Richard Amenyah | Transforming AIDS response to build resilience and hope in the Caribbean

We are in an era of overlapping crises – global financial instability, widening inequalities, and escalating climate shocks, among others, which compound the challenges faced by people living with and most affected by HIV globally.

The devastation caused by Hurricane Melissa exposed just how vulnerable our health systems remain. It struck hardest where the HIV epidemic also bears its greatest weight, exposing just how interconnected our vulnerabilities are; health, climate, and inequality bound together.

The hurricane tore through Jamaica, Haiti, and Cuba, claiming around 100 lives, affecting nearly 6 million people, and causing catastrophic economic losses with more than US$8.8 billion in Jamaica (over one-third of GDP) and over US$1.8 billion in Haiti. Clinics were damaged and destroyed, supply chains interrupted, and laboratory services disrupted.

In Jamaica, rural HIV service points suffered extensive damage. In Haiti, thousands were cut off from treatment; and in Cuba, more than 600 health facilities were impacted, including viral load laboratories in high-prevalence provinces going offline.

For thousands of people living with HIV (PLHIV), the impact of the storm was deeply felt. Continuity of care became uncertain, and the anxiety of potential treatment interruptions was compounded by economic hardship, stigma, and mental health challenges.

Yet, even as government and community-led outreach services responded quickly. CSOs, which are often the lifeline for some who are most at risk, demonstrated their strength and value even with limited resources. Local CSOs, including networks of PLHIV, some with assistance from government, became first responders, checking on clients, delivering medicines, and providing psychosocial support even when roads were impassable and their staff were affected, as well.

CENTRAL TRUTH

This spirit of solidarity underscores a central truth: the Caribbean HIV response has always been powered by people with strong leadership from health ministries. Leveraging digital platforms, including social media, these networks and government tracked displaced clients, reconnected them to care, and coordinated emergency relief. Their swift response mirrors global lessons from conflict zones and humanitarian emergencies that utilise rights-based and people-centred approaches to safeguard people’s health and well-being.

This reality underscores why integrating HIV services into broader, climate-resilient health systems is no longer optional. The future of the Caribbean HIV response lies in linking HIV care with non-communicable disease management, mental health support, and stronger primary care; in building solar-powered clinics and cloud-based patient management systems, telemedicine where power and internet connectivity allows; and in establishing emergency service models that can operate even when roads are impassable or power grids fail.

As countries commemorate World AIDS Day on December 1, with the theme ‘Overcoming disruption, transforming the AIDS response’ and prepare to align their HIV response with the upcoming Global AIDS Strategy 2026–2031, which prioritises people-centred services, community leadership, and long-term sustainability, the region must strengthen its push towards ensuring 95 per cent of people living with HIV know their status, are on treatment and virally suppressed, reach 90 per cent of people at risk of becoming HIV with prevention interventions, and reduce stigma and discrimination to below 10 per cent. These milestones are essential not only for ending AIDS but for securing stronger, more equitable health systems that advance Universal Health Coverage, as well.

Hurricane Melissa must serve as our wake-up call. We cannot allow the convergence of climate devastation, funding shortfalls, and social exclusion to push us backward. Instead, this must be our turning point, a moment to reimagine and transform health in the Caribbean. HIV, non-communicable diseases, and mental health can no longer be treated as silos.

Integrated, people-centred health systems are the only sustainable path toward Universal Health Coverage and ending AIDS by 2030. Now is the moment to build back stronger: clinics elevated and fortified to withstand Category-5 storms; regional antiretroviral stockpiles ensuring continuity of treatment; digital platforms keeping patients connected; and communities empowered as central partners in planning, response, and accountability.

DISPROPORTIONATELY HIGH

HIV prevalence remains disproportionately high among key populations and their partners at 4.6 per cent among sex workers and 8.6 per cent among gay and other men who have sex with men. On the flipside, treatment coverage has reached 74 per cent; AIDS-related deaths dropped by 62 per cent since 2010. These gains, however, are now under growing threat because the world is facing the most significant HIV funding crisis in more than a decade. International health aid has dropped by 30–40 per cent since 2023. With nearly 70 per cent of funding for HIV in the Caribbean coming from international sources, the consequences of shrinking resources are real and immediate. Earlier this year, several organisations were forced to scale down critical interventions for HIV prevention and treatment due to funding cuts.

As UNAIDS executive director, Winnie Byanyima reminded us, “In a time of crisis, the world must choose solidarity and transformation over retreat.” The recent successful Eighth Replenishment of the Global Fund, led by the governments of South Africa and the United Kingdom at the G20 and mobilising approximately US$11.34 billion, offers a powerful reminder that global solidarity and multilateralism remain alive, though they must be continuously nurtured.

The G20 leaders also declared in the summit agreement a call to action on the deepening inequalities to help improve the world’s future health security and to address today’s pandemic like AIDS. It further called for comprehensive and coordinated action on debt vulnerability, as well as for sustainable financing for health and to address HIV, tuberculosis, and malaria. All these efforts will position Caribbean to sustainably respond to the health needs of its people.

Looking ahead to the 2026 High-Level Meeting, the Caribbean must position itself firmly within the ambitions of the new Global AIDS Strategy and its 40+20 goals: 40 million people on treatment and 20 million using antiretroviral-based prevention, delivered through services free from stigma and discrimination. These are the pillars of an AIDS-free future, and they align squarely with the region’s broader health and development aspirations.

This World AIDS Day, as we remember the lives lost and celebrate the resilience of our people, the Caribbean must make a clear choice: transformation over retreat, solidarity over neglect, and real action over promises. By embracing resilience, innovation, and shared responsibility, we can protect our gains, close the gaps that remain, and move with purpose toward ending AIDS by 2030, ensuring every person in the Caribbean can live with dignity, safety, and hope, no matter the storm.

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