Belize has features of both a generalized and concentrated HIV epidemic. As of September 2022, Belize has an estimated 3,515 persons or approximately 1.3% of the general adult population living with HIV. HIV prevalence is known to be higher in vulnerable groups such as men who have sex with men (MSM) (13.9%). By the end of September 2022, the National AIDS Program HIV cohort recorded 2,960 persons diagnosed and living with HIV, of which 128 were classified as newly infected. In 2021, a total of 182 new HIV infections were reported while 83 deaths were related to HIV. Although availability of antiretroviral therapy (ART) has increased, coverage remains low with only 44% coverage in 2021 and 46% coverage up to September 2022. Among those receiving ART, 987 persons have viral load (VL) counts of < 200cp/ml (achieved U=U, e.g.). These 987 people living with HIV (PLHIV) can no longer transmit HIV once ART-mediated viral suppression is maintained and will eventually recover CD4 counts in the normal range (>500 cells). The remaining 74 persons on ART, with their last VL between 500-1000 cp can still transmit HIV and remain at risk for further damage to their immune system, especially if adherence is compromised. With increased cases among vulnerable populations, Belize urgently needs to improve the effectiveness of prevention programs to limit the further spread of HIV. Many approaches are needed to limit ongoing HIV transmission including school-based programs, mass media campaigns and targeted interventions. All of these must cater to specific age groups and to those most at risk. However, the prevention response and targeted interventions need strategic information before programs can be scaled up. This information not only requires estimates on the prevalence of HIV and other sexually transmitted infections (STI) among key populations, but also an in-depth understanding of the characteristics and behaviors driving the epidemic. According to UNAIDS 2019, HIV prevalence among MSM in the Caribbean ranges between 1.1% in Cuba to 29.6% in Jamaica, which reflects the increasingly serious nature of the epidemic in the region. Two territories in the region – Jamaica, and Trinidad and Tobago – have prevalence higher than 20% among MSM. Hostility, verbal abuse, aggression, and physical violence towards MSM and transgender persons (TG) is widespread. Religious beliefs are used to rationalize and justify the negative attitudes towards MSM and TG and contribute to the animosity that sometimes fuels aggression and violence against MSM and TG. Most Belizeans do not understand issues of sexual and gender identities and the challenges faced by those who have their own special needs. According to Belize’s last Bio-behavioral Surveillance Study (BSS) carried out in 2010, HIV prevalence among MSM was 13.9% and <1.0 % among female sex workers. However, key drivers and in-depth analysis on the risk behaviors are needed to understand why, after ten years, newly infected cases continue to occur among vulnerable populations. It is with this in mind that another IBBS is now needed to characterize the current situation among MSM and TG in order to tailor specific interventions and gather new information that may guide and improve HIV/STI interventions among these populations.
The objectives of the IBBS among MSM and TG are to:
1. Estimate the population size
2. Determine the prevalence of HIV and Syphilis
3. Understand sexual and other risk behaviors (e.g., condom use, number and types of partners)
4. Assess knowledge/acceptability on the continuum of HIV prevention (i.e., PrEP, PEP and self-testing) care, and treatment
5. Understand perceptions of the availability and to measure coverage of prevention interventions and services
6. Measure health needs
7. Understand the social platforms and sexual networks
8. Measure indicators related to Global AIDS Monitoring
The implementation of the IBBS will be guided by previously developed protocols. The protocols included a quantitative HIV prevalence and behavioral survey utilizing respondent driven sampling (RDS) methods and the capture-recapture to estimate population sizes. Revision of previous population size estimates study will be needed to guide this project. All study protocols applied will ensure that confidentiality is maintained considering the difficulties in identifying members of the MSM and TG population and the concerns about unwanted exposure. A simple rapid assessment and formative assessment will be conducted to guide aspects of the design, define the incentives, identify barriers to recruitment and other operational considerations related to the study.
Expected Deliverables by the consultant based on the findings noted in the rapid formative assessment done prior, include:
1. Development of the work plan and financial proposal that includes the hiring of personnel for the implementation of the study, transportation costs, lodging of the consulting team and other expenses necessary to complete the study.
