COMBATING HIV/AIDS IN THE CARIBBEAN THROUGH A COMPREHENSIVE, MULTISECTORAL APPROACH 70973 -- '/ --7£7~ /'?c:::;.;; . -=- ./ ..-e:.....-/ .....R7-a~ ~ - .Jugador mas valloso de la Ilga Americana, 2002 Apoya la lucha contra el SIDA Linea de informacion 51DA 54 1-4400 Desde el interior sin cargos 1-200-1170 - Gulf of M.exico ATLANTIC OCEAN . ., ~ JAMAICA 1.20% Caribbean Sea PACIFIC . R. B. DE VENEZUELA '- r • OCEAN ' ......... " ...... " . .",., . .". ". 1 COLOMBIA B RAZ IL GOVER: Poster of Miguel HIVIAIDS in the Caribbean Tejada, of the Oakland A 's and The Caribbean region currently has the highest prevalence of HIV of any the 2002 Most Valuable Player region of the world other than AIDS-ravaged sub-Saharan Mrica. Official of the American Baseball figures show more than 360,000 people living with AIDS, but estimates by League, as the Sponsor of the 2002 World AIDS Day in the UNAIDS place the actual number at over 500,000, adjusting for underreport- Dominican Republic. ing. In the Caribbean, the HIV/AIDS epidemic has been moving into younger and younger population groups. About 83 % of AIDS cases are diagnosed in "With or without AIDS - a right to life" people between the ages of 15 and 54, and almost half of these cases are diag- nosed in people ages 25 to 34. These figures suggest, given an estimated average incubation period of 8 to 10 years from HIV infection to the develop- ment of AIDS, that about half of new HIV infections are occurring among young people ages 15 to 24. The affected age groups are the core of the labor force. Among men, the majority of AIDS cases are in the 30-34 and 25-29 age group; among women, the majority of cases are in the 25-29 year-old age bracket, followed by the 30-34 age group. Currently, the Caribbean region has one of the highest rates of new AIDS cases among women in the Americas, reflecting the growing "feminization" of the HIVIAIDS epidemic. Also, the percentage of AIDS cases who are children infected by HIV-positive mothers is higher in the Caribbean region than in any other part of the Americas. More than 80,000 children have been orphaned by AIDS. Overall the infection rate is estimated to have reached 12% of the population in some urban areas, The Spread of HNIAIDS among the General Population • The Caribbean is the second most affected region in the world with an estimated HIV prevalence rate of more than 2% among the adult population. In some urban areas the infection rate is estimated to have reached 12 % of the population. • The most affected countries such as Haiti, Bahamas, Barbados, Dominican Republic, Guyana and Trinidad and Tobago have HIV prevalence rates among adults that range between 2% and 6%. • Haiti and the Dominican Republic, taken together, account for about 85% of all HIV cases in the Caribbean. • About 83% of AIDS cases are diagnosed in people between the ages of 15 and 54, and almost half of these cases are diagnosed in people ages 25 to 34. • The primary mode of HIV transmission among adults in the Caribbean region is sexual intercourse between men and women. • Five times more girls than boys age 15-19 are HIV-positive in Trinidad and Tobago. • In a study in the Dominican Republic, one-half of young men aged 13-24 used a condom at last sex, while only 17% of young women of the same age said they had. • 46% of sex workers are HIV-positive in Georgetown, Guyana; and one-third said they had never used a condom with a client. TABLE 1. ESTIMATED NUMBER OF PEOPLE LMNG WITH HIV/AIDS IN THE CARIBBEAN, END OF 2001 spreading in many countries from highly vulnerable groups to the Country Total estimated # of women # of men # of children number of people living with living with living with general population. living with HIV/AIDS HIV/AIDS HIV/AIDS HIV/AIDS As a region comprised of small Anguilla 99 33 66 0 island states and mainland nations Antigua & Barbuda 1,128 201 924 3 with rdatively-small populations, Aruba 451 187 262 2 I-llV/AIDS presents unique chal- lenges and the response to it must Bahamas 6,150 2,662 3,461 27 consider consequences specific to Barbados 4,134 1,031 3,094 9 small country circumstances. As Belize 5,120 2,965 2,075 80 such, while trends in Mrican coun- tries have suggested that the Bermuda 539 168 369 2 economic impact of the I-llV/AIDS British Virgin Islands 306 61 244 1 epidemic becomes evident after Cayman Islands 48 16 31 1 experiencing a prevalence of around 7%, such might not be the case in Cuba 3,200 830 2270 100 the Caribbean with countries with Dominica 115 57 57 1 total populations ranging from Dominican Republic 130,000 61,000 69,000 N/A 50,000 to the low millions. Grenada 1,122 224 894 4 People need to be well informed Guyana 24,941 11,274 13,529 138 about transmission mechanisms, Haiti 210,000 NlA N/A N/A risks, and how to protect them- selves-and need to modufy high-risk Jamaica 22,715 8,691 13,906 118 behaviors. Any effective program Montserrat 28 19 9 0 requires effective surveillance. If a Netherlands