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UNAIDS report on the AIDS epidemic shows that 2020 targets will not be met in the Caribbean

KINGSTON, 10 July 2020—A new report by UNAIDS shows that despite individual country successes, overall progress in the Caribbean to expand access to HIV services has slowed. Because of this, HIV targets set for 2020 will not be reached. The report, Seizing the moment, urges countries to act with greater resolve to reach those still left behind.

Caribbean 2019 data

There were an estimated 330,000 People Living with HIV (PLHIV) in the region at the end of 2019. Overall Caribbean adult HIV prevalence was 1.1%.

In 2019 77% of PLHIV in the Caribbean knew their status. This compares to the worldwide average of 81%. Eighty-one percent (81%) of diagnosed Caribbean people were on treatment last year. Eighty percent (80%) of those on antiretroviral therapy were virally suppressed. The global average was significantly higher at 88%.

Some countries have achieved elements of the 90–90–90 targets (90% of PLHIV aware of their HIV status, 90% of diagnosed people on antiretroviral treatment and 90% of those on treatment virally suppressed). Barbados has reached the target for testing while Guyana has exceeded it with 94% of PLHIV diagnosed. Haiti has gotten 98% of diagnosed people on treatment. Suriname and Trinidad and Tobago have achieved viral suppression among at least 90% of PLHIV who are on treatment.

“This shows that within the region there is the capacity to deploy the people, policies and programmes to end AIDS,” said UNAIDS Caribbean Sub-regional Office Director, Dr James Guwani. He was speaking at a virtual launch event hosted by UNAIDS Caribbean.

Last year there were 6,900 AIDS-related deaths in the region. Deaths due to AIDS decreased by 37% since 2010. Total antiretroviral treatment coverage for the region was 63%–71% for women and 56% for men.

New HIV infections decreased by 29% in the region since 2010. One-third of new HIV infections in the Caribbean in 2019 were among young people ages 15 – 24. Males ages 15 – 49 accounted for 57% of new infections.

“Year after year the data tell the story of Caribbean men’s inadequate access to HIV services. It is time for a comprehensive strategy to meet men where they are, increase demand and adapt service delivery to meet their needs,” Dr Guwani said.

Chair of the Spouses of Caribbean Leaders Action Network (SCLAN), Kim Simplis Barrow encouraged the region to increase access to education and sexual and reproductive health services for young people.

Great strides continue to be made in the Caribbean towards the Elimination of Mother-to-child HIV transmission, with seven countries and territories achieving World Health Organization revalidation. Mother-to-child HIV transmission reduced by nearly half since 2010.

Social inequalities and exclusion are key barriers

Sixty per cent of new infections in the region were among members of key population communities and their sexual partners in 2019. This includes 26% among men who have sex with men, 6% among sex workers, 5% among transgender people and 3% among people who use drugs.

“Access to care in most of our countries is hindered by several factors including criminalisation of same-sex relationships, hostile communities, homophobic discrimination, violence internal stigma, and limited health education,” said Dr Rosmond Adams, Director of the Pan Caribbean Partnership against HIV and AIDS (PANCAP).

Prejudice against PLHIV is still commonplace. The most recent data show that while discriminatory attitudes towards PLHIV are declining consistently in some countries like Belize and Guyana, they are rebounding in others.

“We have to engage people consistently around ending discrimination. We must also improve accountability and redress mechanisms when people’s rights are violated,” Dr Guwani said.

The COVID-19 pandemic could seriously disrupt the AIDS response

UNAIDS is urging countries to increase investments in both diseases. The 2020 Global AIDS Update notes that even before COVID-19, Caribbean state health systems were struggling to cover programmes traditionally funded by international donors, including HIV prevention and key population-focused initiatives.

Between 2010 and 2019 there was a 30% decline in disbursements by the Global Fund and a 19% decline in investments by the United States Government. HIV resource availability from domestic sources increased by 38% from 2010 to 2019. At present funding is 42% short of the level needed to effectively respond to HIV in the region during 2020.

Caribbean Regional Network of People Living with HIV (CRN+) Vice-Chair, Renatta Langlais, pointed to the strain COVID-19 placed on community organizations. She said despite funding cuts, they are being forced to do more work to serve clients whose incomes and healthcare access have been impacted by the COVID-19 response.

Executive Director of the Caribbean Public Health Agency (CARPHA), Dr Joy St. John, urged health authorities to adopt measures to assure the health of people living with HIV and those with non-communicable diseases.

“Continuous monitoring and re-evaluation of considerations for vulnerable populations at risk from COVID-19 are critical, as the demographics for COVID-19 are quickly changing,” she said.

CONTACT

UNAIDS Caribbean | Cedriann Martin | martinc@unaids.org

Remarks by Dr Rosmond Adams, Director, PANCAP on the occasion of the UNAIDS Global AIDS Report 2020 launch

It gives me great pleasure to present these brief remarks on next steps on behalf of the Pan Caribbean Partnership against HIV and AIDS (PANCAP) at this virtual launch of the UNAIDS Global AIDS Update 2020.

As COVID-19 rapidly spreads, the global HIV community is increasingly concerned about the potential impact of COVID-19 on the 37.9 million People Living with HIV globally. Indeed, the Caribbean Region is aware of the potential threat that COVID-19 will have on advancing progress towards ending AIDS in the region.