2. Development of the Research protocol and all study materials approved by a Research Ethics Committee that must include:
a. Delimitation of the research problem
b. Research Questions
c. Research objectives
d. Conceptual theoretical framework of the proposal focused on the research questions and objectives
e. Methodological aspects for: i. Survey methodology using a probability-based sampling methodology (RDS) ii. Sample size calculation iii. HIV and STI Sampling / Counseling iv. Diagnostic tests v. Diagnostic algorithm vi. Data collection / survey procedures and steps vii. Interview viii. Population size estimation techniques ix. Reporting of HIV/STI/Treatment Results x. Quality control xi. Reference
f. Review of Ethical aspects required for the IRB approval
g. Proposed Analysis plan
h. Proposed Data collection instruments
k. Data collection tools
3. Data analysis using the appropriate analysis software and weights. An excel spreadsheet of all univariate analysis (each city separately and in aggregate weighted by population size) and cross tabs including a data dictionary and recording.
4. Final report with tables and graphics. Report should include background, methodology, findings, recommendations, and conclusions and be at least 35 pages.
5. Calculation of all population size estimations and determination of possible biases.
6. Dissemination of preliminary data and consensus on size estimations and extraction to a national estimate. Slide presentation of preliminary findings and size estimations.
7. Final report and data analysis including data analysis tables as well as analysis of GAM indicators for reporting to UNAIDS.
8. Access to the database utilized for the analysis as well as that used for the calculation of population size estimations.
Detailed work plan and timeline of the consultancy to implement selected sites, organizations and informants.
1. Development of research protocol to be reviewed by the Country Technical Team.
2. Presentation of protocol to a duly registered Research Ethics Committee (IRB)
3. Final product delivery: Protocol with IRB Opinion
4. Manage the pre-study and study implementation including capacity building and organizing teams and site work, monitor the study implementation (see below for greater detail).
5. Conduct the data analysis, tables of all data analysis, analysis of GAM indicators for reporting to UNAIDS, a database into which data will be entered, calculation of population size estimations, preparation of final report.
Tasks and responsibilities of the IBBS Consultant:
1. The study should follow the guidelines and methodologies used by previous studies.
Study Oversight: Will be carried out by the consultant with support and input of the
• Develop and manage the pre-study and study implementation plan, including division of labor, the definition of roles and responsibilities, and implementation oversight.
• Collaborate in the development of study tools and other related materials, including operations manuals, interview guides, and survey questionnaire and mapping activities
• Manage the Field Coordinators, including implementing quality assurance measures and conducting ongoing training as needed. • Oversee the logistics of survey site preparation.
• Secure and manage physical space of survey sites in multiple locations.
• Coordinate with the community-based organizations (NGOs) working with key populations in the selected districts to ensure successful implementation of the study.
• Conduct fortnightly or monthly visits to assess the logistics and technical progress of the work.
• Assist in all aspects of collection and analysis of formative assessment survey data, including transcription of formative assessment data, sending daily formative assessment briefs and a final formative assessment report. Summarize findings of formative assessment (Community Informant Survey, Site Verification) in a written report
• Ensure adhesion to the approved study protocol and the confidentiality of all study materials.
• Gather relevant information and resources needed to ensure successful implementation.
• Engage Steering Committee/technical assistance providers as appropriate.
• Ensure reporting out on deliverables, including tools, resources, and building blocks of study design and implementation support.
• Present and discuss study progress and findings (using a coupon manager database) with stakeholder groups and technical committee as requested.
2. Prepare final report on participant survey process, agreed on core indicators, and include key recommendations for MSM and TG Programs based on survey findings
Technical Support: with support and input of the Technical Team
• Study Design: be directly responsible for the:
o Preparation of the study design, budget and protocol writing based on lessons learned from previous study in line with IRB and local ethics committee approval o Development of data collection forms, databases, etc.
o Supervise data entry, cleaning, recoding and analysis • Study Coordination: Provide high quality work for:
o Implementation planning and management.
o Strategic engagement of stakeholders (RHAs, NGOs, labs, etc).
o Organize training and logistics for training study staff and interviewers involved community informant survey, site verification and participant interviews and conduct trainings.
o Develop supervision plan for field operations
o Ensure compliance with human subjects requirements.
o Development of reporting forms, study operations documents, etc.
o Data management – entry and analysis o Prepare and present final report
• Prepare and submit accurate and timely financial reports on study expenses.