Antilles 990 578 405 7 three pronged strategy of detailed surveillance, special programs for SI. Kitts & Nevis 347 144 201 2 vulnerable groups, and risk manage- SI. Lucia 877 435 435 7 ment in the general population is SI. Vincent & the Grenadines 1,002 312 686 4 not followed, over time the virus is likely to spread from the more Suriname 3,983 1,583 2,375 25 vulnerable groups and move rapidly Trinidad & Tobago 16,217 5,762 10,372 83 into the general population, as has Turks and Caicos 972 479 504 9 happened in much of Mrica. Source: PAHOICAREC, UNAlOS, 2002 Caribbean governments have sought to address the many facets of the epidemic as it has emerged in the region in partnership with regional and international agencies, including those in the United Nations system, the Caribbean Community and Common Market (CARICOM), the Caribbean Epidemiological Center (CAREC), the University of the West Indies (UWI), CD Combatting HNiAlDS in the Caribbean and Nevis, the Dominican Republic, The Gender Dimension and Trinidad and Tobago have Women often cannot choose with whom or under what circumstances they elevated their national IDV/AIDS have sex. Gender inequities relating to the unequal distribution of power and program to the level of the prime economic and social resources playa large role in this. Women and girls are minister or the president's office in often forced to resort to sex work to support their families because they have order to demonstrate serious no other income generating opportunities. Women and girl children become commitment and multisectoral more wlnerable to sex work when men supporting their households become responsibility. too ill to work or die because of AIDS. Cuba has had an effective strategy Women's risk is further exacerbated because they are physiologically 2 to 4 for addressing IDV/AIDS since times more susceptible to HIV. Young girls and adolescents, whose reproductive 1986, and has conducted studies of tracts are not fully developed, are even more susceptible to STls and HIV. groups at highest risk, carried out Untreated STls increase women's risk of HIV infection. epidemiological investigation of Sautee: PAHO 100% of cases, performed analyses of hospital admission and outpatient care records, and implemented a the Caribbean Regional Network of has confronted sexually transmitted comprehensive program of health People Living with IDV/AIDS infections (STIs) vigorously over the education for the general population. (CNR+), bilateral cooperation agen- years. Barbados, Grenada, St. Kitts For many years, the Dutch cies, and national and international non-governmental organizations (NGOs). The actions taken have Funding Antiretroviral Drugs in Barbados included advocacy and social mobi- Under the Wood Bank-financed project, the Government of Barbados put in lization, regional and national place in 2002 the necessary building blocks for scaling up the anti-retroviral policy development, establishment drug therapy (ARV). Among them, are: of IDV prevention and control activities and programs, develop- • Civil works investments (refurbishing, remodeling, expansion of facilities) ment of mass media campaigns and providing space for voluntary counseling and testing, laboratory and phar- prevention programs and services maceutical services, and home and hospital care for HIVIAIDS patients; for young people. • Laboratory equipment is in place and staff training for HIV (ELISA test), As a result, throughout the opportunistic diseases, CD4 count and viral load testing is completed; Caribbean region, there are exam- • The procurement process for increased quantities of ARV drugs has been ples of successful country-level clearly established; responses to IDV/AIDS. Early inter- vention and good pre-existing public • Staffing and training for the HIVIAIDS Referral Center has been completed; health laboratory work have ensured • Review and updating of protocols for ART has been completed and found the safety of the blood supply in satisfactory; and most of the region. For the smaller island-states of the eastern • Financial feasibility and sustainability for further annual scaling up of the Caribbean in particular, CAREC's number of patients under ART treatment are achieved. assistance has been helpful. Jamaica Source: World Bank project documents Systems for better epidemiological analysis and intervention, confidential- ity protection, and case management; • Baseline surveys of epidemiology, knowledge, and behavior; • Improved I-llV sentinel surveillance to monitor the epidemic; • Analysis of the design and implementation of cost effective interventions; and • Public expenditure reviews to track national commitment and funding to combat the , .. ~If' \ I-llV/AIDS epidemic. Proyeclo Prevenci6n y Control del VIH/SIDA Scaling up care and support 2002 - 2006 activities at national and COPRESIDAlBanco Mundial community levels • Treating STIs and opportunis- tic infections such as