More discussions and decision making needed in the fight against HIV and AIDS in the Caribbean

“There is still a long way to go before HIV and AIDS are under control in the Caribbean. Nonetheless, there is some cause for optimism.”

This was the view of Dr. Patricia Michaèle Amédée Gédéon at the recent launch of the Caribbean launch of the 2008 World Disasters Report which took place in Port-au-Prince, Haiti on June 26.

She explained that there are several success stories in the region: “take Haiti’s failing HIV prevalence, Cuba’s 100 percent treatment coverage, or the progress made in preventing mother to child transmission in Barbados. On top of this, continued support from international agencies will make a big difference in coming years. The involvement of such groups has encouraged political leaders to speak out more about HIV and AIDS.”

Dr Gédéon said these successes should be celebrated, but it is important that the severity of the Caribbean’s epidemics is not overlooked. Both within the Caribbean and amongst the international community, a greater level of discussion and decision-making is needed to fight the spread of HIV in the region.

The focus of this year’s World Disasters Report was HIV and AIDS and it highlighted the need for humanitarian organisations, working in partnership with governments and local communities, to increase the scale and scope of programmes for HIV prevention, treatment and care, and for tackling the associated stigma and discrimination.

According to UNAIDS, almost seven thousand people contract HIV every day – and without a major change in the epidemic’s trajectory, AIDS will claim millions more lives. Since 1981, more than 25 million people have died of AIDS, and some 33 million are currently living with HIV.

The Caribbean launch took place in Haiti this year because of its high HIV and AIDS rate and was a joint effort of the Haitian Red Cross and the Caribbean regional representation office of the International Federation of Red Cross and Red Crescent Societies (International Federation).

Different approaches have been taken to preventing HIV in the Caribbean. Some programmes have achieved significant success but the barriers of poverty and insufficient resources continue to limit HIV prevention throughout the region.

It is difficult to give an overall assessment of how successful HIV prevention has been in the Caribbean, but examples of the Red Cross’ “Together We Can” (TWC) and voluntary counseling and testing programmes as well as preventing mother to child transmission and the promotion of condom use and HIV and AIDS education in schools and other institutions give some indication of the achievements that have been made in certain areas.

Dr Gédéon added that HIV related stigma and discrimination are also extremely common in the Caribbean. “It is generally acknowledged that stigma and discrimination are helping to fuel the HIV epidemics of Caribbean countries. Some progress is being made in overcoming this problem, particularly through the work of organizations of people living with HIV and non-governmental organizations that work with vulnerable populations.”

Rafeal Olaya, the International Federation’s regional representative for Haiti, Dominican Republic and Cuba noted that HIV is a disaster on many levels.

“In the most affected countries development gains are reversed and life expectancy halved. For marginalised groups across the world – injecting drug users, sex workers and men who have sex with men – rates are on the increase.

Yet they often face stigma, criminalisation and little, if any, access to prevention and treatment services. “Natural” and human-made disasters disrupt basic services, exacerbate other drivers of the epidemic, and can increase people’s vulnerability to HIV infection. People living with HIV are among the groups most vulnerable in disaster and crisis situations.”

Since countries in the Caribbean face common problems, and resources are limited, the need for a co-ordinated response to HIV and AIDS has long been recognized. Some strong responses have been formed on a local level too. Most nations developed National AIDS Commissions, strategic plans, legislation and HIV related programmes and services.

However, since most countries in the region are limited by poor infrastructure and fragile economies, acting out these responses have been difficult. Political leadership has also been varied.

Many Caribbean islands are heavily dependent on tourism, and in some areas officials are reluctant to draw attention to the problems of AIDS for fear that this might discourage visitors.

“This is exactly what happened to Haiti in the early 1980s, when it was established that a number of early cases of HIV in the United States had occurred among Haitian immigrants. Since AIDS had only recently emerged, people were quick to associate this new problem with Haiti,” explained Dr Gédéon.

Despite differences between countries, the spread of HIV in the Caribbean has taken place against a common background of poverty, gender inequalities and a high degree of HIV related stigma.

Migration between islands and countries is common, contributing to the spread of HIV and blurring the boundaries between national epidemics. Additionally, poor availability of HIV and AIDS data makes it difficult to gain a clear picture of each country’s situation.

Apart from launching the World Disasters Report the opportunity was also taken to recognize the contributions of Haitian Red Cross volunteers who went beyond the call of duty during last year’s Hurricane Dean operation.

Dr Guiteau Jean Pierre, executive director, Haitian Red Cross said without the help of volunteers many of there programmes would suffer significantly since they do not have the resources to hire paid staff.

“Volunteers are at the heart of our organization and every year with every disaster whether it be hurricanes or flooding they always show their dedication by helping others despite being affected themselves. It is for this reason why it is so important that we recognize their efforts and contributions no matter how small it may be. The Red Cross cannot survive without the hard work and dedication of its volunteers.”