Development of a PANCAP Model Condom Policy
Consultant’s Report N° 1
Submitted to the PANCAP Coordinating Unit, Georgetown / Guyana
by
Luise Lehmann
Tutzing / Germany
17 October 2007
Table of contents
1.
Introduction .................................................................................................................... 1
2.
Background .................................................................................................................... 1
3.
Participatory stakeholder consultation ............................................................................ 2
4.
Activities during the reporting period............................................................................... 3
5.
Questionnaire and feedback ........................................................................................... 4
5.1
Development of questionnaire and mailing .............................................................. 4
5.2
Feedback to questionnaire ...................................................................................... 4
5.3
Issues raised in responses ...................................................................................... 5
6.
Planning of personal consultations in selected countries ................................................ 7
7.
Planning of key stakeholder meeting .............................................................................. 8
8.
Conclusion and next steps ............................................................................................10
9.
Annexes ........................................................................................................................11
1.
Elements of the PANCAP Model Condom Policy .......................................................11
2.
Questionnaire sent out to stakeholders ......................................................................11
3.
List of stakeholders ....................................................................................................11
4.
List of National AIDS Coordinators.............................................................................11
5.
Travel itinerary of consultant’s round trip November 2007 .........................................11
6.
List of references .......................................................................................................11
1. Introduction
In response to the HIV/AIDS pandemic in Caribbean countries and with the aim to reduce the
incidence of HIV and AIDS, a Regional Strategic Framework on HIV/AIDS was agreed upon
and the Pan Caribbean Partnership against HIV/AIDS (PANCAP) was established. Low
condom usage has been identified as one of the major factors impeding the control and
prevention of HIV in the region. Thus, the CARICOM Secretariat, with a grant from the
International Development Association, has initiated the development of a regional model
condom policy, to help reduce the spread of HIV and other sexually transmitted diseases. A
senior consultant was selected, Ms Luise Lehmann, to assist in the elaboration process of
the policy. The consultancy agreement with the CARICOM Secretariat came into effect on 10
September 2007. It is envisaged that the process of stakeholder consultation and elaboration
of a final draft for the model condom policy will take about six months.
The consultant’s scope of work comprises the following activities.
The Consultant

Will prepare a work plan and methodology for developing the PANCAP model
condom policy.

Will review previous studies and reports that are relevant to the current project.

Interview key stakeholders including policy makers at the regional and national levels.

Convene a regional stakeholders meeting to discuss the draft PANCAP model
condom policy.

Develop a draft PANCAP condom policy framework (Elements of the policy - cf.
annex 1)