• Supervise study staff, including orientation, mentoring and performance reviews as appropriate.
• Plan and lead survey team meetings with the Technical Team.
• Establish and maintain good working relationships with key stakeholders and implementing partners.
• Plan, conduct and evaluate workshops and/or trainings in coordination with NAC and PR
• Develop a concise communication plan in collaboration with the NAC.
• Support the NAC in publishing and disseminating study outcomes. Length of project Pre-study (literature review), protocol development, study implementation, data entry, preliminary analysis and final report will be completed during the time period July 2023 – February 2024
Qualifications and Experience
1. Masters’ Degree in Public Health, Social Science, Demography, or similar
1. Previous experience in conducting health or social surveys within the Caribbean region
2. Expert knowledge of HIV and STI context in Belize
3. Expert knowledge of adequate methodologies relevant to these studies.
4. Previous experience with MSM and TG
5. Previous experience with national survey implementation
6. Expert knowledge of applicable statistical programs.
7. Excellent interpersonal skills and ability to establish rapport with a range of stakeholders
8. Excellent Project Management skills
9. Excellent reporting and technical writing skills in the English Language.
10. Ability to work in a team
The Study Lead will work under the overall guidance of Dr. Russell Manzanero, the Technical team and with input from Consultant from Global Fund.
Santo Rosario a sociologist by training is the Executive Director of the Centre for Integrated Training and Research (COIN). Over the past 19 years his work has supported and strengthened disenfranchised groups empowering them to set up their own organizations. Examples of this include “Amigos Siempre Amigos,” an NGO by and for the MSM community, which is now a leader in the field; and MODEMU, the first Sex Workers Association in the Dominican Republic and indeed the Caribbean. Rosario is a co-founder of the National Coalition of AIDS Service Organizations (ONGSIDA) which helps coordinate civil society’s response to HIV/AIDS in the Dominican Republic.
Name of organization
Foundation He & HIV
HIV+ Men who have sex with men
This project provides outreach, referrals, testing and care and support for low-income HIV positive men who have sex with men.
Suriname Men United
Men who have sex with men
This project reaches gay-identifying men who have sex with men and develops media spots to address LGBT stigma and discrimination.
“BUILDING ON WHAT WORKS: REPLICATING MODEL PROGRAMMING AND ADVOCACY INTERVENTIONS AND DEEPENING CARIBBEAN COMMUN
Name of organization
National Council on Drug Abuse (NCDA)
This model integrates peer education and mobile outreach to people who use crack in Kingston, Jamaica.
Jamaica AIDS Support for Life
Men who have sex with men and sex workers
One of the region’s oldest civil society organizations reaching sex worker and MSM peers, JASL is scaling-up the quality of its interventions with increased training of its peers in sexual health.
Sex Workers Association of Jamaica
This sex-worker led project aims to provide empowerment and human rights education for sex worker peers and sensitize police officers in Jamaica.
This project provides theatre/edutainment interventions and voluntary counseling and testing with youth in Kingston. It has a new social media component for Phase II.
Stand Up for Jamaica
Men who have sex with men
This new project for Phase II intervenes men who have sex with men in prisons in Kingston.
Jamaicans for Justice
This project delivers sexual reproductive and human rights focused interventions with young people in institutions in Jamaica. It has an advocacy component for structural change.
Name of organization
TRANSSA (Trans Siempre Trans)
Transgender women living with HIV
provides a minimum package of services to HIV positive transgender women as well as information about safer feminization processes and access to primary healthcare.
Men who have sex with men
delivers an LGBT-led community radio show addressing a wide range of health and human rights issues in the community.
