Paper short abstract:

While formulating a national plan - influenced by international organisations - to tackle HIV in Colombia, the voices of locals affected by HIV were silenced. This resulted in implementation barriers in Cartagena; a participatory approach is thus needed in policymaking to include local stakeholders.

Paper long abstract:

With the highest prevalence of HIV/AIDS in the world after sub-Saharan Africa, the Caribbean region is greatly affected by the epidemic. The disease burden is linked to social determinants specific to the region - such as social inequalities, sexual tourism, machismo culture and stigma - leading to detrimental social, economic and health repercussions across the region. This paper focuses on the example of Cartagena, one of the largest Colombian cities, significantly affected by the disease and its determinants. Although a national plan to tackle the epidemic was formulated, with the influence of international organisations, did the plan fit the local needs in Cartagena?

Through participatory research, barriers to implementation and possible solutions were investigated in a first fieldwork in Cartagena in 2006-2007 with 27 interviews of stakeholders and 13 life stories of local people living with HIV/AIDS. A follow-up fieldwork took place in June 2013 with 10 participants, either policymakers, policy implementers, NGO representatives or local inhabitants.

Barriers identified included: the gap between the national plan and locals' cognitions; stigma and discrimination; lack of cooperation from the Church, educators and local politicians; corruption; hindrances to access of HIV prevention and treatment; low economic and human resources; and numerous changes in leadership and staff. Several achievable solutions to overcome implementation barriers were discussed with participants. However, implementation efforts can only be successful and democratic with the inclusion, during policy formulation and implementation, of all stakeholders from all levels of governance to ensure that local needs are met and attainable actions identified.