Make a presentation to COHSOD on the draft PANCAP model condom policy.
The following report is the first report regarding the development of the PANCAP model
condom policy and covers the first month of the consultancy.
2. Background
In February 2006, the Caribbean Regional Consultation on Universal Access to HIV/AIDS
Prevention, Treatment, Care and Support recommended to “Improve availability,
accessibility, coverage, appropriateness and acceptability of HIV/AIDS diagnostic,
prevention, protection, treatment, care and support services through, for e.g., free HIV/AIDS
testing, first line medicines in primary health care, improved services hours, particular
attention to populations in crisis, unsupervised access to condoms, youth friendly
services, respect of the dignity of individuals, provision of low cost, high quality prevention
commodities.” (Accentuations by the author)
Condoms are a vital tool in all efforts to prevent HIV infection and they are essential to the
maintenance of other elements of sexual and reproductive health, such as the prevention of
unwanted pregnancy and of sexually transmitted infection. According to UNAIDS, condoms
have played a decisive role in HIV prevention efforts in many countries. Condoms have
helped to reduce HIV infection rates where AIDS has already taken hold and curtailed the
broader spread of HIV in settings where the epidemic is still concentrated in specific
populations. Condoms have also encouraged safer sexual behaviour more generally.
1
Condom use is a critical element in a comprehensive, effective and sustainable approach to
HIV prevention and treatment.
Access to condoms is widely accepted as a human right. National governments and their
partners at national, regional and international level have an obligation to provide accurate
information on condoms as well as ensuring an adequate supply. But lack of political will and
condom programming often results in weak condom procurement and distribution systems.
Consistent condom use is often undermined by laws and policies that restrict their supply
and use.
Prevention programmes need to ensure that high-quality male and female condoms are
available to all those who need them, when they need them, and that people have the
knowledge and skills to use them correctly. Yet social and cultural norms make negotiating
condom use and safe sex difficult. Conservative beliefs can stigmatise sex and condom use
making it difficult for people to speak openly and honestly about their realities and their
desires. Misinformation about condom effectiveness, the denial of education on sexual risk
and the stigmatisation of marginalised groups makes condom use less likely. All these
factors lead to unsafe sex.
In view of the enormous need of HIV/AIDS prevention in Caribbean countries, the above
statements justify a special policy focus with the aim to provide a broad legal basis for
individuals’ ability to have safe sex by using condoms and thus help reduce the risk of
spreading HIV/AIDS. The envisaged PANCAP model condom policy will provide guidance on
how to deal with the relevant areas that need to be regulated in order to finally assure
consistent and unsupervised access to condoms. Two major areas are BCC (Behaviour
Change Communication) as well as a comprehensive (or total) market approach. A special
condom policy shall help to acquire commitment from all sectors of the societies including
political, religious, business and commercial, social interest and civil society, family,
community and academic leaders and, in particular, young people.
However, in view of the large variety of legal systems in the Caribbean region, a regional
condom policy cannot serve as the applicable model for all respective national policies.
Therefore, the PANCAP model condom policy shall be developed in a way that individual
countries can draw key elements to improve their own particular policy areas with regard to
condoms. The participatory process of the consultancy is expected to give the necessary
overview of condom related national regulations and to present options for policy
development in individual countries.
3. Participatory stakeholder consultation
The process of developing the PANCAP model condom policy is intended to be as
participatory as possible. Important leaders and individual stakeholders from various sectors
involved in HIV/AIDS prevention and the health community of the region are sought to
contribute their views. Given the large variety of PANCAP member countries and the high
number of stakeholders representing different sectors, the policy development process
strives to get as many contributions as possible.
Regional institutions are very important in the consultation process. Among all, the CCNAPC
(Caribbean Coalition of National AIDS Programme Coordinators) plays an important role in
getting access to national HIV/AIDS programme leaders and their respective government
2
departments. Another important facilitating partner is CARISMA as this project is directly
concerned with condoms under various aspects, particularly striving to monitor the total
condom market in the region. It was hoped that a key stakeholder meeting on the condom
policy could be combined with the Consultative Monitoring Group and Technical Working
Group in order to profit from their expertise and reduce travel time and costs for participants.
But this was not possible due to timing constraints.
With regard to stakeholder input and feedback, regional entities are consulted, such as the
Caribbean Council of Churches, CRN+ (Caribbean Regional network of PLWHA), the
umbrella organization of Family Planning Associations, regional research institutions like
CAREC and CRHC, the Pan Caribbean Business Coalition on HIV/AIDS. Due to budget
limitations, it was not possible for the consultant to participate in other meetings of regional
organizations to get maximum input (such as PANCAP AGM VII, CCNAPC annual meeting,
workshops).
An important contribution is expected from private sector companies procuring and
distributing condoms throughout the Caribbean region or in individual countries only.
Organizations managing condom social marketing programmes in the region are interviewed,
i.e. Population Services International (PSI) and Family Planning Associations as well as the
Constella Group and Howard Delafield International. UNAIDS and UNFPA have been
consulted at regional and national level. Last but not least, the international donor community
involved in HIV/AIDS prevention in the Caribbean region was consulted, to name KfW,
USAID, and CIDA.
In order to achieve multiple input and feedback, the following steps are envisaged until the
end of the consultancy:

Identify key sector stakeholders per country, within regional or international entities

Contact key stakeholders to get commitment to participate in the process

Send out a questionnaire about condom policy elements

Get responses to questionnaire and follow up

Do personal interviews in selected countries, eventually in ad-hoc stakeholder
meetings

Send out first draft condom policy framework to participants of stakeholder workshop

Hold stakeholder workshop in cooperation with PANCAP Coordinating Unit; CCNAPC
and/or CARISMA (Consultative Monitoring Group) and get recommendations

Get feedback from key stakeholders and leaders on second draft policy (COHSOD)
The selection of key stakeholders to be invited to the consultation meeting will be done in
close cooperation with the PANCAP Coordinating Unit after first contacts have been
established. (cf. also chapter 7)
4. Activities during the reporting period
As part of the consultancy agreement with PANCAP, the consultant prepared and updated a
work plan that was followed during the first reporting period. Activities during this period
comprised the following:

Extensive internet research on institutions and reference material
3

Establishing and updating a list of relevant national, regional and international
stakeholders

