The Status Of The HIV Epidemic In The Caribbean: Implications for research, surveillance and priority setting at country level

Morris Edwards-PANCAP Coordinating Unit (PCU)Franka Desvignes-Caribbean Health Research Council (CHRC)

Nassau, The Bahamas, 18 November 2011

Presentation Outline

• Context of the report

• Characteristics of the Caribbean epidemic at

end of 2009

• Regional trends in the last decade

• Implications for regional research

• Summary of epidemic

• Conclusion

Context of the report

PANCAP 10th AGM targets (2015)• Reduce new HIV infections by 50%

• Elimination of Mother To Child

Transmission Of HIV

• Increase access to care, treatment and

support to 80%

• Accelerate the agenda to achieve human

rights for persons living with HIV

Characteristics of the Caribbean epidemic at

end of 2009• Prevalence varies from 0.1% (Cuba) to 3.4%

(Bahamas), averaging 1.1%• The Caribbean continues to be the second most

affected region• An estimated 240,000 PLH in the region• Vast majority (83%) of PLH were in four countries• Haiti, The Dominican Republic, Jamaica, Trinidad and

Tobago

• Gender distribution

varies

• Equal in Guyana

• More males- Barbados,

Cuba, Suriname,

Trinidad & Tobago

• More females –

Bahamas, Belize, Dom.

Republic, Haiti

HIV by Gender by country (UNAIDS 2010)

Characteristics of the Caribbean epidemic... • Most affected age group: - 15-24,

prevalence varying from 0.02% (Cuba) to

3.2% (Bahamas).

• Most at risk populations have prevalence

significantly higher than in general

population

• MSM - 6.7% (Suriname) – 32% (Jamaica)

• FSW – 4.8% (Dom. Republic) – 24%

(Suriname)

Regional trends in the last decade• Belize, the DR, Jamaica, Suriname

have demonstrated a 25%

reduction in new HIV infections

• PMTCT coverage has increased

from <30% - almost 60%

• ART coverage has seen an

almost 7 fold increase• Retention on ARV at 82%

• Increased life expectancy of

PLH 9,842 18,393 24,19337,595

49,09162,238

0

100,000

2004 2005 2006 2007 2008 2009

ART coverage 2004 – 2009 (WHO 2010)

PMTCT coverage 05 - 09

• Despite the increase in HIV-related data available from annual and biannual reports, many research questions remain unanswered

• HIV research in the Region needs to be prioritized, supported and strengthened

Implications for research

• In 2011, CHRC developed the Health Research Agenda for the Caribbean guided by Caribbean Cooperation in Health (CCHIII) adopted by the CARICOM Ministers of Health

• Inclusive process

• HIV/AIDS, STIs and Tuberculosis – A sub-priority of Communicable Diseases Area

Health Research Agenda for the Caribbean

• HRAC # 1. Adherence with Anti-retroviral Treatment• PANCAP Focus Area 3: Increased access to treatment to 80%

• HRAC # 2. Evaluation of prevention programmes • HRAC # 4. Prevention in most-at-risk populations

• PANCAP Focus Area 1: 50% reduction in new HIV infections• PANCAP Focus Area 2: Elimination of mother-to-child t-mission

• HRAC #12. Stigma and discrimination in HIV• PANCAP Focus Area 4: Accelerate the agenda to reduce stigma and discrimination

HIV/AIDS, STI, Tuberculosis Research Priorities

• In 2011, CHRC produced a report “Status of Monitoring and Evaluation in the Caribbean”

• Using the 12-components approach

• Evaluation and Research being one of the 12 required components

National HIV Evaluation and Research Agendas

Successes:• The Caribbean Research Agenda has been

adopted by CARICOM Health Ministers

• Building of research and M&E capacity

• Growing recognition of value of M&E

• Large number of HIV papers published and

presented at CHRC annual meeting

HIV Evaluation and Research Agenda

Challenges: • Updating the comprehensive inventory of HIV research and evaluation studies conducted in the region

• No clear structure for disseminating and using information generated from various research and evaluation studies carried out in the Caribbean.

• Unclear how these results influence policy and programmes, if at all

HIV Evaluation and Research Agenda

• Many areas of research required to deepen our understanding of the epidemic

• Challenges of funding and human resources

• Need for increased coordination and effective partnerships at the regional level (e.g. RHIs, Universities, PANCAP, NGOs)

Towards 2015

• Critical for a regional research strategy to be implemented

• Research translated into policy

• Interface between research and policy needs to be strengthened

Towards 2015

Summary• Epidemic has at least stabilized, reversing in some countries• Four countries bear the brunt of the epidemic• Greater burden of disease in teens and young adults• MARPs more disproportionately affected than the general population• Successes in areas of

• PMTCT• Reducing mortality by increasing access to care and treatment and retention on ARV.

• Engagement of researchers and funding agencies critical to implementing research projects

• Research and M&E crucial to making progress in the four focus areas: Reduction in new HIV infection; Elimination of mother- to-child transmission; increased access to treatment; and, reducing stigma and discrimination.

Conclusion