CAJIR (Consejo Asesor Internacional de la Juventud Rural)
This is a peer education model with marginalized youth in an impoverished, rural community called Vallejuelo. Youth are exposed to sexual reproductive health information through film nights. Community health centers are sensitized on the needs of these youth.
Fundación Red de Jóvenes Unidos de Guachupita
This is a youth-led peer education and empowerment model with marginalized youth in several of the most underserved and stigmatized barrios of Santo Domingo; where unemployment, drug-use, gangs, and family violence impact young people’s access to healthcare and result in teenage pregnancy and STI’s.
Centro de Promoción y Solidaridad Humana (CEPROSH)
Migrant sex workers
uses peer education in Creole to target migrant Haitian women engaged in transactional sex and sex work in Puerto Plata. It includes sensitization of duty-bearers such as police and health services to address structural violence and barriers to health services.
Red Nacional de Jóvenes viviendo con VIH/SIDA(REDNAJCER)
This project builds on the findings of the community monitoring system built in Phase I, and will sensitize SAI’s (centers of attention, care and support for PLHIV) about the findings of the Phase I study which showed high levels of perceived and real discrimination towards marginalized youth.
This project is a drug user-led, needle exchange program targeting both non-injecting and injecting drug users in Santo Domingo. The project also includes sensitization trainings for decision-makers on the structural determinants of drug use and HIV, and highlights barriers for drug-user access to services.
Men who have sex with men
This is a peer education model with 15-25 year old men who have sex with men in the Eastern Province of the Dominican Republic. The project tries to reach young men who have sex with men with a minimum package of prevention services as they become sexually active.
Movimiento de Mujeres Unidas (MODEMU)
This is a peer education model reaching non-identifying, home and street-based sex workers in Barahona, one of the poorest provinces of the Dominican Republic. The project provides a minimum package of services for women and transgender sex workers, many of whom experience high levels of gender-based violence.
Trans sex workers
This peer education model aims to increase access to primary and sexual reproductive health care services for transgender women sex workers.
Name of organization
Artistes in Direct Support
This project targets young men who have sex with men and aims to give them the life-skills and sexual reproductive health information they need as young men.
Youth Challenge Guyana
This project reaches low-literacy sex workers in mining communities with a minimum package of services.
Volunteer Youth Corps Inc.
This project provides peer education, income generation training and case management for marginalized youth.
This project addresses stigma and discrimination towards LGBT people in Guyana through targeted campaigns.
Name of organization
This project delivers peer education to men who have sex with men in Port-au-Prince in three neighbourhoods.
Movimiento Socio Cultural Para Los Trabajadores Haitianos/as (MOSCTHA)
Marginalized youth in the border town of Ouanaminthe, Haiti
This project works with marginalized youth to deliver peer education and strengthen youth advocates for structural change.
Men who have sex with men
In the north-west of the country, this project will deliver a peer education program targeting MSM; build capacity of MSM leaders, and sensitize community leaders to reduce stigma and discrimination.
Men who have sex with men
In Port-au-Prince this project will target MSM.
Joan Didier, Executive Director (volunteer) of the St. Lucia AIDS Action Foundation (AAF) which is an umbrella NGO based in St. Lucia that works with a wide range of stakeholders, including the private sector, persons living with HIV and AIDS, youth, men who have sex with men, and sex workers.
She is the Director of the OECS Regional Co-ordinating Mechanism for the current OECS Global Fund Grant. Miss Didier is an experienced Trainer and Facilitator with expertise in Voluntary Counseling and Testing, Behavior Change Communication, Advocacy and Human Rights. She has been instrumental in helping to get the St. Lucia private sector involved in HIV and has succeeded in helping the private sector to develop HIV policies for their enterprises. She is a human rights advocate and assisted in the organization of the PLHIV support group TLC. Miss Didier has represented both St. Lucia and the OECS at several regional and international meetings.
Name of organization
Productive Organization for Women in Action (POWA)
The project uses peer education to strengthen girls and women in leadership and decision making skills; provide knowledge and support for referral services and continued access to education.
Promoting Empowerment Through Awareness for Lesbian and Bisexual Women (PETAL)
This project aims to expand women’s knowledge and leadership capacity to advocate about gaps in violence and discriminatory laws in Belize through workshops on gender-based violence among other topics.
