“The pathway to end AIDS in the Caribbean is clear, but men and children are being left behind,” is the headline emerging from the Joint United Nations Programme on HIV/AIDS (UNAIDS) with the release of the 2023 UNAIDS Global AIDS Report
The report reveals that the Caribbean has an estimated 330,000 people living with HIV, of whom 83% know their status and 68% are receiving treatment. However, 57% 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.”
Dr Richard Amenyah, director for the UNAIDS multi-country office in the Caribbean, calls for political leadership and 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 report shows 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.
While several Caribbean countries eliminated mother-to-child transmission of HIV, children are lagging in treatment across the region; 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% in Suriname to a high of 81% in The Bahamas whereas among females, treatment ranged from a low of 49% in Belize to a high of 83% in Haiti.
“Obviously, more work is needed to improve access to treatment among men and children in the region. Dr Amenyah noted.
The 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,” he stated.
By end of 2022, there was a 15-% 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% 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.”
Dr Amenyah, who is a medical doctor from Ghana and public health specialist, further stated:
“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.”
