The Caribbean takes a stand

Ministers of Health from 14 Caribbean Community (CARICOM) countries have taken a step to ensure the survival of the region's AIDS response.

The Caribbean has asked the Global Fund for HIV/AIDS TB and Malaria to review new eligibility criteria for funding which "have prejudiced the region".  The letter was sent to Global Fund General Manager Gabriel Jaramillo, its board members and UNAIDS in September. In it, the Ministers noted that although the region continues to have the world's second highest HIV prevalence, there has been "a narrowing window for Caribbean countries to access Global Fund resources".

This is largely due to the fact that the first benchmark for funding eligibility is now income level according to the World Bank's annual Income Classifications. Several Caribbean nations are currently categorised as Upper Middle Income. The Health Ministers argued that the World Bank metric doesn't reflect the economic reality of the region as it is "slow to respond to changes in our economic conditions".  Specifically, they pointed to the impact of the global economic crisis on tourism revenues, extractive industries and the agriculture sector. They added that the debt service burden in some Caribbean states is very high, limiting the amount of resources available to invest in HIV.

The shift in Global Fund eligibility criteria means that many countries only have access to limited funds for interventions targeting higher risk populations. This may have dire implications in a region where the Global Fund has been the main donor for antiretroviral treatment. In eight CARICOM countries between 75 and 100 percent of financing for HIV treatment comes from external sources.

"Excluding some Caribbean countries from accessing the Global Fund and reducing the funding for technically sound proposals will not allow us to achieve our goals in the Caribbean and secure the gains that have been made," the letter stated. These gains include high treatment coverage and the near elimination of mother-to-child HIV transmission. 

According to UNAIDS Regional Support Team Director, Ernest Massiah,  this marks  "the start of a new phase of awareness and advocacy among Caribbean governments about HIV, health and development". He noted that the region was committed to sharing the responsibility of the HIV response, but needed the global community to continue to support successful implementation and good governance.