The Caribbean is on track to become the first region to eliminate mother-to-child transmission of HIV, but while there has been a decline of HIV incidence in the region of some 49% it still remains the second most affected region in the world after Sub-Saharan Africa due to the population size compared to other regions, Director of the Pan Caribbean Partnership against HIV and AIDS (PANCAP) Coordinating Unit Dereck Springer said yesterday.
“That [the reduction of mother-to-child transmission] is something that we can extremely proud of; we have been able to do this because of national and regional efforts have seen significant numbers… the majority of pregnant women accessing HIV testing during their pregnancy…and those who test positive put in treatment…” Springer told a media breakfast yesterday at the Cara Lodge.
Speaking to the fact that the Caribbean remains the second most affected region, Springer pointed out that when previously so many died within of years of having tested positive, now because of treatment they continue to live longer. As a result even if the region eliminates HIV transmission people would continue to live with the virus and as such Springer said what needs to be monitored is the incidence of new cases.
But while the Caribbean has made significant strides in the fight against the disease its vulnerable groups—especially men who have sex with men (MSM) and sex workers—continue to suffer. In the case of MSM, the prevalence rate remains high with as much as 33% of them in Jamaica being infected even though there are some encouraging signs in countries like Guyana.
While discriminatory legislation contributes to this, Springer said this issue is being addressed under PANCAP’s Justice For All initiative, launched in 2013, which aims to address legislative and other reforms to eliminate HIV-related stigma and discrimination. The initiative also focuses on family life and those in need, eliminating gender inequality, including violence against women and girls, and promoting sexual and reproductive health and rights which will also include education at all levels. Under the programme, the region will continue to look at the barriers to people’s access to prevention, care and treatment.
The PANCAP Director explained that fighting this issue has a lot to do with helping people do a value clarification and for them to understand that they are not giving up their values because they respect another human being.
“We need to recognize that we live in a diverse world and therefore we need to get to a point where we can respect differences,” Springer said.
ARVs
According to Springer, who has been piloting the unit since 2013, over the last 14 years the Caribbean has benefited from significant investment which has seen returns such as the decline in the HIV incidence which is the “sharpest decline when compared to any other region of the world.” He said that some 70% of affected persons access anti-retroviral (ARVs) drugs which has resulted in a reduction of deaths due to AIDS and improved quality of life for those who live with the disease. He recalled during a conference in the Barcelona, Spain, the Caribbean delegation used the opportunity to meet with five pharmaceutical companies and a result there was a significant reduction in the cost of ARVs for the region. The partnership, he said, continues to work with other partners to reduce the price of ARVs.
PANCAP, like the rest of the world, has embraced the new global target 90-90-90 (90% of persons living with HIV tested and knowing their status, 90% of those remaining on treatment, and 90% of those on treatment achieving viral suppression). UNAIDs has estimated that should this strategy be achieved worldwide then the world would be on track to eliminate HIV by the year 2030.
According to Director of the National AIDS Programme Secretariat (NAPS) Dr Shanti Singh, while Guyana was one of the first countries with Cuba to be able to report universal access to treatment for persons living with HIV a key challenge remains with TB/HIV population – persons who have both HIV and tuberculosis.
She explained that persons with HIV and who have TB must be placed on ARVs but there has been some resistance in terms of persons being placed on both medications.
“So our coverage in terms of ARVs for the TB patients has improved but it remains relatively low so at the end of 2014 we reported about 65% coverage for ARVs among the TB population…,” Singh said.
As at the end of last year there were some 5,041 persons in the HIV care and treatment programme and of that number 89% were using ARVs, which Dr Singh said is a significant improvement.
And for the first time in 2014 Guyana has seen greater survivability of men who are on ARVs which in the past was a challenge as men on treatment had the poorer outcome with many of them defaulting.
Meanwhile, under its regional public goods aspect PANCAP has been able to produce and model anti-discriminatory legislation which has been shared with countries and it is hoped that this would be adopted.
Those involve in the fight against the disease have repeatedly said that stigma and discrimination remain a challenge to the success of the battle.
Another challenge the region has to grapple with, according to Springer, is dwindling donor resources since many donors are now focused on climate change and the environment and addressing issues surrounding crime and security. As a result PANCAP has to ensure that the gains over the years are sustained and country efforts would continue to be supported. A priority area is shared responsibility, recognizing that HIV and AIDs goes beyond being a health problem and must be tackled by different partners. The integration of HIV into health and development is important, he said pointing out that in the past HIV had parallel programmes as opposed to being integrated which is a cost-effective measure in the response of the disease.
The partnership is now awaiting approval from the Global Fund of its concept note for US$12.1 million which would focus on addressing human rights as it relates to discriminatory laws as well as community system strengthening to ensure that there is not only a top down approach to the region’s response to HIV but also a bottom up approach.
Meanwhile, on the local front, Dr Singh said, Guyana recently received assistance from PANCAP and other partners in looking at delivering culturally sensitive mobile and migrant responses. This was coordinated with the German government. Under this initiative Guyana received support for its Biological and Behavioural Surveillance Survey (BBSS) which would have seen the completion of the study as it relates to the prevalence rate among the key populations and the dissemination of the findings last December. Further, through the PANCAP/Global Fund grant Guyana has been able to deliver prevention services and access to treatment and care to key populations and this has benefited the country tremendously.
Dr Singh also said that for the first time Guyana has seen a significant scale up of its prevention services to the key populations which has seen over 3,000 female sex workers and over 3,000 MSMs in 2014. The numbers of miners and loggers and others have also been increased.
PANCAP describes itself as an organizational model designed to harness the resources of governmental organisations and donors in order to achieve a synergistic and effective response to the AIDS evidence in the region under the coordination of CARICOM.
