PANCAP News-in the caribbean

The 's' word

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• Last Updated on Tuesday, 19 June 2012 14:23
• Published on Tuesday, 19 June 2012 14:23
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Ask any of the region's HIV stakeholders what sustainability means to them and you’re likely to hear a mouthful.  US$1.6 billion has been spent on the Caribbean's AIDS response to date yet many countries face looming disaster as international donor financing steadily dwindles. Criteria for funding have become more restrictive and therefore biased against any but the world’s poorest countries. Plus there have been dramatic reductions in the amount of money available from the Global Fund.

At present the Bahamas, Trinidad and Tobago and Suriname are the only Caribbean countries that do not depend on external financing for antiretroviral treatment (ART). Barbados, Cuba and St. Lucia are moderately reliant on foreign sources. In Antigua and Barbuda, Dominica, the Dominican Republic, Grenada, Guyana, Haiti, Jamaica, St. Kitts and Nevis and St. Vincent and the Grenadines, however, all or almost all financing for ART comes from international sources.

What do these sobering realities have to do with the wider development agenda? In the Caribbean AIDS remains the leading cause of death for men and women for precisely the span of a working life—ages 20 to 59. And although more people who need treatment are able to access it, in 2010 there were 12,000 new HIV infections. At that rate the HIV burden and bill aren’t getting smaller.

“We need prevention interventions that are informed by evidence, cost effective and sustainable if we’re ever going to lower the cost of HIV treatment and care and spend that money on other things like education or development. We can no longer resist putting the focus where it matters—men who have sex with men, sex workers, women and youth. Sinking money into generic, general population prevention efforts is the definition of unsustainable,” Massiah asserted.

If “sustainability” has become a buzz word for the HIV movement of late, so too has “integration”.

“It still feels like a vertical approach,” said Dr. Sonja Caffe of the region’s HIV response. The Pan American Health Organisation’s HIV/STI Prevention Adviser added: “You might have HIV counsellors in clinics but these counsellors are still under the National AIDS Program and they are not fully integrated into the structures of the health centre. Many AIDS programs are funded externally. If that money disappears, the service goes too.”

The era of stand-alone HIV responses with their own staff, systems and funding sources is coming to an end. Integrated services will improve efficiency and cost-effectiveness by delivering more each time a client comes into contact with the health system. Caffe stresses that there are also benefits for the individual.

“People will have access to a broader range of services, with better health and social outcomes. For example, more people living with HIV also have non-communicable diseases,” she illustrated. “Health systems must become more adept at addressing this spectrum of needs by using the same human and technical resources.”

One area where this is increasingly feasible is the prevention of mother-to-child HIV transmission. Some countries have reached, or are close to reaching, elimination targets. In Barbados, for example, there hasn’t been a recorded case of mother-to-child transmission since 2006. But throughout many parts of the region, primary prevention is failing. Just over one percent of pregnant women are HIV positive and infection by mothers accounts for eight to ten percent of all HIV cases.  Attacking the challenge from both ends—integration and prevention—will dramatically lower the HIV costs to health systems and lives. 

"We're going to have to do more with less," Massiah urged. "The opportunity of this is that we're forced to come up with smarter, more creative solutions for building an AIDS-free generation.

Source: UNAIDS Caribbean