In the Caribbean, the rate of new HIV infections, concentrated among key population, remained stable ART 8

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1 Background 10,711,067 1 In the Caribbean, the rate of new infections, concentrated among key population, remained stable Coinfections Co-management of Number of people living with 3 prevalence 6 Number of people receiving Coverage of people receiving People receiving a and treatment 12 ART 7 ART 8 test and receiving test results in 130, % 68,849 52% the last 12 months 10 38% Number of new infections 4 <1000 <1000 Number of people living with and percentage receiving antiretroviral therapy (ART) % 13.4% Women Men Treatment of and hepatitis B coinfected persons 13 HEP B Number of AIDS-related deaths 5 3,900 3,500. / % Women (aged 15+) 74,000 57% Men (aged 15+) 50,000 47% Children (aged 0-14) 9,500 30% Viral load suppression 11 4% Treatment of and hepatitis C coinfected persons 14 HEP C Elimination of mother-to-child transmission of Mother-to-child transmission rate (at 18 months) 15 Number of new child infections 17 Number of -positive women delivering 16 Maternal deaths attributed to 18 Pregnant women who know their status 19 Demand for family planning satisfied with a modern method of contraception 5.6% 4, % 90.6% 1,500 for all women (15-49) 20 for women living with (15-49) 21 Adolescents Estimated number of adolescents living with 22 (aged 10 19) AIDS deaths among adolescents 23 (aged 10 19) 8,400 <500 Key populations Men who have sex with men Sex Workers People who inject drugs Transgender people Inmates/Detainees estimate 24 prevalence 25 estimate 26 prevalence 27 30, % 70, % estimate 28 prevalence 29 estimate 30 prevalence 31 estimate 32 prevalence 33 Stigma and discrimination Health systems Funding Supportive of AIDS response: Are there laws that criminalise transmission or exposure? 34 NO Commodity stockouts Antiretrovirals 37 spending from domestic public and international sources 39 $ 128,000,000 Has the Stigma Index been conducted? 35 NO Community service delivery Percentage of general population reporting discriminatory attitudes to? % Is there a national policy and strategy on community delivery of antiretroviral therapy? 38 spending from domestic public sources 40 $ 352,174 01

2 Policies, Strategies & Laws Policies and Strategies Supportive of AIDS response: strategy Is there a national strategy? 41 If yes, has the plan been costed? 42 Have the following SRHR components been included as a measurable target: Gender-based violence Prevention / elimination of mother to child transmission of SRHR of people living with Sexually transmitted infections Mentioned and a target Mentioned and a target Mentioned and a target Sexual and reproductive health and rights (SRHR) strategy Is there a national SRHR policy or strategy? 43 Have the following components been included as a measurable target? counselling and testing Prevention / elimination of mother to child transmission of SRHR of people living with Sexually transmitted infections Mentioned Mentioned testing and counselling strategy Is there a national policy/strategy or other policy document from your government on testing? 44 Elimination of mother-to-child transmission strategies Is there a plan to eliminate MTCT of and syphilis? 45 Integrated plan to eliminate MTCT of and syphilis 46 Is there a national policy to eliminate MTCT of hepatitis B? 47 SRHR and integration strategy Viral hepatitis strategy 52 Is there a national SRHR and integration policy or strategy? 48 NO Is there a specific strategy for the prevention and control of hepatitis B and/or hepatitis C? Tuberculosis () strategy Is there a national policy/strategy or other policy document from your government on Tuberculosis? 49 What are the main focus areas: Cervical cancer policy Is there a cervical cancer policy? 50 NO Community service delivery strategy Does your Government have goals for the prevention and control of hepatitis B and/or hepatitis C? Does your Government have a hepatitis B vaccination policy? Does a hepatitis B vaccination policy exist for: 1. Improve the rate of screening 2. Improve case management 3. Improve / co-infection management 4. Improve testing and management of cases of MDR- 5. prevention in hospitals and other social environments. 6. Improve the technical and managerial capacities of the program s central unit 7. Health system strengthening 8. Operational research 9. Improve advocacy, communication, awareness raising and social mobilization around Is there a national policy and strategy on community delivery of antiretroviral therapy? 51 What approaches are utilized to support community delivery of antiretroviral therapy Infants Adolescents Healthcare Workers Military personnel Travelers Persons at high risk Laws Supportive of AIDS response: Partially Age of consent People living with Are there laws that: 53 Key populations Are there laws that: 58 What is the minimum legal age for marriage without parental consent? criminalise transmission or exposure? 54,54a impose specific restrictions on entry, stay or residence? 55,55a address -related discrimination and protect people living with? 56,56a Gender-based violence Are there laws that address gender-based violence? 57,57a criminalise same-sex sexual activities? 59,59a deem sex work as illegal? 60,60a mandate the death penalty for drug offences? 61,61a demand compulsory detention for people who use drugs? 62,62a recognise a third, neutral and non-specific gender besides male and female? 63,63a What is the legal age for testing (without parental consent)? 65 What is the legal age for accessing contraceptives? 66 What is the legal age for consent to sexual intercourse? Girls 12 There are no laws, regulations or policies which make it difficult for young people or unmarried people to acces effective family planning services. Boys 02

