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 2 0 1 7 Anton Best, MBBS, MPH&TM, MPA Senior Medical Officer of Health, HIV/ STI Programme, Ministry of Health, Barbados
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 2016- 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
HIV prevalence Among Adults in the Caribbean (2014) Data source: SPECTRUM 2014, AIM Files 2014 HIV IN THE CARIBBEAN - IAS WORKSHOP 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 2010. Bahamas Haiti New HIV infections in Jamaica 1700-1600 since 2010. 15% 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 2016- annexes. HIV IN THE CARIBBEAN - IAS WORKSHOP 5
Distribution of AIDS Related Deaths in the Caribbean in 2015 Number of AIDS related deaths decreased by 61% from 21,000 in 2010. 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 2016- annexes. HIV IN THE CARIBBEAN - IAS WORKSHOP 6
HIV among MSM in the Caribbean; 2009-2013 HIV IN THE CARIBBEAN - IAS WORKSHOP 7
HIV among FSW in the Caribbean; 2009-2013 HIV IN THE CARIBBEAN - IAS WORKSHOP 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
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
Progress towards 90-90-90 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
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 2016- annexes. 0 10 20 30 40 50 60 70 80 90 100 ART Coverage Gap
Dominican Republic Dominican Republic: 67-70-84 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 20,000 105,700 70% 68% 12,052 84% The DR is on track to reach epidemic control by 2030 10,000 - 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 2016- annexes. Country Reports. HIV in the Caribbean - IAS Workshop 13
Guyana Guyana: 71-82-79 Estimate PLHIV: 7,800 9000 71%: (5,534) PLHIV who know their status: aim 90% 82% (4,551) of PLHIV who know their status have access to treatment: aim 90% 8000 7000 6000 7,800 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% 5000 4000 3000 82% 2000 VL testing coverage is very low and should be scaled up. 1000 0 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 2016- annexes. Country Reports
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
HIV Expenditure by Financing Source in the Caribbean Country Year % Domestic Funds % External Funds Saint Kitts And Nevis 2013 100% 0% Barbados 2013 99% 1% Cuba 2013 92% 8% Bahamas 2009 90% 10% Trinidad and Tobago 2009 85% 15% Grenada 2013 80% 20% Dominica 2012 52% 48% Suriname 2011 50% 50% Dominican Republic 2012 49% 51% Saint Vincent and the Grenadines 2012 44% 56% Belize 2012 34% 66% Jamaica 2012 23% 77% Saint Lucia 2007 22% 78% Antigua and Barbuda 2013 21% 79% Haiti 2011 1% 99% Regional Average 59% 41% HIV IN THE CARIBBEAN - IAS WORKSHOP 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 2016- annexes. HIV in the Caribbean - IAS Workshop 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
Attitudes towards Homosexuals: hate, accept or tolerate; Country Polls 2013/2014 60% 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
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
We have the vision and clearly articulated goals But it will be challenging. Image courtesy: Autorevolution (https://www.autoevolution.com/news/one-third-of-the-french-speed-bumps-are-illegal-69213.html) HIV IN THE CARIBBEAN - IAS WORKSHOP 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
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