National HIV/STI Programme Overview

National HIV/STI Programme Overview

HIV/AIDS IN JAMAICA Sero-prevalence among adults 1.7% Estimated No. with HIV/AIDS 27,000 (?31,000) Est. No. unaware of HIV status 15,000 No. of persons in need of ARV 14,000 No. of persons currently on ARV >7,000

JAMAICA AIDS Cases & Deaths Reported Annually in Jamaica (1982 to 2009)

JAMAICA AIDS CASE RATE PER 100,000 POPULATION* BY AGE AND GENDER: 1982-2009

JAMAICA Annual AIDS Case Rates in Jamaica, St. James & Kingston/St. Andrew (Rate per 100,000 Population) 1982-2009

JAMAICA Annual AIDS Case Rates by Gender (Per 100,000 population): 1982 2009

JAMAICA AIDS CASES BY TRANSMISSION CATEGORY 1982 2009

Factors Driving the Epidemic

Factors Driving the Epidemic Early initiation of sexual activity Limited life-skills and sex education Insufficient condom use Multiple sex partners Stigma and Discrimination Commercial and transactional sex Substance abuse: crack/cocaine, alcohol Men having sex with men & homophobia Gender inequity and gender roles

Males; 61.5% 15-24yrs; 47.2% Females; 16.8% 25-49yrs; 32.6% Union status Married/cohabiting; 21.7% Not cohabiting; 51.0% Hope Enterprises Ltd.; June 2008; 2008 KABP Survey Findings Presentation 10

MULTIPLE PARTNERSHIPS 63.3% used a condom the last time they had sex Hope Enterprises Ltd.; June 2008; 2008 KABP Survey Findings Presentation 12

TRANSACTIONAL PARTNERSHIPS Transactional sex, defined as the exchange of gifts or money for sex Transactional sex within the last year was common among just over a third (37%) of sexually active respondents or more than a quarter (27.3%) of the total population 15-49yrs. Hope Enterprises Ltd.; June 2008; 2008 KABP Survey Findings 13

TRANSACTIONAL PARTNERSHIPS 57.1% used a condom the last time they had sex Hope Enterprises Ltd.; June 2008; 2008 KABP Survey Findings Presentation 14

HIV/AIDS KNOWLEDGE *Correct preventive practices is a Ministry of Health HIV/AIDS Program indicator which measures the proportion of the population able to endorse correct HIV/AIDS preventive practices. The younger age cohort (15-24 year olds) must endorse 3 preventive practices: condom use always, one faithful partner, abstinence while the older age cohort (25-49 year olds) must endorse 2 preventive practices: condom use always, one faithful partner Hope Enterprises Ltd.; June 2008; 2008 KABP Survey Findings 15

STI INCIDENCE YR 2004 (n=) % Males15-24yrs YR 2008 (n=274) % Males 25-49yrs YR 2004 (n=) % YR 2008 (n=398) % Ever had and STI 9.8 8.0 34.3 34.9 Had genital discharge in last 12 months 2.1 6.6 4.0 4.3 Had genital ulcer in last 12 months - 2.9-1.5 Females 15-24yrs YR 2004 (n=) % YR 2008 (n=299) % Females 25-49yrs YR 2004 YR 2008 (n=) (n=367) % % Ever had and STI 8.2 14.4 15.0 17.2 Had genital discharge in last 12 months 8.1 18.1 9.1 16.1 Had genital ulcer in last 12 months 0.9 2.0 0.4 1.4 Hope Enterprises Ltd.; June 2008; 2008 KABP Survey Findings 16

CSW -5% Prevalence

Condom Use By Type of Partner 120 100 97.8 97.4 93.3 90 80 60 40 20 33.3 20.8 Street SW Bar/Club SW 0 New paying partner Regular paying partner Main partner

HIV and Other STI By Age

HIV and STI Test Results from 201 MSM Infection Percent % HIV 31.8 Chlamydia 8.5 Gonorrhea 2.5 Syphilis 5.5 Trichomoniasis 0% of 67

MSM Number of partnerships Had 2+ male partners in past 4 weeks 27.4% Had a new male partner in past 4 weeks 25.9% Had 1 partner only in past 12 months 17.4% Had 2+ partners in past 12 months 80.1% Had 2+ new partners in past 12 months 54.2% Had a female partner in past 4 weeks 28.8% Is living with a female sexual partner 15.9% Had 2+ female partners in past 12 months 33.8%

The face of AIDS in Jamaica

Strategic Way Forward 2007-2012

Vision Statement To protect the rights of all Jamaicans including those infected with and affected by HIV/AIDS and to create an enabling environment free of stigma and discrimination, providing access to prevention knowledge and skills; treatment care and support; and other services

