On March 31- April 1, 2024 PANCAP led a delegation of 16 persons from the Caribbean to the Public Health Service of Amsterdam on a learning journey. Country delegations were from the Bahamas, Barbados, Belize, Guyana, Jamaica, Suriname and Trinidad and Tobago. The Pan-American Health Organisation (PAHO) provided technical assistance in the planning and implementation of the learning journey.
OBJECTIVES
- Understand the systems and processes relevant to the planning, implementation, and evaluation of PrEP and nPEP services as well as Sexual Health, HIV prevention and STI programs and service delivery at the GGD Amsterdam.
- Understand the lessons learned and factors contributing to the successful delivery of Sexual Health, HIV prevention, PrEP and nPEP services, STIs and other prevention programming at GGD Amsterdam and how these can be applied in national programmes in the Caribbean.
- To determine their adaptability and applicability of key aspects GGD Amsterdam the Caribbean.
- Understand the collaboration and partnership model between GGD Amsterdam and other organizations conducting similar work, including community and key population-based organisations such as the Ballroom Community and the Rainbow House.
- Understand the use of innovation, technology and AI application in service delivery.
- Develop country specific action plans to strengthen HIV prevention programming.
- Establish and strengthen the networking between clinical providers in the Caribbean and GGD Amsterdam.
FACILITATORS
- 1. Dr. Henry de Vries, Dermatologist and Professor of Skin Infections, University of Amsterdam. Academic Medical Centre and Public Health Service (GGD Amsterdam) and Expert at the Dutch Institute for Public Health (RIVM). 1. Dr. Henry de Vries, Dermatologist and Professor of Skin Infections, University of Amsterdam. Academic Medical Centre and Public Health Service (GGD Amsterdam) and Expert at the Dutch Institute for Public Health (RIVM).
- Dr. Wendy Emanuelson-Telgt, Director, PANCAP
- Dr. Shanti Singh- Anthony- Knowledge Management, Coordinator, PANCAP
- Ms. Sandra Jones- Technical Advisor, HIV/ STI, TB and Vital Hepatitis, PAHO Caribbean Subregional Office.
WELCOME TO AMSTERDAM
Participants were welcomed by Geke van Velzen, Deputy Head of Public Health Services at GGD Amsterdam; Dr. Elske Hoornenborg, Head of the Center for Sexual Health at GGD an internist-infectiologist; and Henry de Vries, Professor of Dermatology and Infectious Diseases at the University Medical Center and GGD Amsterdam. The team encouraged participants to take advantage of the learning journey, to be curious, ask questions and interact with the GGD team leveraging their knowledge and experiences. They also expressed their hope that the knowledge transferred and learnings will be bidirectional as participating countries discuss their local experiences and best practices
Expectation Board
To set the tone for the learning journey, participants discussed their expectations using padlet- an online tool. Most of the expectations focused on gaining new knowledge on PrEP and Sexual and Reproductive Health Services.
COUNTRY VISION BOARD
Participants worked in country teams to develop their country vision board. This is a graphic representation of a mapping process that depicts the status of their national or a specific technical area of their response including critical gaps that could potentially be addressed by strategies and activities identified at the learning journey. New ideas from the learning journey were incorporated onto the vision board at the end of each day. These were used to guide the development of a country workplan to strengthen and advance key areas of their response including but but not limited to PrEP and HIVST.
PRESENTATIONS FROM GGD AMSTERDAM
GGD Amsterdam team presented on diverse issues related to HIV and STI prevention and treatment. Topics included PrEP and EziPrEP, Doxycycline PEP, Mpox, Drug Use and Chemsex, HPV and HPV Vaccination , Viral Hepatitis, Motivational interviewing among others.
Participants engaged in discussions on motivational interviewing
Angelita Casanovas and Annemijn Hageman, two Motivational Interviewing trainers, employ motivational interviewing and motivational intervention strategies that include asking open-ended questions to allow clients to explore their feelings, thoughts, and ideas, demonstrating empathy, and actively listening to clients. The importance of effective listening to clients, without giving instructions but rather allowing them to chart their own course, is emphasised.
SITE VISIT TO GGD AMSTERDAM CLINIC
Participants were taken on a tour of the GGD STI clinic by Rodrigo Braga Rodrigues, a Doctor's assistant. Mr. Rodrigo Braga Rodrigues, explained the process for patients accessing STI services, starting from an online appointment. He explained the clinical processes, systems and standard operating procedures in the intake, clinical assessments and follow up of persons seeking services for PrEP, nPEP, HIV testing and self-testing, Sexual Health, STIs including Doxy PEP, hepatitis B and C. This will allow participants to understand how HIV prevention service delivery are organized and delivered, the number and skill set of the clinical team, and other resources available for supporting service delivery.