Development of a questionnaire for stakeholders to comment on

Personalized mailing of questionnaire to Caribbean stakeholders and follow-up

Collecting and analysing the feedback to questionnaire

Planning of round trip to selected Caribbean countries

Regular consultation with the PANCAP Coordinator

Planning of in-country meetings

Planning of key stakeholder meeting
The following chapters will provide further information on the above mentioned activities.
5. Questionnaire and feedback
5.1
Development of questionnaire and mailing
The first step of consultation was to develop a questionnaire to be sent via email to
stakeholders of various sectors in Caribbean countries and solicit their comments. The
questionnaire was developed and agreed upon with the PANCAP Coordinator. (cf. annex 2).
The questionnaire refers to the elements of the model condom policy as outlined in the
consultancy agreement (Policy elements cf. annex 1). The questionnaire was slightly
modified for specific stakeholders such as the private sector and the technical and financial
partners.
The list of HIV/AIDS and FP stakeholders in the Caribbean region was set up with
contributions from important institutions, such as PANCAP, CCNAPC, CARISMA, PSI
Caribbean, and KfW. Turn-over of staff however makes it necessary to continuously revise
the list.
Between 12 September and 10 October, the questionnaire has been sent as personalized
emails to about 120 stakeholders out of which about 40 in charge of national HIV/AIDS
programmes. The list is still growing based on further recommendations or address
modifications associated with the feedback. (List of stakeholders cf. Annexes 3 and 4)
5.2
Feedback to questionnaire
The process of getting feedback to the questionnaire as such is still ongoing. So far, 12
detailed responses (about 10 percent) have been returned to the consultant. In addition,
many respondents have declared their general interest in the condom policy. Some more
detailed contributions have been announced and are to be expected during the month of
October.
The following matrix shows respondents from whom detailed responses have been received
until mid-October 2007, often accompanied by policy and research documents:
Type of organization
Respondents
NAC / NAP
Curaçao, Suriname
support from CCNAPC
4
Family Planning Associations
None, support from IPPF/WHR
Social Marketing
CARISMA UK, Constella Group Jamaica,
GHARP Guyana, PSI Caribbean, PSI
Dominican Republic, PSI Haiti
Private sector
Female Health Foundation
Faith-based organizations
none
PLWHA + NGOs
none
Research institutions
none
Technical and financial partners
UNFPA Haiti, USAID Guyana, KfW
Germany, GTZ Germany
In terms of quantity, stakeholders’ feedback and contributions are rather limited. This is most
probably due to the fact that the volume of issues to be discussed is overwhelming so that
the time required to respond exceeds respondents’ immediate capacity. Many national AIDS
programme coordinators assume multiple functions in their sector. Another explanation is
that many stakeholders lack a personal relation to the consultant so that there is little priority
put on this agenda. Others seem to be barely used to this kind of electronic communication
exchange.
Nevertheless, the consultation process via internet is regarded as an ongoing process so
that further encouragement is expected to help solicit more interest and input. The consultant
will continue to do personalized follow-up via email, fax and telephone. In addition, the
upcoming PANCAP VII Annual General Meeting should be utilized to encourage the
participation in the policy consultation and invite representatives to come up with
contributions. It would also be useful if the condom policy issue could be published on the
PANCAP website.
5.3
Issues raised in responses
The analysis of responses is being done simultaneously with this report and will be
integrated into the policy outline to be discussed at the key stakeholder meeting. The
feedback shows that major issues are as follows (as per 15 October 2007):
Coordination

Coordinated forecasting between government departments, particularly between
HIV/AIDS, STI and Family Planning programmes

Notion of a “total condom market” is crucial and in the interest of governments in
order to target different population groups, i.e. balancing the role of free,
commercially priced and subsidized condoms in planning and implementation

Committees to be established for the formulation of principles of condom policies (at
regional or national level), they should constitute members of public, community and
private sectors

Synergy to be sought between different national policies (HIV/AIDS, youth,
workplace, family planning, tourism), also with regional policies and strategies
5
Condom importation

Streamlining of condom importation for quality assurance

Regulation by standards bureau for importation of acceptable or internationally
approved product standards for condom imports to protect consumers

Registration of condoms

Tax exemption – removal of duties and taxes on condom imports, VAT exemption or
reduction

Facilitation by customs authorities for easy clearance of condom imports

Storage directives for the Caribbean climate (for importers, distributors, Ministries of
Health, retailers)

Promotion of local condom production in the Caribbean
Condom distribution

Coordination among all sectors procuring and distributing condoms (Government and
donors, NGO social marketing, private commercial and clinical sector, civil society
and faith-based organizations)

Tracking of condom distribution, particularly public sector and link to existing
monitoring instruments in the region (such as CARISMA)

