This report was produced under the supervision of Ernest Massiah, Director UNAIDS
Caribbean Support Team
The research, data quality control and validation, and writing of the report were coordinated
by Bilali Camara who supervised the team responsible for the production of the report. The
team includes Maxine Jackson-Ghent, Jose Picans, Natalie Sydney, Shelona Ali, Emmanuel
Villafana and Cheryl O’Neil who provided administrative and editorial support.
Thanks to the following individuals for their suggestions and written contributions to
this publication: Civilla Kentish (Anguilla), Delcora Williams (Antigua and Barbuda), Perry
Gomez (The Bahamas), Henrick Ellis (Barbados), Nigel Taylor (Barbados), Carol Jacobs
(CBMP, Barbados), Allyson Leacock (CBMP, Barbados), William Conn (PEPFAR, Barbados),
Tracy Robinson (UWI, Barbados), Marvin Manzanero (Belize), Julie Frampton (Dominica),
Felipe Garcia (Dominican Republic), Paula Disla (Dominican Republic), Shanti SinghAnthony (Guyana), Miriam Edwards (CVC, Guyana), Ryan Rawlins (Guyana), Carl Browne
(PANCAP, Guyana), Suzanne A. French (Guyana), Joëlle Daes-van Onacker (Haiti), Jean
William Pape (Haiti), Nathalie Cameau Legros (Transgender, Haiti), Pamelon Nickenson
(Haiti), Kevin Harvey (Jamaica), Ian McKnight (CVC, Jamaica), Dwayne Gutzmer (CARICOM
Youth Ambassador, Jamaica), Peter Figueroa (UWI, Jamaica) Brendan Bain (UWI, Jamaica),
Gardenia Destang-Richardson (St Kitts and Nevis), Nahum Jean Baptiste (St. Lucia), Erma
Jules (St. Lucia), Marcus Day (CDARI, St. Lucia), James St Catherine (OECS, St. Lucia), Del
Hamilton (St. Vincent and the Grenadines), Firoz Abdoel Wahid (Suriname), Kenneth van
Emden (Suriname), Wendy Fitzwilliam (Trinidad and Tobago), Andy Fearon (Trinidad and
Tobago), Yolanda Simon (CRN+, Trinidad and Tobago), David Soomarie (CARe, Trinidad and
Tobago), Colin Robinson (CAISO, Trinidad and Tobago), Ashily Dior (Transgender, Trinidad
and Tobago), Suzy Q (Transgender, Trinidad and Tobago), Carmen (Transgender, Trinidad and
Tobago), Tanoa (Transgender, Trinidad and Tobago), Colleen Connell (Clinton Foundation)
and the United Nations, Kwame Boafo (UNESCO), Mark Connolly (UNICEF), Giovanni di Cola
and Madhuri Supersad (ILO), Maria Tallarico and David Ruiz Villafranca (UNDP), Amalia
del Riego (PAHO/WHO), Federico Duarte (UNHCR), Shiyan Chao (World Bank), Hugo Farias
(WFP), Karen Stanecki , Michel de Groulard, Walter Saba, Reeta Bhatia, Ruben del Prado,
Izola Garcia, Ernesto Guerrero, Anita Navarro, Pierre Somse, Yordana Dolores, Kate Spring,
Beatrice Dalencour-Turnier, Melissa Sobers, Otilia St. Charles, Erva Stevens and Sandra Smith
(UNAIDS).
All rights reserved. Publications produced by UNAIDS can be obtained from the office of the
UNAIDS Caribbean Regional Support Team (CAR-RST). Requests for permission to reproduce
or translate UNAIDS publications whether for sale or non-commercial distribution should
also be addressed to the office of the UNAIDS Caribbean Regional Support Team (CAR-RST )
at the address below or by fax, at 1-868-623-8516 or email [email protected]
The designations employed and the presentation of the material in this publication do not
imply the expression of any opinion whatsoever on the part of UNAIDS concerning the legal
status of any country, territory, city or of its authorities, or concerning the delimitation of
its frontiers or boundaries.
WHO Library Cataloguing-in-Publication Data
KEEPING SCORE III
THE VOICE OF THE CARIBBEAN PEOPLE
UNAIDS/2011
1. Acquired immunodeficiency syndrometreatment, care and support.
2. HIV infections-therapy.
3. HIV infections-statistics.
4. HIV infections-prevention.
5. Delivery of health care.
6. Human Rights. Caribbean Region.
7. UNAIDS Programme Effectiveness and
Country Support Department.
ISBN 978-976-8210-43-2
(NLM classification WC 503.4 DC3)
The mention of specific companies or of certain manufacturers’ products does not imply
that they are endorsed or recommended by UNAIDS in preference to others of a similar
nature that are not mentioned. Errors and omissions excepted, the names of products are
distinguished by initial capital letters.
www.unaidscaribbean.org
Disclaimer Photographs in this report do not
necessarily represent the situation, opinions,
or beliefs of the persons depicted, and in no
way imply their HIV status.
UNAIDS Caribbean Regional Support Team
3A Chancery Lane, UN House
PO Box 812, Port of Spain
The Republic of Trinidad & Tobago
Dedication
This publication is dedicated to
Dr. Robert Carr
Robert, a son of the Caribbean, was an activist,
a scholar, a social worker, a social networker
and a family man and was a bright and visionary
soldier for human rights.
He demanded that we respect the rights of
every person, whatever their sexual, social,
political or economic background, and if not,
we were abdicating our responsibility to respect
and uphold the human rights of all people.
The death of this Caribbean champion reminds
us of others like Godfrey Sealy and Geoffrey
Stanforde (Trinidad and Tobago), Salomon
Wellington Adderley (The Bahamas), Kerwin
Jarvis (Antigua and Barbuda), Michael Fox
(Bermuda), Keith Andre Sobryan (Guyana),
Joseph Robinson (Jamaica), Juanita Altenberg
(Suriname), Emilie Damier and Eddy Génecé
(Haiti) and Barrington Wint and Dorothy Blake
(Jamaica). They have left us but will not be
forgotten.
Ernest Massiah
Director
UNAIDS Caribbean Regional Support Team
Port of Spain, Trinidad and Tobago, WI
www.unaidscaribbean.org | KS III | 1
List of Abbreviations
AIDS
Acquired Immune Deficiency Syndrome
LGBT
Lesbian, Gay, Bisexual and Transgender
ANT
Antigua and Barbuda
MARPs
Most-at-Risk Populations
ART
Antiretroviral Treatment
M&E
Monitoring and Evaluation
BDO
Barbados
MSM
Men who have Sex with Men
BEL
Belize
MSW
Male Sex Workers
BHA
The Bahamas
NASA
National AIDS Spending Assessment
CAISO
Coalition Advocating for Inclusion of Sexual Orientation
NSP
National Strategic Plan
CAREC
Caribbean Epidemiology Centre
OECS
Organisation of Eastern Caribbean States
CARICOM
Caribbean Community
PAHO
Pan American Health Organization
CDARI
Caribbean Drug and Alcohol Research Institute
PANCAP
Pan Caribbean Partnership Against HIV/AIDS
CDC
Centers for Disease Control and Prevention
PCR
Polymerase Chain Reaction
CD4
Cluster of Differentiation 4
PEPFAR
US Presidential Emergency Plan for AIDS Relief
COPRESIDA
Consejo Presidencial del Sida
PLHIV
People Living with HIV
CRN+
Caribbean Regional Network of People Living with HIV
PMTCT
Prevention of Mother-to-Child Transmission
CRTA
Caribbean Regional Trans in Action
PNLS
Programme National de Lutte contre le SIDA
CSWC
Caribbean Sex Worker Coalition
SKN
St. Kitts and Nevis
CUB
Cuba
SLC
St. Lucia
CVC
Caribbean Vulnerable Communities Coalition
SVG
St. Vincent and the Grenadines
DHS
Demographic and Health Surveys
SUR
Suriname
DNA
Deoxyribonucleic Acid
SW
Sex Workers
DOM
Dominica
TB
Tuberculosis
DOR
The Dominican Republic
TNT
Trinidad and Tobago
FSW
Female Sex Workers
UNDP
United Nations Development Programme
GFATM
Global Fund for AIDS, Tuberculosis and Malaria
UNESCO
United Nations Educational, Scientific and Cultural
GHESKIO
Groupe Haïtien d’Etudes du Sarcome de Kaposi et des
Organization
Infections Opportunistes
UNFPA
United Nations Population Fund
GRE
Grenada
UNGASS
United Nations General Assembly Special Session
GUY
Guyana
UNICEF
United Nations Children’s Fund
HAI
Haiti
UNHCR
United Nations High Commissioner for Refugees
HIV
Human Immunodeficiency Virus
USD
United States Dollar
IASC
Inter-Agency Standing Committee
USAID
United States Agency for International Development
ILO
International Labour Organization
UWI
University of the West Indies
JAM
Jamaica
WHO
World Health Organization
2 | KS III | www.unaidscaribbean.org
4
Foreword
5
Fast Facts (SpaniSh, EngliSh, and FrEnch)
7
Key Recommendations
16
Where Are We in the Epidemic?
25
The Caribbean Scorecard
37
Country Scorecard
86
What Do You Say?
87
A Human Rights Activist’s Report
88
Reporting without Prejudice and Sensationalism in
the Caribbean Media
(SpaniSh, EngliSh, and FrEnch)
The Voice of The cAribbeAn PeoPLe
CONTENTS
105
The Voice of the Pan Caribbean Partnership
(PANCAP) on HIV/AIDS
106
A Regional Manager’s Feedback
107
The Voice of Academia
108
The Voice of Bilateral Agencies
109
Role of Caribbean Business in the HIV Response
110
The Voice of the UnaidS co-Sponsors
What are the challenges?
89
From Carol Elizabeth Jacobs
90
The Voice of a Middle Class Gay Man in Kingston,
Jamaica
91
gay and living with hiV
112
92
a gay leader Speaks-Out From paramaribo
113
93
life of a gay Man in a Small Eastern caribbean
Setting
human rights: caribbean constitutional Standards
and the Rights of Sexual Minorities
115
gender: rethinking gender in the caribbean
94
The Voice of a gay Man living in guyana
116
95
la Vie d’un gay en haiti (life of a gay Man in haiti)
Transgender: looking Back and Thinking about
Tomorrow
96
living with hiV in the caribbean
119
la Vie d’une personne Transgenre en haiti (life of a
Transgender in Haïti)
97
living with hiV in the dominican republic:
Testimonio (Testimony)
120
Addressing HIV in Humanitarian Settings
98
Sex Work and HIV in the Caribbean
122
la Situation après le Séisme en haïti vue par Jean
Pape
99
A Male Sex Worker in a Small Caribbean Setting
124
Improving Strategic Information on HIV
100
HIV and the Drug Use Situation in the Caribbean
126
Sustainability of AIDS Programmes
102
living with hiV and Being on drugs
103
Young and living in a World of aidS
104
Faith and HIV Response in the Caribbean
127
From Wendy Fitzwilliam
Former Miss Universe and UN Goodwill Ambassador
for HIV/AIDS
www.unaidscaribbean.org | KS III | 3
FOREWORD
This publication, Keeping Score III,
presents strong evidence of progress
in the Caribbean in responding to HIV,
and it also makes clear how much work
remains to be done.
during the period under review (20082009), national authorities have
worked to keep HIV high on national
agendas and mobilise domestic and
international resources to scale-up
access to HIV prevention, treatment,
care and support.
This has been
done in collaboration with the Pan
caribbean
partnership/caricOM,
civil society, international partners
such as UnaidS and its co-sponsors
(UnicEF, pahO/WhO, Unhcr, UnFpa,
ilO, World Bank, Undp, UnEScO, WFp
and UnOdc) and donors e.g. pEpFar,
GFATM, KfW and DFID.
One of the key accomplishments
was in the area of prevention of
mother-to-child transmission of hiV
to such an extent that the prospect
of eliminating new HIV infections
among children has become a real
possibility in the Caribbean. Four
countries have reduced their new
HIV infections by 25% between 2001
and 2009. In addition, improved
access to antiretroviral treatment has
contributed to a 43% decline in the
number of aidS-related deaths.
Since 2008, the region has been
grappling with the consequences of
the global financial crisis coupled with
competing public health priorities.
To ensure sustainability and make
new gains, Caribbean authorities
must address: the high level of new
infections; predominantly vertical
interventions; the heavy dependence
of the HIV response on external
funding; stigma and discrimination
against key populations; issues around
gender; vulnerability of women
and girls; and building an enabling
environment to broaden access to HIV
services by the key populations.
As young people play a key role in
the social transformation process, we
need to nurture youth leadership to
guide the future response to HIV. New
leadership at all levels, more voices
and new faces are necessary for the
social movement for change to address
the HIV epidemic in a comprehensive
manner.
We, the UN family and the PANCAP/
caricOM
support
this
new
orientation. We are confident that our
renewed commitment and our joint
and coordinated support to Caribbean
countries will result in the necessary
change to break the back of the HIV
epidemic.
Dr Ernest Massiah
Director
UNAIDS Caribbean Regional Support Team
Port of Spain
Trinidad and Tobago
Ms Myrna Bernard
Officer-in-charge
directorate of human & Social development
caricOM Secretariat
Georgetown, Guyana
Brent Aasen
Regional Director
UNICEF
Panama
Pedro Medrano
regional director for latin america & the caribbean
World Food Programme
Panama
Dr Kwame Boafo
director and representative
Kingston cluster Office for the caribbean
Kingston
Jamaica
Ana Teresa Romero, Ph.D
Director
international labour Organisation
Port of Spain
Trinidad and Tobago
Heraldo Munoz
regional director of rBalc
UNDP
panama-city
Panama
Dr Hernando Agudelo
Deputy Director
United nations population Fund
Kingston
Jamaica
Dr Mirta Roses Periago
Director
pahO/WhO
Washington D.C.
USA
D David Wilson
Program Director
Global HIV/AIDS Program
The World Bank
Washington D.C.
USA
Marta Juarez
Director
Bureau for the Americas, Geneva
UNHCR
Jose Vila del Castillo
Regional Advisor Costa Rica
UnOdc project Office
San Jose
4 | KS III | www.unaidscaribbean.org
Since its inception in 1981, the HIV epidemic has affected all the Caribbean people,
especially men who have sex with men, sex workers, crack cocaine users and
prisoners; and it has also become an issue among Caribbean women. However,
there are differences between countries in the sense that there are countries
where women are more affected than men; these include The Bahamas, Belize, the
Dominican Republic and Haiti. In Guyana, HIV affects men and women equally, but
in countries like Barbados, Jamaica, Trinidad and Tobago, Cuba and Suriname there
are more men than women living with HIV.
The adult HIV prevalence varies between countries from 0.1% in Cuba the lowest, to
the Bahamas with 3.1%, the highest. Again, data show that there are three categories
of countries. Guyana, Haiti and Jamaica have seen declining HIV prevalence from
2001 to 2009; in the Bahamas, Dominican Republic and Suriname there is a stable
trend; and in Barbados, Belize, Cuba, and Trinidad and Tobago there is an increasing
trend.
Regarding HIV incidence in 2009, Belize, the Dominican Republic, Jamaica and
Suriname have reduced their cases by 25% while a stable trend was observed in
haiti. Overall, the caribbean has reduced its number of new hiV infections by 14%.
For UNGASS reporting, the Caribbean was the first region in the world to submit
all national reports on time. However, only 38% of countries reported on more
than 50% of the relevant UNGASS indicators, compared with 81% in the previous
reporting period. Six countries are without updated National Strategic Plans or a
Monitoring and Evaluation framework.
Of concern is that the vast majority of indicators for which information is not available
are related to MSM, SW, orphans and vulnerable children, and HIV knowledge,
behaviours and practices among general population groups. This situation needs
improvement as it is established that the epidemic is disproportionately affecting
men who have sex with men, sex workers, crack cocaine users and prisoners, and
reaching the general population as well.
FAST FACTS
In 1981, thirty years ago, the Caribbean was confronted by a new epidemic when its
first cases of AIDS were recorded in Haiti. This is one of the oldest HIV epidemics in
the world and it is still growing. Data show that from 2001 to 2009, the number of
people living with hiV (plhiV) increased by 10,000 to 260,000 in the wider caribbean.
The 1% adult HIV prevalence in the Caribbean is the second highest in the world,
and the highest in the americas. in 2009, there was a 43% decline in aidS-related
deaths but hiV remains the leading cause of death among people 20-59 years old,
with 33 deaths on a daily basis. Also, during that year, there werean estimated 50
new HIV infections occurring every day and the total number of orphans due to AIDS
was 140, 000.
in total, 12 of 16 countries reported on their aidS spending for 2008-2009. USd
497 million was spent on AIDS with the majority of resources i.e. 64% coming from
external sources. Only 32% went to prevention in a region where the reduction of
new HIV infections remains a serious challenge.
According to the National Composite Policy Index report, while the majority
of countries have developed HIV policies, in some cases they have not been
www.unaidscaribbean.org | KS III | 5
approved and in others, they have
not been implemented. Generally the
involvement of civil society in the
national HIV response is limited, if not
poor.
In the area of blood safety, with the
exception of the Dominican Republic,
all countries screen 100% of donated
blood units. The region has achieved a
48% coverage for ART, with 29% among
children. For prevention of motherto-child transmission of hiV, eleven
countries reported that more than
90% of the annual cohorts of pregnant
women are tested for HIV; there was a
59% coverage for PMTCT in 2009. The
caribbean needs to see a rapid scaleup of ART and PMTCT.
The screening and management of TB/
hiV co-infection is low in countries
with serious co-infection issues such
as the Dominican Republic, Haiti, and
Trinidad and Tobago, and this situation
needs immediate improvement.
life-skills hiV education is a good tool
to prepare young people to protect
themselves against HIV. Unfortunately
there are seven countries (Belize,
Dominican Republic, Haiti, Jamaica,
St. Kitts and Nevis, Suriname and
Trinidad and Tobago) where the
percentage of schools offering HIV
6 | KS III | www.unaidscaribbean.org
education varied from 0% to less than
45%. This situation must be addressed
as among young people, early initiation
of sexual activity remains high in the
majority of countries and this is not
generally accompanied by consistent
use of condoms. Also, the level of
condom use and HIV testing behaviour
is low in the general population. This
needs to be remedied in the short
term.
Among MSM and sex workers, it is
essential to make HIV testing services,
condoms and other commodities
available and accessible as essential
components of the response to HIV.
But the majority of countries do not
report on these indicators.
Challenges identified in national
UNGASS reports, and the feedback
from National AIDS programme
managers, other leaders and cosponsors include limited availability
and use of strategic information for
planning, lack of understanding of
gender issues, sustainability of AIDS
programmes and human rights issues
including stigma and discrimination.
To respond effectively to all these
issues, national leadership at all levels
should work together to promote
and implement the following key
recommendations.
Key recommendationS
1
NEW HIV INfEcTIoNs AMoNg cARIBBEAN cHIlDREN cAN BE ElIMINATED By 2015
2
NEW HIV INfEcTIoNs sloWINg BuT slIgHTly ouTPAcE TREATMENT succEss
3
TreaTmenT musT improVe, be less expensiVe and sCaled-up
4
aids-relaTed deaThs need furTher deCline
5
A loT of TAlK ARouND HuMAN RIgHTs BuT VERy lIT TlE cHANgE oN THE gRouND
6
gENDER IssuEs NEED REVIsITINg IN THE cARIBBEAN
7
sTRATEgIEs To ENsuRE susTAINABIlITy IN TIMEs of scARcITy ARE PARAMouNT
In 2009, 4,400 pregnant women living with HIV benefitted from interventions to prevent HIV transmission
to their babies. This represents 59% coverage from 22% in 2005. The impact of these programmes is that
fewer children are born with HIV in the Caribbean. By adopting a faster pace and using efficacious drug
regimens, it is possible to reach out to the 41% who did not get access to these interventions and eliminate
HIV among children by 2015.
For every five persons put on ART in 2009 there were seven new HIV infections. For every 1,000 people
who died of an aidS-related illness there were 1,500 new hiV infections. Therefore while scaling-up treatment,
more resources should be allocated to ensuring sustainable prevention programmes to invest in evidencebased interventions firstly among most at-risk populations, young people and then the general population.
in 2009, 110,000 plhiV needed treatment, but only 52,400 received it, which represents a 48% coverage.
This has resulted in a 43% reduction in deaths due to aidS-related illnesses. Still 52% i.e. 57,600 people who
need treatment are not accessing it. Concerning ART, only 38% of countries achieved a 90% survival rate of
plhiV at 12 months after initiation of therapy.
The number of deaths due to aidS-related illnesses declined from 21,000 in 2001 to 12,000. This is a
direct benefit from treatment programmes whose coverage went from 1% in 2004 to 48% in 2009. However,
there is still a need to scale-up treatment, as every day 33 people have died of aidS-related illnesses in 2009.
All countries have integrated some elements of human rights in their national response to HIV, however
in many instances new policies were not approved or implemented. Eleven out of the 16 Caribbean states
have laws that criminalise consensual same sex sexual encounters and two states have restrictions on travel
for plhiV. Stigma and discrimination remain a challenge and need to be addressed at all levels to support
the scale-up towards universal access. gay men, transgender people, sex workers, plhiV and crack cocaine
users all confront stigma and discrimination on a daily basis. Involvement of civil society in the national HIV
response should be greater and strengthened at all levels.
HIV affects women and girls and is disproportionately affecting transgender persons as well, therefore,
gender issues cannot be limited to the role or place defined for men and women in society. Discussions around
gender must be reopened to achieve a clear understanding of how many genders exist in the Caribbean
and what role sexual orientation plays in the redefinition of gender. Issues confronting gay, transgender or
transsexuals should be taken into consideration in this debate. Serious consideration should also be given to
issues around gender-based violence and hiV and the monitoring of this dimension within the hiV epidemic.
The Caribbean regional response relies heavily on external resources. During the past two years, 64% of
all resources spent on AIDS were from external sources. This needs to be changed and national authorities
must commit national resources to respond to HIV if gains are to be sustained and expanded. Sustainability
could be achieved by using new approaches such as achieving true multi-sectoral involvement, investing in
strengthening health systems, integration of HIV interventions, decentralisation of services including HIV in
humanitarian settings, new approaches to collect strategic information such as internet-based surveys, and
use of evidence to guide planning to focus national attention and allocate resources for interventions among
population groups where new HIV infections are occurring the most.
www.unaidscaribbean.org | KS III | 7
AVANT-PROPOS
Cette édition, « Keeping score III »,
atteste des nets progrès de la réponse
au VIH dans la Caraïbe, et montre aussi
la quantité de travail qui reste à faire.
pendant la période revue (2008-2009),
les autorités nationales ont gardé
le VIH à un niveau élevé dans les
programmes de développement et ont
mobilisé des ressources nationales et
internationales pour améliorer l’accès
à la prévention du VIH, au traitement,
aux soins et soutien. ce progrès a
été réalisé en collaboration avec le
partenariat pan-caribéen de lutte
contre le Sida/caricOM, la société
civile, les partenaires internationaux
tels que l’OnUSida et ses organisations
co-parrainantes (UnicEF, OpS/OMS,
hcr, UnFpa, OiT, la Banque Mondiale,
pnUd, UnEScO, paM et OnUdc) et les
donateurs, essentiellement PEPFAR,
Fonds Mondial, KfW et DFID.
Une des réalisations clé a été faite
dans le domaine de la prévention de
8 | KS III | www.unaidscaribbean.org
la transmission mère-enfant du Vih, au
point que la perspective d’éliminer le
VIH chez les enfants est devenue une
réalité potentielle dans la Caraïbe.
Quatre pays ont réduit le nombre de
leurs nouvelles infections VIH de 25%
entre 2001 et 2009. l’accès amélioré
aux traitements antirétroviraux a
contribué à une diminution de 43% du
nombre de décès liés au sida.
Depuis 2008, la région affronte les
conséquences de la crise financière
mondiale,
mais
aussi
d’autres
priorités de santé publique devenues
compétitives.
Pour
garantir
la
pérennité et obtenir de nouveaux
gains, les autorités caribéennes
doivent agir contre le niveau élevé de
nouvelles infections; les interventions
qui sont essentiellement verticales;
la dépendance lourde de la réponse
au VIH aux subventions externes; la
stigmatisation et la discrimination
contre les populations clés; le genre;
la vulnérabilité des femmes et des
jeunes filles; et pour la construction
d’un environnement favorable pour
améliorer l’accès aux services par les
populations clés.
les jeunes jouent un rôle clé dans le
processus de transformation sociale,
il faut susciter un leadership de la
jeunesse pour l’avenir de la réponse au
VIH. Mais aussi un leadership renouvelé
à tous les niveaux, un plus grand
nombre de voix et de nouveaux visages
sont nécessaires pour le changement
social qui répond a l’épidémie de VIH
de manière exhaustive.
Nous, la famille des Nations unies avec
pancap/caricOM, soutenons cette
orientation nouvelle. Nous sommes
confiants que notre engagement
renouvelé et notre soutien conjoint
et coordonné aux pays des Caraïbes
apporteront le changement nécessaire
pour changer le cours de l’épidémie de
VIH.
la prévalence de 1% du Vih dans la population adulte de la caraïbe est la seconde
plus élevée au monde, et la plus élevée du continent américain. En 2009, il y a eu
une diminution de 43% des décès liés au sida, mais la maladie reste la première
cause de décès dans la population âgée de 20 à 59 ans, avec 33 morts par jour. au
cours de cette même année, on estime à 50 le nombre de nouvelles infections pa
jour et le nombre total d’orphelins dus au sida est de 140 000.
De son début a maintenant, l’épidémie de VIH a affecté l’ensemble de la population
caribéenne, en particulier les hommes qui ont des rapports sexuels avec les
hommes (HSH), les personnes impliquées dans le travail du sexe, les utilisateurs de
crack, et les prisonniers. Elle est devenue un problème grave pour les femmes avec
des différences d’intensité selon les pays au sens qu’il y a des pays où les femmes
sont plus affectées que les hommes, comme les Bahamas, le Belize, la République
Dominicaine et Haïti. Au Guyana, le VIH affecte autant les hommes que les femmes,
mais dans des pays comme la Barbade, la Jamaïque, Trinité et Tobago, Cuba et le
Surinam il y a plus d’hommes que de femmes qui vivent avec VIH.
la prévalence du Vih dans la population adulte varie selon les pays de 0,1% à
cuba, la plus basse, à 3,1% aux Bahamas. les données montrent aussi qu’il y a trois
catégories de pays. le guyana, haïti et la Jamaïque ont vu une diminution de la
prévalence du VIH de 2001 à 2009 ; aux Bahamas, en République dominicaine et au
Suriname la tendance est à la stabilité ; à la Barbade, au Belize, à Cuba, et à Trinité
et Tobago il y a une tendance à l’augmentation.
Quant à l’incidence du VIH en 2009, le Belize, la République Dominicaine, la
Jamaïque et le Surinam ont réduit le nombre de leurs nouveau cas de 25% alors
qu’une tendance stable a été observée à en Haïti. En général les pays Caribéens ont
réduit le nombre de nouvelles infections au VIH de 14%.
En ce qui concerne le rapport de l’UngaSS, la caraïbe était la première région
au monde à soumettre tous les rapports nationaux dans les délais. Toutefois,
seulement 38% des pays ont soumis un rapport sur plus de 50% des indicateurs
d’UNGASS, comparé à 81% dans la période précédente. Six pays n’ont pas de
plan stratégique on de cadre de suivi et évaluation. Aussi, la grande majorité des
indicateurs pour lesquels les informations ne sont pas disponibles sont ceux lies aux
HSH, le travail du sexe, les orphelins et enfants vulnérables et sur la connaissance
du VIH, les comportements et les pratiques parmi les groupes clés et la population
générale. Cette situation doit être améliorée puisque l’épidémie affecte d’une façon
disproportionnée les HSH, les milieux du travail du sexe, les utilisateurs de crack et
les prisonniers et atteint aussi la population générale.
au total, 12 des 16 pays ont soumis un rapport sur leurs dépenses en matière de
sida pour 2008-2009. 497 millions de dollars américains ont été dépensé sur le sida
avec la majorité des ressources (64%) provenant de l’extérieur et seulement 32%
alloués à la prévention, dans une région où la réduction des nouvelles infections de
L E S FA I T S E N B R E F
En 1981, il y a trente ans, la Caraïbe a été confrontées à une nouvelle épidémie
quand les premiers cas de sida ont été enregistrés en Haïti. Il s’agit d’une des plus
anciennes épidémies de Vih dans le monde qui continue de s’accroitre. les données
montrent que de 2001 à 2009 le nombre de personnes vivant avec VIH (PVVIH) a
augmenté de 10 000 pour atteindre 260 000.
www.unaidscaribbean.org | KS III | 9
le dépistage et la prise en charge de la coïnfection
tuberculose/VIH sont insuffisants dans la plupart des pays
avec des pourcentages élevés de coïnfection dans des
pays comme la République Dominicaine, Haïti, et Trinité et
Tobago, cette situation doit faire l’objet d’une amélioration
immédiate.
VIH reste un défi majeur.
Selon le rapport de l’indice composé sur les politiques
nationales, on note que la majorité de pays a développé
des politiques VIH, mais dans certains cas elles n’ont pas
été approuvées et dans d’autres, elles n’ont pas été mises
en œuvre. d’une manière générale, l’engagement de la
société civile dans la réponse nationale au VIH est limité,
voire très faible.
Dans le secteur de la sécurité transfusionnelle, à
l’exception de la République Dominicaine, tous les pays
testent 100% des dons de sang. la région atteint 48% de
taux de couverture pour le traitement antirétroviral, avec
29% chez les enfants. Pour la prévention de transmission
mère-enfant du Vih, onze pays ont rapporté que plus de
90% des cohortes annuelles de femmes enceintes sont
testées pour le VIH ; il y avait 59% de taux de couverture
pour la pTME en 2009. la caraïbe doit accroitre rapidement
les traitements et la PTME.
1
l’éducation pour la compétence au Vih représente un bon
outil pour préparer les jeunes à se protéger vis-à-vis du
VIH. Malheureusement dans sept pays (Belize, République
dominicaine, Haïti, Jamaïque, St Kits et Nevis, Surinam et
Trinité et Tobago), le pourcentage d’écoles qui proposent
une éducation pour le VIH varie de 0% à moins de 45%.
Cette situation doit changer sachant que chez les jeunes,
l’initiation précoce de l’activité sexuelle reste élevée
dans la majorité de pays et ceci n’est généralement pas
accompagné d’un usage régulier de préservatifs. Enfin,
le niveau d’utilisation de préservatif et les habitudes en
matière de dépistage au Vih sont insatisfaisants dans la
population générale. On doit remédier à cela sur le court
terme.
En ce qui concerne les HSH, et les personnes impliquées
dans le travail de sexe, il est impératif de rendre les services
de dépistage au VIH, les préservatifs et les autres services
disponibles et accessibles et d’en faire des composantes
essentielles de la réponse au VIH. Mais la majorité de pays
n’ont pas produit de rapports sur ces indicateurs.
les défis identifiés dans les rapports nationaux de l’UngaSS,
les réactions des directeurs de programmes nationaux,
d’autres leaders et partenaires comprennent la limitation
de la disponibilité et de l’usage de l’information stratégique
pour la planification, le manque de compréhension des
problèmes liés au sexe et au genre, la pérennité des
programmes sida et les problèmes de droits humains. pour
répondre efficacement à tous ces problèmes, les décideurs
nationaux à tous les niveaux doivent travailler ensemble
pour promouvoir et exécuter les recommandations
suivantes.
lEs NouVEllEs INfEcTIoNs Au VIH PEuVENT êTRE élIMINéEs cHEz lEs ENfANTs EN 2015
En 2009, 4 400 femmes enceintes vivant avec le VIH ont bénéficié d’interventions pour prévenir la transmission
de Vih à leurs bébés. ceci représente 59% de taux de couverture, alors que ce taux était de 22% en 2005. l’impact de
ces programmes est que moins d’enfants sont nés avec le VIH dans les Caraïbes. En adoptant un rythme plus rapide
et utilisant les régimes de drogue efficaces, il est possible d’atteindre les 41% qui n’a pas eu accès à ces interventions
et éliminer le VIH chez les enfants en 2015.
10 | KS III | www.unaidscaribbean.org
2
lE NoMBRE DE NouVEllEs INfEcTIoNs VIH RAlENTIT MAIs DIsTANcE lEs succès Du
TRAITEMENT
3
lE TRAITEMENT DoIT s’AMélIoRER, êTRE MoINs cHER AVEc uNE couVERTuRE Plus lARgE
4
lEs Décès lIés Au sIDA DoIVENT DIMINuER DAVANTAgE
5
BEAucouP DE DIscouRs suR lEs DRoITs HuMAINs MAIs TRès PEu cHANgEMENT suR lE
TERRAIN
6
lE gENRE DoIT êTRE REVIsITé DANs lA cARAïBE
7
lEs sTRATégIEs PouR gARANTIR lA PéRENNITé EN PéRIoDEs DE RARéfAcTIoN DEs
REssouRcEs soNT EssENTIEllEs
Pour cinq personnes mises sous antirétroviraux en 2009, il y avait sept nouvelles infections à VIH. Pour 1 000
personnes décédées de maladies liées au sida, il y a eu 1 500 nouvelles infections à VIH. Ainsi, tandis qu’on améliore
l’accès au traitement, plus de ressources doivent être allouées à la pérennité des programmes de prévention pour
investir dans des interventions basées sur la science, tout d’abord pour les populations les plus à risque, les jeunes
et ensuite la population générale.
En 2009 110 000 PVVIH ont eu besoin du traitement, mais seulement 52 400 en ont reçu, ce qui représente
48% de taux de couverture. ceci a eu pour résultat une réduction de 43% des décès en raison de maladies liées au
sida. Cependant, 52% (57 600) des personnes qui ont besoin de traitement ne peuvent y accéder. Seulement 38%
des pays a atteint un taux de 90% de survie de pVVih à 12 mois après l’initiation de la thérapie.
le nombre de décès en raison de maladies liées au sida a chuté de 21 000 à 12 000 depuis 2001. ceci est un
bénéfice direct des programmes de traitement dont le taux de couverture est passé de 1% en 2004 à 48% en 2009.
Toutefois, il y a encore un besoin d’élargir l’accès au traitement, puisque tous les jours 33 personnes sont décédées
de maladies liées au sida en 2009. Zéro décès liés au sida n’est pas hors de portée.