This report comes at an important time when we are faced with so many uncertainties in this very vulnerable corner of the globe. In addition to COVID-19, the region is faced by slow economic growth, which will present a challenge for financing and sustaining national and regional HIV/AIDS response. Additionally, other health sector challenges such as the rising burden of non-communicable diseases, the impact of climate change on health and the ever-looming threat from natural disasters are just a few examples.

The theme of this year’s report is, “Seizing the Moment: Tackling entrenched inequalities to end epidemics”. As we continue to maneuver the challenges of COVID-19, this theme is very fitting for us to look for the opportunities that the pandemic has presented and to seize the moment to accelerate action in filling gaps that exist in the regional response to ending the epidemic.

While the report highlighted that the Caribbean region has made progress in reducing new HIV infections and AIDS-related deaths and great strides have been made towards the Elimination of Mother-to-child HIV transmission, progress across the testing and treatment cascade has slowed. Awareness of HIV status is the first step in accessing care but is also a potential prevention tool and a way to normalise and destigmatise HIV. Therefore, any action on HIV must start with testing and awareness of one’s status.

Likewise, we have to focus on interventions aimed at improving linkage to and retention in HIV care to achieve the greatest reductions in HIV incidence especially among Key Populations as they are the drivers of the epidemic in the region accounting for 60% of new infections.

It is important to note that if we are to end AIDS and even eliminate a number of communicable diseases especially those referenced by the SDG-3, we must tackle the entrenched inequalities that stand in the way of progress. The HIV epidemic, as we know has been unusual in the extent to which discourse about its epidemiology has been linked to poverty and inequalities. This virus thrives on inequality.

Adolescents and young people, particularly girls and young women, must be the focus of any meaningful response. They are subjected to poor access to healthcare and education, limited empowerment, representation and opportunities to contribute to decision making with partners, family members and communities. Issues such as gender-based violence, harmful cultural norms, stigma and discrimination put them at increased risks.

Addressing the needs of Key Population is also critically important. Access to care in most of our countries is hindered by several factors including criminalisation of same-sex relationships, hostile communities, homophobic discrimination and violence, external and internal stigma, and limited health education.

We must also not forget men. There are many cultural and social norms that are proving to be obstacles to prevention and control among Caribbean men. Partially to blame is the “macho” culture that influences Caribbean men to suppress awareness of their bodies and not to show emotions or vulnerabilities. This puts them at increased risk and can result in not accessing care, not testing and loss to follow up.

We must continue our ongoing efforts to accelerate equitable HIV incidence decline.

Finally, I want to touch briefly on the 90-90-90 Targets. The region is lagging in these targets. According to the report, 77% of People Living with HIV (PLHIV) know their status, 81% of people who know their status are on treatment and 80% of PLHIV on treatment are virally suppressed with only 50% of all PLHIV are virally suppressed. These gaps must be filled. We must get these bars rising.

Another worrying challenge is that of data to guide strategic interventions. Significant data challenges exist in the region ranging from data quality and the timeliness of data. Go down to the granular level. 90-90-90 at the site level.

Supply chain management must be strengthened to ensure continued access to ARVs and other commodities.

Ending AIDS and addressing STIs requires a coordinated multisectoral regional response as articulated in the Caribbean Regional Strategic Framework (CRSF) – 2019-2025. The CRSF is our blueprint towards ending AIDS, and it highlights policies and programmes to accelerate progress for achieving the UNAIDS 90-90-90 Targets to Test, Treat and Defeat AIDS, to which the region has committed.

We also hold strong to our Justice for All programme that was launched in 2015 to promote activities consistent with the UN Universal Declaration of Human Rights to which all countries are committed. It is intended to achieve one of the goals of the United Nations High-Level Meeting Political Declaration (2011) to eliminate stigma and discrimination against PLHIV by 2015 and to uphold the human rights and dignity of all.

PANCAP will continue to support the regional response by working with National Programmes, Key Partners and Civil Society Organizations, FBO etc. We will address these challenges and work to break down the inequality barriers and other barriers that can hinder our move towards ending AIDS in the region.

Address ‘unprecedented’ impact of Coronavirus on Latin America and the Caribbean, urges Guterres

As COVID-19 continues to spread throughout the world, Latin America and the Caribbean have become a “hotspot of the pandemic”, the UN chief said on Thursday, releasing a new policy initiative on how best to recover in a region already embroiled in poverty, hunger, unemployment and inequality.

The UN brief reveals that several countries in the region, are now among those with the highest per capita infection rates worldwide and shines a light on how the crisis is impacting vulnerable groups, including indigenous communities and women.

“The most vulnerable populations and individuals are once again being hit the hardest,” Secretary-General António Guterres said in a video message on the pandemic’s effect throughout a zone grappling with fragmented health services – even before the coronavirus.

‘Unprecedented’ impacts

The UN chief emphasized the impact of the coronavirus on women across the region, who make up the majority of the workforce and now bear the brunt of additional caregiving. He highlighted the plight of older persons and individuals with disabilities, who are at greater risk; and indigenous peoples, those of African descent, migrants and refugees, who suffer disproportionately.

It is projected that there will be a 9.1 per cent contraction in the gross domestic product (GDP), which will be the largest in a century.

While stressing the need to “do everything possible to limit the spread of the virus and tackle the health effects of the pandemic”, Mr Guterres noted that “we must also address the unprecedented social and economic impacts.”

