Since 2005, PSI/Caribbean (PSI-C) has worked to empower individuals by providing them with key health information in ways they can understand and linking this to easy, affordable access to life-saving services. Headquartered in Trinidad , with sub-offices in Jamaica and Suriname, PSI-Caribbean currently manages country programs in Antigua and Barbuda, Barbados, Belize, Dominica, Grenada, Jamaica, St Kitts and Nevis, St Lucia, St Maarten, St Vincent and the Grenadines, Suriname and Trinidad. PSI-Caribbean’s initial work focused primarily on HIV prevention by promoting condom use and availability among youth at risk and more recently among other groups including males and females at risk and members of the military through its branded Got it? Get it. campaign. The organization has since expanded to address sexual and reproductive health, gender-based violence prevention efforts and the growing burden of non-communicable diseases in the region.
According to The Gap Report, published by UNAIDS in 2014, there are an estimated 250 000 [230 000–280 000] adults and children living with HIV in the Caribbean. The predominant mode of HIV transmission is heterosexual intercourse, with new HIV infections among young women now surpassing those among men in many countries. PSI-C seeks to reduce risk and promote sexual health among the target populations through behavior change communication activities and messages designed to respond to key behavioral determinants such as the ability to use a condom correctly, personal risk perception, concurrent partners, social support (for youth), and in the support of uptake of reproductive health services. PSI-C has built strong partnerships with leading commercial networks and infrastructure. PSI/C’s work in the region has focused on underserved target groups particularly youth, women in difficult circumstances including Spanish-speaking sex workers, MSM and military personnel.
With the Got it? Get it. campaign PSI/C created a powerful, youth oriented, Caribbean-flavored brand that has the ultimate goal of empowering Caribbean youth to be sexually responsible. The brand is unusual because it aims to promote condom use (positive behavior) and signify condom availability rather than promotion of any one particular product.
UNFPA , along with the rest of the international community, strongly advocates for closer linkages between HIV/AIDS interventions and sexual and reproductive health care. The HIV epidemic is integrally linked to sexual and reproductive health: The majority of HIV infections are sexually transmitted or associated with pregnancy, childbirth and breastfeeding. Both HIV/AIDS and poor sexual and reproductive health are driven by common root causes, including poverty, gender inequality and social marginalization of key populations.
In 2010, PSI-C began partnering with local affiliates of International Planned Parenthood to build their clinical capacity, whilst looking at the community level, targeting the underserved to increase knowledge, social support, and demand for services and products. Meanwhile through community interventions, BCC educators trained by PSI/C, reach out to the most at-risk populations educating them about sexual health. BCC educators follow guidelines to provide referral cards/vouchers for redemption at partner clinics. When the voucher is presented at a partnering clinic, the client can access sexual and reproductive health services that include a variety of family planning options such as: oral contraceptives, injectable contraceptives, condoms and IUDs. Many have used this opportunity to not only access contraceptive services, but also Pap Smears, Breast Exams, VIA Screening, Prostate Exams, Blood Sugar and Blood Pressure Tests all supported by PSI-Caribbean, which also contribute to NCD prevention.
In Trinidad and Tobago, the number of reported cases of violence against girls and women is staggering. Three of the top ten countries with the highest incidence of rape are Caribbean countries—the Bahamas, Jamaica and Barbados . Trinidad and Tobago is not far behind. Interpersonal violence (including gender-based violence and rape) ranks fifth out of 44 disease areas, accounting for 5.4 percent of the total years of lives lost due to premature deaths – demonstrating the extent to which gender based violence is a public health issue. Gender inequality and negative gender norms are the root causes of GBV. Eliminating GBV means transforming attitudes and engaging influencers. In Trinidad and Tobago, PSI-C works with local partners, community members and policy makers on a comprehensive response as outlined below:
- At the individual level, to increase access to quality, comprehensive services and support for women and girls experiencing violence.
- At the family level, working with men, boys and mother’s in-law to address harmful traditional practices and to change negative gender norms.
- At the community level, engaging community members on prevention and support services for survivors – making women and girls an active part of the solution.
- At the institutional level, developing guidelines for comprehensive screening, treatment and care for women and girls, including the establishment of support programs for social assistance, housing, education and work placement.
- At the societal level, raising public awareness and advocacy efforts for legal reform and law enforcement that will help shift societal paradigms.
A Joint Report by the United Nations Office on Drugs and Crime and the Latin America and the Caribbean Region of the World Bank. “Crime, Violence, and Development: Trend, Costs and Policy Options in the Caribbean”. 2007.