Tous les pays ont intégré des éléments de droits humains dans leur réponse nationale au VIH, cependant dans
beaucoup cas les nouvelles politiques n’ont pas été approuvées ou mises en œuvre. Onze des 16 états de la caraïbe
ont des lois qui criminalisent les rapports sexuels consensuels de même sexe et deux états ont des restrictions sur
la circulation des pVVih. la stigmatisation et la discrimination restent un défi et doivent être prises en compte
à tous les niveaux pour soutenir la marche vers l’accès universel. les homosexuels masculins, les personnes
transgenre, les personnes faisant commerce du sexe, les PVVIH et les utilisateurs de crack, sont tous confrontés
quotidiennement à la stigmatisation et la discrimination. l’engagement de société civile dans la réponse nationale
au VIH doit être renforcé à tous les niveaux.
le Vih affecte les femmes et les filles et aussi de façon disproportionnée les personnes transgenre, ainsi
les problèmes de genre ne peuvent se limiter au rôle défini pour les hommes et les femmes dans la société.
les discussions sur le genre doivent être rouvertes pour avoir une compréhension claire sur combien de genres
existent dans la caraïbe et quel est le rôle joue l’orientation sexuelle dans la redéfinition du genre. les problèmes
qu’affrontent les homosexuels, les transgenres ou les transsexuels doivent être pris en considération dans ce
débat. Une sérieuse attention doit aussi être portée aux problèmes de violence liée au genre et Vih et au suivi de
sa dimension dans l’épidémie de VIH.
la réponse régionale dans la caraïbe dépend largement des ressources extérieures. au cours des deux dernières
années, 64% de toutes les ressources dépensées sur le sida ont été des sources externes. Cela doit changer et
les autorités nationales doivent engager des ressources nationales pour répondre au VIH si on veut maintenir
et élargir les résultats obtenus. la pérennité peut être assurée par l’utilisation nouvelles approches, comme un
vrai engagement multisectoriel, un investissement dans le renforcement des systèmes de santé, l’intégration des
interventions sur VIH, la décentralisation de services, y compris le VIH en contexte humanitaire, les nouvelles
approches pour recueillir l’information stratégique comme les enquêtes en ligne et l’utilisation de données pour la
planification pour recentrer l’attention nationale et allouer les ressources pour les interventions parmi les groupes
de population où les nouvelles infections à VIH se produisent le plus.
www.unaidscaribbean.org | KS III | 11
PREFACIO
Esta edición de “Keeping Score III”
presenta evidencias del progreso en
la respuesta al VIH en el Caribe y, al
mismo tiempo, permite observar
cuánto trabajo queda por hacer.
Durante el periodo considerado
en la publicación (2008-2009), las
autoridades nacionales han trabajado
para mantener el tema de la epidemia
de VIH en la agenda nacional y para
movilizar recursos nacionales e
internacionales que permitan ampliar
el acceso a la prevención, tratamiento,
cuidado y apoyo. Esto ha sido
logrado en colaboración con PANCAP/
caricOM, la sociedad civil, los socios
internacionales como OnUSida y sus
co-auspiciadores (UnicEF, OpS/OMS,
acnUr, FnUap, OiT, Banco Mundial,
pnUd, UnEScO, pMa y UnOdc) y
donantes como PEPFAR, FMSTM, KfW
y DFID.
Uno de los logros más importantes se
obtuvo en el área de la prevención de
12 | KS III | www.unaidscaribbean.org
la transmisión del VIH de madre a hijo.
Actualmente, el objetivo de eliminar el
VIH entre los niños es una posibilidad
bastante realista en el Caribe. Por otra
parte, entre el 2001 y el 2009, cuatro
países han logrado reducir las nuevas
infecciones por VIH en 25%. Asimismo,
la mejora en el acceso al tratamiento
antirretroviral ha contribuido a
reducir en 43% el número de muertes
relacionadas con el SIDA.
Desde el 2008, la región ha estado
lidiando con las consecuencias de
la crisis financiera mundial a la
que se suma la competencia por
recursos entre prioridades de salud
pública concurrentes. Para asegurar
la sostenibilidad y alcanzar nuevos
logros, las autoridades del Caribe
deben enfrentar el alto nivel de
nuevas infecciones, la predominancia
de intervenciones verticales, la
dependencia de fondos externos para
la respuesta al VIH, el estigma y la
discriminación contra poblaciones
claves, asuntos relacionados con
el género, la vulnerabilidad de las
mujeres y las jóvenes, y la necesidad
de construir un ambiente propicio para
aumentar el acceso de las poblaciones
claves a los servicios de VIH.
Necesitamos responder al rol clave
que los jóvenes juegan en el proceso
de transformación social fortaleciendo
su liderazgo para guiar la futura
respuesta al VIH. Un nuevo liderazgo
a todo nivel, más voces y nuevos
rostros son necesarios para que el
movimiento social para el cambio
enfrente la epidemia de VIH de una
manera integral.
Nosotros, la familia de Naciones
Unidas, y pancap/caricOM apoyamos
esta nueva orientación.
Tenemos
confianza en que nuestro renovado
compromiso
y
nuestro
apoyo
coordinado a los países del Caribe
lograrán los cambios necesarios para
detener el avance de la epidemia.
Desde su inicio en 1981, la epidemia del VIH ha afectado a toda la población del
Caribe, especialmente a hombres que tienen sexo con hombres, trabajadores
sexuales, usuarios de crack de cocaína, y prisioneros. También se ha convertido
en un tema importante entre las mujeres del Caribe. Sin embargo, hay diferencias
entre los países. En algunos, las mujeres son más afectadas que los hombres. Esta
situación se presenta en las Bahamas, Belize, la Republica Dominicana y Haití. En
Guyana, el VIH afecta a hombres y mujeres por igual, pero en países como Barbados,
Jamaica, Trinidad y Tobago, Cuba y Suriname hay más hombres que mujeres viviendo
con VIH.
la prevalencia adulta de Vih varía entre países. desde la mas baja (0.1%) en cuba,
hasta la más alta en las Bahamas (3.1%). Nuevamente, los datos muestran que hay
tres categorías de países. Guyana, Haití y Jamaica han visto una reducción en la
epidemia de VIH entre el 2001 y el 2009. En las Bahamas, la Republica Dominicana,
Jamaica y Suriname la tendencia es estable. En Barbados, Belize, Cuba y Trinidad y
Tobago la tendencia es creciente.
Con relación a la incidencia en el 2009, Belize, la Republica Dominicana, Jamaica y
Suriname han reducido sus casos en 25%. Una tendencia estable se ha observado
en Haití. En general, el Caribe ha reducido el número de nuevas infecciones por VIH
en 14%.
En lo que se refiere a la notificación para UNGASS, el Caribe fue la primera región en
el mundo en enviar todos los reportes nacionales a tiempo. Sin embargo, solo 38%
de los países reportaron sobre 50% o mas de los indicadores de UNGASS, comparado
con 81% en el periodo previo. Seis países carecen de Planes Nacionales Estratégicos
o de un marco de Monitoreo y Evaluación.
Es preocupante constatar que la gran cantidad de indicadores que carecen de
información son los relacionados con hombres que tienen sexo con hombres,
trabajadores sexuales, huérfanos y niños vulnerables, y con conocimiento, actitudes
y practicas relacionadas con el VIH en la población general. Esta situación necesita
mejorarse ya que la epidemia afecta desproporcionadamente a los hombres que
tienen sexo con hombres, trabajadores sexuales, usuarios de crack de cocaína,
prisioneros y también está alcanzando a la población general.
En total, 12 a 16 países reportaron sus gastos en SIDA para el periodo 2008 – 2009.
Se gasto USD 497 millones con la mayoría de los recursos viniendo de fuentes
extranjeras. Solo 32% fue a prevención en una región donde la reducción de nuevas
ASUNTOS CLAVE
Hace treinta anos en 1981, el Caribe fue confrontado por una nueva epidemia cuando
sus primeros casos se reportaron en Haití. Esta es una de las epidemias de VIH más
antiguas en el mundo y aún sigue creciendo. los datos muestran que desde el
2001 al 2009 se registraron 10,000 casos más de personas viviendo con VIH (PVVIH)
llegando a un total de 260,000 casos en todo el caribe. la prevalencia de Vih entre
adultos en el Caribe es de 1%, la segunda más alta en el mundo y la más alta en las
Américas. En el 2009 hubo una reducción del 43% en muertes relacionadas con el
SIDA. Sin embargo, el SIDA sigue siendo la causa principal de muerte entre personas
de 20 a 59 años, con un promedio de 33 muertes por día. También durante ese año
hubo un estimado de 50 nuevas infecciones por día y el número total de huérfanos
debido al SIDA se elevó a 140,000.
www.unaidscaribbean.org | KS III | 13
infecciones es un reto muy grande.
De acuerdo al informe del Indice Compuesto de Política
Nacional, la mayoría de países han desarrollado políticas
de VIH, pero en algunos casos éstas no han sido aprobadas
o implementadas. En general, el involucramiento de la
sociedad civil en la respuesta nacional contra el VIH ha sido
limitado, sino pobre.
En el área de Seguridad de la Sangre, con la excepción de
la República Dominicana, todos los países tamizan el 100%
de las unidades de sangre donada. la región ha logrado
una tasa de cobertura de antiretrovirales de 48%. Esta
tasa es de 29% entre los niños. En cuanto a la prevención
de la transmisión de VIH de la madre al hijo, 11 países
reportaron que más del 90% de las cohortes anuales de
mujeres embarazadas reciben las pruebas del VIH. Había
una tasa de cobertura de prevención de la transmisión de
la madre al hijo de 59% en el 2009. El Caribe necesita un
rápido aumento en la cobertura de antiretrovirales y de
prevención de la transmisión de la madre al hijo.
las pruebas y el manejo de la coinfección TB/Vih son
bajos en países con serios problemas de coinfección como
la Republica Dominicana, Haití y Trinidad y Tobago. Esta
situación necesita una mejora inmediata.
la educación en habilidades para la vida es un buen
instrumento para ayudar a la gente joven a protegerse ellos
mismos contra el Vih. lamentablemente, hay siete países
1
(Belize, Republica Dominicana, Haití, Jamaica, St. Kitts y
Nevis, Surinam, y Trinidad y Tobago) donde el porcentaje
de colegios que ofrecen educación sobre VIH varia de 0% a
menos de 45%. Esta situación debe ser corregida ya que la
iniciación sexual temprana entre los jóvenes se mantiene
alta en la mayoría de los países y no es acompañada
generalmente por un uso regular de condones. Además, el
nivel de uso de condones y la toma de pruebas VIH es bajo
en la población en general. Esto necesita remediarse en el
corto plazo.
Es esencial asegurar la disponibilidad y accesibilidad a las
pruebas de VIH y a los condones entre hombres que tienen
sexo con hombres, y entre trabajadores sexuales. Aunque
esto es un componente clave de la respuesta al VIH, la
mayoría de los países no reportan sobre estos indicadores.
los retos identificados en los informes nacionales UngaSS,
y la retroalimentacion proporcionada por los gerentes de
los programas nacionales de Sida y otros líderes y coauspiciadores indican una disponibilidad limitada y un uso
limitado de información estratégica para la planificación;
y falta de comprensión de los asuntos de género, de
la sostenibilidad de los programas de SIDA, y de los
derechos humanos incluyendo estigma y discriminación.
Para responder de manera eficaz a todos estos temas, los
líderes nacionales a todo nivel deben trabajar juntos para
promover e implementar las siguientes recomendaciones:
lAs NuEVAs INfEccIoNEs PoR VIH ENTRE los NIños DEl cARIBE PuEDE sER ElIMINADo
EN El 2015
En el 2009, 4,400 mujeres embarazadas viviendo con VIH se beneficiaron de intervenciones para prevenir la
transmisión del VIH a sus bebés. Esto representa una tasa de cobertura del 59%, la misma que era del 22% en
el 2005. El impacto de estos programas es que menos niños nacen con VIH en el Caribe. Adoptando un paso
más rápido y usando regímenes de medicamentos más eficaces es posible llegar al 41% de los niños que no
tuvieron acceso a estas intervenciones y eliminar el VIH entre los niños en el 2015.
14 | KS III | www.unaidscaribbean.org
2
lAs NuEVAs INfEccIoNEs PoR VIH DIsMINuyEN, PERo ToDAVíA suPERAN los éxITos DEl
TRATAMIENTo
3
El TRATAMIENTo DEBE MEJoRAR, DIsMINuIR EN cosTo y AuMENTAR EN coBERTuRA
4
sE NEcEsITA uNA MAyoR REDuccIóN DE lAs MuERTEs RElAcIoNADAs coN El sIDA
5
sE HABlA MucHo soBRE DEREcHos HuMANos, PERo Muy Poco HA cAMBIADo EN El TERRENo
6
sE NEcEsITA REVIsAR los TEMAs DE géNERo EN El cARIBE
7
lAs EsTRATEgIAs PARA AsEguRAR lA sosTENIBIlIDAD EN TIEMPos DE EscAsEz soN
PRIMoRDIAlEs
Por cada cinco personas puestas en tratamiento antirretroviral en el 2009, hubo siete nuevas infecciones por VIH.
Por cada mil personas que murieron por una enfermedad relacionada con el SIDA, hubo 1,500 nuevas infecciones.
Asi, mientras se expande la cobertura del tratamiento, se debe poner más recursos en los programas sostenibles de
prevención con intervenciones basadas en evidencia y, en particular, en aquellos dirigidos a poblaciones de mayor
riesgo, gente joven y luego la población en general.
En el 2009, 110,000 PVVIH necesitaban tratamiento, pero solo 52,400 lo recibieron. Esto representa una
cobertura de 48%. Esto ha resultado en una reducción del 43% en las muertes relacionadas con el SIDA. Sin embargo,
todavía 52% (57,600 personas que necesitan tratamiento) no tienen acceso a él. Con relación a la terapia con
antiretrovirales, solo 38% de los países lograron una tasa de sobrevivencia de 90% de PVVIH después de 12 meses de
iniciada la terapia.
El número de muertes relacionadas con el SIDA disminuyó de 21,000 en el 2001 a 12,000. Este es un beneficio
directo de los programas de tratamiento cuya tasa de cobertura fué de 1% en el 2004 a 48% en el 2009. Sin embargo,
todavía hay necesidad de aumentar la cobertura de tratamiento ya que cada día 33 personas murieron por causas
relacionadas con el SIDA en el 2009.
Todos los países han integrado algunos elementos de los derechos humanos en sus respuestas nacionales al
Vih. Sin embargo, en muchas instancias, no se adoptaron o se aprobaron nuevas políticas. Once de 16 países del
Caribe tienen leyes que criminalizan el contacto sexual consentido entre personas del mismo género y dos países
tienen restricciones sobre viajes de PVVIH. El estigma y la discriminación continúan siendo un reto que necesita
ser enfrentado en todos los niveles para lograr el acceso universal. los hombres que tienen sexo con hombres, las
personas transgénero, trabajadores sexuales, PVVIH, y usuarios de crack de cocaína, todos confrontan el estigma y la
discriminación cada día. El involucramiento de la sociedad civil en la respuesta nacional contra el VIH debe ser mayor
y reforzado a todo nivel.
El Vih afecta mujeres y jóvenes y afecta desproporcionadamente personas transgénero. los asuntos de género
no pueden limitarse al rol o lugar definido por hombres y mujeres en la sociedad. las discusiones sobre género deben
ser reabiertas para lograr un claro entendimiento sobre cuántos géneros existen en el Caribe y cuál es el rol que la
orientación sexual juega en la redefinición de género. los temas que confrontan los hombres que tienen sexo con
hombres, las personas transgénero o transexuales deben ser tomados en consideración en este debate. El tema de
la violencia de género y el VIH debe ser también tomado en consideración y monitoreado como una dimensión de la
epidemia de VIH.
la respuesta regional del caribe está sostenida por recursos externos. durante los dos años pasados, el 64% de todos
los recursos gastados en SIDA fueron de fuentes externas. Esto necesita ser cambiado y las autoridades nacionales
deben dedicar recursos nacionales a la respuesta contra el VIH si se desea mantener y expandir lo ganado hasta el
momento. la sostenibilidad debe ser lograda usando nuevos enfoques tales como el de un verdadero involucramiento
multisectorial, invertir en sistemas de salud, integración de las intervenciones contra el VIH, descentralización
de servicios (incluyendo aquellos servicios de VIH en situaciones humanitarias), nuevos enfoques para recolectar
información estratégica tales como encuestas por Internet, y el uso de evidencias para guiar la planificación y la
distribución de recursos en intervenciones destinadas a grupos poblacionales donde la incidencia de infecciones por
VIH es mayor.
www.unaidscaribbean.org | KS III | 15
16 | KS III | www.unaidscaribbean.org
Where are we in the
HIV EPIDEMIC?
Based on UNAIDS/WHO Estimates
Number of People Living with HIV
Number of New HIV Infections
Number of AIDS-Related Deaths
Adult HIV Prevalence in 2009
HIV Prevalence Among Young People
Percentge of Females Living with HIV
2009
2001
2009
Per Day
2009
Per Day
Lowest
Highest
Lowest
Highest
Lowest
Highest
260,000
18,000
12,000
0.1% Cuba
0.1% Cuba
21% Cuba and suriname
250,000
50
33
3% the bahamas
2% the bahamas
60% the bahamas
*Percentage of females living with HIV refers to the total of all PLHIV
The Caribbean 1 is The region mosT affeCTed by hiV in The ameriCas
In comparison with the rest of the regions of the Americas, as demonstrated in Figure 1, the 1% (0.9%-1.1%) adult 2
HIV prevalence in the Caribbean was double that of North America and Central and South America in 2009 3. Belize has
the highest adult HIV prevalence among Central American countries and the same situation is observed in Guyana and
Suriname in South America 4.
1
2
3
4
The Bahamas, Barbados, Belize, Cuba, Dominican Republic, Guyana, Haiti, Jamaica, Suriname and Trinidad and Tobago
Adult refers to persons 15-49 years old
UNAIDS. Global Report on AIDS.2010
UNAIDS Global Report on AIDS. 2010
www.unaidscaribbean.org | KS III | 17
figure 1: adulT hiV PreValenCe in The Three regions of The ameriCas. unaids/Who 2010
Adult HIV Prevalence in 2009. Three Regions of the Americas.
UNAIDS/WHO.2010
1%
0.5%
Caribbean
Central and south ameriCa
0.5%
north ameriCa and mexiCo
Source: UNAIDS Global Report on AIDS 2010
As demonstrated below, the Caribbean is the second most affected region in the world after sub-Saharan Africa.
Table 1: adulT hiV PreValenCe by region and ranking. unaids 2010
REGIONS OF THE WORLD
ADULT HIV PREVALENCE
RANkING
Africa
5.00% (4.7-5.2)
1
Caribbean
1.00% (0.9-1.1)
2
Eastern Europe & Central Asia
0.80% (0.7-0.9)
3
Central & South America
0.50% (0.4-0.6)
4
North America
0.50% (0.4-0.7)
4
South & South East Asia
0.30% (0.3-0.3)
6
Oceania
0.30% (0.2-0.3)
6
Western & Central Europe
0.20% (0.2-0.2)
8
Middle East & North Africa
0.20% (0.2-0.3)
8
East Asia
0.10% (0.1-0.1)
10
Source: UNAIDS Global Report on AIDS. 2010
The Caribbean aids ePidemiC is one of The oldesT 5 in The World
and is sTill groWing
It began in 1981 when the first cases were recorded in Haiti 6 and since then the epidemic
has continued its devastating evolvement 7. Despite national and regional efforts to
respond to the epidemic, 260,000 (230,000-290,000) Caribbean people were living with
HIV in 2009. Between 2001 and 2009, there was a 4% increase in the total number of
PLHIV in the region, moving from 250,000 to 260,000.
Table 2: Number of PLHIV, New HIV INfectIoNs aNd aIds-reLated deatHs IN 2001 aNd 2009
Year
No of PLHIV
No of New HIV INfectIoNs
No of aIds-reLated deatHs
2001
250,000
21,000
21,000
2009
260,000
18,000
12,000
status
+10,000
-3,000
-9,000
Source: UNAIDS Global Report on AIDS 2010
5
6
7
Jean William Pape. AIDS in Haiti, 1980-1996. The University of the West Indies Press. The Caribbean AIDS Epidemic, 1999, pp-226-42. ISBN 976-640-088-1
M. Thomas P. Gilbert, Andrew Rambaut, Gabriela Wlasiuk, et al. The emergence of HIV/AIDS in the Americas and beyond. www.pnas.org/13-07a
Caribbean Epidemiology Centre. Status and Trends. Analysis of the Caribbean HIV/AIDS Epidemic.1982-2002. ISBN 976-8114-23-1.2004
18 | KS III | www.unaidscaribbean.org
differenT dynamiCs regarding The number of PlhiV by CounTry
Between 2001 and 2009, in Haiti and Guyana the number of PLHIV declined; it remained the same in Jamaica, but increased
in the rest of the seven larger Caribbean countries i.e. the Bahamas, Barbados, Belize, Cuba, the Dominican Republic,
Suriname and Trinidad and Tobago.
figure 2: number of PlhiV by CounTry
unaids/Who.2010
Source: UNAIDS Global Report on AIDS 2010
many Caribbean CounTries haVe an adulT hiV PreValenCe aboVe 1%
In 2009, between 230,000 and 290,000 people were living with HIV in the Caribbean, with 68% of them on the Hispaniola
Island of the Dominican Republic and Haiti. In that same year, countries with the highest adult HIV prevalence were the
Bahamas (3.1%), Belize (2.3%), Haiti (1.9%), Jamaica (1.7%) and Trinidad and Tobago (1.5%).
Table 3: number of PlhiV and adulT hiV PreValenCe by CounTry.
unaids/Who.2010
CounTry
no of PlhiV in 2009
adulT hiV PreValenCe in 2009
The Bahamas
6,600
(2,600-11,000)
3.1% (1.2-5.4)
Barbados
2,100
(1,800-2,500)
1.4% (1.2-1.6)
Belize
4,880
(4,000-5,700)
2.3% (2.0-2.8)
Cuba
7,100
(5,700-8,900)
0.1% (<0.1-0.1)
The Dominican Republic
57,000
(49,000-66,000)
0.9% (0.7-1.0)
Guyana
5,900
(2,700-8,800)
1.2% (0.5-1.9)
Haiti
120,000
(110,000-140,000)
1.9% (1.7-2.2)
Jamaica
32,000
(21,000-45,000)
1.7% (1.1-2.5)
Suriname
3,700
(2,700-5,300)
1.0% (0.7-1.4)
Trinidad and Tobago
15,000
(11,000-19,000)
1.5% (1.1-2.0)
Source: UNAIDS Global Report on AIDS 2010
Varying dynamiCs beTWeen CounTries regarding adulT hiV PreValenCe
In four out of the 10 larger Caribbean countries adult HIV prevalence has increased between 2001 and 2009 9. In three of
the countries declining adult HIV prevalence was observed 8, with stable adult HIV prevalence in three of the remaining
countries 10.
8
9
10
Barbados, Belize, Cuba and Trinidad and Tobago
Guyana, Haiti and Jamaica
The Bahamas, The Dominican Republic and Suriname
www.unaidscaribbean.org | KS III | 19
Table 4: aduLt HIV PreVaLeNce 2001-2009. teN carIbbeaN couNtrIes
unaids/Who.2010
CounTry
PreValenCe in 2001
PreValenCe in 2009
sTaTus
The Bahamas
3.10%
3.10% (1.2-5.4)
Stable
Barbados
0.50%
1.40% (1.2-1.6)
Increased
Belize
2.20%
2.30% (2.0-2.8)
Increased
Cuba
<0.10%
0.10% (<0.1-0.1)
Increased
The Dominican Republic
0.90%
0.90% (0.7-1.0)
Stable
Guyana
1.40%
1.20% (0.5-1.9)
Declined
Haiti
2.60%
1.90% (1.7-2.2)
Declined
Jamaica
1.90%
1.70% (1.1-2.5)
Declined
Suriname
1.00%
1.00% (0.7-1.4)
Stable
Trinidad and Tobago
1.20%
1.50% (1.1-2.0)
Increased
Source: UNAIDS Global Report on AIDS 2010
aids remains a leading rePorTed Cause of deaTh in The Caribbean. HIV/AIDS 11 is the leading reported
cause of death among men and women aged 20-59 at 15.7% and 14.5% of deaths, respectively. Among males of this
group, HIV/AIDS is followed by ischemic heart disease (10.2%), homicide (6.2%), diabetes (6.2%) and suicide (5.9%); among
females, by diabetes (10.9%), ischemic heart disease (7.9%), cerebrovascular disease (6.7%) and malignant neoplasm of
the breast (5%). Overall and irrespective of age, AIDS-related illnesses were the fourth leading cause of death among
Caribbean women and the fifth leading cause among Caribbean men (Caribbean Epidemiology Centre, 2007).
desPIte tHIs obserVatIoN, estImated aIds-reLated deatHs decLINed IN 2009. During the period
2001-2009, due to increasing coverage of antiretroviral treatment in the Caribbean, there was an overall 43% decline in
deaths from AIDS-related illnesses. In larger Caribbean countries such as Haiti and the Dominican Republic, the reduction
was 41%; meanwhile it was 56% in Jamaica.
In absolute numbers, the decline in AIDS-related deaths between 2001 and 2009 was from 21,000 to 12,000 in the wider
Caribbean and for specific countries e.g. from 12,000 to 7,100 in Haiti, from 3,900 to 2,300 in the Dominican Republic and
from 2,700 to 1,200 in Jamaica.
figure 3: estImated Number of aIds-reLated deatHs IN tHree carIbbeaN couNtrIes,
2001-2009. uNaIds/wHo.2010
reduction in aids related deaths in Three Caribbean Countries 2001-2009. unaids/Who.2010
Source: UNAIDS Global Report on AIDS 2010
11
PAHO/WHO Health Conditions and Trends. 2007. Based on 2002 mortality data
20 | KS III | www.unaidscaribbean.org
furTher reduCTion in neW
hiV infeCTions is needed
Compared to 2001, the overall reduction in new HIV
infections in 2009 was 14.3% i.e. new HIV infections
dropped from 21,000 to 18,000. In the Dominican Republic
and Jamaica, the number of new HIV infections went down
by 25%. Belize and Suriname experienced a similar level
and in Haiti it went down by 12%. Unfortunately, there
was no change in the HIV incidence in Trinidad and Tobago
during the same period.
Table 5: estImated aNNuaL New HIV INfectIoNs IN four carIbbeaN couNtrIes, 2001-2009.
unaids/Who.2010
CounTry
neW hiV infeCTions
2001
neW hiV infeCTions
2009
sTaTus
PerCenTage
The Dominican Republic
4,800
3,600
DECLINED
25%
Jamaica
2,800
2,100
DECLINED
25%
Haiti
10,000
8,800
DECLINED
12%
Trinidad and Tobago
1,200
1,200
NO CHANGE
0%
Source: UNAIDS Global Report on AIDS 2010
dIffereNt maLe-to-femaLe sex ratIos
Fifty-three percent of PLHIV were women and 47% men i.e.
HIV affects more women than men. However, this situation
is very much skewed by data from Haiti and the Dominican
Republic where 68% of Caribbean PLHIV live and where more
women are living with HIV than men. Country-by-country
information shows that in 40% of the countries 12, more
females are living with HIV than males; but in 50% of them 13
the reverse trend is seen. Guyana is the only country where
there is a one to one ratio of men to women living with
HIV. This is the individual country epidemiological picture
which should guide national planning and decision making.
figure 4: PerceNtage of PLHIV bY sex aNd bY couNtrY IN 2009,
unaids/Who.2010
Source: UNAIDS Global Report on AIDS 2010
12
13
The Bahamas, Belize, The Dominican Republic and Haiti
Barbados, Cuba, Jamaica, Suriname and Trinidad and Tobago
www.unaidscaribbean.org | KS III | 21
aids affeCTs young PeoPle Too
figure 5: hiV PreValenCe among Caribbean young
PeoPle in 2009. unaids/Who.2010
With HIV prevalence below only Sub-Saharan
Africa’s, young people in the Caribbean are
the second most affected in the world. HIV
prevalence varied between 0.1% in Cuba,
the lowest, to 2% in the Bahamas, the
highest. Variations exist between countries;
in 6 14 out of 10 countries, HIV affects young
females 1.2 to 3 times more than young
males. But in three other countries 15 the
reverse is seen but to a lower degree. In
Cuba, HIV affects young females and males
equally. This epidemiological information
must be used to plan for interventions
among young people in each country. Part of
this observation could be explained by early
sex initiation and age mixing among young
people especially females 16.
PreValenCe of hiV remains high
among Caribbean men Who haVe
sex wItH meN aNd femaLe sex
Workers
In the Caribbean, the HIV epidemic
continues to affect disproportionately men
who have sex with men and female sex
workers. During the period 2005-2009, HIV
seroprevalence surveys have shown that
among MSM, prevalence varied from 6.7%
in Suriname to 32% in Jamaica and among
FSW from 4.8% in the Dominican Republic to
24.1% in Suriname.
Among crack cocaine users, another
marginalised group, in 2007 the prevalence
of HIV was 5% in Jamaica and 7% in St. Lucia.
Use of crack cocaine results in impairment
of judgement and creates dependency and
both could result in increased risky sexual
behaviours among drug users 17.
14
15
16
17
Source: UNAIDS Global Report on AIDS. 2011
Table 6: PreValenCe of hiV among msm and fsW in The
carIbbeaN. 2005-2009.
Country
hiV Prevalence
among fsW
The Bahamas
8.2%
NA
The Dominican Republic
11%*
4.8%
Guyana
19.4%
17%
Haiti
NA
5%
Jamaica
32%
5%
Suriname
6.7%
24%
Trinidad and Tobago
20%
NA
*: Survey conducted among Gay, Transgender and other MSM (GTMSM) 2008.
The Bahamas, Barbados, Belize, The Dominican Republic, Guyana and Haiti
Jamaica, Suriname and Trinidad and Tobago
CAREC/PAHO/WHO. Behavioural Surveillance Surveys in Six OECS 2005-2006.
UNAIDS. The Status of HIV in the Caribbean. 2010
22 | KS III | www.unaidscaribbean.org
hiV Prevalence
among msm
Source: UNAIDS. The Status of HIV in the Caribbean. 2010
NA: Not Available
Incarcerated people have not received enough attention in
terms of access to public health programmes and services
in the Caribbean. During the period 2005-2008, the HIV
prevalence in male prisoners varied between 2% in the
Bahamas and St. Lucia, the lowest, and 5.24% in Guyana,
the highest 18.
figure 6: hiV PreValenCe among male
Prisoners in Ten Caribbean CounTries
2005 -2009
broad aNd oNgoINg sexuaL coNNectIoNs
exIst betweeN carIbbeaN meN wHo HaVe sex
WiTh men, drug users, Prison PoPulaTions
aNd sex workers oN tHe oNe HaNd, aNd tHe
general PoPulaTion on The oTher.
The important issue here is the sexual dynamics among
men who have sex with men and sex workers and the
general population. For example, the majority of MSM in
the Dominican Republic (76%) have reported having had
sex with women 19. In Guyana, the mean number of female
sex partners among MSM in the past 6 months before the
2009 survey ranged from 0 to 8 with 67% reporting having
ever had sex with women 20. In Trinidad and Tobago 25% of
MSM surveyed were married 21 and in Jamaica 34% reported
having had more than two female partners in the past 12
months before the 2008 survey 22. Clients of female sex
workers are from the general population, sexual partners
of drug users are from the general population and the vast
majority of the prison population returns to the general
population.
Although not quantified, there are observations of sexual
interactions between these vulnerable populations and
the general population e.g. male sex workers have both
MSM and female clients; among the female clients are drug
users who sell sex to males and females alike to sustain
their drug habit. Taking this reality into consideration,
we can conclude that sexual activities among vulnerable
populations and between vulnerable populations and the
general population are shaping and sustaining the HIV
epidemic in the Caribbean 23. Therefore, to respond to the
HIV epidemic effectively in this region, national authorities
and decision makers should focus their attention on the
vulnerable populations by providing them with a high
coverage of effective HIV prevention programmes, and high
quality health care including sexual reproductive health
services within an enabling environment.
18
19
20
21
22
23
Source: Caribbean Epidemiology Centre. 2006 and
The Status of HIV in the Caribbean. UNAIDS.2010
EV Boisson, C. Trotman. HIV Seroprevalence among Male Prison Inmates in the Six Countries of the Organisation of Eastern Caribbean States in the Caribbean
(OECS). West Indian Med J 2009; 58 (2): 106
Jose Tor-Alfonso, Nelson Varas-Diaz. Pna. Resumen Ejecutivo. Enero 2005
Ministry of Health Guyana and USAID/FHI. Behavioural Surveillance Surveys among MSM in Guyana. 2009
Rk Lee, C. Poon king et al. Risk behaviours for HIV among men who have sex with men in Trinidad and Tobago. XVI International AIDS Conference. Abstract
CDD 0366. 2006
Sharon S Weir, Carol Jones Cooper et al. Results of Men’s Health Survey in Jamaica. 2008
Daniel T. Halperin, E. Antonio de Moya, Eddy Perrez-The, Gregory Pappas, Jesus M. Garcia Calleja. Understanding the HIV Epidemic in the Dominican Republic:
A Prevention Success in the Caribbean. JAIDS. April 2009
www.unaidscaribbean.org | KS III | 23
Table 7: lisT of ungass indiCaTors
exPeNdIture
Indicator 1
Domestic and international AIDS spending by categories and financing sources.
PoliCy deVeloPmenT and imPlemenTaTion sTaTus
Indicator 2
National Composite Policy Index (NCPI) (areas covered: prevention, treatment, care and support,
human rights, civil society involvement, gender, workplace programmes, stigma and discrimination,
and monitoring and evaluation).
naTional Programmes
Indicator 3
Percentage of donated blood units screened for HIV in a quality assured manner.
Indicator 4
Percentage of adults and children with advanced HIV infection receiving antiretroviral therapy.
Indicator 5
Percentage of HIV-positive pregnant women who receive antiretroviral medicines to reduce the risk
of mother-to-child transmission.
Indicator 6
Percentage of estimated HIV-positive incident TB cases who received treatment for TB and HIV.
Indicator 7
Percentage of women and men aged 15-49 who received an HIV test in the last 12 months and who
know the results.
Indicator 8
Percentage of most-at-risk populations that have received an HIV test in the last 12 months and who
know the results.
Indicator 9
Percentage of most-at-risk populations reached with prevention programmes.
