PANCAP News-in the caribbean

Are we there yet?

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• Last Updated on Friday, 10 August 2012 13:55
• Published on Friday, 10 August 2012 13:53
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Eight to ten percent of the people living with HIV in the Caribbean—including 1,100 babies born in 2011—contracted the virus from their mothers. A regional Elimination Initiative aims to reduce the rate of mother-to-child transmission of HIV and syphilis to below two percent. According to Dr. Noreen Jack, senior HIV care and treatment adviser at the Pan American Health Organisation (PAHO), many Caribbean countries (specifically the Eastern Caribbean states and British overseas territories), may already have reached the target.

“We’re working with the countries on an assessment toward validation of the findings,” Jack revealed. “The issue is data. We know what the countries are reporting but we need an independent assessment to evaluate.”

Many of the bigger countries have also made progress on screening and interventions for pregnant women. In the public sector at least, screening for HIV is close to 90, and in some cases, 95 percent. One gap throughout the region is knowledge of what happens in the private sector. The other key gap is that a subgroup of vulnerable women isn’t accessing timely treatment.

“We are talking about migrants and poor women, for example, who don’t come early enough. Some wait until it’s time for delivery. Others will not use the healthcare system at all. In order to achieve optimal antenatal care we need all women to come early to clinic,” Jack explained.

Jack stressed that the key to optimising the prevention of mother-to-child transmission programmes that have existed in the Caribbean since the late 1990s, is to strengthen the primary healthcare system.

“The countries that are getting there have an underlying maternal and child health system that they’re building on,” she noted. “The system needs to continue to promote the programme so that there is demand for it in the community and people understand that this is available. We really have to focus on early attendance. In many of our countries women think ‘I’ve had a baby before so I don’t need to go now.” We have to communicate that if you are HIV positive, the earlier you start antiretroviral treatment the lower your viral load will be and, in turn, the lower the risk of transmission.”

Jack added that there must be intensified engagement with non-governmental organisations to help boost demand for the intervention. On the issue of stigma and discrimination within the healthcare setting, she notes that while there is still room for improvement there has been remarkable progress. For PAHO getting to zero babies born with the virus isn’t about building a standalone HIV programme. They stress continuity of care and commitment to addressing the full spectrum of women’s healthcare needs.

“Referrals to family planning need to be strengthened,” she illustrated. “It’s not just about the healthcare worker as an individual… the system must ensure that all HIV positive pregnant women are clearly referred to family planning and continuation of antiretroviral treatment after delivery. People are retiring. There should be ongoing capacity building and information so that the system provides all the services she needs for herself, her family and her babies.”

source: unaidscaribbean.org