What can be done to end AIDS?
Kingston and St Andrew (KSA) is among 30 metro-politan regions - the only one in the Caribbean - with a high proportion of people living with HIV (PLHIV) in one city. Collectively, these 30 areas account for 80 per cent of all new infections.
According to the Fast Track Cities Report (2014), "In many countries outside of sub-Saharan Africa, such as Brazil, Jamaica, and the Russian Federation, cities are home to more than half of all people living with HIV nationally." One in every 34 person in the city is living with HIV. Therefore, KSA accounts for 64 per cent (or 19,494 of the 30,313) of PLHIV in Jamaica.
The data is compelling. It urges us to implement evidence-based science and social and behaviour change interventions - not warped values and ill-informed programmes - and provide antiretroviral drugs (ARVs) to reduce new infections, AIDS-related deaths, and stigma and discrimination. Now is certainly not the time for our narrow-mindedness to take precedence over people's lives.
At the end of 2013, a total of 236,583 HIV tests were done and 22,800 (or 75 per cent) of PLHIV were aware of their HIV status. This a marked increase from 50 per cent in 2010. In addition, 9,747 (or 32 per cent) of them have been retained in care. Worryingly, while in excess of 43 per cent are on antiretroviral therapy (ART) only 3,701 (or 12.2 per cent) have achieved viral suppression. Since the introduction of ARVs in 2004, there has been a 76 per cent reduction in AIDS mortality.
Research shows HIV treatment is critical if there is to be an end to AIDS. Elly Katabira (2011), the president of the International AIDS Society (IAS), notes: "People living with HIV who adhere to an antiretroviral therapy regimen almost always achieve undetectable viral loads - the amount of virus in a body fluid such as blood, semen or vaginal secretions - at certain stages of their treatment. When the viral load is undetectable, the risk of HIV transmission is significantly reduced."
The situation begs the question of what can be done to end AIDS. A significant number of the treatment sites - about 10 out of 21 - that provide ART are in KSA, but is this enough given more than half of all PLHIV are in the city? Are our current efforts, including resource allocation, enough to ensure that by 2020, ninety per cent of PLHIV know their HIV status, 90 per cent of all people with diagnosed HIV infection will receive sustained ART, and 90 per cent of all people receiving ART will have viral suppression (UNAIDS).
We will have to make some uncomfortable decisions. We will have to spend less on the general population that is at low risk of HIV transmission and invest in key populations such as homeless drug users, men who have sex with men, prisoners, and sex workers, where the epidemic is concentrated. More of us will have to get involved in the HIV response. All stakeholders will have to understand and appreciate that a successful response to the HIV epidemic requires investment where the epidemic is most concentrated.
I commend Minister Fenton Ferguson and Permanent Secretary Dr Kevin Harvey for their continued leadership. I am especially pleased with the efforts of Mayor Angela Brown Burke and Councillor Andrew Swaby, who tabled a motion on Tuesday, December 9 for a resolution to be passed for the Kingston and St Andrew Corporation to play a greater role in the HIV response.
We desperately need to ensure more people are aware of their HIV status, the number of patients being linked to and then retained in care is of a higher standard and quality, and more persons are on antiretroviral therapy with better levels of viral suppression for patients to benefit from the clinical and preventive impacts of the treatment.
There is no justification for our skirting around the issues at hand - particularly those so-called sensitive ones such as human rights. Let us stop pretending some of us are invincible to HIV transmission or that it only affects 'that group' (read gays) and people who are promiscuous. Likewise, it is pointless to act as if there is absolutely no need to educate our adolescents about sex and sexuality or provide them with access to condoms and lubricants because schools are not rompin' shop. Time and the statistics cannot accommodate our pussyfooting.