Indicator10
Percentage of orphaned and vulnerable children aged 0-17 whose household received free basic
external support in caring for the child.
Indicator11
Percentage of schools that provided life-skills HIV education in the last academic year.
Indicator12
Current school attendance among orphans and non-orphans aged 10-14.
knoWledge and behaViours
Indicator13
Percentage of young people aged 15-24 who both correctly identify ways of preventing the sexual
transmission of HIV and who reject major misconceptions about HIV transmission.
Indicator14
Percentage of most-at-risk populations who both correctly identify ways of preventing the sexual
transmission of HIV and who reject major misconceptions about HIV transmission.
Indicator15
Percentage of young women and men aged 15-24 who have had sexual intercourse before the age of 15
Indicator16
Percentage of women and men aged 15-49 who had more than one sexual partner in the past 12
months.
Indicator17
Percentage of women and men aged 15-49 who had more than one sexual partner in the past 12
months reporting the use of a condom during their last intercourse.
Indicator18
Percentage of female and male sex workers reporting the use of a condom with their most recent
client.
Indicator19
Percentage of men reporting the use of a condom the last time they had anal sex with a male partner.
Indicator20
Percentage of injecting drug users who reported using sterile injecting equipment the last time they
injected (Not relevant for the Caribbean).
Indicator21
Percentage of injecting drug users who reported the use of a condom at last sexual intercourse (Not
relevant for the Caribbean).
imPaCT
Indicator22
Indicator23
Indicator24
Indicator 25
Percentage of young women and men aged 15-24 who are HIV-infected.
Percentage of most-at-risk populations who are HIV-infected.
Percentage of adults and children with HIV known to be on treatment 12 months after initiation of
antiretroviral therapy.
Percentage of infants born to HIV-infected mothers who are infected.
Source: UNAIDS. Guidelines on Construction of Core Indicators. 2010 Reporting on UNGASS. 2009
24 | KS III | www.unaidscaribbean.org
www.unaidscaribbean.org | KS III | 25
The Caribbean SCoreCard
Some Key ReSultS 2009
*Coverage rate refers to ART and PMTCT coverage.
The Caribbean leads The World
All 16 Caribbean member states 24 of the United Nations have
submitted their 2010 UNGASS reports in a timely manner
and in conformity with the Declaration of Commitment
signed off during the UNGASS on HIV/AIDS in 2001. For
the two consecutive rounds of reporting so far, the Joint
United Nations Programme on HIV/AIDS (UNAIDS) has
recognised the Caribbean as the leading region in the world
for submission of national UNGASS reports 25. This in itself
is a success story for the region. It has proven that decision
makers and programme implementers at the country level
understand and adhere to the concept of commitment,
that they have embraced monitoring and evaluation of
HIV programmes and that they have accepted the notion
of measuring progress and identifying challenges to ensure
future success in responding to HIV.
24
25
26
seTbaCks on reporTing on relevanT Ungass
indiCaTors
Comparing the completeness of reporting in the 20062007 and 2008-2009 periods, it is observed that with the
exception of Cuba which kept its 100% reporting on all 23
relevant indicators, and some progress in the Bahamas
and Belize, the remaining 13 Caribbean countries have
reported on fewer indicators in the 2008-2009 period. Only
38% of the countries 26 have reported on more than 50% of
indicators relevant to the Caribbean. This level of reporting
was 81% in 2006-2007; therefore it needs improvement if
decision makers are to have a comprehensive knowledge
of all aspects of the HIV epidemic. A closer analysis of
indicators missing in the national UNGASS reports brings
us to the conclusion that these are very often related to
MARPs, orphans and vulnerable children.
Antigua and Barbuda, the Bahamas, Barbados, Belize, Cuba, Dominica, The Dominican Republic, Grenada, Guyana, Haiti, Jamaica, St. Kitts and Nevis, St. Lucia,
St. Vincent and the Grenadines, Suriname and Trinidad and Tobago.
UNAIDS. Global Report on AIDS.2010
The Bahamas, Barbados, Belize, Cuba, Dominican Republic, Guyana, Jamaica, and St. Lucia.
26 | KS III | www.unaidscaribbean.org
figure 7: perCenTage of CompleTeness of
reporTing on relevanT Ungass indiCaTors,
2006-2007 and 2008-2009
sTaTUs of The naTional sTraTegiC plans. In
Source: UNAIDS Global Report on AIDS.2010 and
2010 UNGASS Reports.
each of the 16 Caribbean countries there is a well-defined
national structure leading the national response, but
unfortunately in six of these countries (38%), there is no
updated National AIDS Strategic Plan and no Monitoring and
Evaluation Framework. This situation is being monitored at
the regional level 27.
Table 8: sTaTUs of naTional sTraTegiC and moniToring and evalUaTion plans in 2010
Country
National AIDS
Strategic Plan
National Strategic
Plan with a Budget
National
M&E Plan
Antigua and Barbuda
Draft
No
No
The Bahamas
Draft
No
No
Barbados
Yes
Yes
Yes
Belize
Yes
No
Yes
Cuba
Yes
Yes
Yes
Dominica
Draft
No
No
The Dominican Republic
Yes
Yes
Yes
Grenada
Draft
No
No
Guyana
Yes
No
Yes
Haiti
Yes
No
Yes
Jamaica
Yes
No
Yes
St. Kitts & Nevis
Yes
Yes
Draft
St. Lucia
Draft
No
Draft
St. Vincent and the Grenadines
Yes
Yes
No
Suriname
Yes
Yes
Yes
Trinidad and Tobago
Draft
No
Draft
The Bahamas has developed a Roadmap for 2006-2010.
Source: UNAIDS Global Report on AIDS.2010 PANCAP-Annual General Meeting. St Maarten.2010.
27
PANCAP-AGM Report. St. Maarten. 2010
www.unaidscaribbean.org | KS III | 27
aids spending is exTernally dependenT.
During 2008-2009, 12 countries reported their information
on national AIDS spending and four i.e. Guyana, Jamaica,
St. Lucia and Suriname did not. In total, USD 497 million
was spent in the region to respond to HIV. USD 155 million
came from domestic sources, representing 31% of the total
expenditure; 64% (USD 315 million) came from bilateral
donors e.g. PEPFAR and the GFATM, USD 18 million from
United Nations agencies, and the remaining USD 8 million
from other external sources 28.
Figure 8: naTional aids spending by soUrCes
in The Caribbean. 2010 Ungass reporTs
To further illustrate this ineffective way of allocating
resources, in the Bahamas USD 9 million was spent on AIDS
but only 11% on prevention. In Trinidad and Tobago, USD
28.5 million was spent on AIDS in 2008-2009 with 42% on
prevention, of which 95% went to programmes for the
general population and only 5% on men who have sex with
men, female sex workers, crack cocaine users and prisoners.
This occurred in a country where one in every five MSM is
living with HIV and where there was an estimated 1,200
new HIV infections every year for the last eight years.
This high HIV incidence could be explained by the sharp
decrease (88%) in the number of prevention interventions
in Trinidad and by 50% in Tobago between 2006 and 2010
(see graphs below). Source: National Prevention Mapping.
UNAIDS/NACC - Trinidad and Tobago. 2010.
figure 10: nUmber of hiv prevenTion
inTervenTions exeCUTed in
Trinidad: 2004 To 2010
Source: UNAIDS Global Report on AIDS.2010 and
2010 UNGASS Reports
prevenTion does noT geT a fair share of aids
spending. The distribution of funds by strategy shows
that USD 160 million or 32% was spent on prevention, USD
182,142,000 or 37% on treatment, USD 100,668,000 (20%)
on programme management (personnel and salaries) and
the remaining 11% (USD 53 million) on other components
of the national response i.e. advocacy, social protection,
human rights, research, care for orphans, etc.
Source: UNAIDS-NACC. The Prevention Mapping in Trinidad
and Tobago. 2011
figure 11: nUmber of hiv prevenTion
inTervenTions exeCUTed in Tobago: 2004 To
2010
Figure 9: Ungass: aids spending in The
Caribbean by STraTegy: 2008-2009
Source: UNAIDS-NACC. The Prevention Mapping in Trinidad
and Tobago. 2011
Source: UNGASS Reports.2010
28
UNAIDS Global Report on AIDS.2010
28 | KS III | www.unaidscaribbean.org
In the Dominican Republic, between 18% and 29% of all
resources spent on AIDS went to HIV prevention with 52%
allocated to interventions among the general population
(see table 8). Overall there is almost a 50% decline in
spending on prevention between 2007 and 2009, equivalent
to 38% of the total spending on AIDS.
Table 9: hiv prevenTion: disTribUTion of fUnding by popUlaTion groUps in The
dominiCan republiC. 2007-2009. CopreSida preliminary daTa. 2010
populaTion/Spending/year
2007
2008
2009
CumulaTive
perCenTage
Adolescents/Youths
1,452,053
1,099,390
1,307,459
3,857,902
17.00%
General Population
5,707,335
3,527,889
2,591,239
11,826,462
52.00%
FSW/Clients/Intermediaries
513,280
332,111
632,648
1,478,040
7.00%
Gays, Trans and MSM
177,031
228,102
324,354
729,486
3.00%
Other Priority Populations
1,661,400
0
0
1,661,400
7.00%
Residents of Bateyes
613,093
538,826
329,874
1,481,766
7.00%
Women
789,091
746,151
258,612
1,820,854
8.00%
Total prevention
10,913,283
6,471,468
5,471,160
22,855,911
29%
27%
18%
percentage Total spending on
aidS
Source COPRESIDA and UNAIDS. 2011
If greater emphasis is put on evidence-informed,
sustainable and cost effective prevention interventions,
this should result in lower costs to the national economy
for HIV treatment and care. Furthermore, by focusing on
prevention and building life-skills among men who have
sex with men, sex workers, crack cocaine users, prisoners,
women and youth, this should help to prevent the further
spread of HIV.
making The laW Work for The hiv response in
The Caribbean. Below is a summary of protective and
punitive laws as they apply in the 16 Caribbean Countries.
This is a snapshot of selected laws that either support or
block universal access to HIV prevention, treatment, care
and support.
removal of pUniTive laWs is a mUsT. Caribbean
authorities have the opportunity to reinforce the
supportive and protective laws which create an enabling
environment for men who have sex with men, sex workers,
drug users, young people and people living with HIV to
protect themselves against stigma and discrimination and
adopt protective practices against the transmission of HIV.
Leaders in the government and civil society must work
together to remove punitive laws (see Box below) which
are disempowering individuals and hindering progress
towards universal access to HIV prevention, care, treatment
and support. Caribbean states cannot afford to continue
discriminatory practices against citizens because of their
sexual orientation, profession or health status.
1
box
a SnapShoT oF The hiv-relaTed legal environmenT in
The Caribbean.2010
• 56%ofcountriesreportnolegalprotectionagainstHIV-relateddiscrimination
• 75%ofcountriesreportlawsandregulationsthatpresentobstaclestoHIVservicesforvulnerable
population groups
• 69%ofcountriescriminalisesamesexactivitiesamongconsentingadults.TheseincludeAntigua
and Barbuda, Barbados, Belize, Dominica, Grenada, Guyana, Jamaica, St. Kitts and Nevis,
St. Lucia, St. Vincent and the Grenadines, and Trinidad and Tobago
• 81%ofcountriescriminalisesomeaspectsofsexwork
• 19%ofcountrieshaveHIV-relatedtravelrestrictions
• 19%ofcountrieshaveHIV-specificlawsthatcriminaliseHIVtransmission
www.unaidscaribbean.org | KS III | 29
making The laW Work for The hiv response
a snapshoT of seleCTed laWs ThaT sUpporT or bloCk Universal aCCess To
hiv prevenTion, TreaTmenT, Care and SupporT (Caribbean - July 2010)
NO
THE BAHAMAS
YES
YES
YES
BARBADOS
NO
NO
YES
BELIzE
NO
YES
CUBA
YES
DOMINICA
NO
G
YES
YES
YES
NO
YES
NO
YES
YES
YES
YES
YES
YES
YES
NO
YES
NO
YES
NO
NO
NO
YES
NO
YES
NO
YES
YES
THE DOMINICAN REPUBLIC
YES
YES
YES
YES
NO
NO
GRENADA
YES
NO
YES
NO
YES
YES
GUYANA
NO
NO
YES
NO
YES
YES
HAITI
NO
NO
NO
NO
NO
NO
YES
JAMAICA
NO
NO
YES
NO
NO
YES
YES
SAINT KIT TS AND NEVIS
NO
NO
YES
NO
YES
YES
SAINT LUCIA
YES
YES
YES
NO
YES
YES
SAINT VINCENT AND THE GRENADINES
NO
NO
NO
YES
YES
SURINAME
YES
NO
YES
CONTRADICTORY
NO
YES
TRINIDAD AND TOBAGO
NO
YES
YES
CONTRADICTORY
YES
YES
NO
Punitive law or lack of protective law
Protective law or lack of punitive law
Information not available
Death penalty as sanctioned under punitive law
laCk
of
poliCy
developmenT
and
implemenTaTion among men Who have
sex WiTh men, sex Workers, CraCk CoCaine
Users, prisoners and yoUng people.
In all 16 Caribbean States reporting, national authorities
and leaders of the civil society agree that HIV policies are
developed and implemented in the area of prevention and
treatment. However, detailed analysis of the scorecard on
this area shows that the two sides disagreed that policies
are in place for risk reduction for men who have sex with
men and sex workers. This disagreement between national
authorities and civil society was reported in nine of the 16
i.e. in Belize, Dominican Republic, Grenada, Haiti, Jamaica,
St. Kitts and Nevis, St. Lucia, Suriname and Trinidad and
Tobago. It becomes a very serious cause for concern
when programmes are not in place for these two mostat-risk populations in a scenario of mixed or concentrated
epidemics, because this lack of attention would certainly
lead to an ongoing spread of HIV.
30 | KS III | www.unaidscaribbean.org
limiTed
involvemenT
H
COMPULSORY TREATMENT FOR
PEOPLE WHO USE DRUGS AND/
OR DEATH PENALTY FOR DRUG
OFFENCES
NO
F
DEEM SEx WORK
(prosTITuTIon)TobeIllegAl
NO
territories and entities
E
crImInAlIsesAme-sex
SExUAL ACTIVITIES BETWEEN
CONSENTING ADULTS
ANTIGUA AND BARBUDA
Countries,
D
SPECIFICALLY CRIMINALISE HIV
TRANSMISSION OR ExPOSURE
PRESENT OBSTACLES TO
ACCESS TO HIV SERVICES FOR
VULNERABLE POPULATIONS
C
SPECIFY PROTECTIONS FOR
VULNERABLE SUBPOPULATIONS
B
PROTECT PEOPLE LIVING WITH
HIV AGAINST DISCRIMINATION
A
PUNITIVE LAWS
HIV-specIfIcresTrIcTIonson
ENTRY, STAY OR RESIDENCE
PROTECTIVE LAWS
DEATH PENALTY
Contradictory information
of
Civil
soCieTy.
Among the 16 Caribbean States, the scorecard regarding
involvement of civil society in the national HIV response
has shown that 13 Caribbean countries scored slightly
above average. However, three countries namely Barbados,
Suriname and Trinidad and Tobago have performed poorly
in this area. This situation needs to be addressed urgently,
because the role of civil society in the scale-up of the HIV
response is crucial, especially when it comes to the mostat-risk populations. 29
blood safeTy is assUred in The Caribbean.
The first regional effort to reduce HIV transmission was
to secure blood transfusions. In comparing data for 20082009, the majority of countries have screened all units
of donated blood in a quality assured manner, with the
exception of the Dominican Republic. Antigua and Barbuda
29
UNAIDS Global Report on AIDS.2010
and Grenada have moved quickly to ensure 100% screening
of all donated units of blood. Unfortunately, the Dominican
Republic experienced a setback, with only 85% of units
screened. Decision makers need to pay urgent attention to
this situation.
perCenTage
figure 12: perCenTage of donaTed blood
UniTs sCreened for hiv in a qUaliTy
assUred manner in The Caribbean
Below is a summary for the PMTCT coverage in the 10
larger Caribbean countries in 2009, showing that the
Bahamas, Barbados, Cuba, Guyana, Jamaica and Suriname
have achieved a high PMTCT coverage, whereas Belize, the
Dominican Republic, Haiti and Trinidad and Tobago need a
rapid scale-up to achieve universal access.
Table 10: pmTCT Coverage in 10 larger
Caribbean CoUnTries.
2009. unaidS/who. 2010
Country
Coverage
in 2009
Towards
Universal
Access
The Bahamas*
95%
Achieved**
Barbados*
95%
Achieved**
Belize
(22-61)
Needs Rapid
Scale-up
Cuba
95%
Achieved**
The Dominican
Republic
(32-95)
Needs Rapid
Scale-up
Guyana
95%
Achieved**
Haiti
60%
Needs Rapid
Scale-up
Jamaica
83%*** (46-95)
Achieved**
Suriname
83%*** (82-95)
Achieved**
Trinidad & Tobago*
55%***
Needs Rapid
Scale-up
CoUnTry
Source: UNAIDS Global Report on AIDS.2010 and 2010 UNGASS
Reports.
ForTy-one perCenT oF pregnanT women
living WiTh hiv did noT reCeive mediCines
To redUCe The Transmission of hiv To
Their babies. In 2009 a total number of 7,400 pregnant
women living with HIV needed ART to prevent mother-tochild transmission, but only 4,400 received the treatment,
resulting in a coverage of 59%. 30 The PMTCT coverage
increased from 22% in 2005 to 52% in 2008 to 59% in 2009.
Source: UNAIDS Global Report on AIDS.2010,
* WHO High Income Countries Data. 2010
** Universal Access is achieved when the coverage is above 80%.
***2010 UNGASS Reports
figure 13: pmTCT regional Coverage:
2005-2010 in The Caribbean
Source: WHO/UNAIDS/UNICEF. Towards Universal Access.
Progress Report 2010
30
UNAIDS Global Report on AIDS.2010
www.unaidscaribbean.org | KS III | 31
very limiTed aCCess To prevenTion programmes by men Who have sex WiTh men, sex
Workers, CraCk CoCaine Users and prisoners.
In the previous reporting period 2006-2007, only three
Caribbean countries out of the 16 had reported on this
indicator (Bahamas, Cuba and Guyana). During the current
reporting period 2008-2009, Cuba is the only country
that has done so, reporting that as much as 92% of its
MSM population is reached by prevention programmes.
The progress accomplished in this one country shows up a
serious lack of information and the absence of prevention
programmes for Caribbean MSM during the last four
consecutive years. This situation needs to be addressed if
universal access to HIV prevention is to be achieved in this
region and among all population groups.
figure 14: perCenTage of msm reaChed by prevenTion programmes in
Three Caribbean CoUnTries
2007
2009
Source: UNAIDS Global Report on AIDS. 2010
A similar situation is seen among female sex workers
whereas from three countries reporting in the previous
cycle, there are only two this time around. In Cuba more
than 97% of FSW were reached by prevention programmes
while in Guyana the percentage was 61%. The Dominican
Republic reported that 44% of sex workers were reached
by prevention programmes without disaggregation by sex.
Figure 15: perCenTage of fsW reaChed by prevenTion programmes in Three Caribbean
CoUnTries
Source: UNAIDS Global Report on AIDS. 2010
Analysis of epidemiological and behavioural data shows
that turning the tide of the HIV epidemic in this region
calls for investment in and programming for men who have
sex with men, male and female sex workers and drug users
who are disproportionately affected by HIV. Unfortunately,
UNGASS reports for the past four years have demonstrated
that only Cuba has consistently reported on this indicator.
32 | KS III | www.unaidscaribbean.org
The remaining 15 countries have not been able to reach
out to these populations with prevention programmes.
Without addressing this clear weakness in their national
response, these 15 Caribbean countries will not be in a
position to stop the spread of HIV nor reverse its trend by
the end of 2015.
2
box
a prevenTion revolUTion is needed
There are six key features to achieving a prevention revolution using the combination prevention
approach:
• Acombinationofbiomedical,behaviouralandstructuralelements-toreduceboththeimmediate
risks and the underlying vulnerabilities.
• Ameaningfulengagementofaffectedcommunities,promotinghumanrightsandgenderissues.
• operating synergistically, consistently over time, on multiple levels - individual, family and
society.
• Investingindecentralisedandcommunityresponsesandenhancedcoordinationandmanagement.
• flexible and continuous learning will allow for adaptation to changing epidemic patterns and
rapid adjustment and deployment of new tools and innovations.
• Tailoringtheprocesstonationalandlocalneedsandcontexts.
Source: UNAIDS OUTLOOK REPORT.2010
Fifty-two percent of PLHIV who needed treatment did not
get it. In 2009, 52,400 of the 110,000 PLHIV needing ART
were receiving it. This was a 31.3% increase from 2008
(39,900). Using the new WHO standards, the ART coverage
increased from 37% to 48% (starting ART at <350CD4 count).
However, when applying the old WHO standards (starting
ART at <200 CD4 count), the ART coverage increased from
1% in 2004 to 67% in 2009. ART coverage was 55% for males
and 45% for females.
figure 16: arT Coverage 2004-2009 in The Caribbean
Source: UNAIDS Global Report ON aids.2010. WHO/UNAIDS/UNICEF. Towards Universal Access. Progress Report 2010
www.unaidscaribbean.org | KS III | 33
TreaTmenT is noT reaChing The Caribbean
Children. From 2005 to 2009, the treatment coverage
increased from 5% in 2005 to 24% in 2008 and 29% in 2009.
In 2009, there were 2,400 children receiving ART while
8,100 needed it.
figure 17: arT Coverage among Caribbean
Children 2005-2009
Source: WHO/UNAIDS/UNICEF. Towards Universal Access.
Progress Report 2010
The following summary of the ART coverage demonstrates
that in the majority of the countries there is a need to
rapidly scale-up programmes to achieve universal access
to antiretroviral treatment in the Caribbean. Only three
countries have achieved high ART coverage (Barbados,
Cuba and Guyana) i.e. above 80%.
Table 11: arT Coverage in The Ten larger Caribbean CounTrieS. 2009
Unaids/Who. 2010
Country
ART Coverage in 2009
Towards Universal Access
The Bahamas
52%**
Needs Rapid Scale-up
Barbados
89%**
Belize
40%
Cuba
95%
The Dominican Republic
47%
Guyana
95%
Haiti
43%
Needs Rapid Scale-up
Jamaica
46%
Needs Rapid Scale-up
Suriname
53%
Needs Rapid Scale-up
Trinidad & Tobago
41%**
Needs Rapid Scale-up
Achieved*
Needs Rapid Scale-up
Achieved*
Needs Rapid Scale-up
Achieved*
Source: UNAIDS Global Report on AIDS.2010
* Achieved when coverage is above 80%, ** WHO. High Income Countries Data.2010.
34 | KS III | www.unaidscaribbean.org
The figure below shows that 50% of the ten larger Caribbean
countries, where 88% of all Caribbean people living with
HIV are located, have their national ART coverage below
50% (Belize, Trinidad and Tobago, Haiti, Jamaica and the
Dominican Republic) and two have ART coverage between
50% and 60% (Bahamas, and Suriname).
figure 18: arT Coverage in The Ten larger
Caribbean CoUnTries. Unaids/Who. 2010
figure 19: perCenTage oF adulTS and
Children WiTh hiv knoWn To be on arT 12
monThs afTer iniTiaTion of anTireTroviral
Therapy. 2007-2009
120%
2007
2009
100%
80%
60%
40%
Source: UNAIDS Global Report on AIDS.2010. WHO High Income
Countries Data. 2010
20%
31
32
33
34
SKN
SLC
CUB
DOM
JAM
BDO
HAI
SVG
DOR
BEL
TNT
GUY
SUR
BHA
GRE
0%
ANT
qUaliTy of Care needs improvemenT. In
2009, only six of the 16 Caribbean States reported a
survival rate above 90% 12 months after PLHIV were put
on ART. Compared with 2007, only four countries have
made progress in this area. In six countries, less than 10%
of PLHIV have died or have been lost to follow-up within 12
months of starting ART for the period 2006-2009. As seen in
figure 19, in comparing the previous reporting period with
the current one, setbacks were observed in five countries
regarding quality of care of PLHIV. The observation is that
people are not willing to come forward early to get medical
attention because of stigma and discrimination attached
to HIV. This situation must be addressed if the number of
premature deaths among PLHIV is to be reduced, as it is
well established that the sooner the treatment starts, if
indicated, the better it is.
Source: UNAIDS Global Report on AIDS. 2010
Overall, PLHIV are facing serious challenges with late
presentation for treatment and adherence issues.
According to 2010 UNGASS reports, an emergent issue is
a rapid increasing trend of patients moving quickly from
first to second line treatment, and the somewhat frequent
use of protease inhibitors in the first line. Although there
is an absence of accurate or comprehensive data in many
instances, this apparent trend is becoming a serious
challenge because of the increased cost of these treatment
regimens 34.
Barbados, Dominica, Cuba, Jamaica, St. Kitts and Nevis and St. Lucia.
Jamaica, St. Lucia, St. Vincent and the Grenadines and Trinidad and Tobago.
Antigua and Barbuda, Dominican Republic, Grenada, Guyana and Suriname.
WHO, UNAIDS, UNICEF. Towards Universal Access. Progress Report 2010.
www.unaidscaribbean.org | KS III | 35
finally, neW hiv infeCTions are oUTpaCing TreaTmenT
in The Caribbean. in 2009, For every 50 people
sTarTing arT, There Were 70 neW hiv infeCTions.
To address these issues and scale-up treatment, UNAIDS recommends that
Caribbean countries adopt the principles of Treatment 2.0 summarised
below.
box
3
TreaTmenT 2.0 is The ansWer for The Caribbean
Treatment 2.0 is designated to maximise the efficiency and effectiveness of HIV treatment through
focus on five priorities:
• optimisingdrugregimens,
• Advancingpoint-of-careandothersimplifiedplatformsandmonitoring,
• reducingcost,
• Adaptingdeliverysystems,and • mobilisingcommunity.
Progress has been made, but there is still a long way to
go. In addition to a reduction of AIDS-related deaths by
43%, there was a 14.3% drop in new HIV infections in the
past decade. Overall, the Caribbean made some progress in
responding to the HIV epidemic; however there is a need
for more reduction in the HIV incidence if this region is to
turn the tide of the epidemic. As shown below, Belize, the
Dominican Republic, Jamaica and Suriname have reduced
their incidence of HIV by 25% in 2009. Haiti reduced its HIV
incidence by 12%.
Table 12: ChangeS in The hiv inCidenCe raTeS during 2001-2009
Source: UNAIDS Global Report on AIDS. 2010
To the five countries which reduced HIV incidence, it is also
important to add the success in reduction of the number
of PLHIV in Guyana, Haiti and Jamaica which resulted in
a decline in adult HIV prevalence. Three countries 35 have
achieved a very high level of treatment coverage and
six for PMTCT coverage 36. The region should learn from
the experience of these countries 37 and use effective
approaches to respond to HIV and break the back of the
HIV epidemic.
35
36
37
The Caribbean decision makers must pay serious attention
to the production and use of strategic information on HIV.
New data on knowledge, attitudes, practices and beliefs are
needed to understand the dynamics of the HIV epidemic
in communities and among different population groups.
Evidence to guide action is paramount.
Barbados, Cuba and Guyana.
The Bahamas, Barbados, Cuba, Guyana, Jamaica and Suriname.
The Bahamas, Barbados, Belize, Cuba, the Dominican Republic, Guyana, Haiti, Jamaica and Suriname.
36 | KS III | www.unaidscaribbean.org
www.unaidscaribbean.org | KS III | 37
AntiguA & BArBudA
Key Issues RequIRIng Focus
FIndIngs oF ungAss IndIcAtoRs: A summARy
The National AIDS Programme reported on seven out of 23 relevant UNGASS
indicators i.e. 30% completeness. Noticeably, the National Strategic Plan
is outdated and new data on knowledge, behaviours and orphans and
vulnerable children are lacking. Their national AIDS spending report showed
that USD 184,000 was spent on AIDS with 71.4% from an external source i.e.
the Global Fund. This poses a problem of sustainability. There is a lack of
basic policies to deal with discrimination and to protect PLHIV and to support
the national HIV response. Progress was accomplished in blood safety with
the percentage of donated blood units tested moving from 31.9% in 2007 to
100% in 2009. All schools provided Life-Skills HIV education and the needs
of orphans and vulnerable children were addressed. In 2009, 98 PLHIV were
on ART; all pregnant women seen at antenatal clinics were tested and only
one was found HIV positive. No TB/HIV co-infection was reported. There is
an 87% Health and Family Life Education coverage in schools. Reported cases
of HIV among young people have shown that from 10 in 2006-2007, 30 cases
were diagnosed during the period 2008-2009. This is a three-fold increase
during the past four years. Regarding quality of care, 53.3% of PLHIV put on
ART were alive 12 months after they started therapy, which is far below the
90% recommended WHO standard.
38 | KS III | www.unaidscaribbean.org
•Develop a National Strategic Plan
and M&E framework to guide the
HIV response.
•Focus on population groups such
as young people to improve their
knowledge and skills to increase
the age at first sexual intercourse
and decrease age mixing behaviours
among young females.
•Pay attention to female sex workers
in brothels in the tourism sector to
increase their knowledge and skills.
•Promotea100%condomuseamong
sex workers and men who have
sex with men by increasing their
knowledge and skills to protect them
against HIV transmission.
•Put efforts into the rapid
improvement of the quality of life
of PLHIV by removing all barriers
to access to treatment, including
stigma and discrimination.
•Remove punitive laws regarding
same sex acts and sex work to
support the roll-out of universal
access to HIV prevention, care,
treatment and support.
delcora Williams
AIDS PROGRAMME MANAGER
ANTIGUA AND BARBUDA
WhAt Is the AIds sItuAtIon In youR countRy?
In Antigua and Barbuda, since the first case of HIV was diagnosed in 1985 and up to the
end of September 2010, the total number of persons who tested positive for HIV was
867, with a male to female ratio of 1:1. The major mode of HIV transmission is through
heterosexual contact, and the economically active population, which consists of persons
in the reproductive age group, is most affected. A review of the HIV notification by age
indicates that HIV is concentrated within the age group 15-49 years. HIV-related illnesses
are among the eight leading causes of death in the age group 20-59 years.
tell us WhAt Is the bIggest AchIevement oF youR AIds pRogRAmme?
Our biggest achievement to date is our HIV Outreach Programme, which takes all HIV
prevention and other services directly into the communities, thereby facilitating
easy access to HIV testing with same-day results, and information, education and
communication activities targeting males.
WhAt ARe the successes In RespondIng to AIds In youR countRy?
The country successes to date are the synergy between us and our partners where we are
able to maximise service provision to the general population and the MARPs (SWs and
MSM) and youth. There is an HIV Patient Monitoring System and strong PLHIV support
groups which offer supportive and palliative care services and assist PLHIV with remedying
human rights and stigma and discrimination violations. The National HIV programme
provides support to a number of young persons orphaned by HIV.
WhIch Key populAtIon gRoups WIll you Keep the Focus on In the FutuRe?
Sex workers, men who have sex with men, and youth will be the key populations for
targeted HIV prevention and education interventions particularly.
www.unaidscaribbean.org | KS III | 39
AntiguA & BArBudA
ungASS indiCAtOrS rEPOrt
I n d I c Ato Rs
2006
2007
2008
2009
AIDS Spending
NA
Yes
National Policy
NA
Yes
Blood Safety
33%
ART
88 PLHIV
98 PLHIV
NA
NA
HIV/TB
NA
NA
HIV Test in GP
25%
NA
HIV Test in MSM/SW
NA
NA
Prevention in MSM/SW
NA
NA
Support to OVC
NA
NA
HIV Education
13%
100%
School for OVC
NA
1.00
NA
NA
NA
NA
NA
NA
55%
NA
NA
NA
Condom Use in SW
NA
NA
Condom Use in MSM
NA
NA
NA
NA
HIV in MSM/SW
NA
NA
12 months on ART
55%
53%
PMTCT
83%
Knowledge YP
48%
Knowledge MSM/SW
Sex<15 years in YP
25%
Xsex Partners in GP
Condom Use in GP
HIV in YP
87%
F 0.08%
100%
100%
NA-NotAvAilAble
GP-GeNeRAlPoPulAtioN
SW-SexWoRkeRS
YP-YouNGPeoPle
xSex-MultiPle
ovC-oRPhANSANDvulNeRAbleChilDReN
MSM-MeNWhohAveSexWithMeN
PMtCt-PReveNtioNoFMotheR-to-ChilDtRANSMiSSioN
40 | KS III | www.unaidscaribbean.org
thE BAhAmAS
Key Issues RequIRIng Focus
FIndIngs oF ungAss IndIcAtoRs: A summARy
The adult HIV prevalence in the Bahamas is 3.1%, the highest in the region.
There were 6,600 people living with HIV, and there were, for every 100
males, 150 females living with HIV in 2009. For the past four years, national
authorities have been working from a roadmap which ended in 2010. Overall,
the country reported on 13 out of the 23 relevant UNGASS indicators i.e. 57%
completeness. NASA reports show that USD 9 million was spent on AIDS with
90% of these resources coming from the domestic side. In terms of strategy,
67% of these resources were spent on treatment, only 11% on prevention
and 22% on management, advocacy, research and monitoring and evaluation.
Using the new WHO standards, the ART coverage rate (1506/2900) was 52%
in 2009, the PMTCT coverage rate was 90% and treatment of TB/HIV coinfection was 100%. Only 2% of the general population was tested for HIV
in 2009, 71% of MSM were reached by prevention programmes and among
them 69% reported having used a condom at last anal intercourse but only
36% of MSM have comprehensive knowledge on modes of transmission of
HIV. Seventy-eight percent of schools are providing life-skills HIV education,
but a staggering 58% of young people have had sex before age 15. Quality of
care needs improvement because only 70% of PLHIV who started ART were
still alive 12 months later.
•Develop a National Strategic Plan
with an M&E framework to guide the
national response to HIV.
•Strengthen national hiv prevention
programmes by introducing new and
effective behavioural modification
programmes and allocating for them
more resources to decrease the
number of new infections. This will
subsequently reduce the high adult
HIV prevalence observed in the past
decade.
•Focus attention on young people
because the majority of them had
initiated sex before age 15, with a
consequential 3% HIV prevalence
among young females.
•Strengthen interventions among
men who have sex with men, sex
workers, and migrant populations
from Haiti, the Dominican Republic
and the rest of the Caribbean
to ensure that prevention, care,
treatment and support programmes
reach them.