Empower Yourself Belize Movement (EYBM)
This project focuses on using mobile technology and peer to peer methodology to engage, empower and educate targeted populations on their Sexual & Reproductive Health and Human Rights and facilitate access to relevant services to maintain healthy lifestyles.
Name of organization
Caribbean Family Planning Affiliation (CFPA)
This project is geared at sensitizing the public on marginalized groups through the distribution of IEC Materials as well as supporting marginalized youth in addressing their sexual and reproductive health by providing increased access to a minimum package of prevention services inclusive of information, education and materials for HIV/STI prevention; talks, condoms, lubricants, condom demonstration, as well as referral to HIV testing, support groups, primary health care and safe spaces.
Women Against Rape Inc (WAR)
The project implements a peer outreach program where peer educators connect with vulnerable and marginalised women to increase their knowledge of STI-HIV/AIDS, sexual health, gender base violence and human rights; increased access to comprehensive sexual health services, HIV testing and counselling, GBV reporting and counselling, increased access to safer sex commodities, educational materials; and referrals to friendly networks including health and legal referral services; increasing human rights awareness and scaling-up of community mobilisation through sensitization of front line workers including health care providers and law enforcement.
Antigua Resilience Collective Inc (ARC)
Migrant Sex Workers
This is a peer education project aimed at training a cadre of female spanish sex worker peer educators who will connect with the sex worker population in Antigua and Barbuda to educate, counsel and support their peers on HIV/STI transmission, safe sex, and violence towards female Spanish sex workers. The project will build the individual capacity of each peer educator with advocacy skills, knowledge of human rights issues, safe sex practices and safe networking with peers.
Name of organization
United and Strong
This project provides peer education training, information, health education and communication materials, and sensitization exercises to the LGBT community as well as health care professionals and support services organizations; and the nation through press releases that inform about HIV, human right, stigma and discrimination.
Dona Da Costa Martinez, EMBA, Co-Chair of CVC joined the Family Planning Association of Trinidad and Tobago (FPATT) in August 1985 and has served as its Executive Director since 1999. She is the Chairperson of the Prevention Sub Committee of the National AIDS Coordinating Committee (NACC) and is a member of several other multidisciplinary committees including a Technical Working Committee on Sexual and Reproductive Health appointed by the Ministry of Health.Under her leadership at FPATT, the organisation has introduced “De Living Room”, the only centre in Trinidad and Tobago providing comprehensive sexual and reproductive health care services to young persons under age 25; health care services for sex workers, and other at risk populations; the integration of voluntary counseling and testing for HIV into SRH services; post abortion counseling; and advocating for the provision of safe abortion services for women who choose to have one.
Mr. Cruickshank has been a member of the senior management team at CVCC since 2009 and has extensive experience in the field of HIV which has given him intimate knowledge of the Human Rights and HIV and AIDS landscape as well as the community-based response to development. He has represented CVCC at the regional and global levels with distinction over the years.
Currently Ivan serves in several major leadership positions in Jamaica’s HIV response, including Chairing both the Jamaica CCM and the National Technical Working Group for Enabling Environment and Human Rights as well as serving as a member of the Board of Governors of the National Family Planning Board – Sexual Health Agency as well as the Prime Minister’s Advisory Council. In addition, he serves as Chair of the Equality for All Foundation and is a past member of the Boards of Jamaica Network of Seropositives, and the Jamaica Youth Advocacy Network
Howard Gough graduated with honors from the Caribbean Graduate School of Theology with a Master of Arts degree in Counseling Psychology. While studying advanced psychiatric nursing in 1986 Mr. Gough became fascinated with drug addiction. This curiosity took Howard first to London on a European Union-funded scholarship where he used one year to qualify for a two-year diploma in Mental Health studies with emphasis on addiction management.
