Anton Best, MBBS, MPH&TM, MPA Senior Medical Officer of Health, HIV/ STI Programme, Ministry of Health, Barbados

Transcription

1 HIV in the Caribbean I N T E R N A T I O N A L A I D S S O C I E T Y ( I A S ) W O R K S H O P : S C I E N C E A N D C O M M U N I T Y I N T H E R E S P O N S E T O H I V I N L A T I N A M E R I C A A N D T H E C A R I B B E A N W I N D S O R C O N V E N T I O N & E X P O C E N T E R, B A R R A D A T I J U C A, R I O D E J A N E I R O, B R A Z I L 5 A P R I L Anton Best, MBBS, MPH&TM, MPA Senior Medical Officer of Health, HIV/ STI Programme, Ministry of Health, Barbados

2 PLHIV in the Caribbean in 2015 Trinidad & Cuba 8% 4% 3% 3% 1% 1% 1% 89% of PLHIV are in Haiti, Dominican Republic, Jamaica & Cuba. Haiti Dom Rep Jamaica Cuba 10% T&T Bahamas Guyana Suriname Belize Barbados Jamaica Reference: HIV Prevention Gap Report, UNAIDS annexes. 24% 270,000 PLHIV Dominican Republic 45% Haiti A 17% reduction from 320,000 PLHIV in 2010 but that means that 50,000 people died during this period. HIV IN THE CARIBBEAN - IAS WORKSHOP 3

3 HIV prevalence Among Adults in the Caribbean (2014) Data source: SPECTRUM 2014, AIM Files 2014 HIV IN THE CARIBBEAN - IAS WORKSHOP 4

4 People newly infected with HIV Caribbean in 2015 New HIV infections in 2010 was 10,000 a reduction of 6%. New HIV infections declined by 59% in Haiti from Bahamas Haiti New HIV infections in Jamaica since % 4% 4% 17% Jamaica 4% 2% 2% 1% 9,400 New HIV Infections 20% 31% Cuba Dominican Republic New HIV infections increased by 82% in Cuba from 2010 making it the country with the highest number of new infections in the region. Reference: HIV Prevention Gap Report, UNAIDS annexes. HIV IN THE CARIBBEAN - IAS WORKSHOP 5

5 Distribution of AIDS Related Deaths in the Caribbean in 2015 Number of AIDS related deaths decreased by 61% from 21,000 in Cuba Bahamas Jamaica 9% 22% 3% Dominican Republic 3% 3% 1% 1% 1%1% 13,000 AIDS related deaths 56% Haiti Haiti had the highest number of HIV related deaths in the region contributing to more than 50% of the number. Reference: HIV Prevention Gap Report, UNAIDS annexes. HIV IN THE CARIBBEAN - IAS WORKSHOP 6

6 HIV among MSM in the Caribbean; HIV IN THE CARIBBEAN - IAS WORKSHOP 7

7 HIV among FSW in the Caribbean; HIV IN THE CARIBBEAN - IAS WORKSHOP 8

8 EMTCT in the Caribbean Cuba was the first country to have eliminated mother to child transmission in the region Many other countries may have reached targets and are seeking validation In Haiti Haiti has the highest rate of MTCT of HIV in the Caribbean: 5.4% with an estimated 500 infants born with HIV in 2015 >90% of the women in ANC tested for HIV, >95% of those put on ART However >50% still giving birth outside health facilities Low retention rates HIV IN THE CARIBBEAN - IAS WORKSHOP 9

9 Countries that reported data compatible with the dual elimination of HIV and syphilis, 2015 Anguilla Antigua and Barbuda Bahamas Bermuda Cayman Islands (the) Cuba Dominica Grenada Montserrat Puerto Rico Saba Saint Kitts and Nevis Saint Vincent and the Grenadines Sint Eustatius Virgin Islands (UK) Virgin Islands (US) 36% 64% 4% 33% 27% 4% 32% HIV Syphilis May have eliminated Very close Progressing Insufficient information May have eliminated Progressing Insufficient information 10

10 Progress towards in the Caribbean By 2020, 90% of all people living with HIV will know their HIV status. By 2020, 90% of all people with diagnosed HIV infection will receive sustained ART. By 2020, 90% of all people receiving antiretroviral therapy will have viral suppression. HIV IN THE CARIBBEAN - IAS WORKSHOP 11

11 ART Coverage in the Caribbean in 2015: Towards the second 90 Regional Jamaica Bahamas Barbados Belize Dom Rep Haiti Suriname Guyana T&T Cuba Reference: HIV Prevention Gap Report, UNAIDS annexes ART Coverage Gap