•Scale-uptreatmentprogrammesand
sustain the high level coverage of
PMTCT and treatment of TB/HIV coinfections.
www.unaidscaribbean.org | KS III | 41
dR. peRRy gomez
NATIONAL AIDS PROGRAMME COORDINATOR
THE BAHAMAS
WhAt Is the AIds sItuAtIon In youR countRy?
The Bahamas is facing a generalised HIV epidemic. As of December 31, 2009 there have
been a cumulative total of 11,803 HIV infections, 6,241 cases of AIDS and 5,545 cases of
HIV; 67% of the cases of AIDS have died. In 2008, the ratio of males to females infected
with HIV was 1.3:1 and antenatal HIV prevalence was 2%.
tell us WhAt Is the bIggest AchIevement oF youR AIds pRogRAmme?
The PMTCT programme remains a best practice for the Bahamas. All attending women
are offered VCT, employing the opt-out strategy. Coverage is estimated at a consistent
97% for clinic attendees. Our PMTCT services also include the general antenatal package
inclusive of STI screening. In 2007, a second screening for HIV at 32 weeks gestation was
added to the protocol to pick-up late HIV infections.
WhAt ARe the successes In RespondIng to AIds In youR countRy?
The successive Bahamas governments have directed important resources to respond to
the HIV epidemic. Successes achieved include the decline in newly reported HIV and
AIDS cases, a drop in reported AIDS-related deaths, a drastic decline in HIV transmission
from mother to child from 30% in 1995 to <2% in 2006, and a seven-fold increase of
PLHIV on treatment i.e. from 300 in 2002 to 2,152 at the end of 2009. The focus on youth
has enjoyed significant success in the primary and secondary schools. The National HIV
Reference laboratory continues to expand with plans underway to begin in-country DNA
PCR and Resistance Testing.
WhIch Key populAtIon gRoups WIll you Keep the Focus on In the FutuRe?
The focus will be on adolescents, young adults, undocumented immigrants (Haitian
nationals), men who have sex with men, persons above 50 years of age and sex workers.
42 | KS III | www.unaidscaribbean.org
thE BAhAmAS
ungASS indiCAtOrS rEPOrt
I n d I c Ato Rs
2006
2007
2008
2009
AIDS Spending
NA
Yes
National Policy
NA
Yes
Blood Safety
100%
100%
100%
100%
ART
43%
No 1,244
1508/2900= 52%
PMTCT
>95%
>95%
HIV/TB
81%
81%
100%
HIV Test in GP
NA
NA
TOTAL 2% M 1 F 4%
HIV Test in MSM/SW
MSM 61%
NA
Prevention in MSM/SW
MSM 48%
MSM 71%*
NA
NA
72%
78%
Support to OVC
NA
HIV Education
School for OVC
NA
NA
NA
Knowledge YP
NA
NA
NA
Knowledge MSM/SW
MSM 45%
MSM 36%
Sex<15 years in YP
NA
M 70%
Xsex Partners in GP
NA
NA
Condom Use in GP
NA
NA
Condom Use in SW
NA
NA
Condom Use in MSM
69%
NA
NA
1%
HIV in MSM/SW
MSM 8.18%
NA
12 months on ART
70%
70%
HIV in YP
F 1.26%
F 41%
*DATA C O L L EC T I O N M E T H O D U S E D I S N OT U N A I D S S TA N DA R D
NA-NotAvAilAble
GP-GeNeRAlPoPulAtioN
SW-SexWoRkeRS
YP-YouNGPeoPle
xSex-MultiPle
ovC-oRPhANSANDvulNeRAbleChilDReN
MSM-MeNWhohAveSexWithMeN
PMtCt-PReveNtioNoFMotheR-to-ChilDtRANSMiSSioN
www.unaidscaribbean.org | KS III | 43
BArBAdOS
Key Issues RequIRIng Focus
FIndIngs oF ungAss IndIcAtoRs: A summARy
In 2009, a total number of 2,100 people were living with HIV in Barbados and
the adult HIV prevalence was 1.4%. UNAIDS estimated that there were for
every 170 males, 100 females living with HIV. The country reported on 12 out
of the 23 relevant UNGASS indicators which represents 52% completeness.
The NASA submission shows that in 2008, USD 11 million was spent on AIDS
with 63% of this amount coming from domestic sources but no distribution
of funds by strategy was reported. In terms of policy, issues remain with
laws prohibiting same sex relations and solicitation. Based on new WHO
standards, the ART coverage (804/903) is 89% and TB/HIV cases are 100%
treated. The PMTCT coverage rate is above 95% and care for orphans is 100%
secured and all attend school. Life-skills HIV education is provided in 85%
of the schools. Only 50% of young people know the sexual transmission
prevention means and reject misconceptions, and 20% of them have had
sex before the age of 15. Quality of care is high with 94% of PLHIV on ART
12 months after initiation of therapy. There is a serious lack of behavioural
information among MARPs in Barbados. This shortcoming is not helping with
the use of evidence to make decisions.
44 | KS III | www.unaidscaribbean.org
•Sustain blood safety measures,
provision of quality ART and PMTCT
services.
•Focus national attention on the
generation, analysis and use of
strategic information among men
who have sex with men and sex
workers. There is a lack of strategic
information among these vulnerable
populations which needs urgent
correction.
•include key populations in the
development, implementation and
evaluation of interventions i.e.
men who have sex with men, male
and female sex workers and young
people.
•Remove
discriminatory
and
punitive laws regarding same sex
relationships and sex work.
•Strengthen and expand national
prevention programmes to reach out
to the most vulnerable populations.
henRIcK ellIs
CHAIR, NATIONAL HIV/AIDS COMMISSION
BARBADOS
In the past few years, our country has produced some notable
successes with our HIV programmes. Our treatment access
numbers have set a strong example for other countries
throughout the Caribbean and the world. But there is a long
way to go if we are to meet the critical Millennium Development
Goals set by the United Nations— all eight of which are affected
by the prevalence of HIV in our community.
The deadline to reach those goals is 2015. To meet it, we must
both focus on the populations in Barbados who are most at risk,
and we must eradicate the stigma of AIDS that is so detrimental,
yet so unfortunately prevalent, in our culture. Although some
work is ongoing in these areas, much more still needs to be
done to reach our goals.
First, HIV infection rates in our country continue to climb at an
unacceptable rate. Before this trend spins out of control, we
must focus on the groups who are most-at-risk of contracting
HIV as we develop policies and funding for our AIDS programmes
in collaboration with our partners. To halt the spread of HIV,
we must focus on those groups which are most-at-risk to make
our programmes as effective as they must be.
Second, we must eradicate the discrimination and stigma of
being HIV positive. As there is a central AIDS treatment site in
Barbados, many who have HIV are reluctant to seek treatment,
for fear of being recognised and discriminated against. This
means risky behaviour often continues, perhaps spreads, and
that those who require help do not receive it merely because
they are too afraid to seek it out.
Leaders in the community, including those in the faith-based
community, should re-double their efforts to help our society
eliminate discriminatory thoughts and feelings about those
living with HIV and most-at-risk populations. Our leaders
must continue their role modelling. But now, we must also
ask them to step in with a bolder message of acceptance and
understanding of HIV as it exists in Barbados. It is spreading
into more and more of our communities. This means that we
must make greater efforts and use more effective strategies
very quickly if we are to stop its momentum. And putting an
end to intolerance by educating our communities about the
realities of HIV is a necessary start.
If the government and people of Barbados work together in
these ways to both focus on and eradicate AIDS, we can make
the necessary changes to meet our deadline for the MDGs, and
to make Barbados a stronger and healthier place to live.
www.unaidscaribbean.org | KS III | 45
BArBAdOS
ungASS indiCAtOrS rEPOrt
I n d I c Ato Rs
2006
2007
2008
2009
AIDS Spending
NA
Yes
National Policy
NA
Yes
Blood Safety
100%
100%
100%
100%
ART
73%
No 719
804/903=89%
PMTCT
[73 - >95%]
HIV/TB
100%
>95%
100%
>95%
0 cases
HIV Test in GP
TOTAL 99%*
NA
HIV Test in MSM/SW
MSM 85%
Prevention in MSM/SW
NA
NA
Support to OVC
NA
100%
HIV Education
TOTAL 41%
85%
School for OVC
NA
1.00%
Knowledge YP
NA
M 52%
Knowledge MSM/SW
FSW 37%
NA
Sex<15 years in YP
NA
M 22%
Xsex Partners in GP
NA
NA
Condom Use in GP
NA
NA
Condom Use in SW
FSW 80%
NA
Condom Use in MSM
NA
NA
HIV in YP
F 0.6%
NA
HIV in MSM/SW
NA
NA
12 months on ART
95%
94%
FSW 73%
NA
F 49%
F 16%
*DATA C O L L EC T I O N M E T H O D U S E D I S N OT U N A I D S S TA N DA R D
NA-NotAvAilAble
GP-GeNeRAlPoPulAtioN
SW-SexWoRkeRS
YP-YouNGPeoPle
xSex-MultiPle
ovC-oRPhANSANDvulNeRAbleChilDReN
MSM-MeNWhohAveSexWithMeN
PMtCt-PReveNtioNoFMotheR-to-ChilDtRANSMiSSioN
46 | KS III | www.unaidscaribbean.org
BElizE
Key Issues RequIRIng Focus
FIndIngs oF ungAss IndIcAtoRs: A summARy
The adult prevalence rate is 2.3% and a total of 4,800 people were living with
HIV in 2009 in Belize. There were for every 100 males, 130 females living with
HIV. A 52% completeness rate was observed in Belize during this reporting
period. Data on NASA show that USD 2 million was spent on AIDS with 32%
from domestic sources. In terms of policy and laws, collaboration with Civil
Society Organisations is limited and punitive laws exist against same sex
relationships and sex work and there are travel restrictions for PLHIV. Blood
safety is ensured, the ART coverage rate is 40%, the PMTCT coverage varies
between 22%-61% and 37% of the general population have been tested for HIV
in 2009. Only 38% of schools offered life-skills HIV education in 2009 and no
information exists regarding orphans and other vulnerable children in terms
of support and access to school. Half of young people have comprehensive
knowledge about HIV and 8% of young people have had sex before the age
of 15 while 9.4% of the general population have had more than one sexual
partner in the past 12 months and 63.1% of them have used a condom during
their last sexual intercourse. HIV prevalence among young females was
1.01% in 2009 and 76% of PLHIV were still on ART 12 months after initiation
of therapy. Belize is among the four Caribbean countries which have reduced
HIV incidence by 25% in 2009.
•Remove discriminatory laws against
same sex relationships, sex work
and travel restrictions for PLHIV,
which is crucial to the respect for
human rights and to the enabling
environment in support of universal
access.
•empower men who have sex with
men, sex workers, transgender and
PLHIV by way of a primary focus by
national authorities.
•target priority groups such as
female sex workers, MSM, migrant
populations and the Garifuna
population 35.
•Generate, analyse and use strategic
information to plan for interventions
among these vulnerable groups. This
is essential for further successes in
Belize.
Justin Buszin, Benjamin Nieto-Andrade, Jorge
Rivas, Kim Longfield. Multiple Partnerships and HIV
among the Garifuna Minority Population in Belize.
Population Services International. 2009
35
www.unaidscaribbean.org | KS III | 47
mARvIn mAnzAneRo
NATIONAL AIDS PROGRAMME
BELIzE
WhAt Is the AIds sItuAtIon In youR countRy?
The HIV situation showed a plateau in the total number of cases up until 2009 and as
of last year, a gradual decrease in the HIV incidence is being documented along with an
increasing number of patients being put on treatment. Increasing evidence is suggesting
that there may be concentrated pockets of certain populations that may have a higher
prevalence than the overall reported prevalence in pregnant women.
tell us WhAt Is the bIggest AchIevement oF youR AIds pRogRAmme?
In particular, the increasing integration of HIV services into the overall health system;
high coverage of prevention of mother-to-child transmission programmes, expansion of
testing to rural health facilities and the gradual increase of the Belize Health Information
System for patient monitoring.
WhAt ARe the successes In RespondIng to AIds In youR countRy?
Strong commitment of the Ministry of Health to the National Response; gradual
incorporation of other ministries into the national response and increasing interest in
integrating HIV as a chronic disease and thus incorporation into the health system.
WhIch Key populAtIon gRoups WIll you Keep the Focus on In the FutuRe?
The focus of the programme will be on men who have sex with men, female sex workers,
incarcerated populations and the mobile-migrant population.
48 | KS III | www.unaidscaribbean.org
BElizE
ungASS indiCAtOrS rEPOrt
I n d I c Ato Rs
2006
2007
2008
2009
AIDS Spending
NA
Yes
National Policy
NA
Yes
Blood Safety
100%
100%
100%
100%
ART
49%
40%
PMTCT
[24 - 64%]
[22% - 61%]
HIV/TB
69%
HIV Test in GP
M 10%
HIV Test in MSM/SW
NA
NA
Prevention in MSM/SW
NA
NA
Support to OVC
NA
NA
HIV Education
NA
38%
School for OVC
NA
NA
NA
M 47%
NA
NA
NA
M 11%
F 8%
M 15%
F 5%
Knowledge YP
M 26% F 26%
Knowledge MSM/SW
Sex<15 years in YP
M 11% F 6%
F 20%
F 4%
M 30%
Xsex Partners in GP
M 13%
Condom Use in GP
NA
63.1%
Condom Use in SW
NA
NA
Condom Use in MSM
NA
NA
HIV in YP
F 0.83%
F 1.01%
HIV in MSM/SW
NA
NA
12 months on ART
NA
76%
F 42%
F 53%
NA-NotAvAilAble
GP-GeNeRAlPoPulAtioN
SW-SexWoRkeRS
YP-YouNGPeoPle
xSex-MultiPle
ovC-oRPhANSANDvulNeRAbleChilDReN
MSM-MeNWhohAveSexWithMeN
PMtCt-PReveNtioNoFMotheR-to-ChilDtRANSMiSSioN
www.unaidscaribbean.org | KS III | 49
CuBA
FIndIngs oF ungAss IndIcAtoRs: A summARy
In 2009, with 0.1% adult HIV prevalence, Cuba had the lowest prevalence
in the Caribbean and it is the only country in the region to achieve 100%
completeness in reporting on all 23 relevant UNGASS indicators. There were
7,100 people living with HIV in this country. The NASA report indicates that
a total of USD 123,700,000 was spent on AIDS during 2008-2009 and the
majority of funds (i.e. 81%) came from national sources. The distribution of
resources by strategy shows that 35% of the budget was spent on treatment,
20% on prevention and research and 45% on programme management and
support. In terms of policy, Cuba has travel restrictions on people living with
HIV and these are a hindrance to human rights. Cuba has achieved universal
access in the areas of blood safety (100%), ART coverage (>95%), treatment
of HIV and TB/HIV co-infection (>95%), PMTCT coverage rate (>95%), support
for orphans and life-skills HIV education (100%). When it comes to survival
at 12 months after initiation of ART, Cuba has sustained quality treatment
for PLHIV and the country kept its HIV prevalence at 0.1% in the general
population during the past decade with low levels of HIV prevalence among
MSM (0.7%), MSW (0.38%), FSW (0.13%) and young people (0.02%). There
were for every 220 males, 100 females living with HIV. The HIV epidemic is
disproportionately affecting the MSM population.
progress Accomplished Among most-at-Risk populations
Cuba is the only Caribbean country which has consistently reported data
among MARPs; results of its national programmes during the past four years
are summarised on the following page.
50 | KS III | www.unaidscaribbean.org
Key Issues RequIRIng Focus
•Sustainhigh-levelcoverageforblood
safety, ART, PMTCT and prevention
programmes
among
vulnerable
groups.
•keep the focus of the interventions
on men who have sex with men, and
male and female sex workers.
•Strengthen
hiv
prevention
programmes among young people.
•Remove punitive travel restrictions
for PLHIV and sex workers.
•Revisitlawsthatreinforcemandatory
treatment for PLHIV in Cuba.
The percentage of MSM and SW tested for HIV during the
past four years remained at the same level i.e. between
32% and 35%. This intervention needs a scale-up since
diagnosing HIV positive cases among vulnerable groups is
a very cost-effective public health approach to reduce the
spread of HIV (Table 9).
Table 16: peRcentAge oF msm, FsW And msW
tested FoR hIv
PoPulAtioN
MSM
FSW
MSW
2006-2007
33%
32%
33%
2008-2009
32%
35%
32%
Source: 2010 UNGASS Report. Cuba.
The percentage of vulnerable groups reached by prevention
programmes has increased very quickly between 2007
and 2009. Among MSM the percentage having access to
prevention programmes increased by 73%, among FSW by
51% and MSW by 56%.
Figure 20: peRcentAge oF mARps ReAched by
pReventIon pRogRAmmes In cubA
The percentage of sex workers reporting use of a condom
during their last sexual intercourse with the most recent
client has remained stable and above 50% during the past
four years. But a 100% condom use among sex workers
must be the target for Cuba.
Table 18: peRcentAge oF mAle And FemAle sex
WoRKeRs RepoRtIng use oF A condom WIth
lAst clIent
PoPulAtioN
FSW
MSW
2006-2007
56%
63%
2008-2009
53%
63%
Source: 2010 UNGASS Report. Cuba.
The percentage of men reporting the use of a condom the
last time they had anal sex with a male sex partner has
been stable during the past four years and remained above
50% in Cuba. Policies need to be put in place to achieve
100% condom use among MSM.
Source: 2010 UNGASS Report. Cuba.
Among vulnerable groups, the level of knowledge of
prevention of sexual transmission of HIV and rejection of
misconceptions has increased among MSM and MSW but
remained almost the same among FSW, but among all three
groups it is above 50%.
Table 17: peRcentAge oF vulneRAble gRoups
WIth coRRect KnoWledge And RejectIon oF
mIsconceptIons
PoPulAtioN
MSM
FSW
MSW
2006-2007
54%
61%
49%
2008-2009
59%
56%
60%
Source: 2010 UNGASS Report. Cuba.
Table 19: peRcentAge oF men RepoRtIng the
use oF A condom the lAst tIme they hAd
AnAl sex WIth A mAle sex pARtneR
PoPulAtioN
MSM
2006-2007
55%
2008-2009
52%
Source: 2010 UNGASS Report. Cuba.
During the past four years national efforts have resulted in
stable levels in HIV testing and use of condoms among FSW,
MSW and MSM and in increased knowledge and access to
prevention programmes.
Overall, this sustained effort and high coverage for HIV
prevention, treatment, care and support could explain
Cuba’s low-level HIV prevalence among the general
population and vulnerable groups.
www.unaidscaribbean.org | KS III | 51
CuBA
ungASS indiCAtOrS rEPOrt
I n d I c Ato Rs
2006
2007
2008
2009
AIDS Spending
Yes
Yes
National Policy
Yes
Yes
Blood Safety
100%
100%
100%
100%
ART
>95%
>95%
PMTCT
[>95%]
39% - >95%
HIV/TB
90%
97%
HIV Test in GP
M 28%
F 32%
M 26%
F 32%
HIV Test in MSM/SW
MSM 33%
MSW 38%
MSM 32%
MSW 35%
FSW 32%
Prevention in MSM/SW
Support to OVC
FSW 35%
TOTAL 60%
MSW 59%
TOTAL 97%
MSW 96%
FSW 65%
MSM 56%
FSW 98%
MSM 92%
NR
100%
HIV Education
TOTAL 71%
School for OVC
1%
Knowledge YP
M 55%
94%
1.00
F 61%
Total 58%
M 57.6%
F 60%
Knowledge MSM/SW
MSM 54%
MSW 49%
FSW 61%
Sex<15 years in YP
TOTAL 24%
MSM 59%
FSW 56%
M 33%
TOTAL 24%
F 15%
Xsex Partners in GP
TOTAL 23%
M 35%
TOTAL 39%
M 41%
M 32%
F 15%
Total 23%
F 10%
Condom Use in GP
MSW 60%
M 34%
F 12%
M 48%
F 38%
TOTAL 56%
MSW 53%
F 33%
Condom Use in SW
TOTAL 61%
MSW 63%
FSW 56%
FSW 63%
Condom Use in MSM
55%
52%
HIV in YP
DHS M&F 0.05%
M&F 0.02%
HIV in MSM/SW
MSM 0.86%
SW 0.12%
MSM 0.71%
MSW 0.13%
FSW 0.12%
MSW 0.38%
FSW 0.13%
12 months on ART
TOTAL 96%
M 96%
>95%
F 96% WITH 100% IN
<15 YRS & 96% IN >15 YRS
NA-NotAvAilAble
GP-GeNeRAlPoPulAtioN
SW-SexWoRkeRS
YP-YouNGPeoPle
xSex-MultiPle
ovC-oRPhANSANDvulNeRAbleChilDReN
MSM-MeNWhohAveSexWithMeN
PMtCt-PReveNtioNoFMotheR-to-ChilDtRANSMiSSioN
52 | KS III | www.unaidscaribbean.org
dOminiCA
Key Issues RequIRIng Focus
FIndIngs oF ungAss IndIcAtoRs: A summARy
The National Strategic Plan has expired and a new one is being developed.
The NASA report has shown that during 2008-2009 a total of USD 356,000
was spent on AIDS with only 17% coming from internal sources. The
epidemic is heavily affecting men and there are no national policies in place
to address the needs of men and especially men who have sex with men.
The country has reported on eight out of 23 relevant UNGASS indicators i.e.
35% completeness.
Blood safety is ensured with 100% of donated blood units being tested for
HIV antibodies. There were 38 persons on ART. All pregnant women were
tested for HIV, four were found HIV positive and all received the full course
of treatment for PMTCT. The two cases of TB/HIV co-infection were evaluated
and one was found eligible for ART.
New data on knowledge and behaviours among the general population
and most-at-risk populations are lacking. One hundred percent of schools
are providing life skills-based HIV education. In terms of quality of care, all
patients on ART were alive after 12 months of initiation of treatment and all
children born to HIV positive mothers tested HIV negative.
•Develop a new National Strategic
Plan and an M&E framework urgently
to guide an effective national
response to HIV.
•Remove punitive laws and adopt
protective laws and policies for
PLHIV and sexual minorities.
•Mobilise more internal resources
to sustain and expand the national
response to HIV, while providing
services to PLHIV and to pregnant
women to prevent mother-to-child
transmission of HIV.
•Focus the national hiv response on
prevention interventions on men
(especially men who have sex with
men), female sex workers and young
people, especially young women to
address age mixing at first sexual
intercourse issue.
www.unaidscaribbean.org | KS III | 53
julIe FRAmpton
NATIONAL AIDS PROGRAMME COORDINATOR
COMMONWEALTH OF DOMINICA
WhAt Is the AIds sItuAtIon In youR countRy?
From 1987 to 2009, the cumulative number stood at 350 confirmed cases of HIV. In 2009
there were eight cases. There continues to be higher prevalence among males, who
account for over 70% of the total number of reported cases.
tell us WhAt Is the bIggest AchIevement oF youR AIds pRogRAmme?
In terms of successes, there are a few to make mention of: scaled-up antiretroviral
treatment with monitoring of HIV drug resistance, a decreased number of AIDS-related
deaths and no seroconversion of infants of HIV positive mothers for ten years now.
WhAt ARe the successes In RespondIng to AIds In youR countRy?
An HIV Workplace programme was implemented in 27 organisations in Dominica. These
workplaces have adopted the PANCAP Workplace Policy. We have also mainstreamed
gender into HIV services as well as in the Education Sector.
WhIch Key populAtIon gRoups WIll you Keep the Focus on In the FutuRe?
We will continue to partner with all stakeholders including line ministries to reach out to
men who have sex with men, sex workers and also young people and workplaces.
54 | KS III | www.unaidscaribbean.org
dOminiCA
ungASS indiCAtOrS rEPOrt
I n d I c Ato Rs
2006
2007
2008
2009
AIDS Spending
NA
Yes
National Policy
NA
Yes
Blood Safety
100%
100%
100%
ART
NA
39 PLHIV*
38 PLHIV
PMTCT
>95%*
NA
2 HIV+
HIV/TB
100%
67%
HIV Test in GP
NA
NA
HIV Test in MSM/SW
NA
NA
Prevention in MSM/SW
NA
NA
Support to OVC
NA
NA
HIV Education
100%
100%
School for OVC
NA
NA
Knowledge YP
NA
NA
Knowledge MSM/SW
NA
NA
Sex<15 years in YP
NA
NA
Xsex Partners in GP
NA
NA
Condom Use in GP
NA
NA
Condom Use in SW
NA
NA
Condom Use in MSM
NA
NA
HIV in YP
NA
NA
HIV in MSM/SW
NA
NA
12 months on ART
95%
100%
100%
100%
*DATA C O L L EC T I O N M E T H O D U S E D I S N OT U N A I D S S TA N DA R D
NA-NotAvAilAble
GP-GeNeRAlPoPulAtioN
SW-SexWoRkeRS
YP-YouNGPeoPle
xSex-MultiPle
ovC-oRPhANSANDvulNeRAbleChilDReN
MSM-MeNWhohAveSexWithMeN
PMtCt-PReveNtioNoFMotheR-to-ChilDtRANSMiSSioN
www.unaidscaribbean.org | KS III | 55
thE dOminiCAn
rEPuBliC
FIndIngs oF ungAss IndIcAtoRs: A summARy
In 2009 a total of 57,000 people were living with HIV in the Dominican Republic,
with an adult HIV prevalence of 0.9%. There were for every 100 males, 138
females living with HIV. Information was provided on 16 out of 23 relevant
indicators i.e. a 70% completeness rate. The NASA report for 2008 has shown
that USD 23.4 million was spent on AIDS with 35% coming from domestic
sources and 26% spent on prevention, 31% on treatment, 38% on programme
management and administrative strengthening, and the remaining 5% spent
on other strategies such as advocacy, research, etc. The greater involvement
of civil society organisations is limited and the laws regarding travel
restrictions remain. There is an 85% blood screening in place, ART coverage
is 47% and PMTCT coverage is between 39-95% i.e. 67% on average, and
42% of TB/HIV co-infections were treated. Among vulnerable groups, 33% of
MSM and 67% of FSW were tested for HIV and know their result and 44% of
SW have been reached by prevention programmes. Thirty-seven percent of
orphans and vulnerable children have received basic external support and
only 6.16% of schools provide life-skills HIV education with a ratio of 0.7 of
orphans and non-orphans attending school. Seventy-three percent of FSW
and 73% of MSM have comprehensive knowledge about HIV prevention; 97%
of FSW have used a condom during their last sexual intercourse with a client,
reflecting a consistently high percentage of condom use among FSW since
2005. Sixty-six percent of MSM reported use of a condom at last anal sex with
a male partner; this is a decline from 79% in 2007. HIV prevalence among
MSM remains at 11% between 2005 and 2009 and among female sex workers
it was 4.8%. The quality of care declined with a drop in the percentage of
PLHIV on ART after 12 months of initiation of therapy from 90% in 2007 to
83% in 2009. The Dominican Republic is among countries which have reduced
their HIV incidence by 25% between 2001 and 2009. HIV prevalence among
the Bateyes population has declined from 5% in 2002 to 3.2% in 2007, as well
as among young people from 0.6% to 0.30%.
HIV INCIDENCE ESTIMATES. The Mode of Transmission survey conducted in
the Dominican Republic has shown that 33.26% of new HIV infections in 2010
would occur among GTMSM, 31.87 among low-risk heterosexuals, 9.07%
among the populations living in the Bateyes, 8.31% among people practicing
casual heterosexual sex, 5.68% among clients of sex workers, 3.69% among
partners of casual heterosexuals, 2.79% among female partners of GTMSM,
1.89% among partners of sex workers’ clients, etc. This demonstrates that
GTMSM, low risk heterosexuals, people living in the Bateyes and people
engaging in casual heterosexual sex are the priority populations which
deserve focus with comprehensive prevention programmes and HIV services.
The relatively low levels of new infections among sex workers and their
clients could be explained by the high level of condom use among the sex
worker population.
56 | KS III | www.unaidscaribbean.org
Key Issues RequIRIng Focus
•Sustain the focus of the national
response on MSM, transgender, sex
workers and the Bateyes population.
•RemovetravelrestrictionsonPlhiv.
•improve quality of care for Plhiv
and people infected by TB and HIV
•100% hiv screening in donated
blood is a must.
•Scale-up
ARt
and
PMtCt
programmes.
•Addressgenderissues.
•increase social support to orphans
and vulnerable children and the
number of schools offering life-skills
HIV education to children.
•Achieve a greater and more
meaningful involvement of civil
society in the national HIV response.
•Mobilise more domestic resources
to ensure sustainability of HIV
programmes and services.
Figure 21: estImAtIng hIv IncIdence RAtes by populAtIon gRoups In the domInIcAn RepublIc.
unAIds/copResIdA.2011
Source: UNAIDS and COPRESIDA. 2011
InequIdAd de gÉneRo con RelAcIÓn Al vIh
A pesar de que las mujeres y niñas y la transversalización del género forman
parte de las estrategias y los grupos priorizados, en el actual Plan Estratégico
Nacional, las respuestas frente al tema han sido escasas y los económicos
dirigidos al tema son deficientes. Por ejemplo, el programa de reducción de la
transmisión vertical, dirigido a las mujeres embarazadas viviendo con el VIH
sigue teniendo importante deficiencias y la violencia contra la mujer, elemento
nodal y que coloca a riesgo frente al VIH, sigue en aumento. Tampoco se dispone
de campañas en medios masivos dirigidos a las inequidades de género. En el caso
de las mujeres viviendo con VIH, los servicios de atención no están dirigidos de
manera específica a sus necesidades, en algunos casos, no se da respuesta a las
especificidades de mujeres que adquirieron el virus a temprana edad y ya van a
cumplir sus 50 años con casi 10 años en TAR, tampoco a aquellas mujeres adultas
jóvenes que nacieron con el virus.
Felipa García. Directora ejecutiva, ASOLSIDA
El país puede mostrar avances en el área, pero los mismos son poco perceptibles
ya que el problema es amplio. Como COPRESIDA, estamos apoyando el
fortalecimiento de las capacidades de organizaciones gubernamentales y de la
sociedad civil en materia de equidad de género. Por ejemplo, con el Ministerio
de la Mujer se desarrolla un proyecto para la prevención del VIH y la violencia
contra la mujer a nivel nacional, también se apoyan las unidades de violencia
de las Fiscalías. Organizaciones de mujeres, como la Colectiva Mujer y Salud y
Mujeres en Desarrollo desarrollan acciones en las zonas más pobres del país y
con mujeres rurales.
Paula Disla. COPRESIDA
www.unaidscaribbean.org | KS III | 57
dOminiCAn rEPuBliC
ungASS indiCAtOrS rEPOrt
I n d I c Ato Rs
2006
2007
2008
2009
AIDS Spending
NA
Yes
National Policy
NA
Yes
Blood Safety
100%
ART
85%
38%
47%
PMTCT
[36 - 65%]
[32% - >95%]
HIV/TB
115%
42%
HIV Test in GP
M 19%
HIV Test in MSM/SW
FSW 64%
MSM 33%
Prevention in MSM/SW
NA
FSW 44%
Support to OVC
4%*
37%
HIV Education
TOTA L 1%
6%
School for OVC
NA
0.71
Knowledge YP
M 34%
Knowledge MSM/SW
NA
Sex<15 years in YP
M 24%
F 15%
NA
Xsex Partners in GP
M 30%
F 4%
NA
Condom Use in GP
M 42%
F 33%
NA
Condom Use in SW
TOTAL 96%
FSW 81%
79%
66%
DHS TOTAL 0.30%
NA
Condom Use in MSM
24%
100%
79% (data
F 21%
F 41%
NA
FSW 67%
NA
FSW 73%
MSM 73%
collected
before 2005)
HIV in YP
M 0.2%
HIV in MSM/SW
F 0.4%
MSM 11%
12 months on ART
MSM 11%
90%
FSW 4.8%
83%
*DATA C O L L EC T I O N M E T H O D U S E D I S N OT U N A I D S S TA N DA R D
NA-NotAvAilAble
GP-GeNeRAlPoPulAtioN
SW-SexWoRkeRS
YP-YouNGPeoPle
xSex-MultiPle
ovC-oRPhANSANDvulNeRAbleChilDReN
MSM-MeNWhohAveSexWithMeN
PMtCt-PReveNtioNoFMotheR-to-ChilDtRANSMiSSioN
58 | KS III | www.unaidscaribbean.org
grEnAdA
Key Issues RequIRIng Focus
FIndIngs oF ungAss IndIcAtoRs: A summARy
Since the beginning of the epidemic in 1984, a cumulative total of 403 cases
were confirmed with 56 cases of HIV in 2009 alone. In recent years there has
been an increasing trend in HIV prevalence among pregnant women (0.4%
in 2004 to 0.7% in 2007). Grenada reported on only 30% of the 23 relevant
UNGASS indicators. New behavioural and knowledge data are lacking. It is
reported that for the past two years, USD 674,000 was spent on AIDS with
100% coming from national sources. In total, 54 persons were on ART and
six HIV positive pregnant women received ART to reduce mother-to-child
transmission of HIV. But the survival rate at 12 months for new persons on
ART is only 60%. There is no updated National Strategic Plan and the national
policy environment for protection of PLHIV and other vulnerable groups is
not enabling.
•Develop a new national Strategic
Plan with a budget and a monitoring
and evaluation framework, as a
matter of urgency, to guide the
national response to HIV.
•improve the legal and policy
environment by removing punitive
laws as an urgent and necessary
means to achieving universal access
to HIV prevention, care, treatment
and support.
•Focus prevention interventions on
priority groups such as female sex
workers, women, girls and men who
have sex with men.
•improvethequalityofantiretroviral
treatment to increase life expectancy
of PLHIV.
www.unaidscaribbean.org | KS III | 59
box
3
A conceRn FoR gRenAdIAn heAlth AuthoRItIes
National health authorities have identified young women as a priority group for attention,
based on information cited below from the behavioural survey which CAREC/PAHO/WHO
conducted in Grenada in 2005.
the level oF Age mIxIng At FIRst sexuAl InteRcouRse Is hIgh. One of the challenges
in responding to HIV in the Caribbean is the fact that older men are having sex with younger
women and Grenada is no exception 36. Thirty-three percent of females 15-24 years old had a
sex partner at first sexual encounter that was five to nine years older and an additional 5%
had a sex partner who was 10 years older at first encounter. This was the highest rate in the
six Eastern Caribbean States surveyed.