Steps towards a better recovery

The policy brief underlines an array of urgent and longer-term steps for better recovery, including the prioritization of distance learning and continued child-centred services to mitigate education interruptions.

Governments within the region are also being asked to do more to reduce poverty, food insecurity and malnutrition, such as by providing basic emergency income and anti-hunger grants.

Mr Guterres also flagged the urgent need for greater international support.

“I have called for a rescue and recovery package equivalent to more than 10 per cent of the global economy”, reminded the UN chief, underscoring the need of the international community to provide liquidity, financial assistance and debt relief for Latin America and the Caribbean.

“Latin American and Caribbean countries – and in particular small island developing States – should not be excluded from global assistance”, he asserted. “The international multilateral response needs to be extended to middle-income countries”.

Structural change

Broader structural challenges must be addressed to build back better and transform the region’s development model.

Against the backdrop of pervasive inequality, accessible and comprehensive welfare systems must be developed, fair taxation systems created, decent jobs promoted, environmental sustainability strengthened, and social protection mechanisms reinforced, according to the UN chief.

Moreover, regional economic integration is required, with “women participating fully and safely in public and economic life”, he stressed.

“Building back better demands strengthening democratic governance, human rights protection and the rule of law, in line with the 2030 Agenda for Sustainable Development”, Mr Guterres spelt out.

Address root causes

The Secretary-General maintained that the root causes of inequality, political instability and displacement must be addressed, while underscoring that at a time when too many citizens feel excluded, “greater accountability and transparency are crucial”.

He expressed his full solidarity with the people of Latin America and the Caribbean as they face these challenges, saying that “solidarity and compassion should be their guide”.

“Together, we can overcome this crisis and build inclusive and sustainable societies for all”, concluded the UN chief.

Key numbers

• Unemployment will surge from 8.1 per cent in 2019 to 13.5 per cent this year – yielding over 44 million people out of work, an increase of more than 18 million from last year.• Poverty is expected to jump by 7.0 per cent to 37.2 per cent in 2020 – leaving 230 million poverty-stricken people.

• Extreme poverty is forecast to rise by 4.5 per cent to 15.5 per cent –representing 28 million people more people in dire straits (96 million in total).

Image: World Bank/Charlotte Kesl | A seasonal worker at a store in Buga, Colombia.

UN warns of COVID-19’s effect on HIV treatment

In March 2020, the Jamaica Observer reported Dr Jennifer Brown Tomlinson, medical director at Jamaica AIDS Support for Life (JASL), urging people living with HIV to ensure that they take their medication daily.

A compromised immune system, Dr Tomlinson cautioned, may not be able to function at its optimum to fight against the coronavirus.

Said Dr Tomlinson: “People living with HIV who are on their antiretroviral medication have the same risk [of contracting the novel coronavirus] as the normal population. All of the precautions that are being advised for the general population also apply to people living with HIV who are adherent to their antiretrovirals.

That very sound advice takes on more relevance now as we are being told by health experts that COVID-19 could cause an additional half a million AIDS deaths if treatment is disrupted long term.

That chilling projection was made Monday at the start of the virtual International AIDS Conference at which it was noted that the COVID-19 pandemic was jeopardising years of progress against HIV.

The United Nations (UN), in its annual report, pointed out that the world was already way off course in its plan to end the HIV/AIDS threat before the COVID-19 outbreak.

According to the UN, despite the fact that AIDS-related deaths have fallen by 60 per cent since the peak of the HIV epidemic in 2004, approximately 690,000 people still died from the virus and 1.7 million people were infected last year.

There are now almost 40 million people living with HIV worldwide.

The emergence and spread of the novel coronavirus now means that the UN’s target of reducing AIDS-related deaths and new HIV infections to fewer than 500,000 this year will now be missed.

A key contributor to that danger is that the pandemic is impacting access to preventative medicine among communities at risk because of lockdowns and distribution difficulties.

A report from the UN conference tells us that one model run in conjunction with the World Health Organization (WHO) showed that if COVID-19 measures disrupted HIV treatment programmes for six months it could leave an additional 500,000 people dead.

Indeed, WHO Director-General Dr Tedros Adhanom Ghebreyesus is reported as saying: “We cannot let the COVID-19 pandemic undo the hard-won gains in the global response to this disease.”

The information coming out of the UN conferences should not be lost on the just over 32,000 people living with HIV in Jamaica. Those who are not compliant with their medication need to heed Dr Tomlinson’s advice. In fact, anyone living with HIV should not, in the first place, be in a position of non-compliance.

As it now stands, our health authorities, and indeed the Government, need to ensure that the COVID-19 pandemic does not result in a shortage of antiretroviral medicines here.

For, while, as we have already stated, we are disappointed that Jamaica will not meet the Joint United Nations Programme on HIV/AIDS 90-90-90 target, which was set to be attained this year, we are encouraged that JASL has already achieved one of the targets and is close to the 2020 goal of having 90 per cent of its more than 730 HIV-positive clients virally suppressed.

WHO to issue new brief on airborne transmission, following ‘active engagement’ with scientists

Epidemiologist Dr. Maria van Kerkhove, WHO technical lead on COVID-19, was responding to a journalist’s question about an open letter signed by hundreds of scientists urging the UN agency to update its recommendations on airborne transmission.

Dr. van Kerkhove said WHO welcomes interaction with the scientific community.