The Trinidad and Tobago Ministry of Health’s Chronic Non-communicable Disease Risk Factor Survey (Pan American STEPS, 2012) revealed that the twin island nation has one of the highest prevalence, morbidity and mortality rates for chronic Non-communicable Diseases (heart disease, stroke, diabetes, cancer) in the Caribbean, and these rates have been steadily increasing over time. In Trinidad and Tobago, Non-communicable Diseases account for over 60 percent of premature loss of life (death before 70 years). The prevalence of diabetes in Trinidad and Tobago is one of the highest of all the countries in the region of the Americas (PAHO). This is likely due, in part, to the high carbohydrate intake, urbanization mostly due to the shift from manual labor and agriculture to a highly technological service sector resulting in low levels of physical activity.
Non-communicable Diseases share common risk factors, including modifiable biological risk factors such as high blood pressure, high cholesterol, and behavioural risks such as unhealthy diets and obesity, tobacco use, alcohol abuse and physical inactivity.
The statistics show a definite need to upscale prevention efforts, and in 2014, PSI-C began developing stand-alone programming using a Life Course Approach, focusing prevention efforts on youth between 10-19 years of age with the aim of increasing their physical activity, improving their diet and reducing tobacco and alcohol use to prevent the development of chronic diseases.
- The Federal Republic of Germany through KfW Entwicklungsbank (the German development bank)
- U.S. Department of Defense
- Private Donor Funding
- NGOs and commercial infrastructures
- Ministries of Health
- International Planned Parenthood Federation Affiliates
- Gender Based Violence Prevention in Trinidad and Tobago
Globally, PSI has been engaging philanthropic individuals to pilot innovative health projects for girls and women to grow the evidence base and take programs to scale. One such partnership is with the Bill and Melinda Gates Foundation. Initial pilot projects are being implemented in India, Uganda and Trinidad and Tobago. In Trinidad and Tobago the pilot project is a gender based violence prevention (GBV) program that was initiated in early 2014.
- Cyber-Educators In Latin America
In Latin America, PASMO has employed cyber-educators to reach young MSM with HIV prevention information through online chat rooms. Check out this video explaining their approach.
- PSI’s sexual and reproductive health programs for youth
This program brief provides an overview of key programs that PSI is implementing to improve the sexual and reproductive health of youth around the world.
- PSI/Carribean At a Glance
In the Caribbean region, PSI operates through its affiliate hub, Society for Family Health, commonly referred to as PSI/Caribbean (PSI/C). Since 2005, PSI/C has been working to measurably contribute to the development of favorable environments that facilitate healthy lives among the people of the Caribbean. PSI/C’s work involves using commercial sector techniques to promote healthier behaviors as well as greater availability of and access to key health information, products and services, especially for low income and high-risk populations.
- The Brand: Got It? Get It.
With Got it? Get it. (GIGI) PSI/C created a powerful, youth oriented, Caribbean-flavored brand that has the ultimate goal of empowering Caribbean youth to be sexually responsible. The brand is unusual because it aims to promote condom use (positive behavior) and signify condom availability rather than promotion of any one particular product.
- 2012 Mid Year Region and Country Dashboards, Latin America and the Caribbean
Mid-year Latin America and the Caribbean region and country impact dashboards for 2012
- 2011 Region and Country Dashboards, Latin America and the Caribbean
Latin America and the Caribbean region and country impact dashboards for 2011
- Consistent Condom Use Among Youth in Tobago: Baseline Findings to Inform an HIV Prevention Intervention
Recent studies suggest that HIV infections are six (6) times higher among 15-19 year-old females compared to males. Cultural barriers, gender roles and sex tourism are major drivers of the epidemic. UNGASS 2010 further states that since 2006 there has been a minimal but steady increase in the prevalence of HIV from 1.2% to 1.5%. The report also highlights that males account for 47.5% and females account for 52.5% of all new HIV infections.
- Condom Use and Exposure to PSI/SFH’s HIV Prevention Intervention Among Young Women 16 to 24 with Concurrent Transactional Partners in Trinidad
Recent studies suggest that HIV infection rates among 15-19 yearold females in Trinidad are six (6) times those of males of the same age. (UNGASS, 2008) Concurrent, transactional relationships are believed to be an important driver of the epidemic. Although there is no accurate estimate of the number of concurrent partners, current data from St Lucia (similar sexual behaviours) show that females 16 to 24 years have an average of 10.6 sexual partners over 12 months. The data also indicates that males 45 to 49 years account for the majority of new HIV infections while a 2007 qualitative study in Trinidad reported that young girls prefer to have sexual relationships with older men.
- Male Youth On the Block in Saint Vincent Caribbean: Risk for HIV and Condom Use Determinants
UNGASS 2008 reports that St Vincent and the Grenadines HIV prevalence rate is 0.4% and is considered to be a generalized epidemic since there is little to no data on sub populations. Current UNGASS reporting further indicates that there is a HIV infection male to female ratio of 1.6:1 and, that young, poor men gathering on the streets are considered most-at-risk.