Figure 22: Age mIxIng At FIRst sexuAl InteRcouRse. young FemAles.
eAsteRn cARIbbeAn stAtes. 2005
Source: Keeping Score II. CAREC-SPSTI: BSS Report. 2006 37
hAvIng multIple sex pARtneRs Is A common pRActIce. Among 15-24 year-old females
30% had between two and six multiple non-commercial sex partners and an additional 3%
had multiple commercial sex partners.
level oF condom use Is loW. Among 15-24 year-old females who had multiple noncommercial sex partners, 78% did not consistently use a condom during sexual intercourse.
Among the young women with commercial sex partners, 44% did not use a condom at their
last sexual encounter and 94% of young females did not consistently use a condom with
commercial sex partners. The immediate consequence of the low percentage of condom use
is the high incidence of self-reported genital ulcer disease among young females, i.e. 3%, the
highest among young women in the six Eastern Caribbean States.
___________________________________________________________________________________
Overall, this situation should be a concern for all national health authorities in the six Eastern
Caribbean States where age mixing at first sexual intercourse among young people is high
and varied from 22% (the lowest) in Dominica to 38% (the highest) in Grenada. Targeted
interventions should be put in place to improve this situation.
36
37
Keeping Score II. A consolidated Regional Analysis of Reports submitted to the United Nations General Assembly Special Session on HIV/AIDS.2008.
ISBN 978 92 9 173726 0
ANT: Antigua and Barbuda, DOM: Dominica, GRE: Grenada, SKN: St. Kitts and Nevis, SLC: St. Lucia, SVG: St. Vincent and the Grenadines
60 | KS III | www.unaidscaribbean.org
grEnAdA
ungASS indiCAtOrS rEPOrt
I n d I c Ato Rs
2006
2007
2008
2009
AIDS Spending
NA
Yes
National Policy
NA
Yes
Blood Safety
91%
91%
ART
NA
47% PLHIV*
91%*
PMTCT
50%*
NA
NA
0 cases
100%
NA
NA
HIV Test in MSM/SW
NA
NA
Prevention in MSM/SW
NA
NA
Support to OVC
NA
NA
HIV Education
0%
94%
School for OVC
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
Condom Use in SW
NA
NA
Condom Use in MSM
NA
NA
HIV in YP
NA
NA
HIV in MSM/SW
NA
NA
HIV/TB
HIV Test in GP
TOTAL 10%
M 6%
Knowledge YP
F 40%
Knowledge MSM/SW
Sex<15 years in YP
TOTAL 25%
M 32%
Xsex Partners in GP
Condom Use in GP
12 months on ART
100%
F 13%
TOTAL 41%
M 43%
100%
F 20%
TOTAL 21%
M 30%
F 13%
M 68%
F 52%
TOTAL 88%
TOTA 60%
M 83%
M 56%
F 100%
F 67%
*DATA C O L L EC T I O N M E T H O D U S E D I S N OT U N A I D S S TA N DA R D
NA-NotAvAilAble
GP-GeNeRAlPoPulAtioN
SW-SexWoRkeRS
YP-YouNGPeoPle
xSex-MultiPle
ovC-oRPhANSANDvulNeRAbleChilDReN
MSM-MeNWhohAveSexWithMeN
PMtCt-PReveNtioNoFMotheR-to-ChilDtRANSMiSSioN
www.unaidscaribbean.org | KS III | 61
guyAnA
FIndIngs oF ungAss IndIcAtoRs: A summARy
In 2009, the adult HIV prevalence was 1.2% in Guyana. The country reported
on 18 out of the 23 relevant UNGASS indicators, a rate of 78% completeness.
Between 2001 and 2009, there was a 24% reduction in the number of PLHIV
(from 7,800 in 2001 to 5,900 in 2009) and a 14% reduction in adult HIV
prevalence (from 1.4% to 1.2%). New HIV infections and AIDS related deaths
were kept below 500 during that period. There were for every 100 males, 100
females living with HIV. There was no NASA report and in the area of policy,
there are laws against same sex relationships and sex work. The collaboration
with civil society organisations needs strengthening and protective laws
are needed for PLHIV and sexual minorities. Guyana achieved successes in
sustained 100% blood screening and in the provision of ART where more than
95% of PLHIV who needed treatment were on it. For PMTCT, the coverage rate
was between 88% and more than 95%. In the area of TB/HIV co-infection,
94% received treatment for both. In the general population, 22% of males
and 27% of females received an HIV test and know their result while this
was 88% among FSW and 87% among MSM in 2009. Information on social
support for orphans and vulnerable children is missing and 62% of schools
provided life-skills HIV education to children. Only 46% of young people
have comprehensive knowledge about HIV transmission, compared with 35%
for FSW and 47% for MSM. Among young people, 19% of males and 10% of
females have had sex before the age of 15; this represents a slight increase
compared to 2006-2007 (males: 13% and females: 9%). The percentage of
adults having multiple sex partners remains the same; 10% for males and 1%
for females. And the level of condom use among adults was 65% for males
and 48% for females. The level of condom use among female sex workers
has declined from 81% in 2007 to 61% in 2009 but slightly increased among
MSM from 81% in 2007 to 84% in 2009. HIV prevalence among young females
remained the same 1% in 2007 and 1.11% in 2009. The proportion of PLHIV on
ART 12 months after initiation was 72%, which is below the WHO standards
and needs improvement.
62 | KS III | www.unaidscaribbean.org
Key Issues RequIRIng Focus
•Sustain gains made in the area
of blood safety, antiretroviral
treatment and PMTCT.
•improvethequalityofcareofPlhiv
as a matter of urgency.
•Focus national attention on issues
facing men who have sex with men,
female sex workers, and also young
people and the mining population.
•Address issues relating to women
and girls, and gender in general.
•Remove punitive laws against same
sex relationships and sex work.
shanti singh-Anthony
MANAGER, NATIONAL AIDS PROGRAMME
SECRETARIAT, GUYANA
WhAt Is the AIds sItuAtIon In youR countRy?
In 1987 the first HIV case was diagnosed. Guyana’s response at that time was a medical
one. This however quickly grew into a multi-sectoral response to HIV led by the Presidential
Commission on HIV and AIDS. The country reported higher adult prevalence in the early
2000’s, but there has been a reversal of that trend, with antenatal prevalence dropping
from 5.6% in 2000 to 1.55% in 2006. A similar picture is found with PMTCT where HIV
prevalence of 3.1% in 2003 dropped to 1.1% in 2009. Prevalence is also down among FSW
from 45% to, 26% to 16.6% in 1997, 2004 and 2009 respectively; MSM from 21.1% to
19.4% in 2004 and 2009 respectively, and miners from 6.5% to 3.9% from 2000 to 2004.
Guyana reported an adult prevalence of 1.2% at the end of 2009.
tell us WhAt Is the bIggest AchIevement oF youR AIds pRogRAmme?
Our prevention of mother-to-child transmission programme stands out as a significant
achievement in the HIV response with rapid growth from the inception in the early 2000’s
to 157 PMTCT sites across all ten administrative regions of Guyana at the end of 2009.
There is an 89.8% HIV testing acceptance rate and 95.8% of HIV positive women are
receiving a complete course of ARVs for the PMTCT.
WhAt ARe the successes In RespondIng to AIds In youR countRy?
Our ART programme that was initiated in 2002 was providing treatment at the end of
2009 to 83.5% of adults and children with advanced HIV infection; it expanded from one
treatment site in 2002 to 16 across all 10 administrative regions. There is a National Public
Health Reference Laboratory with state-of-the art diagnostic capabilities that provides
CD4 count and viral load testing for all HIV patients. The supply chain management system
has been modernised with a state-of-the art warehouse management system.
WhIch Key populAtIon gRoups WIll you Keep the Focus on In the FutuRe?
Guyana will continue to work with the general population and with groups such as:
men who have sex with men, female sex workers, youth (in and out of school), women,
prisoners and the mobile population.
www.unaidscaribbean.org | KS III | 63
guyAnA
ungASS indiCAtOrS rEPOrt
I n d I c Ato Rs
2005
2006
2007
2008
2009
AIDS Spending
NA
NA
National Policy
NA
Yes
Blood Safety
100%
100%
ART
37%
45%
>95%
PMTCT
[29% - >95%]
NA
[88% - >95%]
NA
94%
HIV/TB
100%
HIV Test in GP
TOTAL 11%
M 10%
HIV Test in MSM/SW
FSW 64%
FSW 64%
FSW 88%
MSM 44%
MSM 44%
MSM 87%
FSW 28%
FSW 28%
MSM 17%
MSM 17%
Prevention in MSM/SW
F 11%
100%
M 22% F 27%
NA
Support to OVC
NA
NA
HIV Education
NA
62%
School for OVC
2005 - 0.95%
NA
NA
Knowledge YP
M 34%
NA
TOTAL 46%
Knowledge MSM/SW
MSM 67%
MSW & FSW 63%
FSW 35%
FSW 63%
MSM 67%
MSM 47%
F 44%
Sex<15 years in YP
M 13%
F 9%
NA
M 19% F 10%
Xsex Partners in GP
M 9%
F 1%
NA
M 10% F 1%
Condom Use in GP
M 53%
F 56%
NA
M 65% F 48%
Condom Use in SW
FSW 89%
FSW 89%
FSW 61%
Condom Use in MSM
81%
81%
84%
HIV in YP
HIV in MSM/SW
F 1%
FSW 26.6%
F 1.11%
NA
MSM 21.25%
12 months on ART
FSW 17%
MSM 19%
75%
NA
72%
NA-NotAvAilAble
GP-GeNeRAlPoPulAtioN
SW-SexWoRkeRS
YP-YouNGPeoPle
xSex-MultiPle
ovC-oRPhANSANDvulNeRAbleChilDReN
MSM-MeNWhohAveSexWithMeN
PMtCt-PReveNtioNoFMotheR-to-ChilDtRANSMiSSioN
64 | KS III | www.unaidscaribbean.org
hAiti
FIndIngs oF ungAss IndIcAtoRs: A summARy
Haiti reached only a 39% completeness rate on relevant UNGASS indicators
during this 2008-2009 reporting period. There are 120,000 people living with
HIV in Haiti with an adult HIV prevalence of 1.9%. There were for every 100
males, 140 females living with HIV. The 2010 NASA report shows that a total
of USD 289 million was spent on AIDS in Haiti. This represents 58% of the
total amount spent on AIDS in the entire Caribbean. The majority of these
resources (99%) came from international and bilateral donors. This very
heavy dependence on external resources remains a serious challenge for
Haiti’s national response to HIV. In terms of distribution of funding between
strategies during the past two years, prevention interventions received 41%,
while 40% was spent on treatment. The greater involvement of PLHIV is still
limited and very few policies are in place to protect the rights of PLHIV and
sexual minorities. Blood safety is quality assured with 100% of donated blood
screened for HIV. National ART coverage is estimated at 43% and PMTCT at
60%. Treatment of TB/HIV is low with only a 24% coverage rate. New HIV
infections have declined by 12% and AIDS-related deaths by 41%. No new
data are available regarding knowledge, beliefs, practices and attitudes of
the general population or MARPs or the coverage of MARPs by prevention
programmes. It is reported that the ratio of orphans and non-orphans
attending school is 0.8. An HIV prevalence survey among pregnant women
has shown that 2.1% of pregnant women aged 15-24 are infected with HIV.
And the survival rate after 12 months on ART has remained the same at 84%,
which is below the WHO standards.
In 2009, Haiti was among countries with a stable HIV incidence rate.
However, this could dramatically change when one takes into account the
consequences of the devastating earthquake of January 2010, which have
impacted negatively on the national environment in social, economic and
developmental terms. The earthquake has killed 250,000 people and has sent
1.5 million people into shelters and camps and displaced another quarter
million people. The economic loss was estimated at USD 8 billion for the
country. Also, the earthquake which occurred in areas where 68,000 PLHIV
were residing has had a serious impact on both the health infrastructure and
the national infrastructure in general. Preliminary data collected from the
populations living in camps and shelters have shown that there is widespread
stigma, discrimination and violence against sexual minorities and sex workers,
and the incidence of gender-based violence and unwanted pregnancies has
seriously increased. During the next UNGASS reporting period (2010-2011),
the real impact of this disaster on the national response to HIV could be
accurately measured.
Key Issues RequIRIng Focus
•Scale-up and improve the quality of
treatment and PMTCT programmes
and issues surrounding HIV/TB coinfections.
•Mobilise more national resources
to ensure sustainability of the HIV
response.
•engageinthecollectionandanalysis
of new data to understand an
evolving HIV epidemic especially
after the earthquake.
•Focus the national response on
priority population groups i.e. young
people, women, men who have sex
with men, transgender and female
sex workers.
•Addresstheimpactoftheearthquake
i.e. rebuilding health infrastructure
and providing HIV programmes and
services to displaced populations in
camps and shelters.
www.unaidscaribbean.org | KS III | 65
Joëlle Deas-van onacker
COORDINATRICE DU PROGRAMME DE LUTTE CONTRE LE SIDA
HAïTI
quelle est lA sItuAtIon de l’ÉpIdÉmIe du sIdA en hAïtI?
En Haïti, malgré les efforts déployés, l’épidémie est toujours a un stade généralisé de
2.2% de prévalence du VIH chez les adultes et 120,000 personnes vivant avec le VIH selon
l’ONUSIDA. Nous avons pu infléchir la courbe et atteindre la stabilisation de l’épidémie.
Dites-nous le plus granD succès De votre programme De lut te contre le
sIdA?
Notre plus important accomplissement est dans le domaine des soins et traitement, nous
avons aujourd’hui 27,904 personnes vivant avec le VIH qui reçoivent la trithérapie. Et nous
avons au minimum 2 centres par départements qui offrent les services de dispensation
des Antirétroviraux.
Quels sont les autres succès en Haïti?
Nos succès, nous avons eu du succès, tant au niveau des soins et traitement que dans le
domaine de la prévention.
1) Nous avons eu beaucoup de succès dans la prise en charge cible des jeune.
Nous avons pu mettre sur pied des activités de prévention, nous avons
ouvert plusieurs maisons de jeune aussi bien que des cliniques pour jeunes.
2) Nous avons pu mobiliser la communauté pour faire face a la féminisation
du SIDA, la Coalition Haïtienne sur les Femmes et le SIDA est implanté
maintenant dans les 10 départements du pays.
3) Nous avons fait beaucoup d’effort pour que les services puissent atteindre
les populations migrantes ainsi que les populations déplacées.
4) Un autre succès est que suite au tremblement de terre, les services de prise
en charge et de soin n’ont pas été discontinués après le tremblement de
terre du 12 janvier 2010.
quels sont les FutuRes populAtIons cIbles pouR votRe pRogRAmme?
Nous continuerons à cibler les jeunes et les femmes.
66 | KS III | www.unaidscaribbean.org
hAiti
ungASS indiCAtOrS rEPOrt
I n d I c Ato Rs
2006
2007
2008
2009
AIDS Spending
NA
Yes
National Policy
NA
Yes
Blood Safety
100%
100%
ART
26%
41%
43%
PMTCT
20%
22%
60%
HIV/TB
5%
24%
HIV Test in GP
M 5%
F 8%
NA
HIV Test in MSM/SW
FSW 71%
MSM 48%
NA
Prevention in MSM/SW
NA
NA
Support to OVC
5%
NA
HIV Education
13%
NA
86%
0.86
NA
School for OVC
87%
Knowledge YP
M 40%
F 32%
NA
Knowledge MSM/SW
MSM 36%
FSW 6%
NA
Sex<15 years in YP
M 43%
F 15%
NA
Xsex Partners in GP
M 23%
F 1%
NA
Condom Use in GP
M 34%
F 21%
NA
100%
Condom Use in SW
FSW 90%
Condom Use in MSM
73%
HIV in YP
DHS TOTAL 1.0%
M 0.5%
HIV in MSM/SW
FSW 5.23%
12 months on ART
84%
100%
F 2.1%
F 1.5%
84%
NA-NotAvAilAble
GP-GeNeRAlPoPulAtioN
SW-SexWoRkeRS
YP-YouNGPeoPle
xSex-MultiPle
ovC-oRPhANSANDvulNeRAbleChilDReN
MSM-MeNWhohAveSexWithMeN
PMtCt-PReveNtioNoFMotheR-to-ChilDtRANSMiSSioN
www.unaidscaribbean.org | KS III | 67
jAmAiCA
FIndIngs oF ungAss IndIcAtoRs: A summARy
Key Issues RequIRIng Focus
The adult HIV prevalence is 1.7% and there were 32,000 PLHIV in 2009
in Jamaica. There were for every 190 males, 100 females living with HIV.
Among the 23 relevant indicators there was 70% completeness in reporting.
No information was submitted regarding NASA. The policy report suggests
limited involvement of civil society organisations and the existence of
punitive laws on same sex relationships and solicitation. Blood safety is
secured, ART coverage is 46% and the PMTCT coverage is between 46% and
95%. It is estimated that 20% of adult males and 35% of adult females have
been tested and know their results. This is an increase from 12% and 19%
respectively in 2007. It is reported that 73% of FSW and 53% of MSM are
tested for HIV. In Jamaica, 44% of schools provide life-skills HIV education.
Among young people, 38% of males and 43% of females have comprehensive
knowledge of HIV prevention and 57% of males and 16% of females have
initiated sex before age 15. This latter is a 19% increase among males when
compared to 2007 when the percentage was at 48%. Among adult males 62%
and 17% of adult females reported having had more than one sex partner in
the past 12 months; this is an increase among both sexes when compared to
2007 (48% males and 11% females). Condom use for these adults was 65%
among males and 52% for females. Among female sex workers, 97% reported
use of a condom during last sexual intercourse with a client while among
MSM this was 73% during their last anal intercourse with a male partner. The
HIV prevalence among young females declined slightly from 1.3% in 2007 to
1.0% in 2009. Among female sex workers, the HIV prevalence was 5.5% in
2009. The proportion of PLHIV on ART after 12 months of initiation of therapy
was 92%, an improvement compared to 88% in 2007. Jamaica is among the
countries around the world which have reduced their HIV incidence by 25%
in 2009.
•Prioritise
interventions
based
on epidemiological data on the
following key population groups:
men who have sex with men,
female sex workers, young people
(essentially males), populations
living in depressed areas and crack
cocaine users.
•Scale-up treatment services and
consolidate PMTCT programmes.
•Address cross-cutting issues such as
gender and the removal of punitive
laws against same sex relationships
and solicitation.
•Address issues surrounding poverty
and inequitable distribution of
wealth.
•Develop strategies to achieve
sustainability of the national HIV
response including mobilisation
of
internal
resources
and
implementation of policies to
support decentralised and integrated
HIV services.
68 | KS III | www.unaidscaribbean.org
Kevin harvey
NATIONAL AIDS PROGRAMME MANAGER
JAMAICA
WhAt Is the AIds sItuAtIon In youR countRy?
It is estimated that in 2009, 1.7% of the Jamaican adult population was HIV infected, with
no significant change over the last decade. There are, however, features of concentrated
pockets of higher prevalence among most-at-risk populations where the HIV prevalence
for men who have sex with men is 32%; for female sex workers it is 5% and for crack
cocaine users 3.3%.
tell us WhAt Is the bIggest AchIevement oF youR AIds pRogRAmme?
Testing programmes resulted in 95% coverage among pregnant women in 2009. The
provision of ART reduced mother-to-child transmission of HIV to below 5% in 2009 from
25% in 2002. There was also a 19% decline in paediatric AIDS between 2008 and 2009
with 32 cases reported in 2008 compared to 26 cases in 2009.
WhAt ARe the successes In RespondIng to AIds In youR countRy?
An 18% decline in HIV/AIDS cases was reported annually between 2006 and 2009. Reported
cases peaked in 2006 at 2121 compared to 1738 cases in 2009. In 2009, about 378 AIDS
deaths were reported, accounting for a 43 % decline when compared to 665 persons who
died in 2004 (first year of public access to antiretroviral treatment).
WhIch Key populAtIon gRoups WIll you Keep the Focus on In the FutuRe?
The focus will be maintained on the most-at-risk populations including the following:
heterosexual males with multiple partners, men who have sex with men, STI clinic
attendees, sex workers and their clients, in and out-of-school youths between the ages
of 10-19, prison inmates, crack-cocaine users and homeless persons, persons living with
HIV, residents of high-risk/high-prevalence communities and tourism workers.
www.unaidscaribbean.org | KS III | 69
jAmAiCA
ungASS indiCAtOrS rEPOrt
I n d I c Ato Rs
2004
2005
2006
2007
2008
2009
AIDS Spending
NA
NA
National Policy
NA
Yes
Blood Safety
100%
ART
20%
33%
100%
100%
43%
46%
PMTCT
[45 - >95%]
46% - >95%
HIV/TB
72%
NA
HIV Test in GP
M 12%
HIV Test in MSM/SW
FSW 43%
F 19%
M 20%
F 35%
FSW 73%
MSM 53%
Prevention in MSM/SW
FSW 60%
NA
Support to OVC
NA
NA
HIV Education
TOTAL 24%
44%
School for OVC
NA
NA
NA
TOTAL 40%
Knowledge YP
FSW 60%
M 23%
F 47%
M 38%
Knowledge MSM/SW
FSW 26%
Sex<15 years in YP
NA
TOTAL 36%
M 57%
Xsex Partners in GP
M 48%
NA
F 11%
Condom Use in GP
M 67%
F 43%
F 16%
M 62%
F 17%
NA
F 54%
M 65%
F 52%
Condom Use in SW
FSW 84%
FSW 97%
Condom Use in MSM
NA
73%
HIV in YP
F 1.30%
F 1%
HIV in MSM/SW
MSM 32% Crack
FSW 5%
Cocaine users 5%
12 months on ART
88%
91%
NA-NotAvAilAble
GP-GeNeRAlPoPulAtioN
SW-SexWoRkeRS
YP-YouNGPeoPle
xSex-MultiPle
ovC-oRPhANSANDvulNeRAbleChilDReN
MSM-MeNWhohAveSexWithMeN
PMtCt-PReveNtioNoFMotheR-to-ChilDtRANSMiSSioN
70 | KS III | www.unaidscaribbean.org
St Kit tS And nEviS
Key Issues RequIRIng Focus
FIndIngs oF ungAss IndIcAtoRs: A summARy
Only eight out of the 23 relevant UNGASS indicators were reported on in
2010; this represents 35% completeness. Among reported cases of AIDS,
the male-to-female sex ratio is 2:1 with a cumulative total of 310 cases of
HIV. The NASA report shows that USD 2.6 million was spent on AIDS during
2008-2009 and 91% was from domestic sources. The majority of resources
went to programme management (85%) and the remaining 15% to prevention
(5%) and treatment (10%). Blood safety is secured but laws and policy issues
regarding prohibition of same sex acts and sex work exist. HIV prevalence
among females 15-24 years old is 0.55%. Only 45% of schools are providing
life-skills HIV education. No new population based data exist on MARPs and
the general population. One hundred percent of PLHIV were still on ART 12
months after initiation of therapy.
•Focus national attention on
the removal of punitive and
discriminatory laws.
•Reach out with quality services and
programmes for key population
groups such as men and especially
men who have sex with men, female
sex workers in the tourism sector
and young people.
•Mobilise national efforts towards
collection, analysis and use of new
data on knowledge, behaviours,
practices and beliefs to guide
interventions among men who have
sex with men, female sex workers,
young people and the general
population.
•Allocate more hiv resources for
prevention, advocacy and research.
www.unaidscaribbean.org | KS III | 71
garDenia Destang-ricHarDson
NATIONAL AIDS PROGRAMME COORDINATOR
ST. KITTS AND NEVIS
WhAt Is the AIds sItuAtIon In youR countRy?
Since the epidemic was first identified in 1984, a cumulative total of 310 cases were
reported to the Ministry of Health. Of this number, there were 143 males, 112 females
and 55 whose sex was not recorded. The majority of cases occur in the 20 – 49 age group,
although all age groups are affected.
tell us WhAt Is the bIggest AchIevement oF youR AIds pRogRAmme?
A key achievement has been the increased number of persons who present themselves for
voluntary counselling and testing at community outreach sessions. Prior to the advent of
outreach testing, uptake was barely over 200. However, there has been a drastic increase
with 1,577 persons accepting services in 2009.
WhAt ARe the successes In RespondIng to AIds In youR countRy?
Programme successes include the provision of first line and, to a limited extent, second line
treatment for persons living with HIV. Additionally, the integration of HIV programming
into primary health care has increased access and decreased stigma as persons are free
to access health services without their HIV status being known to others.
WhIch Key populAtIon gRoups WIll you Keep the Focus on In the FutuRe?
The key target populations under consideration for the future are women in vulnerable
situations such as in gender unequal relationships, and low socio-economic situations.
Youths are also considered as they are seen to be influential to work with their peers.
These are in addition to those already identified, such as men who have sex with men
and sex workers.
72 | KS III | www.unaidscaribbean.org
St. Kit tS And nEviS
ungASS indiCAtOrS rEPOrt
I n d I c Ato Rs
2006
2007
2008
2009
AIDS Spending
NA
Yes
National Policy
NA
Yes
Blood Safety
100%
100%
100%
ART
NA
53 PLHIV*
PMTCT
>95%*
100%
37 PLHIV
3PW
HIV/TB
100%
NA
HIV Test in GP
TOTAL 10%*
NA
HIV Test in MSM/SW
NA
NA
Prevention in MSM/SW
NA
NA
Support to OVC
NA
NA
HIV Education
NA
45%
School for OVC
NA
NA
Knowledge YP
TOTAL 52%
NA
Knowledge MSM/SW
NA
NA
NA
NA
NA
NA
NA
NA
Condom Use in SW
NA
NA
Condom Use in MSM
NA
NA
HIV in YP
NA
F 0.55%
HIV in MSM/SW
NA
NA
Sex<15 years in YP
F&M 22%
Xsex Partners in GP
M 53%
Condom Use in GP
TOTAL 67%
12 months on ART
F 19%
100%
NA
100%
*DATA C O L L EC T I O N M E T H O D U S E D I S N OT U N A I D S S TA N DA R D
NA-NotAvAilAble
GP-GeNeRAlPoPulAtioN
SW-SexWoRkeRS
YP-YouNGPeoPle
xSex-MultiPle
ovC-oRPhANSANDvulNeRAbleChilDReN
MSM-MeNWhohAveSexWithMeN
PMtCt-PReveNtioNoFMotheR-to-ChilDtRANSMiSSioN
www.unaidscaribbean.org | KS III | 73
St. luCiA
FIndIngs oF ungAss IndIcAtoRs: A summARy
Key Issues RequIRIng Focus
Ten out of the 23 relevant UNGASS indicators were reported on, representing
43% completeness. A cumulative number of 760 HIV cases were reported
since the inception of the epidemic. The 2009 HIV data show that the maleto-female sex ratio is 1.4:1. There was no NASA data, and in terms of policy,
work has been done to improve the workplace environment, but laws exist
which prohibit and discriminate against same sex relationships and sex work.
Overall blood safety is secured and from 78 PLHIV on ART in 2007, there were
124 in 2009 (a 59% increase). All TB/HIV co-infections were treated and 100%
of PLHIV were on ART 12 months after initiation of therapy. Eighty-three
percent of orphans and vulnerable children received care and 100% of them
attended school. Unfortunately there was a drop in the number of schools
which provide life-skills HIV education from 93% in 2007 to 59% in 2009.
PMTCT screening has helped identify eight HIV positive pregnant women who
were put on ART to reduce mother-to-child transmission. Data on MARPs
were not collected under UNAIDS standards, were not representative and
therefore cannot be used.
•Give priority attention to the
collection, analysis and use of
strategic information among the
general population and vulnerable
groups. This shortcoming needs
urgent attention.
•Focus the national response on
men who have sex with men, male
and female sex workers and crack
cocaine users.
•Focus attention on young people
because data from 2005 surveys
show they should be targeted by the
national response to increase the
age of first sexual intercourse.
•Develop urgently a new National
Strategic Plan and M&E framework
to guide the national response.
•Mobilise more national resources
to respond to HIV and ensure
sustainability.
74 | KS III | www.unaidscaribbean.org
nahum jean baptiste
NATIONAL AIDS PROGRAMME COORDINATOR
ST. LUCIA
WhAt Is the AIds sItuAtIon In youR countRy?
The first case of AIDS was reported in 1985 and since then, to the end of June 2010, a
cumulative total of 760 cases were reported; of these 312 have died. Among people living
with HIV in 2009, for every 108 men there were 100 women. Regarding age distribution,
8% of PLHIV were under age 15, 12% were aged 15 to 24 and 80% of cases older than 25
years. Fifty percent of HIV cases have no clear reported route of transmission. Progress was
accomplished in the area of treatment and prevention of mother-to-child transmission. A
total number of 239 people living with HIV are registered into care, among them 95 are
on ART with 12 on second line treatment.
tell us WhAt Is the bIggest AchIevement oF youR AIds pRogRAmme?
Reduction in deaths from AIDS-related illnesses in the past five years due to broader
access to antiretroviral treatment.
WhAt ARe the successes In RespondIng to AIds In youR countRy?
Since 2006 there have been no recorded cases of MTCT among registered clients. There is
an increase in the enrolment of HIV positive clients into care and treatment programmes
because of scaling-up of HIV testing and clinic access in six sites, and there is a greater
involvement of Civil Society Organisations.
WhIch Key populAtIon gRoups WIll you Keep the Focus on In the FutuRe?
Specifically the focus will be on MARPs i.e. sex workers, men who have sex with men and
crack cocaine users.
www.unaidscaribbean.org | KS III | 75
St. luCiA
ungASS indiCAtOrS rEPOrt
I n d I c Ato Rs
2006
2007
2008
2009
AIDS Spending
Yes
NA
National Policy
Yes
Yes
Blood Safety
100%
ART
NA
PMTCT
64%
100%
78 PLHIV*
100%
124 PLHIV
8 cases
HIV/TB
50%
100%
HIV Test in GP
TOTAL 36%*
NA
HIV Test in MSM/SW
NA
NA
Prevention in MSM/SW
NA
NA
Support to OVC
69%*
83%
HIV Education
TOTAL 91%
59%
School for OVC
Orphans 1.7
Knowledge YP
M 61%
1.38
F 57%
NA
Knowledge MSM/SW
NA
NA
Sex<15 years in YP
M 32%
F 20%
NA
Xsex Partners in GP
M 42%
F 25%
NA
Condom Use in GP
M 48%
F 39%
NA
Condom Use in SW
NA
NA
Condom Use in MSM
74%
63%
HIV in YP
F 0.51%
NA
HIV in MSM/SW
Crack Cocaine Users
NA
TOTAL 7.50%
M 6.80%
12 months on ART
F 11.1%
98%
100%
*DATA C O L L EC T I O N M E T H O D U S E D I S N OT U N A I D S S TA N DA R D
NA-NotAvAilAble
GP-GeNeRAlPoPulAtioN
SW-SexWoRkeRS
YP-YouNGPeoPle
xSex-MultiPle
ovC-oRPhANSANDvulNeRAbleChilDReN
MSM-MeNWhohAveSexWithMeN
PMtCt-PReveNtioNoFMotheR-to-ChilDtRANSMiSSioN
76 | KS III | www.unaidscaribbean.org
St. vinCEnt And
thE grEnAdinES
FIndIngs oF ungAss IndIcAtoRs: A summARy
During the last UNGASS reporting period, the male to female ratio was
1.2:1 but this has increased during this reporting period to 1.6:1, with more
males having access to VCT as is the case with women through the PMTCT
programmes. The country reported on 10 UNGASS indicators among the 23
relevant ones; this represents 43% completeness. The 2010 NASA information
indicates that USD 4.2 million was spent on AIDS with only 10% coming
from national resources. There was no breakdown of spending by strategy.
Overall, there is a push to improve workplace policies and promote more
inclusive testing policies. However, as in other small settings, laws exist that
are discriminatory towards same sex relationships and sex work. Blood safety
is secured and there were 162 PLHIV on ART, and 14 HIV-positive pregnant
women received a full course of ART to reduce MTCT transmission of HIV.
However, there was a decline in treatment of TB/HIV co-infection from 100%
in 2007 to 27% in 2009. All schools are providing life-skills HIV education
and all orphans are attending school. There is a high HIV prevalence of 2.5%
among young people; this needs urgent attention. The quality of care has
improved but further improvement is needed. In 2007, only 62% of PLHIV
were still on ART after 12 months and now this has increased to 86%. There
is a need for new data about knowledge, behaviours, practices and beliefs
among the general population and vulnerable groups.
Key Issues RequIRIng Focus
•Focus national effort on men,
especially men who have sex with
men, sex workers, young people and
women and girls.
•Gather and use updated strategic
information to guide the national
response to HIV (epidemiological
and behavioural).
•improve quality of care of Plhiv,
especially the treatment of TB/HIV
co-infections.
•Mobilise more national resources
to respond to HIV and ensure
sustainability.
•Remove discriminatory laws against
same sex relationships and sex work.
www.unaidscaribbean.org | KS III | 77
del hAmIlton
NATIONAL AIDS PROGRAMME COORDINATOR
ST. VINCENT AND THE GRENADINES
WhAt Is the AIds sItuAtIon In youR countRy?
Twenty-four years after the first case of HIV was diagnosed in St. Vincent and the
Grenadines, the HIV prevalence among women attending antennal clinics is over 1%.
There has been a 37% decrease in reported HIV cases between 2004 and 2008 and a 40%
decrease in AIDS-related deaths during the same period. The male to female ratio of HIV
has, over the past 20 years, been decreasing from a high of 4.5:1 in 1987 to 1.4:1 in 2008.
The majority of male HIV cases have occurred within the ages of 20-49 years while female
cases have occurred within the ages of 20-39 years.
tell us WhAt Is the bIggest AchIevement oF youR AIds pRogRAmme?
Over the past five years, the following have been the most outstanding achievements:
voluntary counselling and testing through HIV rapid testing; PMTCT whereas in 2009, 98%
of all pregnant women were tested for HIV, within the past two years there have been no
cases of children infected; and care and treatment where over 300 PLHIV are enrolled,
with 177 on ART.
WhAt ARe the successes In RespondIng to AIds In youR countRy?
The national response is led by a National AIDS Council and its Secretariat, co-chaired
by the Prime Minister and the Minister of Health and the Environment, resulting in the
establishment of focal points in nine non-health line ministries with work plans and a
number of CSOs actively contributing to the national response.
WhIch Key populAtIon gRoups WIll you Keep the Focus on In the FutuRe?
Three population groups are to be the focus: youth, men who have sex with men and
young adults in the low economic bracket.
