PSI-Caribbean’s mission is to respond to the prevailing health needs of the people of the Caribbean region through innovative programs that increase access to health education, products and services. Founded in 2005 and headquartered in Trinidad, with country offices in Jamaica and Suriname, the organization’s initial work focused primarily on HIV prevention and increasing access to sexual and reproductive health information and services among youth, men and women at risk, as well as members of the military through its branded Got it? Get it. campaign. This project ended in 2015 and was implemented in Antigua and Barbuda, Barbados, Belize, Dominica, Grenada, Jamaica, Suriname, St Kitts and Nevis, St Lucia, St Maarten, and St Vincent and the Grenadines.
Between 2014 and 2015, PSI-Caribbean expanded its portfolio to include a Gender-Based Violence (GBV) prevention program called Make it Stop, as well as a project to address the growing burden of non-communicable diseases among youth, under the umbrella brand called Core. The organization will be embarking upon a 3-year cervical cancer prevention and control project starting in 2017 in Trinidad and Tobago, with hopes of expanding its regional reach again into critical health areas.
PSI-Caribbean continues to empower individuals by providing them with key health information in ways that they can understand, and linking this to easy, affordable access to life-saving services.
PSI/Caribbean estimates that in 2015, its products and services helped avert 495 DALYs, including, by health area:
- 396 HIV DALYs
- 98 FP DALYs
- 2 NCD DALYs
PSI/Caribbean’s family planning programs also provided 1,161 couple-years of protection.
According to The Gap Report, published by UNAIDS in 2014, there are an estimated 250,000 (between 230,000 and 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/Caribbean seeks to reduce risk of HIV 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 support for the uptake of reproductive health services. PSI-Caribbean has built strong partnerships with leading commercial networks and infrastructure. Its work in the region has focused on underserved target groups, particularly youth, women in difficult circumstances (including Spanish-speaking sex workers), men who have sex with men (MSM), and military personnel.
With the Got it? Get it. campaign, PSI-Caribbean created a powerful, youth-oriented, Caribbean-flavored brand that has the ultimate goal of empowering the region’s youth to be sexually responsible. The brand is unusual because it aims to promote condom use (positive behavior) and signify condom availability rather than promoting any one particular product.
Sexual and Reproductive Health
The United Nations Population Fund (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.
From 2009 to 2015, PSI-Caribbean partnered with local affiliates of the International Planned Parenthood Federation to build their clinical capacity, looking at the community level and targeting underserved populations to increase knowledge, social support, and demand for services and products. Meanwhile, through community interventions, peer educators trained by PSI-Caribbean engaged the most at-risk populations by educating them about sexual health. These peer educators followed 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 intrauterine devices (IUDs). Many have used this opportunity to not only access contraceptive services, but also Pap smears, breast exams, cervical cancer screening, prostate exams, and blood sugar and blood pressure tests.
In Trinidad and Tobago, the number of reported cases of violence against girls and women is staggering. In Trinidad and Tobago interpersonal violence (including gender-based violence and rape) ranks fifth out of 44 disease areas, accounting for 5.4% 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/Caribbean 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 mothers 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.
According to the Trinidad and Tobago Ministry of Health’s ‘Chronic Non-communicable Disease Risk Factor Survey’ (Pan American STEPS, 2012), 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% of premature loss of life (death before 70 years). According to the Pan American Health Organization (PAHO), the prevalence of diabetes in Trinidad and Tobago is one of the highest in the Americas. This is likely caused, in part, by high carbohydrate intake and urbanization, 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 high blood pressure, high cholesterol, unhealthy diets and obesity, tobacco use, alcohol abuse and physical inactivity.
The statistics show a definite need to upscale prevention efforts. In 2014, PSI/Caribbean began developing stand-alone programming using a life course approach. The focus is on youth between ten and 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. More details and photos from the NCD program can be found on the PSI/Caribbean website.
In the Caribbean, cervical cancer is the second leading cancer among women in both incidence and mortality and accounts for over 10% of all cancer deaths. Trinidad has one of the highest cancer mortality rates in the Caribbean. Over 549,000 women over the age of 15 are at risk of developing cervical cancer in Trinidad; in 2016, 209 women were diagnosed with the disease, and there were 105 deaths. It is the most frequent cancer among women aged 15-44 and the second leading cause of cancer death, after breast cancer.
To address cervical cancer in Trinidad and Tobago, PSI-Caribbean will utilize a multi-layered approach based on the WHO comprehensive life-cycle approach to prevention, screening and treatment of the disease, commencing in 2017. The strategy aims to achieve the following key results:
- Increased HPV vaccination coverage rates among target groups.
- Increased access to and uptake of cervical cancer screening services.
- Increased capacity and willingness of service providers to deliver quality, comprehensive cervical cancer prevention and treatment services that meet the needs of girls and women across their lifespan.
- Strengthened referral mechanisms to ensure limited loss to follow-up among women in need of care and treatment.
- Improved national and community dialogue between women and girls on sexual and reproductive health and cervical cancer prevention.
- U.S. Department of Defense (DOD)
- JB Fernandes Memorial Trust
- Private donor funding
- NGOs and commercial infrastructures
- Local governments (ministries of health, gender, youth and education)
- International Planned Parenthood Federation Affiliates
- Local and regional civil society organizations and communities of practice
- 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
- 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.
- 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.