She reported that the group first wrote to the UN agency on 1 April and there has been “active engagement” since then.

“Many of the signatories are engineers, which is a wonderful area of expertise, which adds to growing knowledge about the importance of ventilation which we feel also is very important”, she said.

WHO has been studying the various potential modes of coronavirus transmission, including by airborne or aerosol droplets, but also other channels such as from mother-to-child, and from animal-to-human.

The agency is producing a scientific brief that consolidates the growing knowledge around this subject, which will be issued in the coming days.

Accelerate global solidarity

The WHO chief has repeated his longstanding appeal for global solidarity to overcome the COVID-19 crisis.

Tedros Adhanom Ghebreyesus warned that although cases are accelerating globally, the peak of the pandemic has yet to be reached.

“While the number of deaths appears to have levelled off globally, in reality some countries have made significant progress in reducing the number of deaths, while in other countries, deaths are still on the rise”, he said.

“Where there has been progress in reducing deaths, countries have implemented targeted actions toward the most vulnerable groups, for example those people living in long-term care facilities.”

As of Tuesday, there were 11.4 million cases of COVID-19, and more than 535,000 deaths.

Tedros said while it took 12 weeks to reach 400,000 cases worldwide, this same number was recorded over the past weekend alone.

“I will say it again. National unity and global solidarity are more important than ever to defeat a common enemy, a virus that has taken the world hostage”, he told journalists.

“This is our only road out of this pandemic. I repeat national unity and global solidarity.”

Maintain access to HIV drugs

WHO is concerned about how the pandemic is having an impact on efforts to tackle HIV, as some 73 countries are at risk of running out of antiretroviral medicines (ARVs).

To address difficulties in accessing treatment during the crisis, WHO recommends prescribing these treatments for longer periods of time, up to six months.

The UN agency also urged countries to ensure uninterrupted prevention, treatment and services for HIV amid the pandemic.

While more than 25 million people worldwide have access to ARVs, WHO said progress has stalled in the areas of prevention, testing and treatment because services are not reaching those who most need them.

A virus that affects all

The confirmation on Tuesday that Brazil’s President has tested positive for COVID-19 shows that the disease can affect anyone, according to UN health officials.

Jair Bolsonaro, who has repeatedly downplayed the pandemic threat, made the announcement on Brazilian television.

He joins other world leaders, senior government officials and politicians who have contracted the virus, including United Kingdom Prime Minister Boris Johnson.

“I think it brings home for us all the reality of this virus. No one is special in that regard. We are all potentially exposed to this virus”, said Dr. Michael Ryan, WHO Executive Director.

“The virus does not really know who we are. Whether we are prince or pauper, we are equally vulnerable.”

Both Dr. Ryan and the WHO chief wished Mr. Bolsonaro a speedy recovery.

Tedros also highlighted how the new coronavirus is “public enemy number one”, an expression he has used throughout the pandemic.

“It’s very important to understand the seriousness of this virus and to be really serious. No country is immune, and no country is safe. And no individual can be safe”, he said.

Solving the COVID-19 ‘detective story’

WHO experts will be travelling to China this weekend to prepare scientific plans with their local counterparts for identifying the zoonotic source of COVID-19.

The team will develop the scope and terms of reference for a WHO-led international mission to advance understanding of animal hosts for the coronavirus and ascertain how the disease jumped between animals and humans.

Coronavirus Portal & News Updates

Readers can find information and guidance on the outbreak of the novel coronavirus (2019-nCoV) from the UN, World Health Organization and UN agencies here.For daily news updates from UN News, click here.

Dr. Ryan described this as “quite a detective story”, noting that it took “decades” to unravel the source of Ebola.

“There is the wild animal kingdom, there is the farmed animal kingdom, then there are interfaces with humans. Those interfaces with humans can occur with wild animals, they can occur on farms, they can occur in markets, and we don’t know where that species barrier was actually breached”, he said.

The new coronavirus first emerged in Wuhan, China, late last year.

Tedros explained that the WHO team will not be “starting from scratch” as Chinese researchers have already been studying this issue.

WHO: access to HIV medicines severely impacted by COVID-19 as AIDS response stalls

Seventy-three countries have warned that they are at risk of stock-outs of antiretroviral (ARV) medicines as a result of the COVID-19 pandemic, according to a new WHO survey conducted ahead of the International AIDS Society’s biannual conference. Twenty-four countries reported having either a critically low stock of ARVs or disruptions in the supply of these life-saving medicines.

The survey follows a modelling exercise convened by WHO and UNAIDS in May which forecasted that a six-month disruption in access to ARVs could lead to a doubling in AIDS-related deaths in sub-Saharan Africa in 2020 alone.

In 2019, an estimated 8.3 million people were benefiting from ARVs in the 24 countries now experiencing supply shortages. This represents about one third (33%) of all people taking HIV treatment globally. While there is no cure for HIV, ARVs can control the virus and prevent onward sexual transmission to other people.

A failure of suppliers to deliver ARVs on time and a shut-down of land and air transport services, coupled with limited access to health services within countries as a result of the pandemic, were among the causes cited for the disruptions in the survey.

The findings of this survey are deeply concerning,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General. “Countries and their development partners must do all they can to ensure that people who need HIV treatment continue to access it. We cannot let the COVID-19 pandemic undo the hard-won gains in the global response to this disease.

