| Overview : The number of persons with HIV (PHIV) in Belize is estimated to be between 3,000 (MOH; 2013) and 3,300 (UNAIDS). The Ministry of Health’s 2014 TB/HIV Statistical Report indicates that more than half of PHIV who start ART are not on treatment after 12 months; at 36 months, only 4 out of 10 PHIV who started ART remain on treatment. The improvement of treatment retention and adherence is a logical follow-up in the treatment shift to ART as prevention that Belize is currently considering.The Joint Approach for HIV/AIDS Applications in Central America and Dominican Republic posits that MSM and Trans-Gender populations are at a higher risk for HIV than FSW or Youth, due to multiple socio-political vulnerabilities. In the Belize context, the disease epidemiology and socio-cultural factors disproportionately affect MSM and Trans and warrant greater attention to be placed on interventions with MSM. The National Strategic Plan for TB Control mentions that migrants from neighboring countries with a high burden of TB and people who live in crowded conditions where TB transmission may occur (e.g., prisons and migrant worker housing) are amongst the population groups that are more likely to have latent TB infection. Approximately 1 in 5 persons diagnosed with TB are also HIV positive. In 2013, the WHO reported that Belize had a TB-HIV incidence rate of 8.1 per 100,000. In 2012, TB was responsible for 6 out of 17 AIDS mortalities in Belize. Currently the National TB/HIV Response in Belize does not have a comprehensive prevention strategy that targets Key Affected Populations including MSM and Trans. The absence of such a strategy hinders a more coordinated effort to effectively impact the National Response.
This consultancy therefore hopes to eliminate the gap in an effort to have a more cohesive and strategic TB/HIV prevention strategy for Key Affected Populations in Belize. The primary stakeholder in this initiative is the National AIDS Commission of Belize comprising of multi-sectorial partner agencies including government, civil society, private sector, international partners, and the population affected by the disease. The cultural diversity in each of the three districts with the highest burden of TB and HIV will be crucial to consider: Stann Creek predominantly Garinagu, Belize predominantly Creole and Cayo predominantly Hispanic. Also important to consider in the case of MSM is the high levels of perceived and real Stigma and Discrimination in Belize. | 
