Richard Amenyah | Progress to end AIDS in the Caribbean stagnant

Over four decades, the Caribbean has made remarkable progress against HIV, but structural inequalities and funding cuts by international donors, threaten to stall our momentum. The recently published UNAIDS Global AIDS Update: AIDS, Crisis and the Power to Transform, shows the impact the cuts are having globally with 4.4 million children protected from acquiring HIV since 2000 and more than 26 million lives saved. If the world does not act now, UNAIDS estimates there will be six million new HIV infections and four million AIDS-related deaths by 2029.

In the Caribbean, treatment advances coexist with stagnant prevention. The evidence shows there are multiple challenges faced by those living with HIV and at risk of acquiring HIV such as long waiting times, busy work schedules and stigma, discrimination, as well as lack of human rights protections that continue to impede the achievement of progress toward an HIV free generation and to end AIDS as a public health threat by 2030.

TREATMENT GAINS, PREVENTION STALLS

The Caribbean’s HIV response showcases significant successes. From 2010 to 2024, AIDS-related deaths dropped by 62 per cent, fuelled by expanded treatment access across the region. In 2024, 85 per cent of the 340,000 people living with HIV know their status, 74 per cent are on treatment, and 66 per cent are virally suppressed—up from 33 per cent in 2017. Eleven Caribbean countries are among the 18 globally validated for eliminating mother-to-child transmission of HIV and syphilis, reflecting robust health systems across the region. These public health milestones demonstrate the region’s capacity for impact when political will and resources align. Yet, HIV prevention is faltering. New infections have declined by only 21 per cent since 2010, from 19,000 to 15,000 annually, far below the global average of 40 per cent.

The report underscores the disproportionate burden on marginalized groups. Young people aged 15–24 account for 25 per cent of new infections, limited by inadequate access to youth-friendly prevention services. Key populations face even higher risks: HIV prevalence among men who have sex with men exceeds 10 per cent in four of five reporting countries, reaching over 25 per cent in two, while transgender women face rates up to 60 per cent, compared to 1.2 per cent among the general adult population. Children lag significantly behind, with only 45 per cent knowing their status, 36 per cent on treatment, and 29 per cent virally suppressed far below adult rates of 66 per cent. These disparities stem from a myriad of challenges, including widespread acceptance of myths (in some countries), low levels of knowledge about prevention, limited condom use, and HIV-related stigma and discrimination, among others. High-burden countries like Haiti (38 per cent of new infections, compounded by political instability and economic fragility), the Dominican Republic, Cuba, and Jamaica, which together account for 90 per cent of new cases, face amplified challenges.

The region’s reliance on international funding – 70 per cent of HIV resources, with Haiti at nearly 90 per cent – further compounds these challenges, leaving programs vulnerable to funding cuts as evidenced by the impact of the recent PEPFAR reductions since January 2025. High debt levels and reduced public spending further strain public health systems, threatening sustainability in the region.

A UNIFIED RESPONSE

Caribbean governments must lead with a multi-sectoral and multidisciplinary, integrating HIV into health systems and addressing root causes and key drivers of the HIV epidemic. They should urgently:

• Increase domestic funding: Reduce reliance on external aid by boosting domestic budgets for long term sustainability

• Boost prevention: Scale up youth-friendly programs, including sexuality education, with focus on high-burden countries like Haiti, Dominican Republic, Cuba, and Jamaica, as well as Belize, Guyana and Suriname where infections are increasing.

• Close paediatric gaps: Invest in paediatric interventions which ensure children born with HIV are given the necessary care to safeguard their health and well-being.

• Reform laws and policies: Decriminalise punitive laws, advance gender equality, human rights protections to reduce inequality to ensure equitable access for Caribbean populations.

• Reduce stigma: Foster inclusive care environment and work with people living and affected by HIV and organisations working closely with them to address HIV-related discrimination in all settings.

A whole-of-society effort is essential. Civil society must deliver community-led services, academia should inform interventions with research, and communities must challenge stigma to promote inclusion. The Caribbean’s treatment successes show what’s possible, but stagnant prevention and entrenched challenges demand urgent action. Governments, civil society, and communities must unite to respond to the challenges and create an environment where access to essential health, social and other services are guaranteed to end AIDS as a public health threat by 2030. Our region’s health depends on it.

Dr Richard Amenyah is an international public health specialist from Ghana and the Director of the UNAIDS Multi-Country Office in the Caribbean. Send feedback to columns@gleanerjm.com