Stalled progress

According to data released today from UNAIDS and WHO, new HIV infections fell by 39% between 2000 and 2019. HIV-related deaths fell by 51% over the same time period, and some 15 million lives were saved through the use of antiretroviral therapy.

However, progress towards global targets is stalling. Over the last two years, the annual number of new HIV infections has plateaued at 1.7 million and there was only a modest reduction in HIV-related death, from 730 000 in 2018 to 690 000 in 2019. Despite steady advances in scaling up treatment coverage – with more than 25 million people in need of ARVs receiving them in 2019 – key 2020 global targets will be missed.

HIV prevention and testing services are not reaching the groups that need them most. Improved targeting of proven prevention and testing services will be critical to reinvigorating the global response to HIV.

WHO guidance and country action

COVID-19 risks exacerbating the situation. WHO recently developed guidance for countries on how to safely maintain access to essential health services during the pandemic, including for all people living with or affected by HIV. The guidance encourages countries to limit disruptions in access to HIV treatment through “multi-month dispensing,” a policy whereby medicines are prescribed for longer periods of time – up to six months. To date, 129 countries have adopted this policy.

Countries are also mitigating the impact of the disruptions by working to maintain flights and supply chains, engaging communities in the delivery of HIV medicines, and working with manufacturers to overcome logistics challenges.

New opportunities to treat HIV in young children

At the IAS conference, WHO will highlight how global progress in reducing HIV-related deaths can be accelerated by stepping up support and services for populations disproportionately impacted by the epidemic, including young children. In 2019, there were an estimated 95 000 HIV-related deaths and 150 000 new infections among children. Only about half (53%) of children in need of antiretroviral therapy were receiving it. A lack of optimal medicines with suitable pediatric formulations has been a longstanding barrier to improving health outcomes for children living with HIV.

Last month, WHO welcomed a decision by the U.S. Food and Drug Administration to approve a new 5mg formulation of dolutegravir (DTG) for infants and children older than 4 weeks and weighing more than 3 kg. This decision will ensure that all children have rapid access to an optimal drug that, to date, has only been available for adults, adolescents and older children. WHO is committed to fast-tracking the prequalification of DTG as a generic drug so that it can be used as soon as possible by countries to save lives.

Through a collaboration of multiple partners, we are likely to see generic versions of dolutegravir for children by early 2021, allowing for a rapid reduction in the cost of this medicine,” said Dr Meg Doherty, Director of the Department of Global HIV, Hepatitis and STI Programmes at WHO. “This will give us another new tool to reach children living with HIV and keep them alive and healthy.”

Tackling opportunistic infections

Many HIV-related deaths result from infections that take advantage of an individual’s weakened immune system. These include bacterial infections, such as tuberculosis, viral infections like hepatitis and COVID-19, parasitic infections such as toxoplasmosis and fungal infections, including histoplasmosis.

Today, WHO is releasing new guidelines for the diagnosis and management of histoplasmosis, among people living with HIV. Histoplasmosis is highly prevalent in the WHO Region of the Americas, whereas many as 15 600 new cases and 4500 deaths are reported each year among people living with HIV. Many of these deaths could be prevented through timely diagnosis and treatment of the disease.

In recent years, the development of highly sensitive diagnostic tests has allowed for rapid and accurate confirmation of histoplasmosis and earlier initiation of treatment. However, innovative diagnostics and optimal treatments for this disease are not yet widely available in resource-limited settings.

UNAIDS Launches Global AIDS Update 2020

Missed targets have resulted in 3.5 million more HIV infections and 820 000 more AIDS-related deaths since 2015 than if the world was on track to meet the 2020 targets. In addition, the response could be set back further, by ten years or more, if the COVID-19 pandemic results in severe disruptions to HIV services.

GENEVA, 7 July 2020 — A new report by UNAIDS shows remarkable, but highly unequal, progress, notably in expanding access to antiretroviral therapy. Because the achievements have not been shared equally within and between countries, the global HIV targets set for 2020 will not be reached. The report, Seizing the moment, warns that even the gains made could be lost and progress further stalled if we fail to act. It highlights just how urgent it is for countries to double down and act with greater urgency to reach the millions still left behind.

“Every day in the next decade decisive action is needed to get the world back on track to end the AIDS epidemic by 2030,” said Winnie Byanyima, the Executive Director of UNAIDS. “Millions of lives have been saved, particularly the lives of women in Africa. The progress made by many needs to be shared by all communities in all countries. Stigma and discrimination and widespread inequalities are major barriers to ending AIDS. Countries need to listen to the evidence and step up to their human rights responsibilities.”

Fourteen countries have achieved the 90–90–90 HIV treatment targets (90% of people living with HIV know their HIV status, of whom 90% are on antiretroviral treatment and of whom 90% are virally suppressed), including Eswatini, which has one of the highest HIV prevalence rates in the world, at 27% in 2019, and which has now surpassed the targets to achieve 95–95–95.

The scale-up of antiretroviral therapy has saved millions of lives and new infections. However, 690 000 people died of AIDS-related illnesses last year, and 12.6 million of the 38 million people living with HIV were not accessing the life-saving treatment.

“We cannot rest on our successes, nor be discouraged by setbacks. We must ensure that no one is left behind. We must close the gaps. We are aiming for 100–100–100,” said Ambrose Dlamini, the Prime Minister of Eswatini.