Different social marketing models have their place in the Caribbean context

Price of condoms “must be payable” for all users
Condom promotion

Condom promotion and demand creation to be increased concerning all condoms –
generic and branded

Relation of condom use with abstinence-focussed HIV/AIDS programmes (coexistence of faith-based reservations and Carnival festivals promoting casual sex)

Awareness and importance of consistent condom use

Risk perception to be addressed
Barriers to condom use

Use of condoms – Barriers are mainly cultural

Access – Barriers for unsupervised access for particularly vulnerable age and societal
groups to be alleviated (adolescents, prisoners, MSMs, CSWs) – Stigma,
marginalization and taboos have adverse effects on the health of most vulnerable
groups

Access – outside ‘normal’ operating hours

Dialogue and seeking consensus with faith-based organizations and conservative
societal groups
Comments on the outline of the model policy:

Generally appreciated as well composed

Divide chapter 1.5 into “Condom use” and “Access to condoms”
6
6. Planning of personal consultations in selected countries
With the aim to provide opportunities for more direct involvement in the development of the
PANCAP model condom policy, it is envisaged to visit some countries for personal
consultations with important stakeholders. The countries to be visited were selected based
on socio-cultural distinction and population size. The major Caribbean language areas are
represented (English, French, Spanish) and countries with a concentration of relevant
stakeholders are given a certain priority. Thus, the PANCAP Coordinating Unit decided that
the consultant should visit Barbados, Dominican Republic, Guyana, Haiti, Jamaica, Saint
Lucia and Trinidad and Tobago.
The budget and travel itinerary allows for at least one full day in each country. Some more
time is available for countries with stakeholder concentration. The list of persons and
institutions to meet comprises the following:

Minister of Health (or other relevant policy makers)

National HIV/AIDS Programme Coordinator (or analogical organization) and Regional
CCNAPC

Social Marketing (FPA and international NGO)

Regional or national organizations (Church, PLWHA, Family Planning Association)

Private Sector (Condom manufacturer or distributor)
The final decision concerning people to be met will be done in close cooperation with the
PANCAP Coordinating Unit and a facilitator at the respective country level who is requested
to organize the meetings. A number of interesting persons and institutions are mentioned in
the list of stakeholders (cf. annexes 3 and 4).
The following table shows the time frame in each of the selected countries available for
meetings. Flight details are shown in a separate table (cf. annex 5).
Consultant’s meeting schedule November 2007
Date
Location
Morning Afternoon Evening
Day
X
Thu
Nov 08 Barbados
Nov 09 Barbados
X
Fri
X
Nov 10 Guyana - Meeting PANCAP
X
X
Nov 11 Guyana - Paper work *)
Nov 12 Guyana
Sat
Sun
X
Nov 13 Trinidad
X
X
Mon
X
X
Tue
Nov 14 Trinidad
X
X
X
Wed
Nov 16 Haiti
X
X
X
Fri
Nov 18 Jamaica - Paper work *)
Nov 19 Jamaica
Sun
X
X
Nov 20 Dominican Republic
Nov 21 Dominican Republic
X
Nov 22 Dominican Republic
X
Nov 23 Saint Lucia
X
X
X
Mon
X
Tue
X
Wed
Thu
X
X
Fri
7
Nov 25 Trinidad - Paper work *)
Sun
Nov 26 Trinidad - Preparation of workshop
Mon
Nov 27 Trinidad – Key stakeholder meeting
X
X
Nov 28 Trinidad – Key stakeholder meeting
X
X
X
Tue
Wed
*) Sundays are reserved for paper work, but could be utilized for meetings if needed.
The travel itinerary starts with Barbados followed by Guyana where a briefing meeting with
the PANCAP Coordinating Unit is planned. The round trip through the Caribbean region will
then go to Trinidad and Tobago (Nov 13 to 15), Haiti (Nov 15 to 17) , Jamaica (Nov 17 to 20),
Dominican Republic (Nov 20 to 22) and Saint Lucia (Nov 22 to 24). Trinidad will be visited a
second time (Nov 22 to 28) as it is planned to hold a key stakeholder meeting there at the
end of the round trip (Nov 27 / 28).
7. Planning of key stakeholder meeting
It is envisaged to hold a meeting with key stakeholders representing relevant sectors
concerned with condoms. The objective of the meeting is to give recommendations for the
further development of the model condom policy based on discussions of a first draft of the
policy.
In accordance with the travel itinerary of the consultant, the meeting will be held on 27 / 28
November 2007. It has been decided to hold the meeting in Trinidad, as TRT is easily
accessible and important regional stakeholders can be found there. The number of
participants should be restricted to about 20 in order to provide a working environment and
facilitate mutual exchange. The agenda of the meeting is suggested as follows:
November 27-28, 2007
Draft agenda for key stakeholder meeting on the PANCAP Model Condom Policy
Monday, 26 November 2007
Arrival of participants
Tuesday, 27 November 2007
(08:30 am to 05:00 pm)
(1) Welcome and opening remarks
(2) Presentation of participants
(3) Presentation of first draft condom policy with discussion
(4) Plenary discussion:
How to regulate the coordination of the total condom market among various sectors
(5) Working groups on the following subjects

