PRB

Features of the Epidemic in the Caribbean, End of 2001

Epidemic began: Early 1980s
Adults and children living with HIV/AIDS: 420,000
Adults and children newly infected with HIV: 60,000
Proportion of adults 15–49 years living with HIV/AIDS: 2.2%
Percentage of adults with HIV who are women: 50%
Main modes of HIV transmission: heterosexual sex, men who have sex with men

Source: UNAIDS and WHO, AIDS Epidemic Update, December 2001 (Geneva: UNAIDS, 2001).

(January 2002) Having witnessed some 60,000 new HIV infections and 30,000 AIDS-related deaths in 2001, the Caribbean is shaking itself awake to the need for prevention, care, and treatment programs for the estimated 420,000 people or 2 percent of the population with HIV/AIDS.

As an indication of their intent to combine their modest resources to combat HIV/AIDS, the region’s leaders decided in February 2001 to establish the Pan-Caribbean Partnership Against HIV/AIDS, an initiative that links the resources of the governments and the international community with those of civil society to boost national and regional responses.

According to St. Kitts and Nevis Prime Minister Dr. Denzil Douglas, national strategic plans that feed into a regional plan are “absolutely necessary” if countries of the region are to access the global fund set up by the United Nations to reverse the spread of HIV/AIDS and other infectious diseases by 2010.

UNAIDS describes the HIV/AIDS epidemic as a patchwork of different epidemics, driven by a combination of behavioral, societal, and economic factors. Strategic planning involves understanding the diversity of these forces, including attitudes toward sex and drug use and the availability and use of HIV-prevention tools such as condoms. This kind of planning also involves analyzing the strengths and weaknesses of the national response to date and developing actions that get the most out of a country’s limited resources.

Barbados, Jamaica, St. Vincent and the Grenadines, Trinidad and Tobago, St. Kitts and Nevis, Guyana, Dominica, Grenada, the Bahamas, and St. Lucia have gone the farthest with national strategic plans in the Caribbean, the world region most affected with HIV/AIDS after sub-Saharan Africa.

National Strategic Plans — The Bahamas

The Bahamas, with 4 percent of its adult population (ages 15-49) infected with HIV, is the region’s second worst-affected country after Haiti (5 percent). The nation has, however, gained a measure of success through its Strategic Plan developed during the mid-1980s, a few years following the start of the HIV/AIDS epidemic. Since the plan’s implementation, the fatality rate associated with AIDS has declined from 70 percent in 1985 to 50 percent in the last few years, states the Bahamian Ministry of Health in its June 2001 progress report on HIV/AIDS.

Prevention programs in the Bahamas have targeted high-risk population groups (ages 15–40), including prison inmates, crack cocaine addicts, adolescent girls and boys, sex workers, and men who have sex with men.

The Strategic Plan is a multifaceted program that promotes healthy lifestyles. It involves:

• Special programs that target Creole French-speaking immigrants from Haiti;
• Bartenders promoting the use of condoms;
• Condoms being placed in guest houses, restaurants, and bars;
• Sex education and information programs developed by the Girl Guides and Pathfinders; and
• A junior volunteers HIV/AIDS training program initiated by the Bahamas Red Cross to encourage young people to delay the initial sex act and adopt the use of various contraceptive barrier methods.
• One element of the Bahamian plan has been a consistent and aggressive effort to reduce HIV transmission from mother to child with the anti-HIV regimen zidovudine (AZT). The first study of mother-to-child HIV transmission in the Bahamas in 1992 showed that 30 percent of the babies born to mothers with HIV had the virus; after one year of treating infected mothers, only 10 percent of the babies tested positive. Unfortunately, antiretroviral treatment is not yet available for all infected mothers. Still, the program does provide those without treatment with care. Medical staff members have received training in diagnostic assessment and referral skills and supportive public and private community-based services have been developed.

“We have treated people with dignity and respect,” says the director of the National AIDS Programme, Dr. Perry Gomez, adding that this factor was “one of the main reasons for the measure of success we have achieved.”

The national program found the incorporation of community groups and the church community very effective in identifying and offering services needed by people living with HIV/AIDS. The next step for the Bahamian program is to join the UNAIDS Accelerating Access program to get significant reductions in the cost of drugs from international pharmaceutical companies.

“There are still too many people who do not have access to the antiretroviral treatment; the first target group would be to treat infected mothers to ensure they survive to take care of families and so reduce the social impact of HIV/AIDS on the population,” says Dr. Gomez.

Significantly, the Bahamas has begun to cooperate and share information about its prevention, care, and treatment program with Belize, Antigua and Barbuda, and other Caribbean countries now seeking to develop their own strategies.

National Strategic Plans — Barbados

Barbados, like the Dominican Republic, has been able to attract a US$50 million loan from the World Bank to implement its strategic plan. For the Dominican Republic, much of the funding is targeted at building up the medical infrastructure. Barbados, with a modern health structure, will use the funds to provide care and treatment.

