16th International HIV Drug Resistance Workshop 12-16 June 2007, Barbados

OVERCOMING THE CHALLENGES OF THE CARIBBEAN HIV EPIDEMICS

Antivir Ther. 2007; 12:P3 (abstract no. P1)

N Adomakoh
Clinical Consultant, Ladymeade Reference Unit, Barbados

The Caribbean region has an estimated population of 38 million inhabiting 29 countries and overseas territories with tremendous diversity in size, geography, population, culture, language, development, religion, and governance structures. Against this background, HIV prevalence has remained second only to sub-Saharan Africa for a number of years. Prevalence ranges from 0.1% in Cuba to between 2–4% in Bahamas, Haiti and Trinidad and Tobago. In 2006 there was estimated to be 27,000 (20,000–41,000) new infections in the Caribbean and AIDS claimed an estimated 19,000 (14,000–25,000) lives, making it one of the leading causes of death amongst adults 15–44 years of age.

As with the global pandemic there has been an increasing feminization of the epidemic with female to male ratio now at parity in the region. High prevalence rates still exist amongst the vulnerable groups – amongst MSM, prevalence has been noted as high as 33.6% in Jamaica and 18% in Suriname. Studies in Guyana in 2000 and Suriname in 2001 revealed prevalences of 31% and 21% respectively amongst female sex workers. Stigma and discrimination, whilst on the decline, has been identified as one of the key impediments to access prevention and treatment services, resulting in low levels of uptake of VCT and treatment services. In Barbados this has resulted in very late presentations to care, with >50% of those diagnosed with HIV being diagnosed with AIDS within the first month.

Over the last 5 years there has been a proliferation of multisectoral programmes across the region implementing the UNAIDS ‘three ones’ principle in an effort to provide comprehensive, well-coordinated prevention, treatment, care and support programmes. Successful implementation of treatment programmes has seen a large decline in deaths (56% reduction in the first year of the Barbados Programme) and increasing coverage of services. Awareness of HIV is high, however prevention campaigns are moving to behaviour change interventions to translate this knowledge into risk reduction behaviour. Challenges for the future are those of sustainability and the development of sufficient infrastructure to maintain programmes in resource challenged settings.

2007-06-12
P1

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