The heavy co$t of AIDS - With global funds to dry up, Jamaica in peril
Byron Buckley, Contributor
CARIBBEAN AIDS prevention advocates fear that crucial funding to sustain hard-won gains over the last decade could dry up by year end. Financial support from the Geneva-based Global Fund could cease because Jamaica and other Caribbean states, having been classified as 'middle-income' countries, no longer qualify as recipients of funding.
In addition, a South-South agreement between the Organisation of Eastern Caribbean States (OECS) and Brazil, which facilitates universal access to antiretroviral drugs to treat HIV/AIDS, comes up for renegotiation later this year.
Faced with this spectre, Dr Edward Greene, United Nations special envoy for HIV in the Caribbean, says the world body will be working with Jamaica and other countries in the region to protest the 'middle-income' designation and secure its reversal.
Warns Greene: "With Jamaica experiencing its current level of financial constraints and renegotiating its debt with the International Monetary Fund, we are concerned about the possibility of the country being forced to suspend its social programmes. It would be catastrophic, in particular, for people living with HIV (PLHIV), if a withdrawal of support were to take place."
The UN envoy flays the World Bank's flawed study, based on income, which resulted in Jamaica's reclassification. He notes: "Income does not tell you the burden of debt nor disease."
It is the easing of the burden of HIV/AIDS on Caribbean societies that Greene and fellow advocates wish to sustain. A cessation of funding would threaten the fragile gains made in the Caribbean over the last decade. From 2001-2009:
- The number of AIDS-related deaths declined by 9,000;
- The number of new HIV infections decreased by 3,000;
- The number of PLHIV in Haiti and Guyana declined;
- The number of PLHIV in Jamaica remained the same;
- Adult HIV prevalence rate declined in Jamaica, Haiti and Guyana;
- Adult HIV prevalence remained stable in Suriname, the Dominican Republic, and The Bahamas.
In addition to these positive trends, Greene has high praise for Jamaica's efforts to ramp up its HIV response. "It is obvious that Jamaica is on the path to the elimination of mother-to-child transmission by 2015, and that the Caribbean, as a whole, can aim to be the first region in the world to achieve this goal," he says.
The OECS could eliminate mother-child HIV infection by 2015. Fifty per cent of people in the Caribbean have access to antiretroviral treatment (ART) drugs, 70 per cent in Guyana, and universal in Barbados.
But challenges remain in the regional efforts to control the spread of HIV/AIDS. Overall, between 2001 and 2009, the number of PLHIV increased by four per cent, including in Cuba, Jamaica's nearest neighbour. During the same period, the HIV adult prevalence rate increased in four Caribbean countries: Barbados, Belize, Trinidad and Tobago, and Cuba.
One area of grave concern in Jamaica is the 30 per cent HIV prevalence among gay men. This is among the highest in global terms, and is followed in the region by Trinidad and Tobago (20 per cent), Dominican Republic (11 per cent), and The Bahamas (10 per cent). Overall, the Caribbean, with an adult HIV prevalence rate of one per cent, is ranked second to Africa (five per cent). This makes the Caribbean anomalous in the Americas, where the adult/HIV prevalence is 0.5 per cent in both Central/South America and North America/Mexico.
Indeed, any reversal of the gains from the Caribbean's HIV/AIDS prevention programme would give a black eye to the optimism that characterises the global outlook on the status of the epidemic. Over the last 10 years, there has been a decline in mortality rates for HIV/AIDS across the globe. The mortality rate is down because more people have access to medication.
Greene explains: "Having access to antiretroviral drugs is a lifesaver because it allows people to live a very active and normal life. In the Caribbean, we can almost safely say we can eliminate the disease. I think we are in a more optimistic position than we were 10 years ago."
His optimism is also based on developments in medical science of formulas to eventually eliminate HIV/AIDS, just like what occurred with smallpox and polio in the 1980s. This upbeat posture, perhaps overblown, is also reflected in UNAIDS's goals of getting to zero by 2015:
- Zero AIDS infection
- Zero AIDS-related deaths
- Zero discrimination
- Eliminating discrimination
Lifting the burden of the disease, importantly, involves the elimination of discrimination against PLHIV. Discrimination is considered an important driver of HIV infection rate, according to health advocates, because people refuse to be tested. Studies carried out in the OECS by the Caribbean HIV/AIDS Alliance found that even among medical practitioners, there was the perception of stigma. This often leads to some form of discrimination, - giving more legs to the disease because people don't want to go to the clinic.
Commenting on the hot-button issue in Jamaica of repealing the buggery law, the UN envoy says it is secondary to addressing discrimination and promoting human rights in general.
"For me, that (repealing the buggery law) is not the main problem. The main problem we are dealing with is the human rights, generally speaking," he reasons. "People are entitled to access care, because if they don't, that could affect society on a whole."
Greene believes the State has an obligation to protect citizens on a whole to ensure that people with communicable diseases have access to care and treatment.
He reasons: "If I put the accent on reducing stigma and discrimination and human rights, I am ensuring that there is no overt discrimination for PLHIV in the workplace and in the school. This is because I don't want to exclude one per cent of the population, or 30 per cent of men who have sex with men (MSM), from having access to those things that other people have. Just like how I would not exclude people from certain services because of their race, gender or where they live - as happens to job applicants living in inner-city communities."
According to the UN envoy, it is important that PLHIV have certain responsibilities - to go and get tested, to adhere to their regime of treatment, to ensure that they educate their family and friends.
"So homosexuals have the right to health care," Greene argues, "but they also have to behave in particular ways to conform to the norms of the communities. If they expect to be treated a certain way, they can't behave in ways that are subversive to the community." For example, he notes, members of the homosexual community should not "prey on young, vulnerable boys". They must act responsibly, thus balancing the human rights structure.
The goals of zero infection, deaths and discrimination require the involvement of the faith-based community. Greene is hopeful that after recent consultations with local church leaders, they will be able to adopt a message of abstinence, faithfulness to one's partner and condom use. He points to the role played by faith-based organisations in East Asian societies in producing the lowest HIV/AIDS prevalence rate of 0.1 per cent per population.
"Notwithstanding its religious tenets, East Asia promoted safe sex as a practice for a fairly long time. It has not allowed its religious precepts to get into the way of practical sexuality.
"This is one reason we are seeing the very low prevalence rate, overall," Greene observes.
The situation in East Asia contrasts with what obtains in the Caribbean where family life is breaking down; sexual promiscuity is rampant; and communities foster a culture of fear that leaves young girls vulnerable to sexual predators.
Of course, per capita income is quite high in East Asia, and the level of poverty there does not compare with prevalence rates in India and South/Southeast Asia.
Greene points out: "We have to see AIDS also as a development issue. Enhancing development could impact positively on AIDS outcome."
He was in Jamaica to discuss a number of issues with governmental and non-governmental organisations, particularly surrounding human rights and HIV, as well as the financial sustainability of HIV programmes. As a result of these discussions, it has been agreed that Jamaica will hold a national consultation on human rights and the reduction of stigma and discrimination on World AIDS Day, December 1, 2012.
Low HIV prevalence in East Asia linked to:
- Religious and family patterns;
- Historical cultural mores, spiritualism;
- Less multiple partners in sex;
- Greater degree of abstinence before marriage;
- Higher degree of faithfulness to partners