The Caribbean can build on the gains of its HIV responses to end AIDS as a public health threat. A new global HIV report released today ahead of World AIDS Day, “Focus on Location and Population”, demonstrates the value of targeting the people and places with the highest HIV risk as part of an approach to dramatically reduce HIV transmission.
At the centre of the strategy is new science which shows that early and full HIV treatment reduces the risk of HIV transmission by 96%. The next five years present a window of opportunity to scale up HIV testing and treatment. The new 2020 targets adopted by the region are known as 90-90-90.
Specifically, countries will aim to ensure that 90% of people living with HIV know their status; that 90% of those diagnosed with HIV are placed on treatment and that 90% of those on treatment achieve viral suppression. “Viral suppression” means that the level of HIV in the blood is so low that health outcomes improve while the risk of transmission dramatically declines.
The Caribbean can achieve these ambitious targets. Since 2000, new infections in the region declined by 50%. In the last ten years alone the Caribbean achieved a 61% reduction in AIDS-related deaths. Additionally, following the success of Cuba, several Caribbean countries are on track to be validated as having eliminated HIV transmission from mothers to children by 2016.
All these gains are linked to improvements in HIV testing and treatment. Based on the new World Health Organisation guidelines for initiating patients on antiretroviral medicines immediately after diagnosis, treatment coverage for the region is 44% for adults living with HIV and 36% for children. By scaling up efforts to test and treat, the 90-90-90 targets are achievable.
Leave no one behind
The new UNAIDS report emphasises that in order to dramatically reduce new HIV infections and deaths due to AIDS, we must rethink and renew efforts to eliminate stigma and discrimination. Strategic efforts are required to reach those who are most vulnerable, where they are. The report identifies five groups relevant to the Caribbean that require intense investments and efforts—adolescent girls and young women, gay men and other men who have sex with men, transgender people, sex workers and prisoners.
During his mission to the region earlier this month, UNAIDS Executive Director, Michel Sidibé, stressed the importance of addressing not only the prevention and HIV treatment needs of girls, but also the need for increasing social protection. Education, keeping girls in school and addressing gender-based violence are all key ingredients to reducing the disproportionate HIV risk borne by girls.
Young women in the Caribbean are two to three times more likely to be living with HIV as young men. This is partially explained by the early sexual debut among young women in the Caribbean and the prevalence of intergenerational sex involving younger females and older male partners.
“We need to ensure that our programmes can reach girls where they are and address their concerns. That is not resolved with pills. The problem is structural. We need to have courage to remove boundaries… make sure people should no longer accept gender inequality or the social construction that if I am the man I can abuse women as I want,” Sidibé said.
Targeted efforts are also needed to address key populations. HIV rates among men who have sex with men vary throughout the region but are well documented to be between six and 20 times higher than that of the general population.
“Those groups are very vulnerable,” he said. “We know that when we discriminate they will hide themselves and they will not have access to services. Some of them will have relationships with women and infection goes on to the general population. Justice for all is key if we want to achieve the goal of breaking backbone of the epidemic.”
Sidibé urged increased investments and collaboration with civil society and the faith-based community aimed at reducing prejudice and providing services to hard-to-reach communities.
“It is very clear that the traditional service approach will not work. We need to bring all these partners around the table. We will never reach all people where they are if we do not reduce stigma and discrimination. There is no way to do it without compassion… without realising that any life lost because people do not have access to services is unacceptable,” he ended.