78 | KS III | www.unaidscaribbean.org
St. vinCEnt And thE grEnAdinES
ungASS indiCAtOrS rEPOrt
I n d I c Ato Rs
2006
2007
2008
2009
AIDS Spending
NA
Yes
National Policy
NA
Yes
Blood Safety
ART
PMTCT
100%
100%
NA
104 PLHIV*
100%
168PLHIV
85%
14 Cases
HIV/TB
HIV Test in GP
100%
100%
15-24: 9%
M 8%
27%
F 12%
NA
25-49: 11%
HIV Test in MSM/SW
NA
NA
Prevention in MSM/SW
NA
NA
Support for OVC
NA
NA
HIV Education
TOTAL 87%
100%
School for OVC
NA
1.00
Knowledge YP
M 59%
F 40%
Knowledge MSM/SW
NA
NA
NA
Sex<15 years in YP
M 31%
F 14%
NA
Xsex Partners in GP
M 25%
F 10%
NA
Condom Use in GP
M 62%
F 52%
NA
Condom Use in SW
NA
NA
Condom Use in MSM
NA
NA
F 1.36%
F 2.5%
NA
NA
HIV in YP
HIV in MSM/SW
12 months on ART
M 43%
F 80%
M 90%
F 82%
*DATA C O L L EC T I O N M E T H O D U S E D I S N OT U N A I D S S TA N DA R D
NA-NotAvAilAble
GP-GeNeRAlPoPulAtioN
SW-SexWoRkeRS
YP-YouNGPeoPle
xSex-MultiPle
ovC-oRPhANSANDvulNeRAbleChilDReN
MSM-MeNWhohAveSexWithMeN
PMtCt-PReveNtioNoFMotheR-to-ChilDtRANSMiSSioN
www.unaidscaribbean.org | KS III | 79
SurinAmE
Key Issues RequIRIng Focus
FIndIngs oF ungAss IndIcAtoRs: A summARy
Suriname is one of the four Caribbean countries which have reduced their
HIV incidence by 25% in 2009. There were 3,700 people living with HIV
with an adult HIV prevalence of 1.0%. There were for every 220 males, 100
females living with HIV. Out of the relevant 23 indicators for the country,
13 indicators have been reported on, resulting in 57% completeness. Key
indicators related to the National AIDS Spending Assessment, young people,
coverage of orphans and vulnerable children with support programmes or
access to school and coverage of MARPs by prevention programmes are not
reported on.
In the area of policy, the involvement of civil society is limited. Blood safety
is ensured. In the programmatic area, ART coverage rate is 53% and 83%
for PMTCT but only 60% of TB/HIV co-infections are taken care of. The 2009
survey data show that 59% MSW and 64% FSW have been tested for HIV but
only 33% of them have the correct knowledge about HIV. Also a high level
of condom use was reported among sex workers i.e. 98.4% during vaginal
sex, 87% during anal sex and 94% during oral sex. Data indicate that no
schools in Suriname have life-skills HIV education on their curriculum. The
HIV prevalence among young people has remained at 1% and the percentage
of PLHIV on ART 12 months after initiation of therapy is 62%, which is below
the WHO recommended 90% standard.
80 | KS III | www.unaidscaribbean.org
•Scale-up antiretroviral treatment
and PMTCT programmes.
•Sustainthehighlevelofcondomuse
among male and female sex workers.
•increase knowledge about hiv
transmission among MARPs.
•increase life-skills hiv education
among young people in school.
•Focus attention on men who have
sex with men to document their
access to prevention programmes.
•involve the mining industry in the
national response, and the mining
population should benefit from
prevention programmes as well as
comprehensive workplace policies
and programmes.
•improve rapidly the quality of care
for PLHIV to increase their life
expectancy.
FIRoz Abdoel WAhId
FOCAL POINT TECHNICAL UNIT, NATIONAL AIDS PROGRAMME
SURINAME
WhAt Is the AIds sItuAtIon In youR countRy?
Suriname has a generalised epidemic with an estimated adult HIV prevalence of 1.1%
(UNAIDS 2009). The average prevalence of HIV among pregnant women over the last five
years is 1%, whereas the prevalence in the MARPs is significantly higher than the general
adult population i.e. 6.7% among MSM in 2004, 7.2% among sex workers in brothels and
15.7% among street workers in 2009 (2010 UNGASS Report). Since 2007, there has been
a steady decline in the number of newly registered HIV cases. According to the national
surveillance reports, hospitalisation and mortality rates have been slightly decreasing
since 2006. This is due to the increased access to antiretroviral treatment introduced in
2005.
tell us WhAt Is the bIggest AchIevement oF youR AIds pRogRAmme?
The biggest achievement is the successful scale-up of people on HAART; three-fold since
2005 resulting in reduced AIDS-related deaths.
WhAt ARe the successes In RespondIng to AIds In youR countRy?
We have strengthened coordination through the establishment of a national multisectoral HIV board in 2009, with its Technical Working Groups on Prevention, Treatment
and Care and Monitoring and Evaluation working from a National Strategic Plan and an
M&E plan.
We have seen an increased governmental budget for the response to HIV with the
establishment of the Center of Excellence on treatment and care in 2010 with access to
early infant diagnosis; all treatment protocols were revised.
WhIch Key populAtIon gRoups WIll you Keep the Focus on In the FutuRe?
The focus will be on men who have sex with men, male and female sex workers, young
people, women, and people living in the interior and in the gold-mining areas.
www.unaidscaribbean.org | KS III | 81
SurinAmE
ungASS indiCAtOrS rEPOrt
I n d I c Ato Rs
2005
2006
2007
2008
2009
AIDS Spending
NA
NA
National Policy
NA
Yes
Blood Safety
100%
100%
ART
35%
46%
53%
PMTCT
[18 - 57%]
82% - >95%
HIV/TB
NA
60%
HIV Test in GP
F 30%
F 30%
FSW 59%
FSW 59%
SW 64%
MSW 75%
MSW 75%
MSM 59%
Prevention in MSM/SW
NA
NA
Support to OVC
NA
NA
HIV Education
NA
0%
School for OVC
NA
NA
HIV Test in MSM/SW
Knowledge YP
F 41%
Knowledge MSM/SW
Sex<15 years in YP
MSW 75%
TOTA L
FSW 79%
FSW 33%
NA
NA
Condom Use in GP
100%
NA
F&M 8%
Xsex Partners in GP
Condom Use in SW
100%
TOTAL 49%
NA
NA
MSW 79%
FSW 68%
FSW 68%
MSW 79%
Condom Use in MSM
89%
89%
HIV in YP
F 1.10%
HIV in MSM/SW
MSW 36.2%
TOTAL 98%
87%
F 1%
NA
NA
FSW 21.1%
MSM 6.7%
12 months on ART
80%
53%
NA-NotAvAilAble
GP-GeNeRAlPoPulAtioN
SW-SexWoRkeRS
YP-YouNGPeoPle
xSex-MultiPle
ovC-oRPhANSANDvulNeRAbleChilDReN
MSM-MeNWhohAveSexWithMeN
PMtCt-PReveNtioNoFMotheR-to-ChilDtRANSMiSSioN
82 | KS III | www.unaidscaribbean.org
trinidAd And
tOBAgO
Key Issues RequIRIng Focus
FIndIngs oF ungAss IndIcAtoRs: A summARy
There were 15,000 PLHIV in Trinidad and Tobago and the adult HIV prevalence
was 1.5% in 2009. There were for every 200 males, 100 females living with
HIV. During this reporting period, Trinidad and Tobago reported on only
eight out of 23 relevant indicators resulting in a 35% completeness rate. The
NASA report indicates that USD 28.5 million was spent on AIDS with 42% on
prevention, 40% on treatment and the remaining on management, advocacy
and research. It is important to note that 95% of the expenditure on prevention
went to interventions among the general population (1.5% HIV prevalence)
and only 5% was spent on interventions among MARPs. This distribution of
resources needs more careful thinking, as it has been established that one
in every five MSM in the country is infected with HIV (20% HIV prevalence
among MSM). The PMTCT coverage rate is 56% and for ART it is 44% using
the new WHO standards (2839/6400). In 2009, it is reported that only 6% of
people infected with TB and HIV were treated despite the fact that there was
a 29.3% increase of new TB/HIV co-infections (95 cases) among the 324 cases
of TB reported then. Based on epidemiological data reported by the Ministry
of Health, the case fatality rate of TB/HIV is as high as 23.2% (22/95) and the
number of cases rose from 48 in 2005 to 95 in 2009 - a 98% increase. During
that period a cumulative total of 1,338 cases of TB were reported with 367
cases of TB/HIV co-infections representing on average a TB/HIV incidence
rate of 27%.
The proportion of PLHIV on ART 12 months after initiation of therapy was
77%, which is lower than the 90% recommended by UNAIDS/WHO. No current
behavioural data exist for the general population, orphans and vulnerable
children, young people and MARPs. In Trinidad and Tobago, UNAIDS/WHO
estimates that there were 1,200 new HIV infections every year between 2001
and 2009.
•Develop a new National Strategic
Plan and a Monitoring and Evaluation
framework.
•Scale-up ARt, treatment of tb/
HIV co-infections and PMTCT
programmes rapidly.
•improvethequalityofcareofPlhiv
to avoid premature AIDS-related
deaths.
•Focus national efforts on using
evidence-based interventions among
men who have sex with men, male
and female sex workers, transgender
persons, women and girls and young
males.
•Scale-uphivpreventionprogrammes
to reduce the very high HIV incidence
observed during the past ten years.
•introduce and expand life-skills hiv
education in schools throughout the
entire twin-island nation.
•Direct national hiv resources to
population groups most affected to
ensure high quality care and greater
access to prevention and support
programmes and protection of their
human rights.
•Remove punitive laws against same
sex relationships and sex work to
create an enabling environment to
facilitate progress towards universal
access to HIV prevention, care,
treatment and support.
www.unaidscaribbean.org | KS III | 83
honourable dr. glen Ramadharsingh
MINISTER OF THE PEOPLE AND SOCIAL DEVELOPMENT
TRINIDAD AND TOBAGO 38
WhAt Is the AIds sItuAtIon In youR countRy?
From 1983 to 2009, there was a cumulative total of 21,639
confirmed cases of HIV, 6,306 cases of AIDS and 3,892 AIDS-related
deaths. The decade 1992-2002 saw the most drastic increase in the
number of HIV and AIDS cases with a reported five-fold increase
in the number of HIV cases (from 2,246 cases in 1992 to 11,341
in 2002) and a reported four-fold increase in the number of AIDS
cases (from 1,156 in 1992 to 4,711 in 2002). A look at the reported
cases of HIV shows that the gender gap is narrowing.
WhAt Is the bIggest AchIevement oF the nAtIonAl AIds
pRogRAmme?
There has been a 69% reduction in reported AIDS-related deaths
between 2004 and 2009 (246 vs. 77) due to the provision of
antiretroviral treatment.
WhAt ARe the successes In RespondIng to AIds In youR
countRy?
A multisectoral response is established among state agencies; civil
society, and persons living with HIV; expansion of same-day HIV
testing and counselling sites; 95% HIV testing among pregnant
women since 2007 resulting in a decline in HIV-infected infants; an
increase in HIV testing and treatment sites; a review of the laws of Trinidad and Tobago and how they impact upon people
living with HIV and MARPS has been undertaken; a National Workplace Policy on HIV/AIDS has been implemented and it
prohibits HIV testing for purposes of employment. We work with CSOs including Faith Based Organisations in undertaking
education and counselling interventions in community settings and providing care for PLHIV. Also a computer-based HIV
and AIDS surveillance system is established at eight HIV treatment and surveillance sites to allow real-time reporting of
HIV cases.
WhIch Key populAtIon gRoups WIll you Keep the Focus on In the FutuRe?
The focus of the National Strategic HIV and AIDS Plan 2011-2016 is on five priority areas: prevention; treatment, care and
support; advocacy and human rights; strategic information; and policy and programme management.
The Ministry of the People and Social Development’s HIV Workplace Policy is crafted to effectively provide a framework to
address not only HIV issues in the workplace, but also the vulnerable groups in our society who are invariably the Ministry’s
clients, namely the poor, the indigent, the marginalised, the disabled, the elderly and street children.
It is expected that the Ministry’s HIV and AIDS Workplace Policy (crafted within the context of the National HIV Workplace
Policy) will ensure that the legal framework for dealing with HIV and AIDS is adhered to and mechanisms are in place to
protect staff from stigma and discrimination. As such, the Workplace Policy clearly signals the Ministry’s commitment to
provide a sustainable platform for action to address and enhance the national HIV and AIDS response.
38
The Honourable Dr. Glen Ramadharsingh, Minister of the People and Social Development. Trinidad and Tobago. Presentation for the Regional Consultation
for the Caribbean Universal Access to HIV Prevention, Treatment, Care and Support. HIV IN THE CARIBBEAN: SUCCESS, CHALLENGES & NEW DIRECTIONS.
March 23 rd 2011, Hyatt Regency, Port-of-Spain.
84 | KS III | www.unaidscaribbean.org
trinidAd And tOBAgO
ungASS indiCAtOrS rEPOrt
I n d I c Ato Rs
2006
2007
2008
2009
AIDS Spending
Yes
Yes
National Policy
Yes
Yes
Blood Safety
100%
100%
100%
ART
53%
58%
3,172 PLHIV
PMTCT
[37 - 78%]
100%
2,639/6400=41%
55%
HIV/TB
NA
HIV Test in GP
NA
HIV Test in MSM/SW
NA
NA
Prevention in MSM/SW
NA
NA
Support for OVC
NA
NA
HIV Education
NA
NA
School for OVC
NA
NA
Knowledge YP
6%
TOTAL 8%*
TOTAL 56%
Knowledge MSM/SW
Sex<15 years in YP
Xsex Partners in GP
NA
NA
NA
F&M 12%
NA
M 94% F 79%
NA
Condom Use in GP
NA
NA
Condom Use in SW
NA
NA
47%
NA
Condom Use in MSM
HIV in YP
F 1.64%
HIV in MSM/SW
20%
12 months on ART
NA
NA
NA
72%
77%
*DATA C O L L EC T I O N M E T H O D U S E D I S N OT U N A I D S S TA N DA R D
NA-NotAvAilAble
GP-GeNeRAlPoPulAtioN
SW-SexWoRkeRS
YP-YouNGPeoPle
xSex-MultiPle
ovC-oRPhANSANDvulNeRAbleChilDReN
MSM-MeNWhohAveSexWithMeN
PMtCt-PReveNtioNoFMotheR-to-ChilDtRANSMiSSioN
www.unaidscaribbean.org | KS III | 85
86 | KS III | www.unaidscaribbean.org
A
HumAn
RigHts
Activist’s
RepoRt
Our biggest challenge is that the
Caribbean has not moved beyond the
colonial framework of stratification
and class interests to the notion
that all people are born with human
rights, and that we are building truly
democratic societies where people
have equal citizenship. As a result,
very little progress has been made in
implementing the greater involvement
of people with HIV and AIDS (GIPA);
people living with HIV and communities
most at risk are not at the center of
our HIV response.
COlIN RObINSON
CAISO, Trinidad and Tobago
csos responding to Hiv
are not deeply rooted in
local communities; and the
ngos that are well-rooted
have been slow to address
Hiv as an issue. .
Another huge challenge is that our
interventions do not focus upstream
of risk behaviour, at the core of what
makes people vulnerable. We are also
more prone to jargon than action
when it comes to issues like stigma and
discrimination and capacity-building.
Our non-governmental organisation
(NGO) infrastructure is weak. Funding
and initiatives in the region to facilitate
civil society responses by affected
communities have mainly benefitted
third party providers and have not
built strong indigenous civil society
organisations. CSOs responding to
HIV are not deeply rooted in local
communities; and the NGOs that are
well-rooted have been slow to address
HIV as an issue.
Political
leaders
have
shown
extraordinary timidity in speaking out
and standing up against discrimination
related to HIV. In Trinidad and
Tobago, leaders have tried to create
distinctions
between
protecting
people from stigma and discrimination
based on having HIV, and stigma and
discrimination related to being part
of the social groups most vulnerable
to HIV. We need to create more
conversation about the humanity of
people living with HIV and affected
communities. To do so, people in these
communities need to become more
visible, and that requires creating a
safe environment for them to do so.
Finally, we have to convert resources
into outcomes. We have had a lot of
money invested in the region, but
key barriers remain bureaucracy and
under spending – so-called “absorptive
capacity”. There is a need to foster
more innovation, to get resources
more quickly behind promising ideas
and to be able to evaluate them.
www.unaidscaribbean.org | KS III | 87
RepoRting
witHout
pRejudice
And SenSationaliSm
in tHe
cARibbeAn
mediA
AllySON lEACOCk
Executive Director
Caribbean broadcast Media Partnership (CbMP)
How can tHe media be more involved in tHe response to
Hiv in tHe region?
I think CbMP has a key role in guiding many technically experienced
and sound organisations to avoid the trap of being incestuous. by this
I mean having meetings and workshops only for people working in the
field of HIV. Right now when I go on lIVE UP Roadshows, I visit our
radio and TV stations with all their staff present but I always include
the NAC, MOH, and PlHIV for the media to meet their local resource
people so that a symbiotic relationship can be built. If more workshops
were open to local media houses, beyond covering the Minister at an
opening ceremony of speeches, but actually hearing the issues, I think
it would be very helpful. This way, the media can be involved from
the ground up; see the wider implications of why this work and their
role as media is important and build local relationships which will help
them see the human side of the HIV response while getting the allimportant story.
How do we get tHe media to report witHout prejudice
and sensationalism?
This is an ongoing task because as you train one reporter they may be
moved within the organisation or change jobs and then you have to
start all over again. However, within the CbMP we have seen a marked
growth and development amongst our membership. We have been
approached by organisations that have been pleased that our members
now call to verify certain facts or call for guidance on how to handle
some delicate situations based on the sensitivity of the situation.
The key is for the media not to feel that we are usurping their editorial
authority. We cannot tell the media what to write. It is against the
basic tenets of journalism but as we provide more open discussion
on the facts and they begin to understand the implications of words
and the treatment of people, the balance between a good story and
respecting the rights of PlHIV is more easily attained.
How could tHe media play a role in reducing stigma and
discrimination and increasing respect of Human rigHts?
As the media is more meaningfully engaged in our discussions and
putting a human face to this epidemic, it will become more aware of
blatant violations and report on them. As it is oriented to the legal
implications of human rights in a way that is devoid of jargon but linked
to everyday life, then it will be better able to challenge our policies
and policymakers by highlighting the back story on key issues and
asking the difficult questions. We have to always remind the media
of its important role to be the voice for the voiceless. The challenge
in the Caribbean has been the small size of our societies, and the
tendency in some places for the media to be used as a political tool, in
the unhealthy sense where our reporters may at times feel intimidated
by the vitriol of a public official or political figure if the story does not
present them in a positive light. but our media must develop a sense
of fearlessness because if it has done its homework and upholds the
principles of balanced reporting, then it has nothing to fear.
88 | KS III | www.unaidscaribbean.org
It’s time to start broadcasting the whole
picture of HIV in barbados. When we
have turned on our televisions in the
past several years, often the stories
we’ve seen and heard about HIV were
ones reporting on the success of our
society working together in preventing
and treating AIDS.
barbados’ creation of an effective
multi-sector
HIV
programme
has been, to my mind, our most
significant
achievement
so
far.
A lot of time and energy has been
spent on a widespread campaign of
sensitisation and engagement among
our partners. This brought the various
government areas and civil society
together with established nongovernmental organisations (NGOs).
We linked up with groups working in
sexual and reproductive health (such
as the barbados Family Planning
Association). We linked up with groups
working in the field of HIV (such as
United Gays and lesbians against AIDS
in barbados). We linked up with the
business sector (AIDS Foundation),
the Faith-based Community and with
groups of People living with HIV (such
as CARE barbados).
barbados has succeeded as far as it
has with this multi-sector engagement
due to solid political leadership
at the highest levels; this ensured
sustainability of funding and advocacy
from leaders across all sectors.
And yet, our HIV infection rates
continue to climb. To improve on
our success against the ever-growing
challenge of HIV, we must focus on
preventing new infections. And if we
are to confront the rising infection rate
head on, we must focus on strategies
to
change
collective
behaviour
towards HIV - to reduce the current
stigma of being HIV positive, and to
communicate that AIDS is a very real
BRoadcaSting tHe
wHole pictuRe of HiV
in bARbAdos
risk to people living in this region, no
matter the community to which they
belong.
This is a huge challenge that we face.
It will take a significant commitment
to bring about a significant change in
behaviour. It is possible. but to make
it so, there must be a harmonisation
of partners regionally and nationallythe UN has a critical role to play in this
respect. NGOs must be strengthened
and empowered with funding to
provide the necessary sustainability.
Also, we must engage the media and
faith-based community in the area of
stigma and discrimination.
This is where the whole picture of
HIV in barbados comes in. Many of
the stories we see about HIV in the
news are testaments to our success in
fighting the disease thus far. And many
more are sensationalist stories that
shock and frighten the public: They are
the kind of stories that only perpetuate
the stigma and discrimination faced
by those living with HIV, and often
prevent them from seeking treatment,
thus putting their communities at even
greater risk.
Our media must rise above this cycle
of “nice” messages and sensational
news. I believe we should instead
commit our airwaves and newsprint to
develop targeted messages based on
research and evidence. We should be
stimulating thought on the underlying
issue and not merely eliciting knee
jerk reactions.
CAROl ElIzAbETH JACObS
Chair, Caribbean broadcast Media
Partnership against HIV/AIDS, and
Former Chair, barbados National
HIV/AIDS Commission and
the Global Fund to fight AIDS,
Tuberculosis and Malaria
As the MDG deadlines set by the United
Nations loom - they must be reached
in the next five years - the natural and
necessary progression of our media
is to broaden its role in the national
and regional AIDS response within that
time. We know that the media is one
of the most effective tools we have to
educate the people of barbados and
the region. And it is one of the most
effective tools we have to allow people
to think differently. let us come
together to broadcast a new message
about HIV— the full picture— both in
the media and in our communities.
www.unaidscaribbean.org | KS III | 89
tHe
3.
I have lived in St. lucia, and visited St. Vincent and Saint Maarten
and in my experience, Jamaica’s approach to sexuality is almost
“Taliban-like” compared to those places. While violence against
gays still exists in most parts of the world, the average Jamaican,
even those who are educated and exposed to what happens in the
rest of the world, feels compelled to register their disapproval at
every opportunity. While gays are not necessarily embraced openly
in the places I have named, violence is not the socially accepted
response.
4.
I would narrowly judge successful advocacy by the freedoms my
peers and I feel at liberty to exercise. That being said, I do not feel
that the situation has really advanced in a positive way for the
regular folks who aren’t brave enough to risk their personal safety
by openly challenging the status quo. We are no more confident
today than we were 10 or even 15 years ago to reveal certain facts
about ourselves.
5.
The advocacy movement does not adequately address the issues
of the people who do not feel brave enough to ‘come out’. While
I don’t suggest that the movement is at fault for this, I do believe
that there is still a gap there. After all, we can’t be helped if we
don’t come forward enough to ask for help.
6.
Nationally, the laws must change first. These issues will never
be fully addressed in the absence of the right legal framework.
Socially, straight Jamaicans need to be educated without the biases
of religion and culture being given prominence in the discussion.
On a community level, there are unfortunately the same social
classes that exist in the wider society. Sexuality and its struggles,
as real as they are, are apparently not as uniting as one might
imagine. Until the very clear class barriers are addressed in the
wider society, I fear they will remain even in the minority groups.
7.
Again I would suggest trying to find ways of addressing class
barriers. If the community is to move forward, the strength of its
numbers would be a critical asset. Partnerships will either not be
formed, or they will fail if the community does not see itself as a
whole.
8.
In Jamaica, I hold little hope of things changing legally in my
lifetime. In most of the rest of the Caribbean, I think change might
come within the next 10-15 years.
9.
I don’t know much about HIV status in the Caribbean, but I
know the HIV prevalence is pretty high in Jamaica. I believe that
we will see control of the spread of HIV being directly linked to
change in social attitudes toward tolerance of minorities. Critical
education about prevention cannot be effectively disseminated in
an atmosphere of intolerance.
Voice of a
middle clAss
gay man
in Kingston,
JAmAicA
9 Key points
summarising
the challenges facing
sexual minorities in
Jamaica and future
perspectives.
1.
2.
Daily
challenges
include
restricting
seemingly ordinary conduct. Orientation
and relationships, no matter how stable
and supportive, must be kept secret.
Sexual minorities are treated as less than
second class citizens. If there is genuine
support on a human rights level, I am not
aware of it nor would I want to have to seek
assistance of that nature. I believe doing so
would be tantamount to committing social,
if not literal suicide.
90 | KS III | www.unaidscaribbean.org
wHat is it like being a gay man in your
country?
Interesting question! Honestly never thought about it. I
see myself as a citizen first; one who contributes to the
development of the country. It is my personal belief that
my sexuality does not define my entire existence. I am
not defined by it nor am I limited by it. I acknowledge it
and affirm my sexuality but it’s just a component of my
life, not the sum total of it.
While I can come to this place of empowerment, I think of
those who can not. I think of those gay men and women,
who have deeply internalised feelings of fear, shame
and scorn and believe that they are less because of their
sexual orientation.
G AY
& Living
with H I V
I do recognise that in comparison to most of our Caribbean
neighbours, we are more tolerant and accepting. However,
homophobia is a challenge that we must confront.
wHat support systems exist in your country
for men wHo Have sex witH men?
I would have to publicly commend Friends for life for
their work in this area. This organisation, despite the
odds and challenges, has become a second family to
many gay men, including myself. I am truly grateful for
their support in providing an environment that enabled
me in very positive ways to understand my sense of self
and learning how to cope in the midst of a homophobic
culture. As well, the advent of Facebook and other social
networking sites has created a safe and anonymous way
for the “community” to interact and support each other.
wHat is needed to Help msm in your country?
Firstly, there needs to be a deeper understanding of the
culture and complex identities that shape our existence.
From a programming perspective, an MSM initiative is
limiting, as it does not consider those who do not fall
under this umbrella such as the identifiable gay man,
the ‘down-low’ man, the bi-sexual, the transgender
individual, etc.
Programmes should then be created based on the
understanding and dynamics of these sub-cultures.
Programmes should not only be focused on HIV/AIDS
prevention, but holistic in their approach – addressing
the self-esteem of the individual whose life has been
subjected to psychological abuse. It would call for a
greater allocation of resources, not just financial but
technical.
it is my personal
belief that my
sexuality
does not define
my entire
existence
www.unaidscaribbean.org | KS III | 91
A gay
leadeR
SpeakS out fRom
pARAmARibo
kENNETH VAN EMDEN
Director, Suriname Men United
wHat is it like being a gay man in your country?
being gay in Suriname is quite a normal thing. The level of acceptance
is improving despite the fact that stigma and discrimination exist in
every culture. Gay men still face a lot of problems when they realise
that they feel attracted to the same sex and it is not an easy thing to
disclose their sexual orientation to their parents. That is why a lot of
men decide to keep it a secret and live a hidden life. Although stigma
and discrimination exist, people tend to go about their daily lives. MSM
just enjoy their lives but at the same time keep everything private.
wHat are tHe support systems existing in your country
for men wHo Have sex witH men?
There is an organisation, Suriname Men United, which provides
psycho-social care, distributes condoms and lubricants during outreach
interventions, organises prevention activities, support group sessions
and events, and also works on human rights issues. Another source of
support is the Surinamese anti-discrimination law that forbids any kind
of discrimination based on status.
wHat is needed to Help msm in your country?
What is needed is better policies from higher levels, better involvement
of NGOs, more awareness that lGTb rights are human rights and
financial support to implement interventions.
92 | KS III | www.unaidscaribbean.org
bernie 42, wHat is it like being a
gay man in your county?
I am a trained assistant nurse, VCT
provider, phlebotomist, and do
outreach to young MSM. I am 29 years
old and a native of St. lucia. being a
gay man in my country is like staying
in the closet, and keeping my lifestyle
to me.
wHat support systems exist in
your country for gay men?
Support systems exist in my country
for men who have sex with men and
they include: the CDARI which offers
rehabilitation services, shelter and
holistic care for HIV, MSM and MSM
drug users. The “United and Strong”
offers HIV education, with a focus on
reducing stigma and discrimination.
Clinical services are open to all, but
MSM prefer going to their private
doctors, because they are afraid of
discrimination. There are Human
Rights lawyers (who act as a body) that
focus on justice for all.
42
life of A gay man
in A smAll eAsteRn
caRiBBean Setting
wHat needs do gay men Have in
your country?
In my country gay men need help with
human rights laws that would protect
them, a special clinic where MSM
could go without being stigmatised,
a social atmosphere where gay men
could go and fellowship with each
other without being harassed or have
any form of violence against them,
more education, educational materials
and support on HIV, men’s health and
sexual diversity.
in my country
gay men
need help with
human rights laws
that would
protect them
Pseudonym
www.unaidscaribbean.org | KS III | 93
tHe
Voice of a
gay man
living in guyAnA
wHat is it like being a gay man in guyana?
It is a fearful and frightening feeling to be gay in Guyana. This is because
gays are still ostracised here even though it’s becoming more publicised
that more men and women are coming out. In Guyana, as an MSM you
are being teased, bullied and even beaten in some places. Many times
MSM who are qualified with experience for a job do not get it; we don’t
get invited to certain functions and we are also excluded from certain
sections of society. As a MSM I have endured all of these things to the
point where I feel hurt and sometimes wish I wasn’t gay.
RyON RAWlINS
wHat support systems exist in guyana for men wHo Have
sex witH men?
In Guyana there are two NGOs (SASOD & Guybo) working
comprehensively to address all the needs of MSM and one specific
NGO (Artistes in Direct Support) which provides primarily HIV/AIDS
support for MSM. The above-mentioned NGOs provide a forum for
MSM to meet and interact freely, counselling and testing, advice and
support, capacity building and help with human rights to address
discrimination issues; however these are confined and have certain
limitations. Recently they have worked with the government to provide
more support to train their health care workers on MSM issues.
wHat is needed to Help msm in guyana?
Stronger support groups that can cater for the suffering MSM are
needed. It would be a blessed day when unemployed MSM can get a
job through their support groups. Provide a temporary home for those
who are having housing issues or even a drop-in centre where an MSM
can have a hot meal and a warm bed and above all educating MSM on
how to operate in society so that they can be respected. Also, there
are many MSM that have dropped out of school, hence there should
be programmes in place to assist MSM who would like to further their
education. Government should provide equal opportunity policies for
everyone, ensure the perpetrators of MSM violence are brought to
justice and remove the buggery law which would help to reduce HIV
transmission.
94 | KS III | www.unaidscaribbean.org
la Vie
d’un gay
en Haiti
Qu’est-ce Que représente
d’être gay en Haïti?
En Haïti, ce n’est pas facile d’être gay,
car la société voit les gays comme des
hommes ayant des rapports sexuels
uniquement pour de l’argent ou que
ceux sont des personnes qui ont été
victimes de malfaisance. Chez nous,
la religion joue un grand rôle dans
notre société, et elle considère que
l’homosexualité n’existe pas ou bien
c’est l’œuvre du démon ou du diable.
les parents qui ont un fils gay doivent
le cacher dans leur église, de peur d’en
être chasses.
Alors qu’être gay, c’est exprimer ce que
l’on ressent à l’intérieur, une attirance
que l’on partage avec un être aimé. On
nait homosexuel, on ne le devient pas.
existe t-il de mécanismes de
support pour les gay en Haïti?
En ma connaissance, il y a seulement
SEROVIE qui offre un bon système
de support aux HARSH. A SEROVIE,
on nous apprend à évoluer, on nous
encadre pour nous permettre de mieux
nous accepter, même lorsque la société
nous repousse. En matière de VIH,
ils font l’éducation, la distribution de
condoms et autres types d’activité. Ils
nous accompagnent aussi pour que
nous trouvions du travail.
Quels sont les besoins pour la
population gay en Haïti?
les
cliniques
spécialisées
ou
sensibles aux besoins des HARSH
seront nécessaires pour réduire
la discrimination dont face la
communauté gay dans les hôpitaux
ou autres cliniques. En matière de
prévention, nous aimerions avoir accès
aux lubrifiants en plus des préservatifs.
Dans le temps cela ce faisait, mais
c’était un projet de l’UNFPA mais est
arrêté. Nous aimerions avoir accès
aussi au support psychologique, pas
seulement pour nous permettre de
mieux vivre notre orientation sexuelle.
les HARSH ont besoin d’un espace ou
ils peuvent venir pour se détendre et
être eux-mêmes.
M. PAléMON
NICkENSON, 25 ans
chez nous, la
religion joue un
grand rôle dans
notre société, et
elle considère que
l’homosexualité
n’existe pas ou
bien c’est l’œuvre
du démon ou du
diable
www.unaidscaribbean.org | KS III | 95
liVing witH
HiV in tHe cARibbeAn
The Caribbean Regional Network of People living with HIV was
established on 28 September 1996, and since then I have been at the
helm of the organisation as the Executive Director. The organisation has
between 1,200 and 1,500 registered members. but what is startling,
is the bleeding of its membership due to deaths linked to adherence
issues, signifying the continued need for attention to the pervading
psychosocial factors that lead to this situation. I know of many CRN+
members who, despite being keenly involved in the AIDS response and
having access to medication, had struggled with adherence, and this
led to their demise.
yOlANDA SIMON
Executive Director
Caribbean Regional Network of
People living with HIV (CRN+)
i lament though,
that in the current
scenario this may
take another decade
but cRn+, unlike many
who have disappeared
with the funding, will
remain and continue
to do its part. .
96 | KS III | www.unaidscaribbean.org
Actually, CRN+, like other entities, has been affected by the financial
crisis and by the premature end of its Global Fund grant in January
of 2009. Other funding streams such as the World bank and UNAIDS
grants ended in March 2010. This has impacted on staffing (which
has been reduced from 16 to four persons) and implementation of
its programmes. However, I am resolute that our focus remains on
implementation and representation of our stakeholders, which has
been the CRN+ flagship over the years.
I think that by dint of ‘luck’ the PAHO/WHO Country Office is currently
sharing office with CRN+, which has assisted with rental subsidisation
and therefore the ongoing operation of the organisation. Global Fund
Round 9 funding in the amount of US$1 million for the next five-year
period is expected, contingent on CRN+ passing an assessment and
meeting other conditionalities.
CRN+ has also been the recipient of private sector funding from Johnson
& Johnson Company limited in 2009 and the company has indicated an
interest in continuing, given its successful partnership.
