Richard Amenyah | HIV at a crossroad

The Caribbean has made commendable advancements in the HIV response, but tremendous challenges remain that must be addressed to end AIDS as a public health threat in the region.

It is estimated that 83 per cent of people living with HIV are aware of their status, 68 per cent of them are receiving antiretroviral treatment, and 57 per cent of them achieved viral suppression. However, disparities persist, particularly affecting men and children, while late diagnoses stand as a prevalent challenge that needs to be addressed.

The reduction in new infections and AIDS-related deaths are worth celebrating. There has been a significant reduction in new HIV infections since 2010. In 2022, key populations contributed 47 per cent of all new HIV infections in the region. Additionally, there has been a positive decline of AIDS-related deaths across the region, but some countries still have lots of work to do to ensure there are further reductions. Political commitment resulted in eleven countries being validated and certified for eliminating vertical transmission of both HIV and syphilis (with Belize, Jamaica and St. Vincent and the Grenadines being the latest additions).

The financial landscape presents hurdles as some countries in the Caribbean still heavily depends on foreign aid, especially from the United States Government and the Global Fund for HIV, Tuberculosis and Malaria. This calls into question the long-term sustainability of the HIV response to protect the gains made over the years beyond 2030. As we prepare for the release of the new global AIDS report, titled The Urgency of Now: AIDS at a Crossroads, on July 22, it is important for Caribbean leaders to have a full appreciation of the situation in the region and take stock of the work to be done.

AIDS IS NOT OVER

Prioritising targeted interventions, community-led responses, and integration to leave no one behind; bolstering treatment accessibility and retention in care; advocating for legal reforms; and challenging harmful gender and other social norms will go a long way to address the root causes of risk and vulnerability of people living with, and most affected by, HIV. Furthermore, in a world with poly-crises all over, funding is shrinking worldwide, and insufficient resources are being invested, especially in HIV prevention and social enablers, holding back progress and even leading to rising epidemics in some countries. Therefore, increasing and sustaining funding for improved health outcomes, especially from domestic sources, and addressing economic and social determinants stand as critical imperatives to drive impactful change in the fight against HIV in the Caribbean.

To reduce AIDS-related deaths and onwards transmission of HIV, our political leaders and policymakers must continue to invest and improve access to early HIV testing and treatment services. Supporting people on treatment to remain adherent to their medicines to achieve viral suppression at undetectable levels, where the virus can no longer be transmitted to others, is particularly critical. Similarly, there is need to strengthen our HIV-prevention interventions, especially using pre-exposure prophylaxis for populations at substantial risk to HIV, and encouraging the correct and consistent use of condoms and lubricants, and promoting social behaviour change.

There is a great need to strengthen partnerships with communities and enhance the role of civil society to reach vulnerable and at-risk groups that are hard to reach with HIV services or find it difficult, for whatever reason, to engage our health facilities. This is how we leverage community leadership as partners in public health. Communicable diseases like HIV, TB and sexually transmitted infections must remain a priority for health policymakers, and must be integrated into programmes for non-communicable diseases.

As we navigate these challenges, countries in the Caribbean are at the crossroads. A renewed collective effort and unwavering commitment by our leaders to choose the right path is essential to ensure no one is left behind in the response to HIV. To ensure prevention and treatment services reach everyone, we must uphold human rights in line with the recent resolution of the UN Human Rights Council (Resolution 56/20) that, “the full realisation of all human rights and fundamental freedoms for all is an essential element in the global response to the HIV epidemic and its sustainability”.

We need the whole of government, through political will and commitment, and the whole of society for social solidarity to ensure that everyone’s human rights are protected to protect everyone’s health. For long-term sustainability, there is need to strengthen our health systems, including building robust data and surveillance systems to track and respond to the epidemic. Similarly, we need to build our community systems. This is how we would create a Caribbean with a healthier future for everyone, where people can access quality care and support.

Dr Richard Amenyah is an international public health specialist and medical doctor from Ghana. He is the multi-country director for UNAIDS in the Caribbean. Contact jamaica@unaids.org or on X at @RichardAmenyah and @UNAIDSCaribbean. Send feedback to columns@gleanerjm.com.