Shifting the HIV Paradigm from Care to Cure: Proceedings from the Caribbean Expert Summit in Barbados, August 2017.

The CCAS EXPERT SUMMIT convened an array of international experts in Barbados on August 27-31, 2017 under the theme "From Care to Cure-Shifting the HIV Paradigm." The Caribbean Cytometry & Analytical Society (CCAS) partnered with the Joint United Nations Programme on HIV/AIDS (UNAIDS) to deliver a program that reviewed the advances in antiretroviral therapy and the public health benefits accruing from treatment as prevention. Particular emphasis was placed on reexamining stigma and discrimination through a critical appraisal of whether public health messaging and advocacy had kept pace with the advances in medicine. Persistent fear of HIV driving discriminatory behavior was widely reported in different regions and sectors, including the healthcare profession itself; continued fear of the disease was starkly misaligned with the successes of new medical treatments and progress toward the UNAIDS 90-90-90 targets. The summit therefore adopted the mantra "Test-Treat-Defeat" to help engage with the public in a spirit of optimism aimed at creating a more conducive environment for persons to be tested and treated and, thereby, help reduce HIV disease and stigma at the individual and community levels.

Raising the priority of chronic noncommunicable diseases in the Caribbean.

The Caribbean's long history of cooperation in health now focuses on noncommunicable diseases (NCDs), given that Caribbean Community (CARICOM) countries have the highest NCD burden in the Americas. The heads of government convened a first in the world one-day summit on NCDs, largely due to advocacy by George Alleyne and others, on the health, social, and economic impact of NCDs; the need for upstream multisectoral interventions to address the common, multifactoral risks; and the need for increased global attention to NCDs. Implementation of the NCD Summit Declaration mandates was most effective in larger countries with greater capacity, but countries of all sizes performed well, when they had regional or global support. Progress was limited in regional approaches to food security, labeling, and elimination of trans fats. Inadequate funding stymied several resource-dependent interventions. Monitoring mechanisms were established, but more concrete goals are needed, especially for actions of nonhealth government agencies.

Raising the priority of chronic noncommunicable diseases in the Caribbean / Aumentar la prioridad de las enfermedades crónicas no transmisibles en el Caribe

The Caribbean's long history of cooperation in health now focuses on noncommunicable diseases (NCDs), given that Caribbean Community (CARICOM) countries have the highest NCD burden in the Americas. The heads of government convened a first in the world one-day summit on NCDs, largely due to advocacy by George Alleyne and others, on the health, social, and economic impact of NCDs; the need for upstream multisectoral interventions to address the common, multifactoral risks; and the need for increased global attention to NCDs. Implementation of the NCD Summit Declaration mandates was most effective in larger countries with greater capacity, but countries of all sizes performed well, when they had regional or global support. Progress was limited in regional approaches to food security, labeling, and elimination of trans fats. Inadequate funding stymied several resource-dependent interventions. Monitoring mechanisms were established, but more concrete goals are needed, especially for actions of nonhealth government agencies.

La larga trayectoria de cooperación de los países del Caribe en materia de salud se centra ahora en las enfermedades no transmisibles (ENT), puesto que los países integrantes de la Comunidad del Caribe (CARICOM) soportan la mayor carga de estas enfermedades en la Región de las Américas. Los jefes de gobierno convocaron una cumbre de un día, la primera del mundo, sobre las ENT, en gran parte gracias a la tarea de concientización llevada a cabo por George Alleyne y otros, con objeto de tratar las repercusiones sanitarias, sociales y económicas de las ENT; la necesidad de intervenciones multisectoriales tempranas para abordar los riesgos comunes y multifactoriales; y la necesidad de que se conceda mayor atención a las ENT a escala mundial. La ejecución de los mandatos de la Declaración de la Cumbre sobre las ENT fue más eficaz en los países más grandes y con mayor capacidad, pero países de distintos tamaños actuaron satisfactoriamente cuando contaron con la ayuda regional o mundial. En los enfoques regionales, el progreso se limitó a la seguridad alimentaria, la rotulación y la eliminación de las grasas trans. El financiamiento insuficiente obstaculizó diversas intervenciones que dependían del aporte de recursos. Se establecieron mecanismos de vigilancia, pero es preciso establecer metas más concretas, especialmente en lo referente a las actividades de los organismos gubernamentales de ámbitos ajenos a la salud.

The use of patients' metaphors to assist in mutative interpretations.

The important use of the patient's metaphors as a basis for the analyst's interpretations is considered. The insight gained by this method tends to expand the patient's self-awareness which leads to major changes in his or her functioning. The value of this approach is supported by clinical case material.