The world is far behind in preventing new HIV infections. Some 1.7 million people were newly infected with the virus, more than three times the global target. There has been progress in eastern and southern Africa, where new HIV infections have reduced by 38% since 2010. This is in stark contrast to eastern Europe and central Asia, which has seen a staggering 72% rise in new HIV infections since 2010. New HIV infections have also risen in the Middle East and North Africa, by 22%, and by 21% in Latin America.

Seizing the moment shows unequal progress, with too many vulnerable people and populations left behind. Around 62% of new HIV infections occurred among key populations and their sexual partners, including gay men and other men who have sex with men, sex workers, people who inject drugs and people in prison, despite them constituting a very small proportion of the general population.

Stigma and discrimination, together with other social inequalities and exclusion, are proving to be key barriers. Marginalised populations who fear judgement, violence or arrest struggle to access sexual and reproductive health services, especially those related to contraception and HIV prevention. Stigma against people living with HIV is still commonplace. At least 82 countries criminalise some form of HIV transmission, exposure or non-disclosure, sex work is criminalised in at least 103 countries, and at least 108 countries criminalise the consumption or possession of drugs for personal use.

Women and girls in sub-Saharan Africa continue to be the most affected and accounted for 59% of all new HIV infections in the region in 2019, with 4500 adolescent girls and young women between 15 and 24 years old becoming infected with HIV every week. Young women accounted for 24% of new HIV infections in 2019, despite making up only 10% of the population in sub-Saharan Africa.

However, where HIV services are comprehensively provided, HIV transmission levels are reduced significantly. In Eswatini, Lesotho and South Africa, high coverage of combination prevention options, including social and economic support for young women and high levels of treatment coverage and viral suppression for previously unreached populations, have narrowed inequality gaps and driven down the incidence of new HIV infections.

The COVID-19 pandemic has severely impacted the AIDS response and could disrupt it more. A six-month complete disruption in HIV treatment could cause more than 500 000 additional deaths in sub-Saharan Africa over the next year (2020–2021), bringing the region back to 2008 AIDS mortality levels. Even a 20% disruption could cause an additional 110 000 deaths.

“Those of us who survived HIV and fought for life and access to treatment and care cannot afford to lose the gains that took so much effort to win. In some Latin American countries we are seeing how HIV resources, medicines, medical staff and equipment are being moved to the fight against COVID-19,” said Gracia Violeta Ross, President of the Bolivian Network of People Living with HIV. “Some good lessons and practices of the HIV response, such as meaningful participation and accountability, are being ignored. We will not allow HIV to be left behind.”

To fight the colliding epidemics of HIV and COVID-19, UNAIDS and partners are leading a global call for a People’s Vaccine for COVID-19, which has been signed by more than 150 world leaders and experts demanding that all vaccines, treatments and tests be patent-free, mass produced and distributed fairly and free for all.

UNAIDS is also urging countries to increase investments in both diseases. In 2019, funding for HIV fell by 7% from 2017 to US$ 18.6 billion. This setback means that funding is 30% short of the US$ 26.2 billion needed to effectively respond to HIV in 2020.

“We cannot have poor countries at the back of the queue. It should not depend on the money in your pocket or the colour of your skin to be protected against these deadly viruses,” said Ms Byanyima. “We cannot take money from one disease to treat another. Both HIV and COVID-19 must be fully funded if we are to avoid massive loss of life.”

Helpful links:

UNAIDS 2020 Databook

https://www.unaids.org/en/resources/documents/2020/unaids-data

Core Epidemiology Slides

https://www.unaids.org/en/resources/documents/2020/core-epidemiology-slides

Fact sheet

https://www.unaids.org/en/resources/fact-sheet

Message from Dr Rosmond Adams, Director, PANCAP – June 2020

As the Caribbean Region continues to implement mitigation strategies to ensure the continuity of care for HIV during the COVID-19 pandemic significant challenges are still present and require a coordinated multisectoral response to stay on track if we are to end AIDS in the Region by 2030.

One of the most significant challenges faced by the region is financing healthcare, particularly financing and sustaining the National and Regional HIV response. COVID-19 has caused funds to be diverted to the pandemic response, which could result in a decrease in HIV funding. At the same time, external funders continue to withdraw from the region, reducing the availability of this level of funding, that is a significant contributor to many national programmes.

It is critically important for countries to sustain health gains and increase investments in the National HIV response.

How can countries commit to this in these challenging times?

Many of the countries in the region are tourism-dependent, and so COVID-19 will negatively impact these economies as this sector continues to take a beating.

As the pandemic continues to impact countries, additional resources are required to contain the spread of the virus and to provide health care to those affected. The COVID-19 response will continue to demand more resources. Hence, the possibility of getting additional funds at the national levels for HIV is virtually impossible.

The Caribbean region, being mostly Small Island Developing States (SIDS), is very vulnerable to disasters. One common challenge is our vulnerability to natural disasters, especially the impact of hurricanes. With these adversities, the HIV response will not only be disrupted but there is the potential for economic challenges and implications for health budget allocation.

These challenges are real and continue to be compounded by the pandemic. It is crucial that as we sail these turbulent waters, we build capacity to govern and sustain the national and regional HIV response. There is the need to invest in health financing systems to ensure that the limited resources are managed wisely. Despite these challenges, we have to continue to push for increased domestic funding. Additionally, data continues to be a challenge; we have to look for ways for improving data use for planning, resource allocation and efficient service delivery models that can withstand COVID-19 and other emerging challenges.