3 Stigma and Discrimination, & Gender-based Violence Stigma and discrimination Stigma faced by people living with Percentage of general population reporting discriminatory attitudes to % Stigma Index 69 Supportive of AIDS response: Has the Stigma Index been conducted? 70 NO The People Living with Stigma Index provides a tool that measures and detects changing trends in relation to stigma and discrimination experienced by people living with. In the initiative, the process is just as important as the product. It aims to address stigma relating to while also advocating on the key barriers and issues perpetuating stigma - a key obstacle to treatment, prevention, care and support. Gender-based violence Gender-based violence 71 Girls married before % Prevalence of recent intimate Wife agrees huband justified beating her partner violence 73 One specified reason 74 if she refuses sex with him 75 STOP 16.7% 4.9% 14.8% Five reasons: argues with him; refuses to have sex; burns the food; goes out without telling him; or when she neglects the children. Women s empowerment 76 Ability to participate in decisions regarding their own health 77 Women who believe wife is justified in refusing sex with husband in three specific circumstances 78 35% 65.3% Specific circumstances: knows husband has a sexually transmitted disease, knows husband has intercourse with other women, or is tired or not in the mood 03

4 Children & Adolescents Children (aged below 18) Children and social protection Children who have lost one or both parents due to AIDS ,000 Children whose households received external support 80 5% Adolescents (aged 10-19) and Young People (aged 15-24) Sexual behaviour Sex before age 15 Median age at first sex among young people aged % 36% 17.9% 15.8% Estimated number of adolescents living with (aged 10 19) 85 AIDS deaths among adolescents (aged 10 19) 86 8,400 <500 New infections among adolescents (aged 15 19) 87 Adolescents aged who were ever tested for and received the results <200 9% 4% Young people aged living with 90 4,500 3,400 Sexual and reproductive health and rights Unmet need for family planning among young women aged Young women aged able to participate in decisions about their healthcare 92 35% 56.3% 04

5 Key Populations Key populations: UNAIDS considers gay men and other men who have sex with men, sex workers and their clients, transgender people, people who inject drugs and prisoners and other incarcerated people as the main key population groups. These populations often suffer from punitive laws or stigmatizing policies, and they are among the most likely to be exposed to. Their engagement is critical to a successful response everywhere they are key to the epidemic and key to the response. Countries should define the specific populations that are key to their epidemic and response based on the epidemiological and social context. The term key populations at higher risk also may be used more broadly, referring to additional populations that are most at risk of acquiring or transmitting, regardless of the legal and policy environment. 93 Missing from the data Size estimates, prevalence and testing Men who have sex with men Sex workers People who inject drugs Transgender people Inmates/ Detainees estimate ,853 70, prevalence 18.2% % % 103 testing % 64.5% Prevention Condom use % 89.9% Number of needles per person who injects drugs

6 Elimination of Mother-to-Child Transmission & Integrated Services and syphilis WHO (2015). Elimination of Mother-to-Child Transmission of and Syphilis in the Americas. Update Global guidance on criteria and processes for validation: elimination of mother-to-child transmission (EMTCT) of and syphilis. 114 The global elimination of congenital syphilis: rationale and strategy for action 115 Elimination of mother-to-child transmission of Number of -positive women delivering 116 Number of new child infections 117 4,800 1,500 Four-pronged strategy Prong 1: new infections among women Prong 2: unmet need for family planning for women of reproductive age 119 Prong 3: final mother-to-child transmission rate 120 3, % 5.6% Prong 3: women receiving antiretrovirals (ARVs) (excluding single dose nevirapine) to prevent new infections among children 121 Prong 4: ART coverage among children under 15 years 122 >95% 30% Pregnant women who know their status 123 Pregnant women attending antenatal care Visiting ANC clinic at Visiting ANC clinic at least Skilled attendant (ANC) whose sexual partners were tested least once times 126 at birth (total) 127 for in the last 12 months % 90% 67% 40% Early infant diagnosis 128 Coverage of infant ARV prophylaxis 129 Co-trimoxazole (CTX) prophylaxis coverage 130 Demand for family planning satisfied with a modern method of contraception for women living with (15-49) % Elimination of mother-to-child transmission of congenital syphilis 132 Congenital syphilis rate (live births and stillbirth) (per 100,000 live births) 133 Syphilis testing in pregnant women % Syphilis rates among antenatal care attendees % Syphilis treatment coverage among syphilis-positive 84.4% antenatal care attendees 136 Hepatitis B Elimination of mother-to-child transmission of hepatitis B Coverage of birth dose of hepatitis B vaccine i.e. within 24 hours of birth? 137 HEP B Coverage of third dose of hepatitis B vaccine among infants (<12 months of age) 138 HEP B Integrated service delivery Health facilities provide services integrated with other health services Many Few ne counselling and testing with SRH 139 MANY EMTCT/prevention of mother-to-child transmission of (PMTCT) with antenatal care/maternal and child health 140 FEW 06