Clients have the convenience of minimal interaction with staff and other clients, the peace of mind of having a result and most importantly the opportunity to be treated on the same visit, not having to return again for results and treatment. This is a winwin for both the client and the clinic – optimizing client interactions, clinic efficiencyand bolstering privacy.
Dr. Dale Babb, Senior Medical Officer of Health Ministry of Health and Wellness, Barbados
EMPOWER CENTRUM
Participants visited Empower Centrum, a Community Based Clinic that prioriotises HIV, STI and sexual health services to the key and vulnerable populations including adolescents, youth, MSM, Sex workers, transgender and migrant populations. Suriname nationals comprises a significant proportion of the clinic staff, clients and neighbourhood (Gravenstein) community.
Dr. Camiel Welling, Medical Doctor, Supervisor of the Trans Clinic GGD Amsterdam and EMPOWER CENTRUM and Sexologist led the team of experts at the Empower Centrum. Several topics were discussed including stigma and discrimination, adolescent and youth interventions through online modality - SENSE, interventions to reach key populations with services delivery and transgender care.
Dr. Camiel Welling, Medical Doctor, Supervisor of the Trans Clinic GGD Amsterdam and EMPOWER CENTRUM and Sexologist presented in “ Bridging the gap between health care proffessionals and communities” with a focus on “ Breaking Stigma”. Dr. Welling shared on the intersectional perspective ground this concept in the Academic Wheel of Privilege. Dr. Welling discussed the types, sources and causes of and shared strategies for addressing stigma emphasizing the need to address multiple barriers and listening to communities.
Participants were impressed with SENSE- a platform that provides adolescents and young people with sexual health resources based on the STEPPED Care Model. SENSE is focused on reaching young people younger than 25 years of age with STI services. STEPPED care includes providing information on the SENSE website, engaging individuals through a chat box, utilising a helpline, SMS, and email, and offering medical advice and consultation for STIs.
“I was very impressed with the SENSE program from the Municipal Health Services of Amsterdam. It is an online app that provides information and access to services. By just a click, a young person could find information about STDs, learn about relationships and have a consultation, all of which are free and can be anonymous. To me this program for accessing sexual and reproductive health care made sense, as this population is very protective of their sexual actions and often do not have the financial means to receive medical care”.
Angelie Chotolal, Clinic Coordinator, Family Planning Association Trinidad and Tobago
AT Empower Centrum, Mirjam van Wees, Sexual Health Nurse, Coordinator Nu Niet Zwanger (Making Informed Decisions about Pregnancy), presented their response to addressing pregnancy based on the knowledge that not everyone who is sexually active knows how to get pregnant or prevent unintended pregnancies and/ or use contraceptives the right way. Further, proactively starting a conversation about child wishes, sexuality, and contraceptives can make a difference for people in vulnerable circumstances to prevent unintended pregnancies.
SITE VISIT TO AMSTERDAM CENTER FOR SEX WORKERS
Marianne Craanen, Registered Nurse and Coordinator for the Amsterdam Center for Sex Work, Heleen Driessen, RN and Ashley Arujo, Social Worker received the team and presented on their sex worker programme. They explained that sex workers can either walk in or be referred to their clinic for HIV/ STI/ and other services. The Center also support sex workers in acquiring their annual health certificate that allows them to work. They noted that unlike in many Caribbean countries, sex work is legal. This means that sex workers have to declare their income, pay their taxes, can join unions and have rights as any other worker. To note, sex workers who are HIV positive are allowed to work once there are adherent to their HIV medicines and are unsuppressed. The team then visited the Red Light District of Amsterdam. More on the Amsterdam Center for Sex Workers
Following the discussions at the Amsterdam Clinic for Sex Workers, participants walked through the Red Light District.
The places such as the GGD STI clinic, Empowerment Centre, House of Bodega and Amsterdam Centre for Sex Workers visited during this learning exchange showed that collaboration, innovation, passion and genuine care for others was the recipe for increasing the number of people that sought health care with the desire to live a healthy life. Organizations such as these, have health care providers that understand their patients’ needs and reality as well as providing care that is aimed at putting them at the centre or as I have learned, conducting motivational interviewing.
Ms. Angelie Chotolal, Trinidad and Tobago
Acknowledgements
PANCAP extends heartfelt thanks to
- Dr. Henry de Vries, Mrs. Maria Oud and the entire team at GGD. Special thanks to all of the presenters and guides for investing time and effort in preparing their presentation and sharing their knowledge and expertise.
- The Global Fund Against AIDS, Tubersulosis and Malaria for funding this activity and PAHO for providing technical support to the planning and implementation of the learning journey.
- The Staff of the PANCAP Coordinating Unit for the exceptional admin and logistic support.
- The PCU Communications Specialist for covering the event, albeit remotely and keeping the partnership engaged with the learning journey through social media and other channels.
- Thanks to all of the participants for their active engagement and sharing and
- Everyone who have contributed to the successful planning and implementation of the learning journey.