Priority Areas Coordinating Committee (PACC) convenes virtual meeting to discuss the continuity of HIV services during COVID-19

Wednesday, 24 June 2020 (PANCAP Coordinating Unit, CARICOM Secretariat): The Pan-Caribbean Partnership against HIV and AIDS (PANCAP), the mechanism that provides a structured and unified approach to the Caribbean’s response to the HIV epidemic continues to examine strategies to sustain the HIV and AIDS response in the Caribbean region despite disruptions from the ongoing COVID-19 (Coronavirus) pandemic.

The 39^th Meeting of the Priority Areas Coordinating Committee (PACC), the PANCAP governance body that focuses on coordinating regional priority areas plans, was convened 23 – 24 June 2020 under the chairmanship of Dr Donald T. Simeon, Professor of Biostatistics and Research, Faculty of Medical Sciences, The University of the West Indies, St Augustine, Republic of Trinidad and Tobago.

The PACC received updates from the Director, PANCAP, Dr Rosmond Adams on the work that the Partnership has implemented to respond to COVID-19 and sustaining the HIV response. Dr Adams stated that it is critical especially at this time to ensure the continuity of care in the region and to advocate for maintaining the gains as the Region works towards the UNAIDS 90-90-90 Targets and ending AIDS.

Dr Shanti Singh-Anthony, Coordinator, Knowledge Management, PANCAP Coordinating Unit, provided an update on the knowledge management, marketing and communications initiatives implemented by PANCAP in response to COVID-19. She highlighted that the PANCAP Knowledge Management hub continues to share information and guidelines to support National AIDS Programmes and Civil Society Organizations in service delivery and mitigating the impact of COVID-19.

The PACC also received updates from the various Technical Working Groups (TWGs). Ms Curvelle David, Senior Project Officer, Monitoring and Evaluation (M and E), Strategic Management Unit, CARICOM Secretariat, provided an update on the Regional M and E TWG on Health. She emphasised the need to strengthen data collection and the use of information to guide strategic action to strengthen the regional response.

The meeting also received updates from the Policy and Strategy Working Group on Stigma and Discrimination. Mr Lucien Govaard, Vice-Chair, outlined how the lessons learned from HIV and AIDS can be translated to supporting the COVID-19 response in tackling issues around stigma and discrimination.

Mr Kevin Mendez, Chair, PANCAP Regional Youth Advocacy Steering Committee for the implementation of Regional Youth Advocacy Framework on Sexual and Reproductive Health Rights, reported on initiatives by youth leaders to engage the region’s young people on issues related to HIV and COVID-19. The activities included capacity building and training on HIV prevention and supporting COVID-19 issues.

The meeting also received updates from key partners including the Pan American Health Organization/World Health Organization (PAHO/WHO), the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), the Joint United Nations Programme on HIV/AIDS (UNAIDS), the Caribbean Public Health Agency (CARPHA) and The University of the West Indies (UWI).

The PACC noted the challenges faced by the region including prevention services, treatment, care and human rights-based issues. The PACC committed to engaging with policymakers on support for the regional response, including increasing domestic funding for national HIV programmes. The PACC also pledged support for documentation of the progress and best practices in the Region and to advocate for strengthening supply chain management to minimise interruption in the availability of antiretrovirals (ARVs) and other commodities for the Region.

The PACC also noted that safeguarding providers and clients from COVID-19 is critical and supporting safe and sustained HIV service must continue with a focus on Key Populations.

– ENDS –

Contact:

Timothy Austin

Senior Project Officer, Communications

PANCAP Coordinating Unit

CARICOM Secretariat

Turkeyen, Greater Georgetown, Guyana

Email: taustin.consultant@caricom.org

Tel: (592) 222-0001-75, Ext. 3409 | Visit www.PANCAP.org

Helpful links:

Global AIDS Update 2018 – Miles to Go

https://pancap.org/pancap-documents/global-aids-update-2018-miles-to-go/

Caribbean Regional Strategic Framework on HIV and AIDS (CRSF) 2019-2025

https://pancap.org/pancap-documents/caribbean-regional-strategic-framework-2019-2025/

What is PANCAP?

PANCAP is a Caribbean regional partnership of governments, regional civil society organisations, regional institutions and organisations, bilateral and multilateral agencies and contributing donor partners which was established on 14 February 2001. PANCAP provides a structured and unified approach to the Caribbean’s response to the HIV epidemic, coordinates the response through the Caribbean Regional Strategic Framework on HIV and AIDS to maximise efficient use of resources and increase impact, mobilises resources and build capacity of partners.

Editor’s Notes

What are the Joint United Nations Programme on HIV and AIDS (UNAIDS) 90-90-90 Targets?

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 antiretroviral therapy.
By 2020, 90% of all people receiving antiretroviral therapy will have viral suppression.

NAP Managers and CSOs urged to use COVID-19 as an opportunity to advance the HIV gains for the Caribbean

Monday, 22 June 2020 (PANCAP Coordinating Unit, CARICOM Secretariat): The Pan-Caribbean Partnership against HIV and AIDS (PANCAP), the mechanism that provides a structured and unified approach to the Caribbean’s response to the HIV epidemic, convened a virtual three-day meeting of National AIDS Programme (NAP) Managers, Civil Society Organisations (CSOs) and Key Partners, 16 – 18 June 2020 to discuss the challenges and strategies that are being implemented in the region to respond to the disruption of services posed by the ongoing COVID-19 (Coronavirus) Pandemic.