In the future, CRN+ will be operationalising global products such as the
GIPA, Positive Prevention and the Stigma and Discrimination Index. I
stress that a key area for CRN+ would be for research on persons living
with HIV as part of the vulnerable groups which need to self identify
if we are to make any headway on reducing new HIV infections and
positively impacting the lives of persons living with and affected by
HIV. I lament though, that in the current scenario this may take another
decade but CRN+, unlike many who have disappeared with the funding,
will remain and continue to do its part.
testimonio
Fui adoptada, mi Papá me entregó a
una señora, mi madre murió.
A mi madre adoptiva le llamaba mamá,
pero no le gustaba. Decía que delante
de la gente no la llamara así porque
ella no era madre de una negrita
tan fea. yo era responsable de hacer
todas las labores de la casa, y de estar
ahí para lo que ella y mis hermanos
necesitaran…nunca me compró un
vestido nuevo.
Mi mamá me golpeaba mucho. Cuando
se enojaba conmigo amenazaba con
matarme. En varias ocasiones, me
tuvieron que llevar al médico por
los golpes. Recuerdo cuando tenía 6
años, que uno de mis hermanos me
manoseaba.
Con 13 años, salí huyendo de la casa
sin saber a donde ir. llevé mi ropa
donde una amiga que no me recibió,
pero como estaba decidida, fui a
buscar a mi Papá. El me dijo que me
quedara con él, pero tenia miedo de
que me violara. le pedí $20 pesos y
me fui. Duré 3 noches durmiendo en
el parque.
Nunca dejé de estudiar, a pesar de
todo. lo que hice fue conseguir trabajo
en una casa de familia y cambiar el
horario de estudio para la noche.
En esa época, un hombre ofreció
ayudarme y prometió no abusar de
mí. Era mentira. Cuando me acosté se
abalanzó sobre mí, pero pude huir.
Cuando tenía 14, un hombre que vivía
cerca de la casa de mi papá, prometió
ayudarme.
Dijo
que
podíamos
mudarnos juntos, y prometía que
no me tocaría, y acepté. Al cabo de
un tiempo, me declaró que estaba
enamorado de mí. Por agradecimiento
lo acepté como mi marido. Tuve mis
dos primeros hijos pero a pesar de que
era bueno, no estaba enamorada de él.
Al final la relación terminó.
luego me junté con otro hombre que
lo buscó mi madre. le dijeron que
era de buena posición y me dijo “si
no te juntas con él, te desheredo”.
yo acepté. Tuvimos 3 hijos, lo llegué
a querer pero era mujeriego. Al cabo
de un tiempo nos separamos pero
vivíamos en la misma casa.
Supe que él estaba teniendo problemas
de salud. Con lo del SIDA, yo no tenía
mucha preocupación, porque como un
año antes cuando conseguí trabajo en
un hotel me hicieron la prueba y salió
negativa.
Una noche, mi ex marido entró a
mi habitación y me violó: me quitó
la ropa, me lastimó… me penetró
violentamente agarrándome la cara
con fuerza… Cuando terminó, me dijo
que creía que yo estaba enamorada de
otro y se sentía mal porque yo estaba
ganando más dinero que él y estaba
estudiando. Producto de esa violación
quedé embarazada. Me entere al
cuarto mes al hacerme unos chequeos.
Me dieron la noticia del embarazo y
que tenía VIH…
Mi ex marido murió. Hoy tengo una
nueva pareja, nos cuidamos siempre,
el es muy amoroso conmigo y yo con
él. Este no lo eligió mi madre, ya ella
no tiene la influencia que tenía en mi
vida. ya yo la perdoné.
mujer viviendo con viH
36 años.
liVing
witH
HiV
in tHe
dominicAn
Republic
producto de esa
violación quedé
embarazada.
me entere al
cuarto mes al
hacerme unos
chequeos.
me dieron
la noticia del
embarazo y que
tenía viH…
www.unaidscaribbean.org | KS III | 97
Sex woRk
And
in tHe
cARibbeAn
HiV
wHat is tHe status of sex work and sex workers in
tHe caribbean at large?
As the leader of the Caribbean Sex Worker Coalition, I am in Grenada
helping sex workers to form a national coalition to advocate for their
rights and practise their profession under optimum conditions. Sex
work is the oldest profession in the world. but there is no standard
definition of sex work which makes it difficult to distinguish between
sex work and transactional sex for example. In the Caribbean there are
boys, girls and young adults entering the sex work market and mainly
poverty is driving them into this. Married women are also involved in
sex work to earn money to support their family. One key population
group which is forgotten in the regional response to HIV is the HIVaffected children who are entering the sex work market because of the
necessity to support their family when the bread winners are living
with HIV or have died of an AIDS-related disease. Also, social networks
which have previously existed in the Caribbean to keep communities
together have become weak and that protection is no longer present,
pushing people to choose sex work to survive.
How is sex work organised?
MIRIAM EDWARDS
Chair of the Caribbean Sex Worker Coalition
Guyana
caribbean leadership
should advocate for the
decriminalisation of sex
work in the region, the
empowerment of sex
workers, and the reduction
of stigma and discrimination
towards sex workers
by health care and law enforcement professionals .
98 | KS III | www.unaidscaribbean.org
The regional Coalition of Sex Workers is working with English,
Dutch and Spanish speaking countries to build national coalitions
of sex workers. Under the leadership of the Caribbean Vulnerable
Communities Coalition, this effort is being financed by PANCAP, UNAIDS
and UNFPA and already national sex worker coalitions exist in many
Caribbean countries. These coalitions will work towards building sex
workers’ skills in the area of protection against HIV and other Sexually
Transmitted Infections, and negotiation with clients, law enforcement
officers, gatekeepers and health care workers. This effort to organise
sex workers will also include issues regarding mobility among sex
workers and exchanges with latin America.
wHat are tHe cHallenges facing sex workers?
These are multiple and include stigma and discrimination in the health
care systems and from law enforcement personnel (Police and Customs)
accompanied by violence and abuse including sexual violence. The
criminalisation of sex work is an important challenge because it leaves
sex workers without any legal protection. One other area is the lack
of meaningful involvement of sex workers in the development and
implementation of programmes targeting them.
messages for tHe caribbean leadersHip:
Caribbean leadership should advocate for the decriminalisation of sex
work in the region, the empowerment of sex workers, and the reduction
of stigma and discrimination towards sex workers by health care and
law enforcement professionals. Special attention should be paid to the
provision of care and support to AIDS-affected children and economic
opportunities should be made available to sex workers to get them off
the streets.
A male Sex woRkeR
in A smAll cARibbeAn setting
smokey 43, wHicH country are
you from?
I am a male aged 24 mulato (as they
say in Martinique). I was born in
Saint lucia and lived in Martinique
for 10 years. I speak French, English
and Creole. I left Martinique in 2008
to come back home after some bad
business with St. lucian criminals.
wHere do you work?
My clients are mostly men from
Martinique who come to see me in
Saint lucia. They either come to where
I live (i.e. a squat in the countryside
with no toilet or water) or if they have
money, we go to a guest house or hotel.
They buy me stuff and take care of me
and sometimes give me cash. I also
43
work as a tour guide and sometimes
hook up with the older tourist women.
I am available to women but they are
not always interested. I only top men no bottoming and no affection - even
with women its rough and hard sex.
I have a local girl that I sex regularly
when I have no visitors.
wHat are tHe issues
confronting sex workers
every day?
I cannot be honest about my sex life
with anyone. I used to drink too much
but now I only smoke cannabis. I
have not had an HIV test since I left
Martinique in 2008. There, they ask
no questions, just test and go. I don’t
want to talk about my sex partners.
i am available to
women but they
are not always
interested
Pseudonym
www.unaidscaribbean.org | KS III | 99
HiV
And tHe
dRug
uSe
Situation
in tHe
cARibbeAn
MARCUS DAy
Director
Caribbean Drug and
Alcohol Research Institute
Recognise that
legislatively
induced harms of
drug criminalisation
cause more harm
than the substances
themselves. .
100 | KS III | www.unaidscaribbean.org
wHat is tHe status of drug use in tHe caribbean?
As in most places of the world, the use of illicit drugs is treated as
a criminal justice issue and often leads to incarceration. The public
health aspect is often neglected and even though the prime focus of
the Single Convention on Narcotic Drugs, 1961 is protecting the public
health, this has been interpreted to support prohibition over treatment.
wHat types of drug use exist?
The two main illicit substances used are cannabis and smokeable
cocaine, usually referred to as “crack” cocaine. Alcohol is more widely
used than both of these substances. The substance having the most
impact on the HIV epidemic is crack cocaine with research showing
the magnitude of HIV in crack smoking populations to be similar to
that of injecting drug users. Sex work is a common form of income
generation to support crack use, with poor and indigent females and
males engaged in receptive sex for small amounts of money to afford
the next rock. No links have been established between cannabis and
HIV and only anecdotal links between alcohol and HIV.
wHo are tHe people engaged in drug use? wHat
are their demographic and socio-economic
cHaracteristics?
While it is difficult to estimate the number of users of various substances,
certain indicators may be used to gauge community access. Crack is
available for sale in most places in the Caribbean from urban areas
to tiny hamlets. Cannabis, while much less problematic, is even more
widely available and of course the ubiquitous rum shop found on every
corner. The most visible crack smokers are those who have spiraled
down to the point that they have lost all their material possessions
and family links and live on the street in rags. To demonstrate the
widespread availability of illicit substances all you need to do is ask
a class of 14 year old students if they
know where to buy cannabis (98%) or
crack cocaine (65-70%). The cost of
crack has not risen in the past 20 years,
meaning that adjusted for inflation, it
is cheaper now than ever despite years
and millions of dollars spent on law
enforcement and interdiction. There
is no doubt that poverty compounds
HIV vulnerability. Poor street-involved
crack users fare much worse than
middle class crack users with homes
and safe spaces and regular incomes.
wHat are tHe key cHallenges
facing drug users in tHe
caribbean?
a) being named a population at
higher risk for HIV: the crack using
population, despite high levels of
HIV, has not until recently, been
seen as an HIV risk population.
Despite
the fact that UNGASS
indicators refer to injecting drug
use, the Caribbean has only now
come to recognise crack cocaine as
a contributor in the HIV epidemic,
and research and actions are
planned as part of the 9th Round
Global Fund grant.
b) Silo-ing Populations Ignore drug
use: Recognition that crack use
compounds HIV in populations
already engaged in high risk
behaviours. Sex workers and MSM
who smoke crack compound the risk
of acquiring HIV. In addition to the
heightened risk, most interventions
that target sex workers and MSM
ignore their substance use and
thus reduce their effectiveness in
delivering a relevant prevention
message. We must start to look at
crack use as a cross-cutting issue
that affects all populations and
develop appropriate harm reduction
messages for all populations. We
need Caribbean-appropriate harm
reduction strategies that go beyond
opiate substitution therapy.
How do we address tHese
cHallenges in terms of
policy cHange, legal
approacHes and tHe social
environment?
1. Develop and embrace a philosophy
of harm reduction that accepts
where people are at and what they
do and work to mitigate the harm medical, social and economic.
2. Accept that drug use is a public
health issue and transit from the
existing punitive, criminal justice
approach.
3. Recognise that legislatively induced
harms of drug criminalisation cause
more harm than the substances
themselves. laws designed to
protect society actually compound
the problems associated with drug
use. Further, these anti-drug laws
impact more heavily on the poor
and marginalised, and really serve
as a mechanism of social control.
4. Drug prevention messages based
on facts not fiction: We need to
change the way we teach about
drugs. Fear-based messages inflate
the harms of cannabis while they
dilute the real harms associated
with crack cocaine. Time and time
again, evidence has shown that
fear-based prevention messages
in whatever sphere have proven
ineffective. We need an evidencedbased drug policy free of morality
and ideology.
www.unaidscaribbean.org | KS III | 101
living witH
And
HiV
being
on dRugS
wHat are tHe tHree main issues facing drug users
wHo are Hiv positive?
i don’t have enough
food to eat and since
hurricane tomas there
has not been even clean
water to drink. .
102 | KS III | www.unaidscaribbean.org
HIV is the least of my problems. I have no place to sleep, I live under
the steps in the CDC (public housing) - I used to live in CDARI’s shelter
but left there when I went back to smoking. They did not throw me out;
I just left after stealing some stuff and went back on the street. life on
the street sucks but at least no one tells me what to do.
I would like to stop smoking crack and just smoke cannabis but it is
hard because most weed dealers also sell crack and I get sucked into
it again and again. I stopped taking my meds when I left the shelter
because I lost them and when I went to the clinic for more I had to wait
a long time and the nurse gave me a hard time for leaving the shelter.
She knew I left and that I took things; I don’t think they should have
told her that.
Today, I don’t have enough food to eat and since hurricane Tomas there
has not been even clean water to drink.
young And liVing
in A woRld witH aidS
do you know of a successful
young people’s programme in
tHe caribbean? please, describe
it.
The CARICOM youth Ambassadors
Programme (CyAP), an initiative of
CARICOM Heads of Governments, is
aimed specifically at promoting youth
participation in regional integration
and the social and economic
development processes. The CyAP
also aims to equip young people with
the knowledge, skills, attitudes and
resources to:
• Advocateonbehalfoftheirpeersin
national and regional policy forums
• Educate their peers on CARICOM
issues
• Develop and implement integrated
youth projects and programmes
in collaboration with national and
regional youth organisations and
Non-Governmental Organisations.
wHat are tHe two ma jor
cHallenges facing young
people in tHe response to aids
in tHe caribbean?
a. Many parents and guardians
throughout the Caribbean are still
reluctant to talk with their children
about “SEX” and help them to dispel
the myths that surround some
sexually transmitted infections/
diseases.
b. young people have a wealth of
creative and innovative ideas to
help in getting the information out
to their peers. Oftentimes they are
unable to get adequate funding to
properly execute these ideas, which
leaves them to either implement a
“watered down” version or to scrap
the idea altogether.
DWAyNE GUTzMER
CARICOM youth Ambassador, kingston,
Jamaica
How can young people be more
involved in tHe response to
aids in tHe caribbean?
Firstly, there needs to be some
organised training for young people
where they are able to garner the
knowledge necessary to be able
to communicate effectively with
their peers. Secondly, foster a more
inclusive environment through which
young people can be involved in
the development and execution of
HIV/AIDS messages, making them
“Edutaining” and “youth Friendly.”
in my country
there needs to be
some organised
training for young
people where they
are able to garner
the knowledge
necessary to be able
to communicate
effectively with
their peers.
www.unaidscaribbean.org | KS III | 103
We have long known that the faith-based
community is a key force in the response
to HIV in the Caribbean. but as we continue
to see HIV infection rates rise, and spread
into more and younger groups and among
the vulnerable groups in our region, we
recognise that now is the time for us to step
faitH
And
HiV
ReSponSe
in tHe
cARibbeAn
NIGEl TAylOR
President
barbados Evangelical Association
we have long
known that the
faith-based community is
a key force in the
response to Hiv in
the caribbean. .
104 | KS III | www.unaidscaribbean.org
up with a bold, new, faith-based response.
For several years, the Faith-based Organisations (FbOs) of barbados
have worked together with the government and the people of the
island to address HIV. The FbOs have been a proud and important
part of our nation’s multi-sector approach to the prevention and
support to persons with HIV. We have served as role models. We have
spread awareness about AIDS, equipping friends and neighbours with
information. We have provided support to PlHIV and even though
we have achieved much progress, the HIV infection rates in barbados
continue to climb and spread into the lives of more and more groups in
our community, especially those of our young women.
This stark reality calls for a new AIDS approach from our FbOs in the
Caribbean. We must address two main obstacles to AIDS awareness
and prevention if we are to mount an effective challenge to HIV before
it extends its grasp even further. Clearly, these are obstacles which we
can overcome together.
First, we must address the traditional church culture’s fears about HIV.
Though many of our members have received the message that HIV is
affecting many kinds of people from many walks of life, there are still
pockets in our congregations who resist the facts. We must find a way
to help them rise above the myths and fears of AIDS, and truly reach
all our constituents and leaders with accurate information about the
wide-ranging nature of HIV in the Caribbean.
Second, we must get rid of the stigma and discrimination of HIV held
by far too many members of our community. For this, we need support
from the government and organisations such as UNAIDS with whom we
have collaborated successfully over the years. but we must also commit
to eliminating the stigma of HIV as a community. It is an issue too
often pushed underground. We must now address these challenges
head on, with maturity and pragmatism, in order to be effective in our
service to mankind.
To achieve this, there must be more advocacy, education and
sensitisation about the reality of HIV provided at the FbO and AIDS
programme levels. There must be the availability of more literature
and more interventions like those barbados has undertaken in the past.
but we also require a community commitment—a pledge to approach
HIV with maturity, respect and an open mind. I am speaking of one of
the most basic of Church practices that we must now value more than
ever: We must rise above discrimination and truly be our brothers’
keepers. We did not turn our back on leprosy. So why should we turn
our back on HIV?
I believe that when the FbOs, governments and people work together,
we can overcome these obstacles. In the past we have proved to be a
strong team: When the FbOs in barbados found that the infection rate of
girls between 14 and 18 was rising, we reached out to other countries,
and asked them to join in our educational efforts. by working as a
team, our sensitisation programmes reached even further throughout
our region. let us build anew on these successful partnerships to catch
up with, and stop AIDS in our region. With a fresh approach to the
FbOs’ role in HIV, together we can one day make the spread of HIV in
the Caribbean a thing of the past.
tHe voice of tHe
pan caRiBBean paRtneRSHip
(pAncAp) on Hiv/Aids
CARl F. bROWNE
Director, CARICOM/PANCAP
wHat success stories is tHe
caribbean most proud of?
The Caribbean has made much
progress in scaling-up HIV prevention,
treatment, care and support services.
In very large measure, this success has
been catalysed by the strategic vision
and collaborative action generated
through the mechanism of the PanCaribbean Partnership against HIV and
AIDS (PANCAP). The development and
application of the Caribbean Regional
Strategic Framework on HIV and AIDS
and National Strategic Plans on HIV
and AIDS lie at the heart of the success
of the regional response.
how strong is the multisectoral involvement in tHe
aids response in tHe caribbean?
The Caribbean regional response to
AIDS has been built around partnerships
and
multi-sectoral
collaboration.
Indeed, PANCAP functions as an
amalgam of governments, regional
institutions, civil society organisations,
private sector, bilateral and multilateral organisations and international
development agencies working closely
with shared values and combined
resources.
wHat is tHe biggest cHallenge
facing
tHe
regional
Hiv
response?
The biggest challenge facing the
regional HIV response is in the area of
prevention. Although the number of
new HIV infections in the Caribbean
has declined by 14% over the past
decade, it is below the global average
decline of 17%. A major thrust in
the area of prevention is therefore
required with special focus on the
most-at-risk population sub-groups.
How do you tHink tHe region
could sustain its aids response
wHen external funding dries
up?
Sustaining the AIDS response in the
future will require three fundamental
inter-related initiatives i.e. cost
containment by delivering services
in the most efficient and integrated
manner, mobilising resources from
non-traditional donors and with
specific reference to the private
sector, and increased government
contribution.
www.unaidscaribbean.org | KS III | 105
A RegionAl
mAnAgeR’s
feedbAcK
JAMES ST. CATHERINE
HIV/AIDS Project Unit
Organisation of Eastern Caribbean States
(OECS)
do we Have tHe true picture of tHe Hiv epidemic?
At best, our data is questionable and reflects our limited knowledge.
As a result, we are only ‘programming’ for those who we know and
this has created an unsettling feeling about our ability to bring this
epidemic under control.
wHat is your biggest impact?
Organising country programmes to achieve results. before, people
wanted to respond without establishing measurable results that
will bring about the desired impact. Now guided by scientific
evidence, people agree about common sets of priorities, increased
technical assistance among the countries and better appropriation
of responsibilities among the different interest groups to facilitate
positive collaboration. We have also contributed to increasing access
and putting people who are HIV positive on treatment in larger
numbers.
the single
mother who
is unemployed
is a potential
“soft target” .
106 | KS III | www.unaidscaribbean.org
How empowered are plHiv?
One aspect of this empowerment is that they have an assured package
of services, which no one can deny them. because of the concentrated
nature of our epidemic, our focus must be on MSM and SW and other
MARPs to minimise the level of risk at their interface/links with the
general population to prevent spread.
How vulnerable are women in tHe caribbean?
The single mother who is unemployed is a potential “soft target’; this
particularly increased because of the financial situation, moreover if
she is pregnant and has to depend on ‘benefits’ from relationships with
male companions then “crapaud smoke she pipe”. This is so, because
women who are pregnant and unemployed are seen as easy targets for
sex, because she is ‘already in it’, she has to ‘earn her keep’ and there
is no chance that she can get pregnant now. To deal with this ‘single
mother’ situation, there is a lot of work to be done to improve their
decision making power in terms of condom use and to reduce their
level of unemployment. In the current and foreseeable challenging
financial situation, we will pay a high price if these women are ignored
and denied employment.
wHat success stories is tHe
caribbean most proud of?
At best, the successes that we should
celebrate most have to do with
positive trends, i.e. a reduction in HIV
incidence rates in some countries,
an improved access to antiretroviral
medication resulting in a better life for
PlHIV, the consistent improvement in
blood safety and the marked reduction
in mother-to-child transmission of HIV
in many Caribbean countries. The
mobilisation of a regional response to
HIV is of note and should be celebrated.
PANCAP is a unique structure inclusive
of representatives from governments,
the private sector, UN, academia, CRN+,
CCNAPC, and bilateral and multilateral
donors. These organisations helped
build important bridges between
countries and created synergies that
have augmented individual national
responses.
how strong is the multi-sectoral
involvement in the aids response
in the caribbean?
Evidence of a vibrant multi-sectoral
response is different in each Caribbean
country. My direct observation is
limited.
However, it appears that
those countries in which the HIV
programmes are situated in the Office
of the Prime Minister or President
have been able to rally all relevant
sectors to a greater degree than those
in which the leadership resides in the
Health Sector. This is not a statement
about the relative effectiveness of
the national responses in individual
countries.
wHat is tHe biggest cHallenge
facing tHe regional Hiv
response?
The countries in this region are in
danger of missing the main lessons from
the HIV epidemic, which have a direct
bearing on how the response should
continue to be shaped. A number of
factors combine to perpetuate the
epidemic; these factors are personal,
socio-cultural and ‘structural.’ Our
children must be prepared for the
world, including the sexual world. The
responsibility to educate, orientate
and train the younger generation must
be shared by parents and teachers in
every environment (including, but not
confined to our schools and the mass
media), bearing in mind that behaviour
is more often “caught” than “taught.”
The practical implication of accepting
the multi-factor causes of the epidemic
is that policies and programmes should
ideally be determined and pursued
by a multi-disciplinary group derived
from many sectors.
How do you tHink tHe region
could sustain its aids response
wHen external funding dries
up?
HIV prevention, care and support
should be factored into national
budgets and the budgets of regional
organisations that share programmatic
responsibility. Medium and long-term
investments should be made in order to
sustain relevant programmes. Efforts
to train professionals in areas relevant
to HIV will bear fruit as individuals
make their long-term career choices.
This implies that incentives (salaries
and healthy working conditions)
should be maintained in order to keep
trained persons in the Caribbean.
tHe
voice of
AcAdemiA
bRENDON bAIN
HIV/AIDS Project Unit
Head of the Community Health
Department,
University of the West Indies, Mona,
Jamaica
the mobilisation
of a regional
response to Hiv
is of note and
should be
celebrated.
www.unaidscaribbean.org | KS III | 107
tHe Voice of BilateRal agencieS
WIllIAM J. CONN
PEPFAR Coordinator
Caribbean Regional Framework
COllEEN CONNEll
Regional Director
lAC for the Clinton Health Access Initiative
wHat are tHe two ma jor cHallenges facing tHe region in
responding to Hiv?
First, gaining private sector involvement and support in helping to
strengthen health systems to provide better services, to collect critical
data for making informed decisions that lead to effective targeted
programmes. Second, addressing stigma and discrimination primarily
facing the most-at-risk populations in the region, by addressing policy
and legislation, education and behaviour change, and overcoming
barriers to access services for all who seek those services.
wHat is tHe status of national responses to Hiv?
The Caribbean programmes have made tremendous progress but I do
not see that we have achieved financial sustainment while maintaining
the progress.
wHat is tHe future content?
A lot of work which has been done to date has been with the passion and
goodwill of the people involved. but now we need to institutionalise in
order to maintain the programme and the progress.
wHat sHould be tHe future focus of national responses
to Hiv?
To develop robust management capacity so that programme managers
and directors have programme, monitoring, evaluation and financial
management skills. We need to make sure we maximise every dollar
spent, because we have limited resources. Getting to universal access
through the reinvestment of maximised dollars is paramount.
108 | KS III | www.unaidscaribbean.org
Role of
cARibbeAn business
in tHe Hiv Response
SUzANNE A. FRENCH
Executive Director
Guyana business Coalition on HIV/AIDS
(GbCHA)
the private
sector remains
committed
to the fight
against Hiv .
wHat Have been tHe biggest
cHallenges for tHe private
sector in responding to Hiv?
The private sector remains committed
to the fight against HIV. However,
the lack of enhanced coordination
at the national level hinders the
level of participation of the private
sector. Another challenge to a more
vigorous response is the strategic
involvement of Executive Officers to
help realise policies against stigma and
discrimination.
How can we increase tHe
private sector’s role in Hiv?
The private sector’s role can be
increased if the current work done
by this sector is marketed more and
the other competencies provided
such as products, services and human
resources are recognised as key
contributions in the fight against HIV.
Enhanced coordination at the national
level would maximise the efforts of
this sector and facilitate the efficient
use of the resources supplied by the
private sector, showing the businesses
value for their investment.
www.unaidscaribbean.org | KS III | 109
tHe Voice of tHe
kWAME bOAFO
Director and Representative of the UNESCO
kingston Cluster Office for the Caribbean
wHat are tHe two ma jor cHallenges facing tHe region in
responding to Hiv?
The first major challenge is the persistent one of cultural traditions
and gender norms that are often barriers to prevention interventions.
Caribbean masculinities, power relations between men and women,
accepted gender roles and identities, and the influence of popular
culture and spiritual practices not only fuel stigma and discrimination
towards vulnerable and marginalised populations that prevent them
accessing services. They also entrench those behaviours around sexual
decision making that increases individual vulnerability to contracting
HIV. These drivers of the epidemic have long been recognised. However,
the challenge remains as to how we apply the existing research and
expertise in these areas to the design of targeted messages and
programmes for behaviour change among the various most-at-risk
populations (MARPs). In parallel, there must be continued advocacy
and institutional and structural reform including national policy and
regulatory frameworks for an enabling environment that facilitates
access to and better serving of MARPs.
There is a need for strengthened coordination among implementing
partners operating at regional, sub-regional and national levels. This
is increasingly urgent in the face of dwindling grant resources for HIV
programmes and the middle income status of most Caribbean countries.
MARk CONNOlly
Senior Advisor, HIV/AIDS
UNICEF Regional Office for latin America and
the Caribbean
110 | KS III | www.unaidscaribbean.org
wHat are tHe two ma jor cHallenges facing tHe region in
responding to Hiv?
Primary prevention of HIV among young people remains the greatest
challenge, as each year brings new cohorts of adolescents into
vulnerable situations, in which they need to be protected and to
be able to protect themselves and their friends. The relatively low
investments in prevention with adolescents over the past 20 years are
a fundamental reason why we have not seen major decreases in HIV
incidence. The second huge challenge is the elimination of Motherto-Child Transmission of HIV - the Caribbean can be one of the first
regions in the world to tackle this, but not when only 71% of children
who need ART received it. Children and young people must become
higher priorities in national responses.
unaidS co-SponSoRS
GIOVANNI DI COlA
Deputy Director
International labour Organization (IlO)
Caribbean Office
DAVID RUIz VIllAFRANCA
HIV Regional Advisor
United Nations Development Programme
(UNDP)
FEDERICO DUARTE
Regional HIV/AIDS &
Reproductive Health Coordinator
Deputy Director’s Office for the Americas for
UNHCR
wHat are tHe two ma jor cHallenges facing tHe region in
responding to Hiv?
The lack of sufficient programmes and policies to address discrimination
at the workplace is the major challenge, because the workplace is
where the impact of HIV/AIDS prevention can be better assessed than
anywhere else.
wHat are tHe two ma jor cHallenges facing tHe region in
responding to Hiv?
To protect and promote rights in order to create a human rights
environment, especially for those groups most-at-risk (MSM, gay men,
trans people, sex workers) as well as for those people living with or
affected by HIV. It includes actions against stigma and discrimination,
awareness, working with parliamentarians, removing punitive laws
and strengthening CSOs, among other actions. There is a need to
reinforce alliances and strengthen partnerships to halt new infections,
especially among youth, women and girls, and these key actors should
be involved in planning processes. besides that, the region needs a
strategic approach to achieve effective prevention programmes.
Also, to increase access to ARV for those in need, ensure quality of
antiretroviral medicine and an affordable quality care and support.
wHat are tHe two ma jor cHallenges facing tHe region in
responding to Hiv?
Protection of basic human rights principles should guide the
development of programmes through the involvement of refugees,
asylum seekers, internally displaced persons and stateless persons
into HIV policies and responses. Specific attention should be paid to
the needs of women and girls including gender-based violence in the
humanitarian settings and disaster response in the region.
www.unaidscaribbean.org | KS III | 111
112 | KS III | www.unaidscaribbean.org
Human RigHts: Caribbean
Constitutional standards and
tHe rights of sexual Minorities
Tracy robinson
senior Lecturer, Faculty of Law,
University of the West indies,
cave Hill campus, barbados
The pillars of the caribbean’s
fundamental and highest law, the
constitutions, are respect for human
dignity and human rights. Many
constitutions describe all persons as
being ‘endowed equally by God with
inalienable rights and dignity’ and
declare ‘faith in fundamental human
rights and freedoms’.
The chapters in caribbean constitutions
protecting fundamental rights and
freedoms, using different language,
establish the norms for a just society
that respects human rights and
create an accountability mechanism.
if anyone’s fundamental rights and
freedoms are infringed by a law or
governmental action, they are entitled
to challenge same. The starting point
for this action for redress is the
need to ensure an avenue for access
to justice for minorities who are
discriminated against and stigmatised
or have had their rights abridged. built
into caribbean constitutional design,
therefore, is the acknowledgment
that minorities may need judicial
protection of their rights where there
is hostility, violence and breaches of
their rights by the majority.
Laws in the commonwealth caribbean
that
criminalise
sexual
activity
between adults of the same sex fall
afoul of fundamental values and norms
expressed in caribbean constitutions,
especially the core principle of respect
for human dignity. although these laws
focus on certain sexual acts, like anal
sex, and not homosexuality per se,
they disproportionately and negatively
impact on the lives of gay men,
lesbians, bisexuals and transgender
persons.
Human dignity demands, as the south
african constitutional court put it,
that we recognise ‘the worth of all
members of our society.’ Dignity is at
the heart of the right to privacy which is
protected by caribbean constitutions.
Properly understood, privacy includes
a person’s freedom to have human and
intimate relationships without undue
interference by the state and others.
by making certain sexual forms of
sexual expression between consenting
adults a crime, the law degrades sexual
minorities and their dignity.
While it is not clear that the right to
privacy can be enforced under the
redress provisions of all caribbean
constitutions, it certainly can in some
like Trinidad and Tobago and belize’s,
and arguably antigua and barbuda and
st. Kitts-nevis’.
Moreover, quite apart from the
question of enforcement, the right is
plainly guaranteed as a general right
almost everywhere in the caribbean.
These general declarations of rights
in caribbean constitutions, such as
the right to privacy were designed,
according to the eminent constitutional
jurist, Professor stanley de smith, to
bring “out the general purport of the
guarantees, lifting them above the
austerity of tabulated legalism.”
no caribbean constitution explicitly
www.unaidscaribbean.org | KS III | 113
provides protection against sexual
orientation discrimination, but the
court of appeal of Trinidad and
Tobago explained that the categories
of discrimination were not closed.
adopting an approach used by other
commonwealth courts, the Trinidad
and Tobago judges treated sexual
orientation as analogous to some other
prohibited grounds of discrimination.
in their view, it was not appropriate
for an anti-discrimination statute to
explicitly deny the possibility of sexual
orientation being a prohibited ground
of discrimination. The Privy council,
that country’s final court of appeal,
appears to have taken a different
view, but provided no explanation for
repudiating the sensible conclusion
of that country’s judges. The upshot
is that caribbean judges, especially
in Trinidad and Tobago, Guyana
and belize, where general equality
rights are guaranteed, will have to
grapple with the equality rights of
a range of persons not originally
contemplated at the founding of
caribbean constitutions. The approach
of the court of appeal of Trinidad and
114 | KS III | www.unaidscaribbean.org
Tobago indicates an open mind about
the crucial question of what equality
means in the caribbean today.
a concern is always the impact of
‘savings law clauses’ on the ability
of citizens to insist that their
fundamental rights and freedoms
be respected. These clauses might
entirely shut out judicial review of
laws which were in existence prior
to the constitutions on the ground
that they infringe fundamental rights.
The restrictions of these clauses in
caribbean constitutions should not
be overstated. They are impediments
to judicial review in a material way
only in Jamaica, Trinidad and Tobago,
Guyana, the bahamas and barbados.
but even in those countries, some of
the questionable laws criminalising
certain forms of sexual expression
were enacted in the last twenty years,
long after independence. The savings
law clauses do not stand in the way of
a challenge of these.
Even where formal legal challenges
face hurdles like savings law clauses,
the broad purport and meaning
of caribbean constitutions remain
clear. it was always intended that
the
constitutional
commitment
to respecting the human dignity
and equality of everyone in the
caribbean would sometimes take
place in the courts, but would always
also take place within caribbean
communities (newspapers, talk shows,
demonstrations, community organising
etc) using the constitutional standards
as a bulwark against injustice.
