From left, Ian McKnight, of Jamaica AIDS Support and Yitades Gebre, MoH senior medical officer.Patricia Watson, Senior Staff Reporter
THE MINISTRY of Health and some non-governmental organisations are concerned that HIV-positive persons deported from the United States are unable to continue their treatment and may be a contributing factor in the emergence of drug-resistant strains of HIV in Jamaica.
"Several people deported turn up with only papers saying they are HIV-positive. Sometimes if they are on medication it is only for a few days," Ian McKnight of the Jamaica AIDS Support told The Sunday Gleaner.
He explained that in many instances no provision is made to continue treatment and in some cases they do not have family to care for them.
Carol Charlton, of the Immigration and Passport division, supported this claim.
"We do get cases, some are extremely bad cases and are on medication. We usually consult with the Ministry of Health in these cases. Relatives are usually not too keen to take them in based on the stigma associated with HIV," she said.
The Economic and Social Survey, Jamaica 2002, notes that in 2001, approximately 2,529 persons were deported, 55.8 per cent from the United States and 30.2 per cent from the United Kingdom. Of the 2,529 deported, 719 were illegal aliens, 129 had false documents and more than a half were drug felons. Since the start of the year, approximately 40 persons are deported weekly and in the last 12 years, 17,760 persons were deported with 765 coming from the UK. No data is available on the actual number of deportees who are HIV-positive.
"I can't say the proportion of HIV-positive persons who have been deported. Prisoners do have a higher risk of contracting HIV, but I cannot give the figures," said Dr. Yitades Gebre, senior medical officer in the HIV/STI Control Programme at the Ministry of Health.
However, in a report entitled 'The Health Status of Soon-to-be-released Inmates' and presented to the US Congress earlier this year, it is estimated that in 1996 inmates released from prisons in the US accounted for 17 per cent of AIDS cases and between 13.1 and 19.3 per cent of HIV cases. The report said an estimated 98,000 to 145,000 HIV-positive inmates were released in 1996. In 1997, a further 35,000 to 47,000 inmates were infected with HIV.
What is of concern for persons in Jamaica who work with those living with HIV is that treatment is provided free when the persons deported were in prison. However, once they are deported this treatment stops and many may not be able to continue the regimen they were on prior to deportation.
"There is no tracking system in place. We have been able to assist some in accessing support, but once they get into the system, they may very well be contributing to the spread of the infection," Mr. McKnight noted.
This is also a concern for the Ministry of Health.
"These are normal human beings like us and have sexual urges. Based on stigma, they may engage in unprotected sex and transmit the infection," Dr. Yitades Gebre stated.
He explained that if the individuals were on medication and stopped, or were taking it improperly, then they may pass on forms of HIV which are drug-resistant. It is not known what percentage of new HIV/AIDS cases this year is drug-resistant.
"We don't do drug resistant tests," Dr. Gebre said. He, however, noted that any HIV/AIDS/STI may face 20 to 30 per cent drug-resistant strains in a year.
Dr. Gebre, however, did not feel there is need to track persons deported with HIV.
"We don't know where they are. They are citizens of Jamaica who once deported, are assimilated and they go about their normal lives. We don't do any surveillance, there is no need to do that. I personally believe we need to have guidelines on how to provide care for these individuals. If these individuals re-enter and settle in Jamaica, definitely, we have to address their health needs," Dr. Gebre said.
He explained that the Ministry of Health cannot establish a new programme specifically for deportees. Instead they will have to access counselling, condoms and treatments for opportunistic infections in the normal health sector.
"We do not track social backgrounds in our surveillance programme, we have not started analysis yet. This is a priority for future treatment programmes. In the near future when anti-retrovirals are made available, it will be important for us to know what treatment they were on," Dr. Gebre stated.
