In the heart of the Caribbean a quiet revolution is taking place. Non-governmental organisations (NGOs) in Jamaica are spearheading initiatives that are not only preventing new HIV infections but also supporting people living with HIV to achieve viral suppression. These efforts are giving hope to many and significantly improving health outcomes.

One standout programme is the Community Facilitators Deployment Programme, implemented by the Jamaican Network of Seropositives (JN+). With funding from the US Government, JN+ deploys 13 community facilitators to work closely with health-care professionals in public health facilities. These facilitators provide personalised support to over 500 people living with HIV, helping them navigate the complexities of treatment and care.

The impact of this programme is profound. Since its inception in 2019, the number of people receiving support has increased by over 750 per cent, a testament to the programme’s effectiveness and the dedication of the facilitators.

The success of the Community Facilitators Deployment Programme is not just in the numbers but in the stories of the people it helps. Health-care workers have praised the facilitators for their crucial role in public health treatment sites’ teams. Their efforts have been instrumental in improving the treatment cascade nationally.

In the 2023-2024 programme year, the USAID-funded component of the programme saw a 39 per cent increase in the number of people living with HIV benefiting from the services when compared to the previous year. Women represented 58 per cent of those engaged, while men accounted for 42 per cent. Of the 251 people assigned during the year, 182 were eligible for a viral load test and 77 per cent underwent testing. Impressively, 71 per cent of those tested returned virally suppressed reading. Similarly, the Caribbean Training and Education Center for Health (C-TECH)-funded component of the programme, which operates in the western and north-eastern health regions, saw significant improvements. Of the 260 people assigned, 70 per cent underwent a viral load test and 78 per cent of those tested achieved viral suppression.

Helping people achieve viral suppression is a crucial part of the HIV response. Besides giving them the opportunity to live healthier and longer lives, viral suppression, or undetectability, means that HIV cannot be transmitted to another person, representing a vital strategy to block new HIV infections.

The Global AIDS Strategy 2021–2026 recognises the central role of communities in ending AIDS by 2030. It calls for expanded community-led responses to ensure more effective HIV prevention and treatment services. The Community Facilitators Deployment Programme is a shining example of this strategy in action.

However, the programme’s success is not without challenges. The initial pause in foreign aid by the US Government caused significant distress among community-led organisations and people living with HIV assisted by them. This situation underscores the fragility of international funding that many Caribbean NGOs rely on. As Jumoke Patrick, executive director at JN+, noted, “It caused much panic and anxiety among those offering and those who depend on these life-saving services and programmes.”

Despite these challenges, the resilience of the Caribbean people and the strength of their community networks remain crucial in safeguarding the progress made in health, social justice, and human rights. The success of the HIV response relies heavily on solidarity, innovation, and our capacity as a society to ensure that no one is left behind in the collective journey to end AIDS and promote health equity.

The recent freeze of US funds from the US President’s Emergency Plan for AIDS Relief (PEPFAR) has added another layer of complexity to the situation. Announced by the new Administration in January 2025, this freeze has had a critical impact on several countries in Latin America and the Caribbean, exacerbating existing challenges in the HIV response. For years PEPFAR has been supportive of Caribbean countries for an effective response to the HIV epidemic. Currently, Jamaica and Trinidad and Tobago are the direct beneficiaries of PEPFAR support, together with institutional strengthening of the Caribbean Public Health Agency (Carpha) and the Pan Caribbean Partnership against HIV/AIDS (Pancap).

PEPFAR funding plays a critical role in supporting HIV treatment, prevention, and care, including community-led services that focus on the most marginalised and discriminated communities. This support is provided in collaboration with governments to ensure national ownership and leadership. However, despite recent waivers from the US Department of State, significant concerns and uncertainty remain, particularly among civil society organisations (CSOs), which primarily deliver HIV prevention services for vulnerable key populations.

The Community Facilitators Deployment Programme is a beacon of hope and a model for how governments and communities can work together to improve health outcomes. By empowering communities and providing differentiated interventions, this programme is making significant strides in reducing new infections, enrolling people in care, and achieving viral suppression.

Thankfully, JN+ has received approval for its programme to continue, but its future remains uncertain, threatening to set back the revolution if funding for PEPFAR is cut. We must use this moment to reflect on how continuing US funding to the Caribbean and the world can help accelerate the urgent transition for increased national funding and sustainable roadmaps to ensure the continuity of these vital services.

As we look to the future, continued support and funding for such initiatives will be essential in the fight against HIV in Jamaica and beyond.

Dr Richard Amenyah is an international public health specialist and medical doctor from Ghana. He is the multi-country director for UNAIDS in the Caribbean. Send comments to the Jamaica Observer or jamaica@unaids.org.