“Barbados is not only able to constructively absorb the World Bank loan, but plans to spend US$90 million of its own funds in a five-year program,” says Prime Minister Owen Arthur.

Barbados’ national AIDS Programme is in the process of implementing a decision to make antiretroviral treatment freely available within the public health system to people with HIV or AIDS. Laboratory facilities to test and monitor viral load counts (the quantity of HIV particles in the blood) and CD4 tests that measure the number of fighter cells in the body to counter the virus are being established before antiretroviral treatment is administered.

Antiretroviral therapy will be available to those Barbadian residents who need it starting in January 2002 at the major hospitals and polyclinics, free of charge, says Dr. Timothy Roach, director of the AIDS management team at the Queen Elizabeth Hospital in Bridgetown.

He says the treatment therapy will meet the medical needs of the HIV/AIDS population that numbered 1,383 as of March 2001; more than 1,000 people have died since the first case of HIV infection was discovered in 1984 in Barbados.

“We still have a great deal of stigma and discrimination in the population to overcome,” says Dr. Roach.

While the labs are being established to monitor antiretroviral treatment, medication for the many opportunistic infections that inflict people with HIV/AIDS is available at public hospitals and polyclinics free of charge.

National Strategic Plans — Jamaica

Jamaica is further behind in its attempts to develop a strategic plan. In the meantime, the government has begun preparations to negotiate a 75 percent reduction in the cost of antiretroviral treatment with pharmaceutical manufacturers. The drugs are now available commercially in local pharmacies but cost JA$30,000 to JA$40,000 (US$750 to US$1,000) per month, a figure beyond the reach of most people with HIV or AIDS, says the director of Jamaica AIDS Support (JAS) Christine English.

Occasionally, nongovernmental organizations such as the JAS are able to acquire some quantities of antiretroviral therapy, but this situation is not sustainable and therefore of little use to infected people who need the drugs every day for the rest of their lives.

English and medical practitioner Dr. Dorothy Blake say the public hospitals and health centers offer limited care and treatment for HIV-infected persons who contract the most common of the opportunistic infections, including oral and vaginal thrush, pneumonia, colds, skin rashes, and meningitis.

“But this is obviously short-term. People are treated and sent home as there is little else that can be done for them,” says Dr. Blake. She says the government has started on a limited basis a program of treating mothers with HIV who were tested at public clinics in two major population centres in the south of the country — Kingston-St. Andrew and St. Catherine — and in St. James, a rural area of the north.

The government has also developed a program of treatment for special categories of workers in the health and security sectors who may have been exposed to the virus. The program treats these workers with antiretroviral therapy if they have been accidentally stuck with needles.

“The government is moving in the right direction, seeking to approach HIV/AIDS as a problem requiring effort from many sectors of the society, not merely a health problem,” says Dr. Blake, adding that the program will eventually involve voluntary counseling and testing, as the government seeks to end discrimination against sex workers and other high-risk groups.

National Strategic Plans — Trinidad and Tobago

Further south in the chain of Caribbean islands, the minister of health in Trinidad and Tobago hopes to finalize the government’s strategic plan soon. In 1999, the health ministry instituted a program to treat HIV-infected pregnant women and their babies with antiretroviral therapy, and by September 2000 the program of testing and treatment was expanded to 80 percent of public health facilities.

The government intends to expand the program to all areas of the country in 2002. Negotiations through the UN Accelerated Access Program have been finalized, with the government committing to the purchase of antiretroviral drugs from pharmaceutical companies at 10 percent to 15 percent of the original cost.

“Our intention is to commence treatment early in the New Year [2002] on a phased basis. Our first priority is to interrupt the mother-to-child transmission. Next, we plan to treat the HIV-positive mothers of children so that the children will not be orphaned. We then plan to treat all HIV-positive children, and finally we will treat all the remaining adults as resources permit,” says health minister Dr. Hamza Rafeeq.

Not All Countries on Board

The UNAIDS Caribbean office has commended the few countries that have followed talk with action to develop health care programs for people with HIV/AIDS.

“But for the many governments, it will take more than political rhetoric; it requires the allocation of funding, the institutionalization of programs of prevention and care,” observes UNAIDS regional program adviser for the Caribbean Dr. Ruben del Prado. He says plans involving all government ministries have to be established.

“Until every country in the Caribbean does this, we will see an increase of HIV and AIDS that will continue at the rate of infection we’ve seen in 2001,” says Dr. del Prado.

Tony Fraser is a freelance writer in Trinidad.

For More Information

AIDS Reports, Caribbean Epidemiology Centre: www.carec.org/data/aids/

UNAIDS Epidemiological Database:
www.unaids.org/en/HIV_data/Methodology/epidatabases.asp