Launched on the eve of World AIDS Day, the report, HIV Prevention in the Spotlight - An Analysis from the Perspective of the Health Sector in Latin America and the Caribbean, analyzes progress made and challenges facing health systems in preventing HIV transmission.
PAHO Director, Dr. Carissa F. Etienne, said that progress has been achieved in a number of areas but the challenge of reducing new cases remains.
"We have seen important progress in the fight against AIDS in Latin America and the Caribbean, with major reductions in childhood infections, improved treatment and fewer deaths from AIDS. But we have not yet seen the same success in terms of reducing new cases in adults.”
“Preventing new infections requires intensifying efforts and ensuring that the most vulnerable people have access to all options and new technologies in a discrimination-free environment," Dr. Etienne said.
According to the report and UNAIDS data, the majority (64%) of new HIV cases occur in gays and other men who have sex with men, in sex workers and their clients, in transgender women, in people who inject themselves drugs, and in couples belonging to those key population groups. In addition, one third of new infections occur in young people aged 15 to 24.
The OECS HIV TB Elimination Project is united with UNAIDS, PAHO and WHO in their efforts to reduce infection among key population groups and remains steadfast in its efforts to strengthen treatment, care and support initiatives under the Global Fund Grant (2016-2019).
Project Coordinator of the OECS HIV/TB Elimination Project, Dr. Cleophas D’Auvergne, outlined some of the interventions that have laid the groundwork for prevention and care in the sub region; such as awareness campaigns, workshops and the development of new HIV/STI and HIV/TB Guidelines for standardisation of treatment; and shared the Project’s current initiatives on access to health care and psycho-social support.
“We are now focusing on a Barrier Study, which will enable us to ascertain the difficulties that members of key populations have in accessing health services.
We also just conducted our Psycho-social Support workshop where we developed national plans focused on the overarching goal to reduce stigma and discrimination – very sensitive issues given our small island space and cultural context of intimacy,” Dr. D’Auvergne added.
Essential components of the Commission’s prevention strategy include combination prevention and treatment as prevention in an effort to reduce HIV infection in these key populations. OECS Member States have also signed on to eliminate HIV by 2030, using UNAIDS/WHO 90-90-90 continuum of HIV care targets.
Offering a range of prevention methods
Currently there are many scientifically proven prevention options that health services can offer to help people prevent HIV infection and protect their health. These measures include new options such as self-administered HIV testing, which can be done at home, and the availability of HIV testing in places other than health centers. In Latin America, 2 in 10 people with HIV and 4 in 10 in the Caribbean do not know they have the virus, which represents an improvement over last year. Early diagnosis improves the quality of life of people with HIV and also helps prevent new infections.
Other recommendations include providing pre-exposure prophylaxis (PrEP), to people at high risk of contracting HIV and offering post-exposure prophylaxis (PEP) in emergency situations, such as when someone has sex with a partner without knowing that person’s HIV status. Although the Region of the Americas pioneered early research that supported WHO’s 2015 recommendation to adopt PrEP, only three of the region’s countries currently offer pre-exposure prophylaxis in their public health service.
The report also advocates distribution of condoms and lubricants, offering syphilis testing at the same time as HIV testing, and providing universal access to treatment, which significantly improves the health of people with HIV while also reducing the risk that they will infect their partners. The report also recommends the promotion of peer-led community outreach activities and providing health information and education.
The publication warns against dependence on international funding for prevention actions (such as peer education and provision of condoms and tests by NGOs) for key population groups, while also highlighting the decisive role that civil society can play in making the HIV response more effective, particularly in the area of prevention.
The report calls on governments, civil society and international organizations to work together in partnerships to accelerate the introduction of new prevention technologies, expand the availability of prevention options and ensure universal access to HIV prevention services to reduce new infections and end the AIDS epidemic by 2030.
Elimination of mother-to-child transmission of HIV and syphilis in the Caribbean
On December 1st, Anguilla, Antigua and Barbuda, Bermuda, Cayman Islands, Montserrat, and St. Kitts and Nevis will receive validation from WHO for having eliminated mother-to-child transmission of HIV and syphilis. Experts from the Pan American Health Organization (PAHO), World Health Organization (WHO), UNICEF, UNAIDS, PANCAP/CARICOM and the Regional Validation Committee, along with the Prime Minister of St. Kitts and Nevis, Timothy Harris, will announce this achievement and describe efforts made to reach it, in addition to progress at the regional level. Participants will include health ministers and other high-level officials from the honored islands.
After Cuba in 2015, this group of six countries and territories are the second in the Region of the Americas to receive this recognition.Until now, only two other countries in the world, Thailand and Belarus, have received WHO validation for dual elimination, while Armenia and the Republic of Moldova achieved global elimination goals for mother-to-child transmission of HIV, and syphilis, respectively.
The AIDS epidemic in the Caribbean 2016 *
• An estimated 310,000 (280,000-350,000) people were living with HIV in the Caribbean as of 2016
• Approximately 18,000 (15,000-22,000) new HIV infections occured in the region.
• Some 9,400 (7,300-12,000) people died from AIDS-related illnesses in the Caribbean.
• Between 2010 and 2016, the number of AIDS-related deaths in the region declined 28%.
• Treatment coverage reached 52% (41% -60%) of all people living with HIV in the Caribbean.
• Fewer than 1,000 new HIV infections occurred in children in the Caribbean.