Inter Press Service - December 9, 2008
Peter Richards

"Too many people are still dying of AIDS in the Caribbean," said Dr. Karen Sealy, director of the UNAIDS Caribbean Regional Support Team, as the region launched a 90-page progress report towards universal access to HIV prevention, treatment, care and support over the weekend.

Titled "Keeping Score 11", the report says an estimated 230,000 people are living with the virus in the Caribbean. While at the end of 2007, more were receiving antiretroviral therapy as compared to the previous year -- regional coverage is not yet at half of the targeted 80 percent -- the report said much more attention would have to be directed at vulnerable populations such as sex workers, men having sex with men, crack cocaine users, young women and vulnerable children.

"Strategies, prevention and treatment should go hand in hand because there will be no sustained treatment programmes without a reduction in new HIV infections," said Sealy.

"As a matter of urgency, we really need to address these key populations that are especially vulnerable to HIV. We need to make sure they are reached by targeted and effective prevention programmes and that they have access to services. If this doesn't happen, we will not see an end to the HIV epidemic," she warned.

Overall, significant progress has been made in the Caribbean, which has the second highest rate of infection after Sub-Saharan Africa. The epidemic appears to have stabilised in many Caribbean countries, but UNAIDS officials acknowledge "it has done so at a high level".

"If this situation is to change, all interventions need to be scaled up, and beyond that, decision makers need to tackle stigma and discrimination effectively and implement legislative reform to ensure that the human rights of vulnerable populations and those infected with and affected by HIV are respected," the report said.

It contains stark examples of exactly how such populations are disproportionately affected by HIV given the fact that sex workers and men who have sex with men were often more likely to be living with the virus than the general population.

In addition, young women aged 15-24 in several Caribbean countries have doubled or tripled the likelihood of becoming infected than their male counterparts of the same age.

"These populations are bearing the brunt of the epidemic and yet are not at the heart of the response. Often relatively little is known about them," said a UNAIDS statement urging regional countries to focus more on vulnerable groups in order "to turn the tide of the HIV epidemic".

"We should be prepared to think outside the box and make sure we involve those groups which are bearing the brunt of the epidemic," added Dr. Amery Browne, Trinidad and Tobago's minister of social development, who was the featured speaker at the launch of the report.

Browne, who once headed the National AIDS Coordinating Committee here, said knowledge of those groups was "scanty" and needs bolstering.

"For example, we know little about orphans and vulnerable children. Information relating to this perhaps most vulnerable of vulnerable groups was missing from UNGASS (United Nations General Assembly Special Session) 2008 reports on the whole. This needs to change," he said.

"We need to know how many children we're dealing with, what their circumstances are and ensure that they are reached and supported. Our universal interest and commitment to the rights of children demand nothing less."

The report warns that it is imperative that key challenges are met and key successes built upon "if we are to fulfill our joint responsibility to make universal access by 2010 a reality".

The UNAIDS Caribbean Regional Support Team said it is encouraged by the fact that more regional countries were submitting reports to UNAIDS, but that more work needs to be done in the area of prevention.

Last year, for example, 10,000 people were put on treatment. But in that same year, 20,000 people became newly infected.

"This shocking statistic should give us more than pause for thought. It should encourage us to look at innovative ways to reach key audiences with prevention messages. It should make us examine what really works -- and what does not -- in terms of behaviour change communication and behaviour modification. We need to be bold," said Browne.

The report notes that the political will, as well as domestic and international support, has generally increased in the region and that in increasing instances, within the highest political offices, senior government officials and line ministers were responding to HIV.

It said that several countries have national AIDS commissions or committees which continue to function under the central leadership of the prime minister's office.

"Another significant development is that the project-oriented approach existing in many countries in 2004-2005 is being slowly replaced by joint planning and reporting through national programmes, including monitoring and evaluation structure," the report said.

Sealy said strengthening civil society groups is also key to address issues facing vulnerable groups and that stigma and discrimination should be addressed at all levels with zero tolerance within communities and workplaces.

In fact, the report states that the role of civil society "cannot be overstated", adding that a comprehensive strategic approach to engaging these organisations is needed "so that they can play their central role in service provision, implementation and holding partners accountable.

"In the Caribbean, civil society participation in the national response to HIV is growing and often includes representation from most vulnerable populations and people living with the virus. However, these organisations continue to need capacity building in several areas such as programme management, reporting, advocacy and communications," the report noted.

Project coordinator and founder of the HIV/AIDS non-profit organisation REd Initiatives in Trinidad, O'Leo Lokai, said stigma and discrimination were also preventing many people from coming forward for testing.

"Most people avoid doing the test because of stigma. It basically comes down to stigma. A lot of people feel that if they go to a testing site, some would automatically assume they're HIV-positive or that they've been exposed to the virus so they don't go because they don't essentially want to be labelled or face discrimination," he said. "That's the major issue because we have the sites and many sites offer free rapid testing."

He said even when people do get tested, many are fearful of knowing the results.

The report notes that stigma and discrimination against infected persons were widespread and are recognised as a major barrier to accessing prevention, testing and treatment.

"The Caribbean has to move quickly to confront human rights issues facing most vulnerable populations and to engage in the meaningful involvement of these populations who do not receive the attention they need given that they carry the greater burden of the virus," the report added.

*****

+ Africa: Breaking the Cycle of HIV Transmission (http://www.aegis.org/news/ips/2008/ip081201.html)

+ Q&A: "Less Funding Could Lead to Millions of AIDS Deaths" (http://www.aegis.org/news/ips/2008/ip081111.html)

+ More IPS Coverage of HIV/AIDS (http://www.ipsnews.net/hivaids.asp )

081209
IP081203

Always watch for outdated information. This article first appeared in 2008. This material is designed to support, not replace, the relationship that exists between you and your doctor.

AEGiS presents published material, reprinted with permission and neither endorses nor opposes any material. All information contained on this website, including information relating to health conditions, products, and treatments, is for informational purposes only. It is often presented in summary or aggregate form. It is not meant to be a substitute for the advice provided by your own physician or other medical professionals. Always discuss treatment options with a doctor who specializes in treating HIV.

Copyright ©1980, 2008. AEGiS. All materials appearing on AEGiS are protected by copyright as a collective work or compilation under U.S. copyright and other laws and are the property of AEGiS, or the party credited as the provider of the content. .