Report: Impact of HIV Prevention Response in the Region Has Been Inadequate

BRIDGETOWN, Barbados, Tuesday January 22, 2019 – An evaluation of the Caribbean Regional Strategic Framework on HIV and AIDS (CRSF) has found that while the region has made progress in responding to the HIV epidemic, the impact of the prevention response has been inadequate, particularly among key populations.

Of concern is that the annual number of new HIV infections among adults in the Caribbean declined by only 18 per cent from 2010 to 2017, from 19,000 to 15,000. Key populations, including Men who have sex with men (MSM), Sex Workers (SWs) and their clients, and partners of key populations, transgender persons, and persons who use drugs, accounted for the majority of the new HIV infections (68 per cent) during this period.

Conversely, new infections among children fell from an estimated 2,300 in 2010, to 1100.  However, although significant progress has been made in eliminating mother-to-child transmission of HIV, available data for the period 2015 – 2017 showed that HIV infected pregnant women receiving antiretroviral treatment (ART) to reduce HIV transmission declined from 92 per cent in 2014 to 79 per cent in 2015 and 75 per cent in 2016 and 2017 respectively, illustrating a significant decrease that requires investigation.

“There has been progress in placing more people living with HIV on treatment, however much more needs to be done to increase the numbers and to retain people on treatment,” stated the evaluation which was commissioned by the Pan Caribbean Partnership Against HIV/AIDS (PANCAP) Priority Areas Coordinating Committee (PACC), the technical group of the PANCAP Executive Board with responsibility for the coordination and overseeing the implementation of operational plans for the CRSF 2014-2018.

In fact, it said significant effort is required for the Caribbean to achieve the UNAIDS 90-90-90 Targets (90 per cent of people living with HIV are aware of their infection, 90 per cent of people diagnosed with HIV are linked to ART and 90 per cent of those on ART adhere and have undetectable levels of HIV in their blood). The gap to achieving the first 90 of the 90–90–90 Targets in 2017 was 54,800 people living with HIV [1].

The gap to achieving the first and second 90s of the 90–90–90 Targets in 2017 was 74,700 people living with HIV. The percentage of people living with HIV who achieved viral suppression increased from 37 per cent in 2016 to 40 per cent in 2017.

However, the gap to achieving all three 90s at the end of 2017 was the need for an additional 103,000 people living with HIV to be on ART and be virally suppressed. Given this situation, the report stated, the Caribbean is at risk of not achieving the 2020 Targets.

Global financial resources to support the HIV epidemic have been progressively decreasing since 2011. However, domestic financing has improved during the implementation of the CRSF 2014-2018.

Domestic resources increased between 2006 and 2017 by 124 per cent, while international resources declined by 16 per cent. As at the end of 2017, domestic resources were contributing significantly to the cost of ART and the overall treatment programme. Despite this trend, national resources to support services to achieve prevention continue to be low, with the implication that the gains could be reversed if this gap is not quickly filled.

The Priority Areas Coordinating Committee, which was convened virtually on January 10, 2019, accepted the evaluation report. The PANCAP Executive Board which was convened virtually a week later also accepted the evaluation report, recognizing that while the Caribbean has made progress, much more needs to be done to achieve the targets.

The Executive Board also noted the legal judgments in Caribbean courts affirming human rights arising from litigation and called on countries not to wait on litigation but to make amendments to laws to recognize the rights of key populations and the rights of all to access sexual and reproductive health services. It added that while tens of thousands of cases of HIV infections have been prevented, there is a need to significantly reduce new infections, and this requires that countries promote age-appropriate sexual education and skills and extend sexual reproductive health services to all youth and key populations.

The board also called on all countries to introduce innovative prevention approaches and improve the quality of prevention services to ensure greater impact in reducing new HIV infections, and further called on the Priority Areas Coordinating Committee to develop a new Caribbean Regional Strategic Framework on HIV and AIDS for the period 2019 to 2023.

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