Inter Press Service - July 20, 2005
Peter Richards

The report by the 19-member Caribbean Commission on Health and Development, headed by Sir George Alleyne, director emeritus of the Pan American Health Organisation, also addresses other health problems, including heart disease, cancer, diabetes and obesity.

But its main focus is on communicable diseases like HIV/AIDS, which it says persists in epidemic form and "is grounded in the social and economic vulnerabilities that perpetuate risk-taking behaviour, especially among the young."

"The epidemic is not abating and its continuation is favoured by the pervasive stigma and discrimination that attend all aspects of the disease," the report said.

The commission estimates that there are half a million people living with HIV/AIDS in the wider Caribbean, and that 20 percent of them are in the 15-member Caribbean Community (Caricom) countries.

"Based on the current rate of infection, this figure is projected to be 672,000 by the end of 2009, and in the next five years, AIDS will kill a quarter of a million people if the epidemic is not checked," the commission said in its report to Caricom governments at their recent summit in St. Lucia.

"Children will constitute three percent of the new cases in the next five years," it noted.

St. Kitts-Nevis Prime Minister Dr. Denzil Douglas, who has primary responsibility for health issues within Caricom, told IPS that the virus is taking a particularly serious toll on young people between the ages of 15 and 44.

"It is very sad to report to you that we have not been able to see any serious drop in the HIV cases," he said. "It has now emerged as the highest cause of death. If we are to arrest this, we have to focus on behavioural change."

At the start of next year, Caribbean countries will implement the much talked about Caricom Single Market and Economy (CSME), which allows for the free movement of labour, goods and services across the region. The commission says the CSME "is likely to facilitate the spread of infectious diseases, as is being seen now with HIV/AIDS."

An International Labour Organisation (ILO) "Caribbean meeting on HIV/AIDS and the World of Work" held in Barbados in 2002 found that HIV infection is increasing rapidly in the Caribbean and that countries were confronted "with the frightening reality that HIV/AIDS is threatening their political, economic and social sustainability."

"Unless Caribbean countries mobilise into action, the labour market and employment effects of the HIV/AIDS epidemic will erode the productivity gains and international competitiveness of member states in the region," the ILO meeting warned.

There are no recent data on the economic toll of HIV/AIDS, but calculations in 2001 predicted a significant impact on Gross Domestic Product (GDP), principally through the loss of workers.

"The cost of a scaled up approach to the comprehensive and universal coverage for care and treatment would appear to be within the economic reach of the region, but given the economic situation and prospects, it is highly unlikely that the countries will be able to raise this financing from their own resources," it added.

The commission has acknowledged that "significant efforts" have been made at the regional and national levels to address the epidemic, adding that while there have been some "impressive success stories in some countries" more still needs to be done.

Douglas said that the Caribbean had been able to get Brazil to fund anti-retroviral drugs for 500 patients, mainly from the sub-regional Organisation of Eastern Caribbean States.

Thailand, the first country in Southeast Asia to successfully introduce a universal low-cost healthcare scheme, is also providing free anti-retroviral drugs to 50,000 HIV patients.

Earlier this year, Caribbean health experts and other technocrats met in St. Lucia to assess progress in implementing the Caribbean Regional Strategic Framework on HIV/AIDS.

The review related specifically to projects of the Global Fund to Fight AIDS, Tuberculosis and Malaria, the World Bank, the Canadian International Development Agency and the activities of PANCAP, the Pan Caribbean Partnership Against HIV/AIDS, a network of governments, civil society organisations and donor agencies.

The Alleyne commission said PANCAP's success to date "is an indication of willingness to work collaboratively to control the epidemic".

Douglas said he and his Caribbean colleagues were pleased with the report submitted by the commission, particularly as it is being made available to individual governments and would be published throughout the region.

He said the hope is that the publication would "make a serious impression on the minds of the Caribbean people", particularly since it warns that "too much stress cannot be laid on the influence of stigma and discrimination that serve to drive the epidemic underground and make any public health approach to treatment very difficult."

"It is especially important to tackle vigorously the stigma and discrimination which impede control of the epidemic and scale up care, prevention and treatment," the commission said.

The 2002 ILO meeting had also found that "the culture of silence, fear, denial and stigmatisation that persists in the region continues to inhibit effective action."

One of the strategies being discussed to deal with the issue is a business coalition meeting scheduled for October.

Edward Greene, Caricom assistant secretary general for Human Resource and Social Development, said the meeting would be co-sponsored by the Caribbean Association of Industry and Commerce and would also address the issue of discrimination against people living with HIV/AIDS.

Green said the commission also recommended that Caribbean countries increase the estimated five percent of their national budgets spent on health care. While no specific figure was given, officials point to the fact that developed states spend nearly nine percent of GDP on health.

Douglas said Caribbean governments had also agreed to launch a regionwide insurance scheme, although no time frame has been set.

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+Caribbean Community (http://www.caricom.org)

+Pan American Health Organisation (http://www.paho.org)

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