tubercu- losis; • Improving the availability of and access to essential drugs, training health personnel, better clinical management of I-llV1AIDS-related conditions; • Providing home and commu- nity-based care and support activities; Launching of the HIVIAIDS Program in the Dominican Republic under the leadership of • Developing guidelines and strengthening infrastructure to make use of COPRESIDA, the Presidential Council for ARV drugs safe, effective and sustainable. HIVIAIDS. Scaling up prevention activities at national and community levels • Information, education and communication campaigns or specific target groups to raise awareness and undertanding of I-llV/AIDS and STI trans- mission and to change high risk behavior; • Promoting condom use; • Voluntary testing and counseling for vulnerable groups of the population; • Interventions to reduce mother-to-child transmission of I-llV, including the distribution of nevirapine; and o Combatting HNiAIDS in the Catibbean Multi-Country HIV/AIDS and committed to the Dominican Dominican Baseball Prevention and Control Republic (US$25 million), Barbados Star in the US Major Adaptable Lending Program (US$15 million), Jamaica (US$15 (APL) for the Caribbean million), Grenada (US$6 million), League goes to Bat Region and St. Kitts Nevis (US$4 million). to Prevent HIVIAIDS On June 28, 2001, the World Bank's COPRESIDA, the Presidential Board approved a US$155 million National Projects and Commission for HIVIAIDS in the Multi-Country IDV/AIDS Their Objectives Prevention and Control Adaptable Dominican Republic, managed to The Dominican Republic Program Loan (APL) for the engage Miguel Tejada of the Caribbean Region. Under the APL, The project is supporting IDV/AIDS Oakland A's and the Most Valuable individual countries obtain separate prevention and control in the Player in the American Baseball loans and/or credits to finance their Dominican Republic by scaling-up League in 2002, to be the sponsor national IDV/AIDS prevention and programs and activities targeting of the 2002 World AIDS Day. control projects. The program, highly vulnerable groups, expanding COPRESIDA is also promoting the which is anchored on a awareness among the general involvement of the private sector World Bank study on population, and strengthen- to prevent the spread of HIV in IDV/AIDS in the Caribbean ing institutional capacity to tourist areas. and that was prepared in ensure that the effort is effec- 2000 in partnership with tive. In partnership with the CARICOM and UNAIDS, pharmaceutical industry, the supports a compre- project is also helping • Improving screening to ensure a hensive approach expand the coverage safe blood supply. including preven- of the mother-to-child Capacity Building tion, treatment and prevention program. care, and institu- • Support for program coordination, tional develop- The IDV prevalence resource management, and imple- ment. It endorses a Children living in the Dominican Republic rate among adults in mentation at all levels; participatory near border with Haiti. the Dominican • Establishing monitoring and approach to facili- Republic is estimated impact evaluation systems to tate coordinated work among at 2-3 %, suggesting that this disease enable project management units governments, patients, community now threatens to become a wide- to monitor performance of project groups, religious organizations, non- spread epidemic. Therefore the implementation. governmental organizations, health project's main objectives are to: professionals and the private sector. As an important feature of the Project preparation has been • Reduce by 50% the number of proposed projects, the World Bank is supported by a US$735,000 grant new reported IDV cases in five encouraging countries to develop provided by the Government of years; further their own monitoring and Japan. • Increase the percentage of people evaluation, with the support of using condoms from 30 to 50%; regional bodies such as CAREC and By the end of 2002, under the APL, the University of the West Indies. US$65 million had been approved Barbados Employers in Step with AIDS Commission Members of the Barbados Employers' Commission participated in the Annual AIDS march in November 2002 for the first time. The march was one of the main activities in HIVIAIDS Awareness Week. The week was sponsored by the National HIVIAIDS Commission and the Ministry of Health. Various other local groups and government agencies also participated. 1· Floor Nanwll Building CoIlymore Rock SI Michael Tel: (246) 426-1574 Fax: (246) 429-2907 Web8ite: berbe:cla.np l <7lll'acom Email: bacon OllUnbeach.net C ontents AI DSMarch Come Celebrate MEmbers end Sat of the BEC pa1idpaed in the alnLS AI D~ Barbados Msrd1 this yesr for the firS time. The Msrd1 wa; held m one of the man ectivities in H I VI AI DSAW!I'EI1esS We8<. From Executive Director' s Desk The weB< wa; ~ by the Naiona HIVI AIDSCommiseion end the Minisry of Heath. Vaious other lcall g