the development and implementation of a policy framework that sought to assure social services (including economic and educational opportunities), lower stigma and remove discriminatory practices. However, support to implement more practical ‘day-to-day’ solutions is necessary to achieve stronger outcomes. Stigma and discrimination remain pressing issues for key populations, especially for those populations facing layered stigmas, such as MSM sex workers and PLHIV of lower socio-economic status. The national response particularly underserves transgendered populations. More effort will be needed to understand the needs of this population and to empower them in the development of activities, especially in terms of meeting their basic needs such as employment and access to relevant social services. The national response partners could also benefit from greater coordination and consistent messaging when it comes to addressing the issues of stigma and discrimination. What was done to address the structural and socio-cultural barriers that limit economic and educational opportunities for key populations? During the NSP period, two policies were developed as part of extending the policy framework supporting PLHIV and other key populations. In 2008, the NHAC developed a National HIV Policy8 to guide institutions in the treatment of PLHIV and other key populations, as part of the multi-sectoral response. This policy aimed at protecting the rights of persons infected and affected by HIV and mitigate further exposure to risk. Three key areas of focus were highlighted in the policy: housing, social security, and tourism. In 2009 the Ministry of Labour approved a ‘Policy on HIV/AIDS and Other Life-threatening Illnesses for the Public Sector’ effectively extending their 2004 ‘Code of Practice on HIV/AIDS and Other Life-Threatening Illnesses in the Workplace’. This policy guides private and public sector organisations on how to handle PLHIV employees. While it is commendable that the Government of Barbados established a policy environment that supports and protected key populations, particularly PLHIV, the policy framework needs to be strengthened and more effectively enforced to have greater impact on the lives of key populations. As it stands, the policies offer few practical applications for organisations seeking to address structural and socio-cultural barriers that limit economic and educational opportunities for key populations. Some key informants also believe that these policies need to be taken to the point of legislation to ensure the legal framework is effective. In the pursuit of the National HIV Policy, the NHAC implemented a CSO Grant System. This mechanism sought to provide funding for capacity development and project implementation of activities for key populations. Consequently, there was an increase in the number of CSOs that received grants during the NSP period and an increase in programming (see Figure 8). In total, 109 grants were disbursed to CSOs working with key populations over the five-years of the NSP, mainly focusing on youth and PLHIV. Youth-related grants represented 41 grants or 38% of total grants disbursed while 19 grants (approximately 17%) were disbursed for activities exclusively to PLHIV. An additional four grants were disbursed to CSOs organizing activities exclusively for men and two each for MSMs and CSWs. Thus, disbursement for projects aimed at group outside PLHIV and youth represented no more than 1% of the total grants. Several key informants suggested that this was because CSOs largely planned based on the ease with which the target population could be accessed. The National HIV Policy names PLHIV, women and children in its key populations for which the policy has some focus. While the sexual attitudes of men and the existence of other key populations are mentioned, these ‘other groups’ are obscured within the article. Because, according to some key informants, the conservative nature of Barbadian culture will not allow for easy acceptance of the presence of certain groups. It is imperative therefore for the national response to develop strategies to counter this. Figure 8: Increase in the number of CSOs receiving grants 
Source: NHAC With the support of CSOs and partner Ministry HIV/AIDS Coordinators and Focal Points several activities and projects were implemented to facilitate the continued education and skills training of key populations. The partner Ministries’ initiatives were mainly geared towards PLHIV. While some CSO initiatives were geared towards other key populations such as MSMs and CSW, most were also focused on PLHIV. Many of these programmes do not appear to be well accessed by the people for which they were designed. Some programmes had barriers to access during their registration process, including the perception of persons targeted that their anonymity and confidentiality of information would not be ensured. The education system in Barbados provides free education from primary to tertiary level and continues to have a highest Human Development Index rating according to the United Nations Development Programme. The Ministry of Education reports that school enrolment up to age 16 is mandatory for all children regardless of their HIV status and that enrolment was at 100% in 20139. The Ministry of Education also made efforts to have its staff sensitized to OVCs through workshops, including selective training for special needs teachers on HIV and AIDS. Key informants highlighted the programmes at the Samuel Jackman Prescod Polytechnic and the Barbados Community College as good practices. These programmes are geared towards offering academic and skills training opportunities to key populations. The two institutions provided training in stigma and discrimination as part of their work training programmes, but issues with uptake and attrition were said to be affecting these programme. Again this appears to be due to stigma and discrimination, including internalized-stigma. The National Workplace Policy of Barbados was another activity completed during the NSP period aimed at fostering greater acceptance of and opportunities for PLHIV and other key populations. Out of this, a Code of Practice was developed by employers with the aim of ensuring no discrimination in the workplace in terms of ‘job applications, hiring, upgrading, advancement, promotion, discharge, discipline, layoffs, privileges of employment, compensation, training or other terms and conditions of employment’10. The Code also sought to ensure that employees were safely guarded against having to disclose their health status to employers once their health conditions did not affect their ability to work. According to key informants, however, the framework for Workplace Policy and Code of Practice needs to be strengthened. The Code of Practice, while very well developed, is not supported by legislation or enforcement. This limits the impact that this and similar policies can have on ensuring educational and economic opportunities for key populations. Companies were not mandated to include HIV in their workplace safety policy and currently there is no set response within the Ministry of Labour to address issues related to complaints regarding stigma and discrimination within the workplace. The Labour Department indicated that while success cases were not great in number, the willingness of private business to participate fully in programmes to support key populations was significant. According to the Labour