Access to HIV services slowed
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…new UNAIDS report says 2020 targets will not be met in Caribbean

A NEW report by UNAIDS shows that despite individual country successes, overall progress in the Caribbean to expand access to HIV services has slowed. Because of this, HIV targets set for 2020 will not be reached. The report, Seizing the moment, urges countries to act with greater resolve to reach those still left behind. Caribbean 2019 data showed that there were an estimated 330,000 people living with HIV in the Region at the end of 2019. Overall Caribbean adult HIV prevalence was 1.1 per cent. In 2019 77 per cent of people living with HIV in the Caribbean knew their status. This compares to the worldwide average of 81 per cent. Eighty-one percent (81 per cent) of diagnosed Caribbean people were on treatment last year. Eighty percent (80 per cent) of those on antiretroviral therapy were virally suppressed. The global average was significantly higher at 88 per cent. Some countries have achieved elements of the 90–90–90 targets (90 per cent of people living with HIV aware of their HIV status, 90 per cent of diagnosed people on antiretroviral treatment and 90 per cent of those on treatment virally suppressed).

Barbados has reached the target for testing while Guyana has exceeded it with 94 per cent of people living with HIV diagnosed. Haiti has gotten 98per cent of diagnosed people on treatment. Suriname and Trinidad and Tobago have achieved viral suppression among at least 90 per cent of people living with HIV who are on treatment. “This shows that within the region there is the capacity to deploy the people, policies and programmes to end AIDS,” said UNAIDS Caribbean Sub-regional Office Director, Dr. James Guwani. He was speaking at a virtual launch event hosted by UNAIDS Caribbean today. Last year there were 6,900 AIDS-related deaths in the region. Deaths due to AIDS decreased by 37 per cent since 2010. Total antiretroviral treatment coverage for the region was 63 per cent–71 per cent for women and 56 per cent for men. New HIV infections decreased 29 per cent in the region since 2010. One-third of new HIV infections in the Caribbean in 2019 were among young people ages 15 – 24. Males ages 15 – 49 accounted for 57 per cent of new infections. “Year after year, the data tell the story of Caribbean men’s inadequate access to HIV services. It is time for a comprehensive strategy to meet men where they are, increase demand and adapt service delivery to meet their needs,” Dr. Guwani said. Chair of the Spouses of Caribbean Leaders Action Network (SCLAN), Kim Simplis Barrow encouraged the region to increase access to education and sexual and reproductive health services for young people. Great strides continue to be made in the Caribbean towards the elimination of mother-to-child HIV transmission, with seven countries and territories achieving World Health Organisation revalidation. Mother-to-child HIV transmission reduced by nearly half since 2010. Social inequalities and exclusion are key barriers. 60 per cent of new infections in the region were among members of key population communities and their sexual partners in 2019. This includes 26 per cent among men who have sex with men, six per cent among sex workers, five per cent among transgender people and three per cent among people who use drugs. “Access to care in most of our countries is hindered by several factors including criminalisation of same-sex relationships, hostile communities, homophobic discrimination, violence, internal stigma, and limited health education,” said Dr. Rosmond Adams, Director of the Pan Caribbean Partnership against HIV and AIDS (PANCAP). Prejudice against people living with HIV is still commonplace. The most recent data show that while discriminatory attitudes towards people living with HIV are declining consistently in some countries like Belize and Guyana, they are rebounding in others. “We have to engage people consistently around ending discrimination. We must also improve accountability and redress mechanisms when people’s rights are violated,” Dr. Guwani said. The COVID-19 pandemic could seriously disrupt the AIDS response UNAIDS is urging countries to increase investments in both diseases. The 2020 Global AIDS Update notes that even before COVID-19, Caribbean state health systems were struggling to cover programmes traditionally funded by international donors, including HIV prevention and key population-focused initiatives. Between 2010 and 2019 there was a 30 per cent decline in disbursements by the Global Fund and a 19 per cent decline in investments by the United States Government. HIV resource availability from domestic sources increased by 38 per cent from 2010 to 2019. At present funding is 42 per cent short of the level needed to effectively respond to HIV in the region during 2020.

Caribbean Regional Network of People Living with HIV (CRN+) Vice Chair, Renatta Langlais, pointed to the strain COVID-19 placed on community organisations. She said despite funding cuts, they are being forced to do more work to serve clients whose incomes and healthcare access have been impacted by the COVID-19 response.

Executive Director of the Caribbean Public Health Agency (CARPHA), Dr. Joy St. John, urged health authorities to adopt measures to assure the health of people living with HIV and those with non-communicable diseases. “Continuous monitoring and re-evaluation of considerations for vulnerable populations at risk from COVID-19 are critical, as the demographics for COVID-19 are quickly changing,” she said.

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