A new buzz-phrase emerged at the last global AIDS Conference in 2010: “treatment as prevention”. Studies proved that if HIV positive people were treated earlier, they would be far less infectious and transmission rates would drastically drop. Have countries ramped up testing and timely treatment? And how are they faring with the stubborn social and fiscal barriers to an effective AIDS response?
From July 22 to 27, more than 20,000 activists and researchers from across the globe will assemble in Washington for AIDS 2012, the world’s biggest HIV Conference. A Caribbean delegation of more than 300 is expected to participate. They include representatives from civil society, government and development agencies working on the region’s epidemic.
Dr. Marcus Day, Director of the Caribbean Drug and Alcohol Research Institute and a member of the Conference Coordinating Committee, laments that the region hasn’t really begun to respond to the latest scientific evidence.
“We’re failing in the application of treatment as prevention,” he said. “Now is the time. This is a game changer… we are so close to controlling the epidemic.” So where is the Caribbean? And what will we say to the world next week?
Today we can reduce the chances that an HIV positive mother would pass on the virus to her child to almost zero. The region-wide Elimination Initiative led by the Pan American Health Organisation (PAHO), the Joint United Nations Programme on HIV/AIDS (UNAIDS) and the United Nations Children’s Fund (UNICEF), aims to increase coverage of antenatal care, skilled attendance at birth and routine testing for HIV to 95 percent, while lowering transmission rates to below two percent.
“We are sitting on a success,” said Dr. Ernest Massiah, Director of the Joint United Nations Programme on HIV and AIDS (UNAIDS) Caribbean Regional Support Team. “Most of the Organisation of Eastern Caribbean States (OECS) countries are close to reaching elimination targets and it shows that the Caribbean region can achieve results in the HIV response.”
Between 2001 and 2009 an estimated US1.6billion was spent on the Caribbean’s HIV response. By 2010, 64 percent of AIDS spending in the region came from international donors. But like the global economy, the donor landscape has changed dramatically since then. Most World Bank funding for the region’s AIDS response came to an end that year. Criteria for financing from the Global Fund have become more restrictive and therefore biased against any but the world’s poorest countries. Barbados, Cuba and St. Lucia are moderately reliant on foreign sources for antiretroviral treatment. In Antigua and Barbuda, Dominica, the Dominican Republic, Grenada, Guyana, Haiti, Jamaica, St. Kitts and Nevis and St. Vincent and the Grenadines, however, all or almost all financing for ART comes from international sources.
“Panic time has passed a long time ago,” said Dr. Ingrid Cox Pierre, the Pan Caribbean Partnership on HIV/AIDS (PANCAP) strategy and resourcing officer. “We have passed that time to think about what we are going to do next in terms of persons living with HIV who have already started treatment. You can’t tell them they have to pay or stop their treatment because you cannot afford to do it anymore.”
For Massiah it means doing more with less money. He stresses that the issue is just as relevant for societies like T&T that are financing their HIV response themselves.
“We need prevention interventions that are evidence-based, cost effective and sustainable if we’re ever going to lower the cost of HIV treatment and care and spend that money on other things like education or development. We can no longer resist putting the focus where it matters—men who have sex with men (MSM), sex workers and youth. Sinking money into generic, general population prevention efforts,” Massiah asserted, “is the definition of unsustainable”.
But that’s precisely what most Caribbean countries are doing. The region’s adult HIV prevalence is one percent. But HIV rates are far higher among certain populations. Guyana, Trinidad and Tobago and Jamaica are all among the ten countries with the world’s highest rates of HIV among MSM. HIV prevalence for female sex workers ranges from 4.8 percent in the Dominican Republic to 24 percent in Suriname.
However, resources devoted to HIV prevention, treatment and care for vulnerable and marginalised populations do not reflect their HIV risk. For example in Trinidad and Tobago from 2004 to 2010 less than five percent of the money spent on prevention was allocated to programmes for MSM, sex workers, drug-users and prisoners.
“We have made progress,” Massiah said. “But we have a challenge still with equality that makes it difficult for MSM, transgender persons and sex workers to get treated.”
“There has been increasing inclusion of these groups in national strategic plans on HIV. But unless this is accompanied by budget allocations, it is meaningless,” noted Louise Tillotson, technical and policy coordinator at Caribbean Vulnerable Communities and El Centro de Orientación e Investigación Integral (CVC/COIN).
The burning question for the Caribbean at AIDS2012 is whether governments will respond to the reality of their epidemics.
Captions (Credit: UNAIDS Caribbean):
Dr. Marcus Day, Director of the Caribbean Drug and Alcohol Research Institute
Dr. Ernest Massiah, Director of the UNAIDS Caribbean Regional Support Team
Dr. Ingrid Cox Pierre, the PANCAP strategy and resourcing officer