The meeting examined the challenges experienced by the region in the delivery of services for HIV and AIDS in the context of COVID-19, the sustainability of the regional response amidst decreasing donor funding and the critical role of civil society in supporting the continuity of care and reaching Key Populations.

Ms Victoria Nibarger, PEPFAR Coordinator, Caribbean Regional Program, Office of the Global AIDS Coordinator and Health Diplomacy (S/GAC), Jamaica stated that as the Region experiences unprecedented times with the COVID-19 pandemic, the NAP Managers and Key Partners Meeting is more important than ever, as it will enable the exchange of vital information and learning for the dual pandemics. She commended the PANCAP team for providing leadership at an incredibly challenging time. She highlighted that this ability to adapt and forge ahead has been “truly impressive”.

In his remarks, Director of PANCAP, Dr Rosmond Adams highlighted the critical need for National AIDS Programme (NAP) Managers and Civil Society Organisations to share knowledge and innovations which are essential for the continuity of HIV services during the COVID-19 Pandemic. He thanked the participants for committing to the meeting and stated that he was pleased that PANCAP could provide the virtual platform essential for knowledge sharing about HIV and COVID-19. He further called for the exploration of new and innovative strategies and greater collaboration among governments, civil society, private sector and community-based organisations with the overarching aim of ending AIDS in the region.

The meeting received updates from Member Countries and Civil Society Organizations on the work that they are doing to respond to the disruptions and to sustain national responses. Ms Aldora Robinson, Director of the Health Promotion and Advocacy Unit within the Ministry of Health, Agriculture and Human Services, Turks and Caicos Islands and the National AIDS Programme Managers Representative on the PANCAP Governance Bodies stated that while these are unprecedented times, there are lessons learnt from the HIV response that can be applied to the COVID-19 response.

She underscored that the gains made in the HIV response could easily be reversed unless urgent efforts are made to sustain the progress made thus far. She stated, “while it may seem that we are at risk of losing momentum in the HIV and AIDS response let me assure you that if we continue to do what we have always done including sensitization of vulnerable groups, collation of statistics, instituting preventative measures, administering treatment, putting people at the centre and strongly engaging our civil society, we will get through this unpredictable and highly dynamic situation.”

The meeting encouraged countries to continue to manage health resources wisely considering the numerous challenges faced by the region and to push for increased domestic resources for health and HIV responses as we move to end AIDS as a public health threat. Countries were encouraged to strengthen multisectoral collaboration, implement sustainability plans and to increase the use of data to guide strategic actions that will advance towards the UNAIDS 90-90-90 Targets.

The PAHO Subregional Program Coordinator for the Caribbean, Ms Jessie Schutt-Aine underscored that the COVID-19 pandemic has created new challenges in the HIV and STI response. She stated, “COVID-19 has created unprecedented conditions that hinder the capacity of many health systems to access COVID-19 related supplies but also other essential medicines, due to country lockdowns, travel restrictions, fragmented funding sources, and increased costs for certain commodities. A recent study done by PAHO’s Strategic Fund has found that many countries in the Caribbean region are at imminent or high risk of stock out of essential medicines for HIV, STI, TB and other essential medicines. This calls for the need to strengthen supply chain systems, including forecasting in the region”.

She highlighted that PAHO in collaboration with CARICOM and in support of Member States has been focusing on pooled procurement for essential COVID-19 items.

Dr James Guwani, UNAIDS Caribbean Sub-regional Office Director, highlighted that HIV stakeholders bring to the COVID-19 challenge almost forty years’ worth of experience and wisdom in responding to a pandemic. He stated “this is what we know: Testing and treatment on their own will not ensure we combat either COVID-19 or HIV. Community involvement and investment are vital to building trust and getting results. There must be responsiveness to the lived realities, needs and vulnerabilities of all people, especially the most marginalised. And we have to embrace big, bold targets if we are to super-charge our response.

The role of Civil Society Organizations was also underscored as they play a critical role in working at the community level to reach those most in need and to attend to the psychosocial needs of People Living with HIV. Dr Adams noted that civil society is key at getting to the core of the epidemic and that they should be supported and must have an equal seat at the table as a vital stakeholder in the fight against HIV and AIDS. He reiterated the presentation made by Mr Ivan Cruickshank, Executive Directors, Caribbean Vulnerable Coalition (CVC) that civil society must not be an “add-on” but should be an integral part of the multisectoral response.

The PANCAP Director in closing the meeting reminded participants that the work will continue and must continue and that we should not allow COVID-19 to make us push the pause button but to be a reason for us to fast forward and push for progress in the region. He further emphasised that we cannot speak about regional health security if we do not work towards ending AIDS by ensuring that there is a strong regional response to HIV and other communicable diseases.

Mr Winfield Tannis, HIV and AIDS Advocate, lit a candle to recognise the work that has been done throughout the region and to pay tribute to those who have died from AIDS. He also explained that the candle lighting was also meant to pay homage to those working in the field of HIV and AIDS and to encourage them to continue with efforts to achieve the 90-90-90 Targets and ending AIDS by 2030.