Department, the increase in support from private businesses was mainly driven by moral persuasion. Information also suggested that, in general, there was an increasing display of ‘goodwill’ among the private sector, to offer support to projects as part of the national response. Thus, there appears to be an opportunity to expand support from the private sector, especially in the area of social welfare programming. CSOs were also active in this area of the national response, with MOVADAC, the BFPA, and Jabez House all implementing activities during the NSP period. MOVADAC, a CSO, which supports PLHIV, carried out activities focused on training PLHIV to enter and re-enter the labour force. Activities focused on writing job applications, job interview etiquette and the strengthening of self-esteem. The Vocational Training Board has supported this project by offering work skills training and, in some instances, assigned participants to temporary job placements in the private sector. While this is a promising programme, it could be strengthened by transitioning participants into permanent positions. The BFPA developed a life and academic skills training programme focused on young mothers ages 15-24, to prepare them for income generation. Information on how well this programme was received and its effectiveness was limited as none of the participants were scheduled as part of this evaluation. Jabez House, a CSO formed with the support of CHAA, initiated a project focused on skills training and support for CSWs in finding alternative sources of income through their ‘Life with a Purpose’ programme. This is the only project identified by the evaluation team that specifically targets CSWs with social services in a practical manner. The majority of the women exposed to this programme are trained in cosmetology. This project offers an example for others to follow in targeting hard to reach key populations. What are the structural and socio-cultural factors that continue to contribute to educational and economic development of key populations? Stigma and discrimination remain very real issues for many key populations preventing them from access to services and opportunities. Although the 2011 KABP (pg.22) provides evidence of some improvement in the measures of stigma and discrimination, this was not reflected in the focus group discussions with representative from key populations. The issue of stigma and discrimination were a recurring theme in the focus groups discussions and key informant interviews. This view was often held by interviewees alongside the view that Barbados was a largely tolerant society. For example, in the focus groups with MSM, the participants described Barbados as tolerant before going on to indicate that in accessing services they ‘toned down’ their mannerisms and sought to avoid disclosing their sexual orientation. Further to this, the evaluation team was informed of Ministry senior officials refusing to have the Ministries name associated with a project because it was targeting key populations deemed distasteful by that individual, despite funding for the project being available. This coupled with laws such as the ‘Buggery Law’ that effectively criminalises homosexuality, suggests that there is some institutionalized discrimination within the public sector and that people are maintaining some discriminatory attitudes. Specific key populations such as MSMs and transgendered persons appear to be more likely to face discrimination, as are individuals experiencing layered discrimination. According to one MSM in the focus groups ‘A very effeminate male is at the bottom of the food chain’ when accessing services. For the transgendered populations, the issues faced are further compounded by a poor understanding among the general public. According to one participant: ‘There is usually the perception that a transgender woman is just another gay person…to them it seems like they don’t know when to stop…so the same slogans, the same verses and rhymes they use as insults are usually geared towards homosexual men, but they use them at transgender women, giving no thought to the fact that this is not someone who sees himself as a man, but as entirely female…’ The transgender group also noted that there was no protection in place for people who are discriminated against based on their sexual orientation or gender identity. In contrast to the MSM and transgendered populations, PLHIV expressed that they felt more accepted among the general population in terms of stigma and discrimination. This may be in part, due to extensive training conducted on the subject by HIV/AIDS Focal Points and Coordinators. However there is a lack of data to confirm this, and a paucity of information about stigma and discrimination, in general. The issues of self-stigma and self-esteem among key populations are also significant barriers to accessing services and opportunities. Several accounts of persons refusing to access care and support services because they feared stigma, whether real or only perceived, were highlighted in the focus groups and key informant interviews. During the NSP period, programming in this area was quite limited. When programming did occur, many of the focus group participants felt that they were most empowered when approach by a person from their population. Both the LRU and Food Bank may offer entry points for such work and model practices for dealing with key populations. Were the activities implemented in supporting the educational and economic development of key populations effective? It is noteworthy that the draft 2014-2018 Barbados NSP has prioritized this area for further work and identified the need to develop legislation to address stigma and discrimination. While legislation is significant other strategies, especially at the community and interpersonal levels, should also be pursued in concert with this effort. More practical ‘day-to-day’ solutions is necessary to have stronger outcomes in this area. Stigma and discrimination remain pressing issues for key populations, especially for those populations facing layered stigmas, such as MSM sex workers and PLHIV of lower socio-economic status. The national response particularly underserves transgendered populations. More effort will be needed to understand the needs of this population and empower them in the development of activities, especially in terms of meeting their basic needs such as employment and access to relevant social services. Peer-led and community-based interventions that take a holistic approach to individuals and their needs are likely to have greater success. The national response partners could also benefit from greater coordination and consistent messaging when it comes to addressing the issues of stigma and discrimination. Recommendations Develop and implement a strategy for engaging elected officials and senior level public sector executives in public health and management of the epidemic. Further strengthen capacity building in project evaluation among CSOs and Focal Points to analyse project outcomes. Enhance psychosocial support to empower key populations – A Positive Health Dignity and Prevention Programme could be established (based on CDC best practices). Strengthen coordination of CSOs by NHAC to improve programme planning and targeting. Leverage S&D studies to develop more targeted programming and facilitate a more enabling environment. Download 0.92 Mb. Share with your friends:
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