7 Testing and Counselling, & Treatment testing and counselling Consolidated guidelines on testing services 141 Guidelines on self-testing and partner notification 142 People receiving a test and receiving test results in the last 12 months % Women 13.4% Men treatment Consolidated guidelines on the use of antiretroviral drugs for treating and preventing infection 144 Number of people receiving ART ,849 Coverage of people receiving ART % Deaths averted due to ART 147 4,800 Late diagnoses (i.e. -positive people with first CD4 cell count <200 cells/μl) month retention on ART month retention on ART 150 Viral load suppression % 4% 07

8 Tuberculosis, Viral Hepatitis & Cervical Cancer Ending 152 Tuberculosis Integrated services Incident cases in people living with 154 -related deaths among people living with 155 Number of patients living with receiving ART 156 Health facilities providing services with other health services Reduce mortality due to tuberculosis by at least 24% by 2019 (0.8 per 100,000 population) compared to 2014 (1.1 per 100,000 population) ,700 Co-management of and treatment % Proportion of people living with receiving preventive therapy ,396 12% Proportion of people living with newly enrolled in care with active disease 159 >95% counselling and testing, and tuberculosis 160 ART and tuberculosis 161 Hepatitis B and C: prevention, care and treatment 162,163 Viral Hepatitis Estimated mortality (2004) per 100,000 population 165 Acute hepatitis B (HBV) Hepatitis B testing among people in care 166 -HBV coinfected persons currently on combined treatment 167 -HBV Promote the development and implementation of coordinated public health policies and interventions with the aim of eliminating hepatitis B and hepatitis C in Pan American Health Organization (PAHO) Member States by Acute hepatitis C (HCV) Liver cancer Cirrhosis Hepatitis C testing among people in care 168 -HCV coinfected persons currently on combined treatment 169 -HCV Monitoring ringand evaluation tionfor viral hepatitis B and C: recommended indicators and framework 170 Guidelines on hepatitis and C testing 171 B Guidelines inesfor the screening, carea eand treatment of persons with chronic hepatitis C infection. Updated version, April Guidelines inesfor the prevention, care and treatment of persons with chronic hepatitis B infection 173 Cervical cancer 174 Epidemiology Cancer screening and early detection 178 Cancer treatment and palliative care 179 Women living with are at 4 5 times greater risk of developing cervical cancer. Number of new cervical cancer cases (Year) 175 Number of cervical cancer deaths (Year) 176 Vaccination 177 Human Papillomavirus vaccination schedule: HPV vaccination for adolescent girls Cervical cytology (PAP) Acetic acid visualization (VIA) Radiotherapy Chemotherapy (medicines not specified) Oral morphine (formulation not specified) 08

9 Human Resources, Service Coverage, Stockouts & Rapid Assessment Human resources 180 Doctors per 1,000 Nurses and midwives per 1,000 Community and traditional health workers per 1, Sexual and reproductive health and rights (SRHR) and service coverage Sexual and reproductive health and rights programmes and policies include, but are not restricted to: services for family planning; infertility services; maternal and newborn health; prevention of unsafe abortion and postabortion care; prevention of mother-to-child transmission of ; sexually transmitted infections, including infection from, reproductive tract infections, cervical cancer and other gynaecological morbidities; promotion of sexual health, including sexuality counselling; and prevention and management of gender-based violence. 181 testing and counselling facilities per 100,000 adult population Primary level service delivery points offering at least three modern methods of contraception 183 Combined oral contraceptives (COCs) or the pill, progestogen-only pills (POPs) or the minipill, implants, progestogen only injectables, monthly injectables or combined injectable contraceptives (CIC), combined contraceptive patch and combined contraceptive vaginal ring (CVR), intrauterine device (IUD): copper containing, intrauterine device (IUD) levonorgestrel, female condoms, female sterilization (tubal ligation), lactational amenorrhea method (LAM), emergency contraception (levonorgestrel 1.5 mg), standard days method (SDM), basal body temperature (BBT) method, two day method, sympto-thermal method. 184 Commodity stockouts Contraceptives 185 Antiretrovirals 186 STI drugs % Rapid assessment on sexual and reproductive health and linkages tool 188 Supportive of AIDS response: Has the Rapid Assessment for Sexual and Reproductive Health and Linkages been conducted? A rapid assessment of sexual and reproductive health and rights and linkages is a useful tool for countries to assess existing bi-directional linkages at the policy, systems and service delivery levels. 09

10 Haiti Spending & Funding Spending World Bank income classification190 Per capita health expenditure in US$192 LOW INCOME Gross national income per capita in US$191 $ 813 funding193 spending from domestic public and international sources spending from domestic public sources $ 128,000,000 spending from international sources $ 352,174 $ 127,522,213 Tuberculosis funding194 National budget: financing, 2016 National budget 2016 (US$ millions) Total budget (US$ millions) 10 Funding sources Internationally Domestically Unfunded <1% 100% <1% Domestic International Unfunded Data are as reported to WHO. Estimates of and MDR- burden are produced by WHO in consultation with countries. Generated: patients facing catastrophic total costs195 not Data able avail Viral hepatitis funding196 Supportive of AIDS response: Does your Government fund or part-fund the treatment of hepatitis B and/or hepatitis C? not Data able avail HEP C HEP B 10