Findings of UNGASS Indicators: A summary
There were 15,000 PLHIV in Trinidad and Tobago and the adult HIV prevalence was 1.5% in 2009. There were for every 200 males, 100 females living with HIV. During this reporting period, Trinidad and Tobago reported on only eight out of 23 relevant indicators resulting in a 35% completeness rate. The NASA report indicates that USD 28.5 million was spent on AIDS with 42% on prevention, 40% on treatment and the remaining on management, advocacy and research. It is important to note that 95% of the expenditure on prevention went to interventions among the general population (1.5% HIV prevalence) and only 5% was spent on interventions among MARPs. This distribution of resources needs more careful thinking, as it has been established that one in every five MSM in the country is infected with HIV (20% HIV prevalence among MSM). The PMTCT coverage rate is 56% and for ART it is 44% using the new WHO standards (2839/6400). In 2009, it is reported that only 6% of people infected with TB and HIV were treated despite the fact that there was a 29.3% increase of new TB/HIV co-infections (95 cases) among the 324 cases of TB reported then. Based on epidemiological data reported by the Ministry of Health, the case fatality rate of TB/HIV is as high as 23.2% (22/95) and the number of cases rose from 48 in 2005 to 95 in 2009 - a 98% increase. During that period a cumulative total of 1,338 cases of TB were reported with 367 cases of TB/HIV co-infections representing on average a TB/HIV incidence rate of 27%.The proportion of PLHIV on ART 12 months after initiation of therapy was 77%, which is lower than the 90% recommended by UNAIDS/WHO. No current behavioural data exist for the general population, orphans and vulnerable children, young people and MARPs. In Trinidad and Tobago, UNAIDS/WHO estimates that there were 1,200 new HIV infections every year between 2001 and 2009.
Key Issues Requiring Focus
- Develop a new National Strategic Plan and a Monitoring and Evaluation framework.
- Scale-up ART, treatment of TB / HIV co-infections and PMTCT programmes rapidly.
- Improve the quality of care of PLHIV to avoid premature AIDS-related deaths.
- Focus national efforts on using evidence-based interventions among men who have sex with men, male and female sex workers, transgender persons, women and girls and young males.
- Scale-up HIV prevention programmes to reduce the very high HIV incidence observed during the past ten years.
- Introduce and expand life-skills HIV education in schools throughout the entire twin-island nation.
- Direct national HIV resources to population groups most affected to ensure high quality care and greater access to prevention and support programmes and protection of their human rights.
- Remove punitive laws against same sex relationships and sex work to create an enabling environment to facilitate progress towards universal access to HIV prevention, care, treatment and support.
Honourable Dr. Glen Ramadharsingh
Minister of the People and Social Development
Trinidad and Tobago 38
WHAT IS THE AIDS SITUATION IN YOUR COUNTRY?
From 1983 to 2009, there was a cumulative total of 21,639 confirmed cases of HIV, 6,306 cases of AIDS and 3,892 AIDS-related deaths. The decade 1992-2002 saw the most drastic increase in the number of HIV and AIDS cases with a reported five-fold increase in the number of HIV cases (from 2,246 cases in 1992 to 11,341 in 2002) and a reported four-fold increase in the number of AIDS cases (from 1,156 in 1992 to 4,711 in 2002). A look at the reported cases of HIV shows that the gender gap is narrowing.
WHAT IS THE BIGGEST ACHIEVEMENT OF THE NATIONAL AIDS PROGRAMME?
There has been a 69% reduction in reported AIDS-related deaths between 2004 and 2009 (246 vs. 77) due to the provision of antiretroviral treatment.
WHAT ARE THE SUCCESSES IN RESPONDING TO AIDS IN YOUR COUNTRY?
A multisectoral response is established among state agencies; civil society, and persons living with HIV; expansion of same-day HIV testing and counselling sites; 95% HIV testing among pregnant women since 2007 resulting in a decline in HIV-infected infants; an increase in HIV testing and treatment sites; a review of the laws of Trinidad and Tobago and how they impact upon people living with HIV and MARPS has been undertaken; a National Workplace Policy on HIV/AIDS has been implemented and it prohibits HIV testing for purposes of employment. We work with CSOs including Faith Based Organisations in undertaking education and counselling interventions in community settings and providing care for PLHIV. Also a computer-based HIV and AIDS surveillance system is established at eight HIV treatment and surveillance sites to allow real-time reporting of HIV cases.
WHICH KEY POPULATION GROUPS WILL YOU KEEP THE FOCUS ON IN THE FUTURE?
The focus of the National Strategic HIV and AIDS Plan 2011-2016 is on five priority areas: prevention; treatment, care and support; advocacy and human rights; strategic information; and policy and programme management.
The Ministry of the People and Social Development’s HIV Workplace Policy is crafted to effectively provide a framework to address not only HIV issues in the workplace, but also the vulnerable groups in our society who are invariably the Ministry’s clients, namely the poor, the indigent, the marginalised, the disabled, the elderly and street children.
It is expected that the Ministry’s HIV and AIDS Workplace Policy (crafted within the context of the National HIV Workplace
Policy) will ensure that the legal framework for dealing with HIV and AIDS is adhered to and mechanisms are in place to protect staff from stigma and discrimination. As such, the Workplace Policy clearly signals the Ministry’s commitment to provide a sustainable platform for action to address and enhance the national HIV and AIDS response.
38 The Honourable Dr. Glen Ramadharsingh, Minister of the People and Social Development. Trinidad and Tobago. Presentation for the Regional Consultation for the Caribbean Universal Access to HIV Prevention, Treatment, Care and Support. HIV IN THE CARIBBEAN: SUCCESS, CHALLENGES & NEW DIRECTIONS.
March 23rd 2011, Hyatt Regency, Port-of-Spain.