He returned to Jamaica in 1989 and began the development of drug treatment programmes on behalf of the government. He first crafted the treatment programme for the Detoxification Unit at the University Hospital and then moved to co-develop ‘Patricia House’ a residential, rehabilitation centre which he managed for 22 years. He has also served as consultant to CARICOM; as a Caribbean trainer for the London-based Richmond Psychosocial Foundation; Lecturer at UWI, Northern Caribbean University and the Mico Teachers’ College in Jamaica. He has traveled extensively across the Caribbean, Central and North America, Asia and Europe, in a bid to advance his understanding of addiction and the people affected.
Jaevion Nelson holds an MSc in Social Development and Communication from the University of Wales, Swansea in the United Kingdom where he was a Chevening Scholar; and a BSc in Management Studies (Marketing) from the University of the West Indies.
He has over seven years of work in social development and communication. He has experience working in civil society as a programmer and advocate on issues relating to governance, sexual and reproductive health and rights, violence prevention, human rights, youth rights and participation and communication.
Some of his previous positions include being a reporter at Jamaica’s oldest newspaper – the Gleaner Co. Ltd.; Teacher at the Convent of Mercy Academy “Alpha” and Programme Officer & Campaign Coordinator at the Violence Prevention Alliance (VPA), where he managed two national peace campaigns. He has lobbied US foreign policymakers on Capitol Hill in Washington DC on issues relating to youth sexual and reproductive health, human rights and HIV. He has represented civil society at several human rights, youth development and HIV meetings, including speaking on panels on Capitol Hill and the UN High level Meeting on HIV.
Ian McKnight, MSc, has been involved in HIV development work since 1991 when he co-founded Jamaica AIDS Support for Life (JASL), serving as its Executive Director from 1991 until 2002. He later served as Director of Targeted Interventions and Director for Social Marketing and Public Education. He was the Violence Prevention Specialist and Media and Communications Specialist on JA-STYLE, a USAID-funded/Ministry of Health adolescent reproductive health project and later became the Programmes Manager of the Caribbean Vulnerable Communities Coalition (CVC) from 2006-November 2009 and Executive Director from 2009 – 2013.
As a Facilitator, McKnight has given service to PANCAP/CARICOM’s “Champion for Change” initiative and the Saint Maarten National HIV Programme’s Advocacy and Policy Development Training. As a trainer, McKnight’s clients include UNIFEM, Fluid Bodies Project in New York, the Caribbean HIV AIDS Alliance, Kwanza Productions and Value Added Services.
Ethel Pengel is the founder and CEO of the Double Positive Foundation which is an NGO in Surinam catering for women and girls affected by and living with HIV. As someone who is herself a woman living with HIV, she has been involved with numerous local and regional entities inclusive of the Caribbean Network of Sero-Positives (CRN +). She is a member of Suriname’s Country Coordinating Mechanism (CCM) and a member of the Advisory Board of the Ministry of Health regarding HIV/AIDS.
She has managed two grassroots organizations (Stichting Broko Doro and Stichting Mamio Namen project Suriname) both of which had an enviable track record of providing care,support and income generating opportunities for persons living with HIV.
R. Anthony Lewis, PhD. serves as CVC Board Secretary. He has been an advocate and strategist on human rights and social justice issues since he was a teenager, and went on to work as a reporter specializing in, among other things, HIV and AIDS reporting (1993 – 1995). He was Director of Advocacy and Public Education at Jamaica AIDS Support between 2003 and 2005 and also worked in Targeted Interventions for MSM, inmates and sex workers. He is a trained translator who speaks French, Spanish, English, Jamaican and Haitian Kreyol.
He has represented CVC in a number of regional and international fora, including the 17th Conference of Commonwealth Education Ministers meeting, the International AIDS Conference in Mexico City, the Global Forum on MSM and HIV Pre-Conference, training meetings of the PANCAP law, ethics and human rights program; and the PANCAP Regional Condom Policy process with a mandate to ensure it addressed an enabling environment for condom access for youth, sex workers, gay and bisexual men, and other at risk groups.
ethnography of masculine sexual work carried out by Columbia University and Amigos Siempre Amigos (ASA) in the Dominican Republic, as well as other studies to design and develop educational material on human sexuality, HIV and AIDS, and Sexual Transmission Disease (STD).