Dr Richard Amenyah
The pathway to end AIDS in the Caribbean is clear, but it requires political leadership, investment in evidence-informed initiatives to bridge the gaps within and among communities living with and most affected by HIV and removing discriminatory laws and policies.
The Caribbean region has an estimated 330,000 people living with HIV of which 83 percent know their status and 68 percent are on treatment. However, 57 percent of people living with HIV are virally suppressed and thus have a reduced risk of transmitting the virus to their sexual partners. The region therefore still has over 100,000 people still waiting to be put on treatment.
It is important to note that like regions such as sub-Saharan Africa and Eastern Europe and Central Asia, men living with HIV in the Caribbean are still significantly less likely than women living with HIV to be on treatment. Since 2010, antiretroviral therapy coverage has increased from 19% to 63% among men, and from 21% to 74% among women by end of 2022. Sadly, while several countries have eliminated mother-to-child transmission of HIV, children are lagging in treatment across the region as only 39% of the 11,000 children living with HIV are on treatment. In 2022, treatment coverage among males varied across the region ranges from as low as 38 percent in Suriname to a high of 81 percent in The Bahamas whereas among females, treatment ranged from a low of 49 percent in Belize to a high of 83 percent in Haiti. Obviously, more work is needed to improve access to treatment among men and children in the region.
The just released 2023 UNAIDS Global AIDS Report highlights that countries with strong political leadership invest in scaling up evidence-based HIV prevention and treatment; tackle the inequalities holding back progress; engage and enable communities and civil society organisations in their vital watch-dog role in the response; and make available domestic resources which is sufficient and sustainable. UNAIDS believes these are key components of what is required to end AIDS as a public health threat and thereby advance progress to achieve the Sustainable Development Goals (SDGs).
The progress to end AIDS in the Caribbean needs to be sustained. By end of 2022, there was 15 percent reduction in new HIV infections since 2010 (18% among males and 13% among females). It is worthy to note, however, that there was an observed nominal increase in new HIV infections in the Caribbean from 14,000 in 2021 to 16,000 in 2022. AIDS deaths declined by 53 percent between 2010 and 2022. These epidemiological shifts vary across different countries in the region and continuous efforts are needed to sustain downwards the incidence and mortality trends.
Commendably, many countries in the region are integrating communicable and non-communicable diseases to deliver HIV services at the primary health care level. All these pathways show that Caribbean countries have a clear path to sustainably end AIDS in the region. Jamaica, for example, is piloting social contracting and public-private initiatives as part of a multi-sectoral HIV response involving civil society organizations and the private health sector to deliver high quality HIV-related services.
The catastrophic effect of the COVID-19 pandemic, the debt crisis and the on-going climate crisis have further weakened socio-economic development and resilience in the Caribbean sub-region. Even though most of the Caribbean countries are classified as middle- or upper middle-income countries, they are highly indebted due to lack of access to concessional loans which help make it difficult to fully invest in health to achieve universal health coverage from domestic resources. Notwithstanding the difficulties, Caribbean Governments should be applauded for their full commitment and support for the 2021 Political Declaration on AIDS to end the HIV epidemic as a public health threat by 2030. To ensure long term sustainability, most Governments across the region fully cover the HIV treatment programmes in their countries. Some countries, however, receive international funding from The Global Fund and The President Emergency Response for AIDS Relief (PEPFAR) to scale up their HIV responses.
Ending AIDS is a political and economic choice, and most Governments in the Caribbean are making the effort to put the health and well-being of their people first. That is why we are seeing declines in new infections and AIDS mortalities. However, there should be no room for complacency as stigma and discrimination towards people living with HIV and key populations is still rampant in our schools, workplace, health facilities, communities and even within the judiciary and law enforcement agencies. These negative attitudes and behaviours have the potential of pushing people further underground with a consequence of uncontrolled spread of HIV, and late presentation with advanced HIV disease and premature deaths.
No one should die of AIDS-related illnesses in this era because treatment works, it saves lives. So many people should not be uninitiated in care. Governments must ask themselves what the sociocultural and policy and legislative barriers are that keep men and children across the region away from HIV prevention and treatment services.
Caribbean Governments should continue to put their people and communities first and keep investing in HIV and health programmes to increase life expectancy, build and protect their human capital for turbo-charging the Sustainable Development Goals. There will be obstacles, but with political leadership and investment in the AIDS response to sustain and scale up what works and removing harmful laws and policies, and through partnership and global solidarity, the Caribbean will be on the right path to end AIDS as a public health threat by 2030.
Dr Richard Amenyah is a medical doctor from Ghana and public health specialist. He is the director for the UNAIDS multi-country office in the Caribbean. You can reach him on Twitter at @RichardAmenyah or @UNAIDSCaribbean and firstname.lastname@example.org