Quality assurance for condoms

Condom importation and tax regulations

Monitoring condom distribution

Suggestion from the plenary
(6) Group presentations to the plenary
(7) Working groups on the following subjects
8

Demand creation for condoms

Improving and assuring “unsupervised” access to condoms for vulnerable groups

Integration of diverging values and positions into the condom policy

Suggestion from the plenary
Wednesday, 28 November 2007
(08:30 am to 03:30 pm)
(1) Continuation of working groups
(2) Group presentations to the plenary
(3) Implementation of the PANCAP model condom policy
Discussion and recommendations
(4) Conclusions
(5) Closing remarks
Suggestion: Key stakeholders to be invited (maximum 20)
Type of organization
Organization / representative
N°
Country
CCNAPC
Sharon Mottley, Chief Operations Officer
1
TRT
NACC Trinidad
Dr. Amery Browne, Technical Director
2
TRT
NAPS Guyana
Dr Shanti Singh, National AIDS Director
3
Guyana
Caribbean FPA
Dr Tirbani Jagdeo, Director
4
Antigua
PLWHA
CRN+, Ms Yolanda Simon
5
TRT
Caribbean Vulnerable
Communities
NN
6
Jamaica or other
country
CCC – Caribbean
Conference of Churches
NN
7
TRT
Private Sector
Pharmaco, Stephen Aboud
8
TRT
No glove, no love, NN
9
Jamaica
? CAIC Business Coalition, NN
10
? Female Health Foundation, Simone
Martins
11
Brazil
PSI Caribbean, Pamela Faura
12
TRT
CARISMA, Elizabeth Gardiner
13
UK
Constella Futures Jamaica, Kathy McClure
14
Jamaica
GHARP, Susan Howard ?
15
Guyana
UNAIDS
Dr. Michel de Groulard, Caribbean
Regional Support Team
16
TRT
UNFPA
Leah-Mari Richards
17
TRT
OECS HIV and AIDS
Project Unit (HAPU)
Dr James St Catherine, Coordinator
18
Saint Lucia
PANCAP
Coordinator, Mr Edward Emmanuel
19
Guyana
Social Marketing
9
Consultant
Luise Lehmann
20
The suggestions above will be discussed and amended with the PANCAP Coordinating Unit
as soon as possible so that invitations can be sent out without delay.
8. Conclusion and next steps
The process on the development of the PANCAP Model Condom Policy has been
successfully started since mid-September 2007. About 120 stakeholders in the Caribbean
region and among the donors have been informed about the objectives and the envisaged
content of the policy. They have been invited to participate in the consultation process.
Responses have been positive, although detailed feedback was limited so far. The
consultation process is ongoing and contributions are still solicited. It will be essential to get
more feedback from governmental institutions as well as from representatives of vulnerable
groups, faith-based organizations, Family Planning Associations and the private commercial
sector.
The following steps of the consultation process strive to provide more opportunities for
exchange during a round trip of the consultant from 7 to 30 November 2007. Seven countries
will be visited and a key stakeholder meeting held.
The next steps ahead are to be organized in close cooperation with the PANCAP
Coordinating Unit:
Activity
Responsibility
Encourage stakeholders to join the consultation process at all promising
opportunities (PANCAP VII AGM, PANCAP website, other meetings)
PANCAP
Contact policy makers in selected countries to facilitate meeting with
consultant
PANCAP
Organize meetings in selected countries with local partners
Consultant
Decide on details for key stakeholder meeting and send out invitations
PANCAP /
Consultant
Organize venue for key stakeholder meeting
PANCAP
Develop the first draft of the model condom policy to be discussed at
meeting with PANCAP 10 November 2007
Consultant
10
9. Annexes
Cf. extra files
1. Elements of the PANCAP Model Condom Policy
2. Questionnaire sent out to stakeholders
3. List of stakeholders
4. List of National AIDS Coordinators
5. Travel itinerary of consultant’s round trip November 2007
6. List of references
11