Litigation is an important tool for
vindicating rights and communicating
the value of fundamental rights to
the entire society. it will not always
be available or evenly so across the
caribbean when constitutional norms
are breached. nevertheless, caribbean
constitutions establish the benchmarks
for ensuring that caribbean people
can, according to the Guyanese
constitution, “live in a safe society
which respects their dignity, protects
their rights, recognises their potential,
[and] listens to their voices…”
gender
RetHinking
gendeR in tHe
CaRibbean
The caribbean ideologies of
masculinity center on sexual
prowess and deter condom use,
while motherhood continues
to enhance femininity and both
contribute to an increased
vulnerability of women and
girls to HiV infection 45. These
ideologies manifest themselves
in the Dutch, English, French and
spanish-speaking caribbean. For
example, in countries like the
bahamas, belize, the Dominican
republic and Haiti, the estimated
number of females living with HiV
surpasses the number of males,
and also young women are two
to three times more affected by
HiV than males in the same age
group. yet few resources and
little attention are dedicated to
addressing the particular needs
of women and girls.
also, the increasing number of
young women who are living
with HiV is evidence not only of
physiological vulnerability, but
also of both their powerlessness
to negotiate safer sexual practices
and the early initiation of sexual
activities e.g. 22% of young
females in st. Kitts and nevis have
had sexual intercourse before
age 15. of particular concern in
this regard are the relationships
between young girls and older
men, where recent surveys have
shown that 25% of older men
report sexual partners at least 10
years younger.
4
Box
Women and Girls 46
The vulnerability of women and girls to HiV is sometimes acknowledged
in national strategies, but, as in many caribbean countries, remains
inadequately addressed by HiV programming. Most programmes directed
at women and girls focus on female sex workers, on pregnant women
for prevention of vertical transmission, and on youth broadly. Despite
the widespread impression that participation in the education sector
and the labour market is an indication that women do not experience
inequality in caribbean societies, that is wrong. Women remain at risk and
vulnerable because power inequalities within relationships compromise
their ability to engage in condom use and other risk reduction strategies.
To address this issue, the caribbean coalition on Women and aiDs has
been established as a multi-sectoral group to address the vulnerability of
women and girls to HiV. its membership includes crn+, cVc, the gender
desk at caricoM, PancaP, UWi, the caribbean association for Feminist
research and action (caFra), UnaiDs and UniFEM caribbean. The latter
currently hosts the coalition’s secretariat. its focus includes research on
the linkages between gender-based violence and HiV in the caribbean,
addressing the significant gap in HiV programming for women and girls,
and advocacy on reducing women’s vulnerability to HiV.
youth subcultures are increasingly
centred on sexuality with hyperheterosexuality often with strong
homophobic overtones found in
music, language and the media.
a new culture of materialism has
emerged, influencing transactional
sex whereby young women engage
in sexual relations in exchange for
“brand-name” items, cellular phones
and other symbols of modern day
“success”. 47
Programmes should be implemented
to change gender norms that condone
violence against women including rape
and domestic violence and coercive
sex, and also address the needs of men
in that context of gender 48, because
the major challenge in the caribbean is
that gender issues have been subsumed
45
46
47
48
49
under women’s issues and the feminist
movement concentrated its efforts on
women’s issues and has not embraced
gender issues confronting men and
boys in caribbean societies 49.
Furthermore, gender itself is not well
defined in this region. How many
genders exist in the caribbean is a
question worth asking. also, can sexual
orientation be part of discussions
around gender in the caribbean? The
answers to these questions will help
the caribbean decision makers to deal
with the HiV epidemic effectively.
in the meanwhile, in discussions
around gender it would be worthwhile
to consider transgender issues as
discussed below by the transgender
population itself.
report of the caribbean Technical Expert Group Meeting on HiV Prevention and Gender. Jamaica. 2004
Dr robert carr, former Technical Director cVc, Personal communication
report of the caribbean Technical Expert Group Meeting on HiV Prevention and Gender. Jamaica. 2004
UnaiDs. The status of HiV in the caribbean. 2010
Prendergast Patrick and Grace Hylton. bringing the male voice to the gender agenda: The task of male
organisations in the caribbean. UWi.2006
www.unaidscaribbean.org | KS III | 115
tRansgendeR
Looking baCk and tHinking about tomoRRow
Ashily, Carmen, Suzy Q and Tanoa are great friends and have come together to
discuss the past, the present and the future of the transgender population in
Trinidad and Tobago and the Caribbean.
ashily: i came out some 20 years ago
as a transgender person, not knowing
what or who i was because of the lack
of information back then on gender
identities. i struggled to find my place.
i first thought or rather was told all
my life that i was gay and that’s what i
thought it was, so i started to wonder
why i did not fit in with gays. We were
similar but at the same time, distinctly
Box
different, so i gravitated to the group
that most closely related to me which
was the cross dressers. some were
drag queens, some trans, but we all
had things in common: we needed
to live, and sex work was our only
form of employment so we all tried
to get along; but still i did not quite
fit in either, at least not with the drag
queens.
Transgender people had to support
each other. one of the greatest
mistakes that we make, and it is an
affront to transgender persons, is
mis-identities or not knowing the
differences between transgender,
transsexuals,
transvestites,
drag
queens and gays. My wish is to quickly
give you a bit of a gender identity
lesson.
5
some definitions
• TransGEnDEr: a person whose gender identity and biological gender do not match up. This is
noT purely an emotional thing it is also physical and biological because it has a lot to do with
your hormones. it is important to note that trans persons are not gay; they can be identified as
straight, bisexual, gay, or trans, hence the offence when this trans population is classified as Men
who have sex with Men.
• TranssExUaLs: a transsexual person understands that their gender identity and biological
gender do not match and they have accepted it; they do not need to have gender reassignment
surgery.
• TransVEsTiTEs: are heterosexual men who so love women that they cross dress to feel closer to
females.
• DraG QUEEns: are gay men who cross dress for entertainment purposes (cabaret, sex work etc.).
• Gay MEn: are men that like men, men that are comfortable in identifying as men (whether they
are effeminate or not); they identify themselves as men who like men.
116 | KS III | www.unaidscaribbean.org
continues even today. We do not wish
to see our issues confused with those
of gay or men who have sex with men,
because we are different and would
always want to see that difference
respected.
in those early days, it appeared
easier because there was only one
principal activity for transgender
people: sex work, so it got us
together. also, in the transgender
community there was great
awareness of organisation. There
was a hierarchy and security
enforcement services respected
us because we were disciplined;
there were issues between
transgender and the drags;
although it was difficult to tell
the difference out there, but we
knew the difference. in those
days, we were divided into three
classes: the higher, the middle
and the lower class. and there
was a clear respect of these three
classes by all members.
in those days, there had been
some animosity between the
transgender and gay populations.
it has since changed and we have
come from not being welcomed to
any of their parties to now being
the ViPs in that community and
also i think a bridge between the
gay and heterosexual community.
We had a close relationship
with the heterosexual female
community also and that reality
Things changed when the structure
and
hierarchy
collapsed.
This
happened because of competition
between members for some sort of
acknowledgement
and
notoriety.
The struggle for clients did not
help any, and because of this the
police intervened, which resulted in
closing down of the areas where the
transgender population was both
“liming “and operating as sex workers.
The pimp system has appeared and has
created mistrust among members and
resulted in the appearance of the so
called “many leaders but no followers”
and the lack of mutual respect.
This whole scenario means that
today, members of the transgender
community have returned to survival
mode and the solidarity between
them has disappeared completely.
it is my strong belief that instead
of progressing, the transgender
community has regressed in many
ways during the last five to ten years.
and lucky are the transgender people
who have completed primary school.
With this big handicap in terms of
education, there are few employment
opportunities for the transgender
population. so we fall easily into
sex work or lower level professional
categories, hard labour and lower paid
jobs such as hairdressing. it is our best
estimate when we say that less than 1%
of transgender people are educated to
secondary level and less than 1% are
in decent jobs. When we have a job
we are generally discriminated against
in the workplace or we become the
jesters if we can make everyone laugh
then we can crawl by with little or no
self-respect.
since sex work is criminalised in many
of our countries and transgender does
not exist in the laws, police abuse is
disproportionately high among us
because we depend very much on sex
work to survive.
our daily life is monotonous and
boring; it is not easy to face such
a hard life when you have to run
away from yourself every day. We
communicate among ourselves but
not very often and our communication
with transgender people in other
suzy Q and tanoa: Today we are
facing real social challenges, because
it is very difficult for a transgender to
live a proper life; in many instances,
we hide our lifestyle. it is very difficult
for a family or a community to accept
transgender people. Many families
throw their transgender children on
the street without any options for
survival except to become another sex
worker.
in the area of education, we are less
educated because early on, stigma
and discrimination prevented us from
continuing our studies; the school
drop-out level is very high among us
www.unaidscaribbean.org | KS III | 117
b)
countries is very limited. contacts are
used for learning purposes to see how
experiences or achievements from
other countries can be implemented in
Trinidad and Tobago.
younger
transgender
generations
face hardship because there are no
counselling or guidance systems in
place to help them and many times
they are misused by pimps and they
cannot request redress from the law.
“Falling between a rock and a hard
place” summarises their daily life.
beyond the social rejection and the
abuse by law enforcement agencies,
there are two other major areas of
stigma and discrimination against us,
the transgender population:
a)
in the health care system. This is
a major of concern for us because
many health professionals are
not educated on gender issues
and the transgender population
is stigmatised and discriminated
against in the health system on a
daily basis and no special attention
is given to us because of our special
situation of being a transgender.
When we are sick, and need to be
hospitalised, there are no clear
policies and procedures regarding
whether we should be placed in
the men’s or women’s ward. no
118 | KS III | www.unaidscaribbean.org
specific health standards exist
for us. Therefore the majority
of the transgender population
avoid health institutions and will
be hospitalised at a late stage,
and generally that is true for
transgender persons living with
HiV.
in the prison system. This is also
a source of discrimination and
stigma against the transgender
population, and the prison service
appears to have made a policy
decision to place us in the male
prison. and members of the
transgender community often
report rape and other sexual
abuses during jail time. also there
is a lack of health standards for the
transgender population within the
prison system. because of their
specific activities, members of the
transgender population are often
arrested and put in jail without
respect for their individual human
rights.
Carmen: My focus will be on the
future since we have already discussed
the past and present. i will summarise
these in five areas:
• DEVELoP a naTionaL nETWorK.
it is important for us to reorganise
and rebuild ourselves into a national
network with a common purpose:
the well-being of the transgender
population. We should make efforts
to establish a network which can
mobilise resources and build a
strong support system which will
empower its membership to improve
their lives and working conditions.
• EDUcaTE.
This
should
be
comprehensive education at all levels
in society: family, to understand the
transgender population; at school,
to tolerate transgender people; at
the level of the law, to understand
that transgender people exist; law
enforcement officers to be educated
on how to deal with abuse against
transgender people; health care
workers to handle transgender
health issues under optimum
standards; and prison officers should
be educated about dealing with the
transgender population.
• rEsPEcT oUr HUMan riGHTs. This
should happen at all levels; laws
should be in place that acknowledge
the existence of and protect the
rights of transgender people.
• EsTabLisH a sociaL sUPPorT
sysTEM. it is important for us to
have a HoME or a half-way house
where transgender people could
meet, organise themselves and be
guided, counselled and well taken
care of by well-trained health
professionals who understand their
specific needs.
• crEaTE EconoMic oPPorTUniTiEs.
opportunities should be created
for the transgender population to
be re-educated and equipped with
skills which will help them access
the workplace and employment
opportunities.
i invite all transgender populations
to work together on these five
recommendations for improvement of
our well-being and working conditions,
to educate the society at large to
understand gender and respect our
fundamental human rights.
nathalie Cameau legros
22 ans
La Vie d’une
PeRsonne
tRansgenRe
en Haïti
QuelS SonT leS problèmeS Que ConfronTenT
leS TrAnSgenreS en HAïTi?
en Haïti,
le terme «
transgenre »
n’est même
pas connu .
r. En Haïti, le terme « transgenre » n’est même pas connu. La vie d’une personne
transgenre n’est pas facile en Haïti. La société haïtienne ne nous traite pas
comme des êtres humains. nous subissons beaucoup de discrimination de la
part de nos parents d’abord, de nos entourages et des gens dans la rue. notre
vie est constamment marquée par la peur, la misère et la crainte et nous
sommes victimes de viol, les couts et les injures. nos parents sont victimes de
discrimination et de stigmatisation de tous genres, et c’est une des raisons qui
fait qu’en retour, ils nous discriminent car ils ne veulent pas être associés avec
leur enfant transgenre.
Pour se faire soigner nous préférons traverser en république voisine, ou nous
avons accès à de meilleurs services médicaux et recevons un meilleur support,
c’est mieux accepter le transgenre là-bas. si tu n’as pas de passeport pour te
permettre de voyager, en tant que transgenre tu es condamnée. si tu es agressée
par d’autres et tu appelles la police, une fois qu’elle te voit, elle ne te protège
pas de la violence des autres. En tant que transgenre, tu as des problèmes
partout même quand tu dois présenter une pièce d’identification a la banque, a
l’immigration, etc.
CommenT lA populATion TrAnSgenre S’eST
orgAniSée pour fAire fACe Aux diffiCulTéS?
r. En Haïti, les transgenres restent dans leur petit coin, comme je disais, elles
vivent dans la peur, se cachent et ne se déclarent pas et se font passer pour
des femmes. Elles changent de quartier souvent et ne se fixent nulle part. Un
transgenre est généralement abandonner par sa famille, elle est un être rejeté
qui se retrouve seul. En Haïti, a part sEroViE qui nous apporte du support, il n’y
a rien autre comme système d’organisation.
www.unaidscaribbean.org | KS III | 119
addRessing
HiV in
HumanitaRian
settings
at the global level, conflicts, disasters
or displacements affect 1.8 million
PLHiV i.e. 5.4% of all PLHiV. among
these are 930,000 women and 150,000
children under 15 years living with
HiV and affected by humanitarian
emergencies. 50
The caribbean is a disaster-prone
region regularly subject to hurricanes,
floods, volcanoes and earthquakes. in
2010 alone the devastating earthquake
in Haiti which killed a quarter million
people and displaced 1.5 million people
to camps and shelters has also caused
UsD 8 billion damage to the economy.
Hurricane Tomas has created damage
in the Eastern caribbean i.e. st. Lucia,
st. Vincent and the Grenadines as well
as in Haiti. as demonstrated in the map
below, the caribbean must be ready on
an ongoing basis to respond to tropical
storms and hurricanes.
The consequences of these natural
disasters include also the destruction
of health infrastructure, stocks of
medicines and pharmaceuticals, food,
water and sanitation, roads and other
utility services. Their negative impacts
on people’s health including people
living with chronic conditions such as
HiV is important and exacerbate issues
such as the easy spread of Tuberculosis
in shelters or the spread of malaria in
flooding situations in endemic malaria
areas, etc.
The United nations inter-agency
standing committee (iasc) Task Force
on HiV has developed guidelines to
support the response to HiV before
and after humanitarian crises. sectors
and action items to be considered are
summarised in Table 32.
50
Lowicki-Zucca M, spiegel Pb, Kelly s, Dehne KL, Walker n, Ghys PD. Estimates of HiV burden in emergencies. sex Transm infect 2008: 84 suppl 1:i42-i48.
120 | KS III | www.unaidscaribbean.org
table 32: hiV in humanitarian set tinGs: seCtor and aCtions
seCtor
HiV awareness raising and community support
aCtions
raise HiV awareness and Empower communities
Health
Prevent HiV transmission in health-care settings
Provide access to good quality condoms
Provide post-exposure prophylaxis
Manage sexually Transmitted infections
Prevent mother-to-child transmission of HiV
Provide care for PLHiV
Provide arT to whose PLHiV in need
Provide basic health care and support to key
populations at higher risk of exposure to HiV
Protection
Protect against HiV-related human rights violations
Protect orphans and unaccompanied, separated
and other vulnerable children and youth
Protect the population from gender-based violence
Food security, nutrition and Livelihood support
Ensure food security, nutrition and livelihood
Provide nutritional support to PLHiV
Education
Promote access to relevant and protective
education for all children and young people
shelter
integrate HiV in shelter activities
camp coordination and Management
integrate HiV in camp coordination & management
Water, sanitation and Hygiene
integrate HiV in water, sanitation and hygiene programmes
HiV and the work place
implement HiV in workplace programmes & policies
Source: Guidelines for Addressing HIV in Humanitarian Settings. UNAIDS.2010
www.unaidscaribbean.org | KS III | 121
la situation après le séisMe
Quel est l’état des traitements
antirétroViraux en haïti?
il y a environ près de 30,000 patients
recevant activement la trithérapie
dont plus de 50% dans le réseau que
nous avons aux centres GHEsKio avec
le Ministère de la santé Publique et
de la Population. nous avons conduit
une étude pour déterminer a quel
moment on doit placer les patients
sous antirétroviraux en comparant
les recommandations de l’oMs
(cD4 < 200/mm3) a celles des pays
développés (cD4< 350/mm3) 52. L’étude
a montré qu’il y avait 75% de moins de
décès et 50% de moins d’incidence de
la tuberculose (Tb) chez les patients
qui ont débuté leur traitement plus
tôt. nous allons appliquer bientôt ces
nouvelles normes de traitement en
Haïti.
Quelles sont les prinCipales
sourCes de finanCement et
leur impaCt?
Le Fond Mondial (GFaTM) et PEPFar
sont les principales sources de
financement pour la lutte contre
le siDa en Haïti. Les financements
du Fond Mondial étaient parmi les
plus performants au monde et ont
sauvé beaucoup de vies, mais ont
connue des difficultés énormes au
cours de trois dernières années,
ce qui a profondément affecté les
sous récipiendaires qui sont restés a
plusieurs reprises plus de 8 mois sans
51
52
53
financement. Jusqu’à cette date des
sommes importantes qui nous sont
dues depuis 2009 comme les frais de
gestion n’ont pas été versées, ce qui
a ralenti nos initiatives. Malgré cette
situation désagréable et révoltante les
programmes des sous récipiendaires
ont eu une bonne performance. nous
espérons que le nouveau récipiendaire
principal sera plus performant que
l’ancien et que la sérénité sera rétablie
pour la poursuite des actions en faveur
des plus démunis. PEPFar continue de
supporter le pays et a des résultats
très tangibles en sauvant des vies,
en diminuant la transmission du ViH
de la mère à l’enfant et l’information
stratégique.
Quel a été l’impaCt du séisme
du 12 janVier 2010 sur le
traitement en haïti?
nous avons pu établir le contact avec
tous nos patients des les 2 semaines
qui ont suivi le séisme du 12 janvier. Le
nombre de nouveaux patients mis sous
traitement par mois est actuellement
plus élevé maintenant qu’avant le
séisme malgré que nos espaces de
travail aient été en grande partie
détruits. Tout comme notre peuple
qui vit depuis trop longtemps dans des
conditions difficiles, nous avons appris
nous aussi à travailler dans les mêmes
conditions et cette expérience nous
a été utile. Le séisme a détruit 80%
du bas de la ville de PaP forçant 1.3
millions de personnes à vivre dans 1321
camps de fortune. Deux conséquences
immédiates: Les femmes vivant sous
ces tentes sont plus exposées à la
violence sexuelle et la grossesse non
désirée. La Tb y trouve aussi un terrain
favorable. En plus de nos multiples
interventions sur le ViH et maladies
associées, nous gérons un camp de
plus de 7,000 personnes qui sont
venues spontanément prendre refuge
sur notre propriété en les prenant en
charge. 53
nous avons une équipe de volontaires
qui au lendemain du séisme enquête de
façon journalière sur 4 manifestations
cliniques: la toux, la fièvre, la diarrhée
et les éruptions cutanées et qui
réfère à une équipe médicale dédiée
entièrement à cette population pour
tout patient présentant l’un de ces
signes. avec cette approche nous
n’avons eu aucun décès. nous avons
même ouvert une école maternelle et
primaire et une école professionnelle
pour les habitants de notre camp.
La Tb demeure une préoccupation
majeure pour les raisons suivantes: le
département de l’ouest le plus affectée
par le séisme compte a lui seul près
de la moitié de tous les cas de Tb du
pays, les 2 hôpitaux pour tuberculeux
de ce département y compris le notre
ont été détruits, les prisonniers du
pénitencier national, les plus grand
centre de détention du pays, se sont
Jean William Pape. Directeur des centres GHEsKio. Port-au-Prince, Haiti.
sévère P et al, Early versus standard antiretroviral Therapy for HiV-infected adults in Haiti, nEJM 363:3, 257-265, 2010).
Pape JW et al; the Earthquake in Haiti — Dispatch from Port-au-Prince, new Engl J Med. 2010 10 (1056) 1-3; Pape JW et al; The GHEsKio refugee camp after
the Earthquake in Haiti — Dispatch 2 from Port-au-Prince; new Engl J Med. 2010 10 (1056) 1-2; Pape, JW et al; The GHEsKio Field Hospital and clinics after
the Earthquake in Haiti – Dispatch 3 from Port-au-Prince new Engl J Med. 2010 10. 10561001787)
122 | KS III | www.unaidscaribbean.org
en haïti vue par Jean pape
échappés de cet établissement après
le tremblement de terre. Plus d’une
centaine était en traitement par notre
équipe pour le sida et la Tb mais ils
ne sont pas manifestés pour prendre
leurs médicaments et comme ils se
cachent dans les camps des sans abris,
ils peuvent disséminer cette maladie.
Finalement les villes “tentes” sont
parfaites pour répandre la Tb. nos
labos effectuent plus de 200 tests de
crachats par jour pour les patients
des autres hôpitaux et camps de sans
abris. Une fois le diagnostic établi ces
patients sont traités dans notre hôpital
de campagne pour la Tb. Dans notre
labo P3 “rodolphe Mérieux” qui fort
heureusement n’a pas été affecté par
le tremblement de terre, nous faisons
le diagnostic de 10 nouveaux cas de
Tb multi résistante par mois. nous
avons dépassé de loin notre quota de
médicaments et bien que le « Green
Light committee » ait approuvé notre
demande pour une augmentation
des médicaments de 2eme ligne, le
financement pour ces médicaments
n’est pas toujours pas disponible.
En plus notre projet Tb avec le Fond
Mondial a également des problèmes
d’approbation et de financement. sans
financement toutes ces interventions
importantes vont s’arrêter et mettre
ces populations encore plus a
risque. Deux mesures mises en place
dans notre camp ont pu empêcher
la violence contre les femmes: la
présence de 4 femmes dans le comité
54
55
qui dirige le camp et l’électricité la nuit
fournie par des panneaux solaires. Le
Ministère de la santé et ses partenaires
nationaux et internationaux ont fait
un travail considérable pour empêcher
l’arrivée d’épidémie de toutes sortes.
Les populations des camps de fortune
présentent aussi des opportunités
d’intervention si les moyens étaient
disponibles.
Quelles stratéGies sont ou
deVraient être en plaCe pour
Garantir la pérennité du
traitement?
Haïti est actuellement dans une
situation extrêmement fragile ayant
perdu avec le séisme 70% de son
GDP. c’est une question qui doit
être reposée au moment de la
reconstruction. on devra repenser
complètement le système de santé et
être capable d’offrir une couverture
d’assurance à la population. nous
avons mémé 2 études sur les couts du
traitement. Dans une première étude
notre cout complet y compris les
médicaments était autour de $1,000
par an 54. Une autre étude a montré
que plusieurs tests de laboratoire
pourraient être omis dans le bilan du
patient et de ce fait réduire encore
davantage les couts. 55 Une troisième
étude sur les couts est en cours.
c’est notre responsabilité de faire en
sorte que chaque dollar compte et
de réduire le cout des soins tout en
gardant la qualité.
51
La tb demeure
une préoccupation
majeure .
Quelles futures perspeCtiVes
sur le traitement en haïti?
Le traitement antirétroviral est offert
partout en Haïti. nous avons 5 équipes
mobiles multidisciplinaires (médecin,
infirmière, laborantin) qui supervisent
le traitement offert dans notre réseau.
nous avons 2 grandes préoccupations:
1) maintenir
l’adhérence
au
traitement. on doit pouvoir déceler
le plus tôt possible les patients qui
sont en échec thérapeutique. nous
avons établi un profile assez précis
de ces patients qui doivent être
identifiés au plus vite.
2) Le second problème noté dans tous
les pays particulièrement les pays a
faibles ressources est la mortalité
élevée en début de traitement.
nous avons des études en cours pour
trouver une solution à ces 2 problèmes.
on devra en dernier lieu former des
infirmières spécialisées capables de
remplacer les médecins dans la grande
majorité des cas. nous avons débuté
au GHEsKio le premier programme de
“nurse Practitioner” spécialisé dans le
ViH/siDa et maladies associées. c’est
grâce à ce personnel spécialisé que
nous pourrons étendre davantage le
traitement.
Koenig s et al. The cost of antiretroviral therapy in Haiti. cost Effective resource allocation 6; 3; 2008
Koenig s et al clinical impact and cost of Monitoring for asymptomatic Laboratory abnormalities among Patients receiving antiretroviral Therapy in a
resource-Poor setting, ciD 2010:51 (sept.1st), 600-610
www.unaidscaribbean.org | KS III | 123
iMproving
STrATegiC
infoRmation
on
HIV
The modelling of HiV incidence is essential to understanding
the sources of new HiV infections and to plan for
interventions among the exposure groups where more
infections are occurring. This kind of study, commonly called
a mode-of-transmission (MoT) survey, will help decision
makers to understand the sources of new HiV infections,
the importance of each and to use the information for
programme planning.
Broad-Basedstrategici nformationi s
nEEDED
beyond data from monitoring and evaluation processes,
data from ongoing national surveillance and from specific
surveys such as behavioural surveillance surveys and
Demographic and Health surveys, key tools and methods to
support these surveys should be used by decision makers,
especially the monitoring and evaluation units at country
level to help them with planning for evidence-based
interventions to achieve effectiveness of HiV programmes.
MoVinG ToWarDs MEasUrEMEnT oF HiV
inciDEncE is a MUsT
The increased coverage of antiretroviral treatment and
its positive impact in improving and prolonging the life
of PLHiV, have limited the usefulness of measurement
of HiV prevalence for monitoring the spread of HiV and
the dynamics of the epidemic in general. Therefore, it is
necessary to measure the incidence of HiV.
124 | KS III | www.unaidscaribbean.org
Modelling the expected distribution of new HiV infections
by exposure group uses four main modes of transmission
by order of importance: sexual (men who have sex with
men, commercial sex, casual sex and marital sex), injecting
drug use, blood transmission and medical injections.
Data needed include population sizes, HiV prevalence,
sTi prevalence, number of sexual acts by exposure group,
number of partners by exposure group, percent protection
in each exposure group and transmission probability.
Data are entered in the MoT software, which uses the
current prevalence of HiV, numbers of individuals with
particular exposures and rates of these exposures, to
calculate the expected incidence of HiV infection over the
coming year. This modelling software will help caribbean
Monitoring and Evaluation officers to use the outcome of
the MoT surveys to advise programme implementers to
act on exposure groups where the highest numbers of new
infections are likely to occur i.e. to act pre-emptively by
putting in place interventions which will prevent new HiV
infections.
EsTiMaTinG THE nUMbEr oF MEn WHo
HaVE sEx WiTH MEn, sEx WorKErs, anD
cracK cocainE UsErs is ParaMoUnT
Measuring the effects and scale of the HiV epidemic
presents many challenges. Without accurate estimates of
the size of most-at-risk populations, it is impossible for
caribbean countries to carry out essential HiV programme
activities, e.g. advocating for vulnerable groups, planning
and implementing HiV prevention, care and treatment
programmes, conducting HiV surveillance and evaluating
the reach and impact of programmes.
Most caribbean countries have developed national
surveillance systems for tracking HiV infections, and
behaviours and practices that spread HiV but many lack the
capacity to estimate the size of the populations involved.
Therefore it is essential that national professionals are
trained to acquire the necessary skills to conduct size
estimates among MarPs using methods such as census
and enumeration, capture-recapture, nomination, and
multiplier, etc. results of these surveys should be used
to guide national planning and budgetary allocations
for prevention activities and public health services for
vulnerable groups and to assess their reach and impact.
internet-Basedsurveyssavemoney
anD iMProVE rEPrEsEnTaTiVEnEss
are these surveys applicable in the caribbean? since the
beginning of the epidemic, many attempts have been made
to conduct surveys among MarPs 56. There has been some
progress 57 in this area, but representativeness has always
been a challenge. recently, a new method has been getting
more and more attention: the use of the internet to conduct
surveys among these populations. Web-based surveying
(Wbs) is becoming widely used 58 in social sciences and
research because it offers significant advantages including
cost savings over more traditional survey techniques. 59
This method presents some methodological concerns
about issues such as coverage bias, or lack of access to
the internet by targeted populations, or some may choose
not to use the internet. More learning is necessary on the
most effective ways to conduct surveys over the internet.
Especially for HiV programmes it will be useful to establish
some parameters such as frequency of surveys and specific
populations to be surveyed. some consideration should
be given to the general population as well. Despite these
issues, there are techniques to improve and increase the
quality and responsiveness of internet-based surveys.
There are a variety of software tools for conducting internet
surveys and they are sophisticated but easy to use 60.
To illustrate this progress, researchers in Estonia studied
the efficacy of convenient sampling through internet
versus respondent driven sampling (rDs) among MsM.
They found a more representative, diverse sample in the
Wbs compared with the rDs. The Wbs captured more
MsM, who were older, bisexual, had female sex partners
during the last six months, and were unlikely to have been
tested for HiV. 61
Without replacing other survey methods, the Wbs
can complement traditional methods by improving
representativeness, thus the understanding about
knowledge, beliefs, behaviours and practices among
vulnerable groups. as a cost-saving method, the Wbs
should be considered for the general population and young
people.
56
57
58
59
60
61
The European MsM internet survey (EMis). community report 1. sigma. 2010
stuart Koe. Fridae. asia internet MsM sex survey 2010 preliminary report.
cDc. Web-based HiV behavioural surveillance Protocol no 4719. cdc.gov,nchstp/od/hiv.plan/default.htm
David J. solomon, conducting Web-based surveys. Michigan state University
a. Mettey, r crosby etal. associations between internet sex seeking and sTi associated risk behaviours among men who have sex with men. sex Transm. infect
2003, 79:466-468
Lisa Grazilina Johnston et al. Efficacy of convenience sampling through the internet versus respondent driven sampling among males who have sex with males
in Tallinn and Harju county, Estonia: challenges reaching a hidden population. aiDs care Vol. 21, no.9, september 2009, 1195-1202
www.unaidscaribbean.org | KS III | 125
sustainabiLity
of aids PRogRammes
recently many caribbean countries have been facing a lack of external funding
to support their national HiV response and this trend will continue, since donor
countries are facing a global financial crisis and the majority of caribbean
countries are classified as high or middle income.
To achieve sustainability of aiDs programmes and successes accomplished,
caribbean decision makers should exercise leadership by:
a.
Modelling future demand and projecting the financial cost of multi-sectoral HiV programmes to be included in
national annual budgets.
b.
improving efficiency in the use of existing resources, and mobilising more internal resources through greater
involvement of the private sector in financing the HiV response, mobilising civil society and other social entities
e.g. Fbos and international private companies operating at country level to get involved in and support the
national response to HiV.
c.
improving cost-efficiency of interventions through integration and decentralisation of HiV programmes and
services; strengthening human resources, reducing vertical programming, planning and implementation of HiV
interventions.
D.
Mobilising the international community to review trade agreements to reduce treatment cost by allowing all
caribbean countries to do bulk purchasing of generic antiretroviral drugs, medicines to treat opportunistic
infections and laboratory reagents for diagnosis. This will also support treatment 2.0.
E.
creating an environment free of stigma and discrimination which is supportive of early diagnosis and adherence
to treatment so that patients will not move quickly from the first line to the more expensive second line
treatment.
F.
Ensuring that prevention programmes and other health services reach the most-at-risk populations and are
achieving impact by reducing new HiV infections.
G.
reinforcing life-skills HiV education to ensure that young people will be part of the solution in the short and
long term. Preparing caribbean children to understand and respect diversity and human rights is critical to
the HiV response. increasing people’s acceptance and adherence to zero discrimination against PLHiV and
sexual minorities and zero violence against women and girls will positively shape not only the future of the HiV
epidemic but social relations in general.
H.
removing punitive laws will result in enabling and more supportive environments which will result in increased
access to HiV prevention, care, treatment and support interventions among most-at-risk populations.
i.
Preparing for and addressing HiV in humanitarian settings because of the specific nature of the caribbean as a
disaster-prone region.
126 | KS III | www.unaidscaribbean.org
fRom
Wendy
FitzWilliaM
Miss Universe 1998 and Former
Un Goodwill ambassador on HiV/aiDs
2010 has been a year of triumphs and some disappointments
in the caribbean response to HiV. our citizenry living
with HiV are truly living with HiV. in many instances our
mortality rate has dramatically decreased and many of the
countries within the region have much to celebrate about
reducing mother-to-child transmission of HiV.
the same commitment in ensuring that he has a healthy
understanding of his sexuality and sex as he grows. in
his four years i have learnt so much through him (his
questions and self-exploration) about my own quirks and
discomfort in facing my own sexuality, much less discussing
it intelligently and sensitively.
We have fallen far short, yet again, in the areas of prevention
and stigma. Like UnaiDs, i have been at this disease in
the region for well over 10 years and i am convinced that
our collective failure to effectively address the spread of
HiV and aiDs and the stigma faced by PLHiV is because
HiV in the caribbean is primarily a sexually transmitted
disease. of the many cultures that i have been fortunate
to experience and participate in beyond the superficial
tourist experience, we are the most uncomfortable in
embracing our sexuality.
i am determined to raise a healthy, West indian male,
steeped in our best traditions and deliberately void of the
idiosyncrasies that stunt our growth. it started for me with
baby steps e.g. simply referring always to his penis as a
penis and not a “piggy” and my vagina as a vagina and
not “a suzie”. seems simple enough but try it at home as
you read this. it has also included answering his questions
honestly about his birth in the most matter-of-fact manner.
i answer his questions honestly and my own discomfort in
doing so has gradually begun to dissipate. Four year olds
are very smart. you should know; you were once four also.
For us, sexuality and sexual relations in its many forms are
at the core of this disease and until we all individually face
our sexuality and sex head on, our progress in addressing
the spread of HiV and the stigma associated with living
with this disease will continue to be disappointing. My
personal journey in living my sexuality out loud began
with the birth of my son. in much the same way i have
been determined to ensure he is a happy, well-adjusted
and physically healthy human being (eating veggies myself
to set that all important “good example”) i’ve taken on
it is in the knowing, internalising and living that knowledge
that the tremendous work of UnaiDs and so many other
organisations will start to bear fruit in the region. as we
start this second decade of the 21st century, let’s make the
hard work of those who have gone before us count. Let’s
make the lives of those we have lost to this disease count.
Let’s make the hard work of those living with HiV or aiDs
count for all of us.
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www.unaidscaribbean.org