12 Dominican Republic Dominican Republic: Estimate PLHIV: 68,459 67% (46,107) PLHIV that know their status: aim 90% 70% (32,291) of PLHIV who know their status have access to treatment: aim 90% 80,000 70,000 60,000 50,000 46,107 67% 68% (21,926) of PLHIV that know their status tested for Viral Load 84% (18,475) of PLHIV on ART tested for VL with undetectable VL: aim 90% 40,000 30,000 20, ,700 70% 68% 12,052 84% The DR is on track to reach epidemic control by ,000 - PLWH PLWH who know their status PLWH who know status on ART PLWH on ART tested for VL Undetectable VL Reference: HIV Prevention Gap Report, UNAIDS annexes. Country Reports. HIV in the Caribbean - IAS Workshop 13

13 Guyana Guyana: Estimate PLHIV: 7, %: (5,534) PLHIV who know their status: aim 90% 82% (4,551) of PLHIV who know their status have access to treatment: aim 90% ,800 71% 15% (677) of PLHIV on ART tested for Viral Load (VL) 79% (536) of PLHIV on ART tested for VL have undetectable VL: aim 90% % 2000 VL testing coverage is very low and should be scaled up PLWH PLWH who knowplwh who know their status status on ART 15% PLWH on ART tested for VL 79% Undetectable VL Reference: HIV Prevention Gap Report, UNAIDS annexes. Country Reports

14 Implementing Treat All in the Caribbean Since the introduction of Treat All by the WHO in Sept. 2015, 3 countries in the Region have implemented the new ART initiation criteria; The Bahamas (April 2016) Barbados (Oct. 2016) Jamaica (Jan. 2017) But can countries afford to implement and sustain Treat All? HIV IN THE CARIBBEAN - IAS WORKSHOP 15

15 HIV Expenditure by Financing Source in the Caribbean Country Year % Domestic Funds % External Funds Saint Kitts And Nevis % 0% Barbados % 1% Cuba % 8% Bahamas % 10% Trinidad and Tobago % 15% Grenada % 20% Dominica % 48% Suriname % 50% Dominican Republic % 51% Saint Vincent and the Grenadines % 56% Belize % 66% Jamaica % 77% Saint Lucia % 78% Antigua and Barbuda % 79% Haiti % 99% Regional Average 59% 41% HIV IN THE CARIBBEAN - IAS WORKSHOP 16

16 Development Partner Contribution to the HIV response in selected Caribbean countries, 2016 Global Fund PEPFAR 10% 4% 1%4%0%1% 5% 0% 9% 35% 9% 6% US$31.8 million Haiti US$138.3 million Haiti Cuba 22% 14% Haiti Dominican Rep Cuba Guyana Belize Jamaica Suriname Dominican Republic 80% Haiti Dominican Rep Cuba Guyana Belize Jamaica Suriname TnT Reference: HIV Prevention Gap Report, UNAIDS annexes. HIV in the Caribbean - IAS Workshop 17

17 Situation of MSM in the Caribbean The Caribbean is one of the regions with the worst laws, policies and regulations for effective HIV prevention in key populations: 11 countries criminalize consensual sex between adults of the same sex The Caribbean report of the Global Commission on HIV and the Law found human rights abuses and laws that criminalize key populations impede access to sexual and reproductive health and justice services across the Caribbean Even where same sex relations NOT illegal - discrimination is widespread and only Cuba has anti-discrimination legislation for LGBT Slide courtesy: Dr J. Carolyn Gomes, Executive Director, Caribbean Vulnerable Communities Coalition

18 Attitudes towards Homosexuals: hate, accept or tolerate; Country Polls 2013/ % 50% 40% 30% 20% 10% 0% St Vincent Grenada Trinidad Tobago Guyana St Lucia Barbados (2013) Belize Suriname Hate Accept Tolerate Beck EJ, Espinosa K, Ash T, Wickham P, Barrow C, Massiah E, Alli B, Nunez C. Attitudes towards Homosexuals in Seven Caribbean Countries: implications for an effective HIV response, AIDS Care (in press) HIV IN THE CARIBBEAN - IAS WORKSHOP 19

19 HIV and the Sustainable Development Goals Ending AIDS and combatting HIV is firmly enshrined in SDG 3 and is included in 14 out of 17 SDG By 2030, end the epidemics of AIDS, tuberculosis, malaria and neglected tropical diseases and combat hepatitis, water-borne diseases and other communicable diseases HIV IN THE CARIBBEAN - IAS WORKSHOP 20

20 We have the vision and clearly articulated goals But it will be challenging. Image courtesy: Autorevolution ( HIV IN THE CARIBBEAN - IAS WORKSHOP 21

21 Acknowledgements Dr Eddy Beck, Senior Adviser, Strategic Information and Policy, UNAIDS RST LAC Ms Sandra Jones, PAHO Dr J. Carolyn Gomes, Executive Director, Caribbean Vulnerable Communities Coalition HIV IN THE CARIBBEAN - IAS WORKSHOP 22

22 Thank you for your attention! Anton Best, MBBS, MPH&TM, MPA Senior Medical Officer of Health, HIV/ STI Programme, Ministry of Health, Barbados HIV IN THE CARIBBEAN - IAS WORKSHOP 23