Goal Universal access to Prevention, treatment care and support services

Strategic Areas 2007-2012: Prevention Building Capacity for HIV prevention in all sectors Structured targeted interventions among vulnerable populations- MSM, CSW & IEW Comprehensive HIV/AIDS response in the Education sector

Prevention Targeted interventions Implementation of prevention intervention for MARPs (adolescents,msm,sw,plhiv) Increase access to HIV testing, including MARPs Interventions in lower income high prevalence communities with focus on reducing social vulnerability Develop out-of-school youth strategy Expansion of positive prevention strategy including 4 PLWHIV liaison officers

Prevention Mass media campaigns Anti-Stigma Time To Talk Smart, Sexy, Wise Get Tested, ah nuh nutten Stick to ONE Partner

Targeted Community Interventions Scale up of interventions in lower income high prevalence communities increased from one per year per parish to 5 per parish. Main focus on reducing social vulnerability via collaboration with other social agencies Empowerment Workshops held with the involvement of social agencies to reduce social vulnerability e.g.heart NTA, RGD, Financial institutions, NCDA, and JFLL being active partners

Adolescents (HFLE) -Maintain Prevalence Among Adolescents Increase awareness re HIV/AIDS/STI Dispel myths relating to the transmission of HIV/AIDS Improve the self efficacy of adolescents to practice safer sexual behaviours that is; delaying sex consistent condom use, appropriate risk assessment Increase basic knowledge of sexuality and to increase comfort level with sexuality

Treatment Care and Support HIV Testing Provider initiated testing at all hospitals Family Planning and Outpatient Clinics. Screening of un-booked pregnant women on labour wards Screen at least 90% of antenatal clinic attendees and over 90% of STI Clinic attendees for HIV Outreach testing of high risk and vulnerable groups e.g. commercial sex workers and men who have sex with men.

HIV Testing 2005-2009 250,000 200,000 150,000 100,000 50,000 0 2005 2006 2007 2008 2009*

Treatment and Care Universal Access to Treatment Continue scaling up of ARV Therapy for those with AIDS, by providing access to updated treatment regimes (150 new cases per month) Provision of support targeting 100% adherence Improved Laboratory capacity Linkages between TB and HIV programmes including prophylactic therapy and TB prevention STI case management at point of first contact Positive prevention Social support

Numbers of Persons on ARVs 2004-2009 14000 12000 10000 8000 6000 4000 2000 0 2004 2005 2006 2007 2008 2009

PMTCT in Jamaica (Public Sector data) 2005-2009 2005 2006 2007 2008 2009 # ANC Attendees Tested 28,651 (96%) 28,446 (95%) 22,478 (95%) 28,659 (>95%) 24,659 # HIV +ve women delivered % of women getting ARVs # of HIV exposed infants # Infants getting PMTCT Transmission Rate 401 442 358 616 440 74% 84% 84% 84% 84% 407 433 362 612 439 353 (87%) 403 (93%) 350 (97%) 605 (98%) 430 (98%) 10% <10% <5% <5%?

Enabling Environment and Human Rights Advocacy for Supportive Policy and Legislative Framework to facilitate interventions among key populations - MSM,CSW, Youth, Young Men, the Homeless, Drug users, PLHIV etc. Stigma reduction activities Advocate for antidiscrimintaion legislation

Policy Framework National HIV/ AIDS Workplace Policy was tabled in parliament November 2009. Draft Sector Workplace Policy for the Ministry of National Security drafted in 2005, edited in 2009 Draft Sector Workplace Policy for the Ministry of Education revised 2009 Multisectoral Working Group on Discrimination Reduction met 9 times during the year

Campaign/Media Relations Achievements 2009

Empowerment and Governance Strengthened capacity and commitment of the Health Sector Strengthened capacity of other key sectors Three ones (M&E, Strategic plan, One Authority) Effective Procurement Monitoring & Evaluation Comprehensive and standard data collection tools Routine availability and utilization of reports for programme planning

Empowerment and Governance Ministry of Education: Roll-out of the HFLE curriculum Ministry of National Security - Institutionalization of HIV screening for inmates Ministry of Labour and Social Security- HIV screening and HIV sensitization focusing on riskreduction for migrant workers Sub-recipients- Increase in the number of Subrecipients moving from 4 primary SRs in 2003 to over 25 sub-recipients receiving over J$200 million in sub-grants annually

Conclusions Much has been done to slow the HIV epidemic but far more needs to be done Achieving Universal Access to HIV prevention, treatment and care is a realistic goal HIV testing is an important tool towards this end We need to expand our outreach programs to those most at risk and improve the quality Structural changes to reduce social vulnerability and change social norms & gender inequity is important

Discussion