Richard Amenyah | The end of an era, but the fight against HIV is not over

The HIV response in the Caribbean stands at a critical crossroad. Global funding is contracting, foreign aid cuts are accelerating, and a UN reform report has even proposed folding the Joint Programme on HIV and AIDS (UNAIDS) into other agencies.

These are not mere debates. They carry real consequences for our people’s lives. And yet, reflecting on what we have achieved, and what remains possible, one truth is clear: ending AIDS is not only achievable but within our reach if our commitment does not falter.

PROGRESS THAT MATTERS

When I arrived in 2022, the region was still grappling with the aftershocks of COVID-19. Our office serving twelve countries from Antigua and Barbuda to Suriname, focused immediately on stabilising and strengthening national HIV responses that yielded tangible results. Through partnerships with PAHO, UNICEF, and UNFPA, we supported health ministries to eliminate mother-to-child transmission of HIV and syphilis in Belize, Jamaica, and St Vincent and the Grenadines.

In Trinidad and Tobago, Jamaica, Belize, and Suriname, we provided technical assistance, including mid-term reviews of national strategies, strategic planning, strengthened use of data for decision-making, and targeted capacity building. High-level political engagement, including visits by our Executive Director Winnie Byanyima and Deputy Executive Director Christine Stegling translated advocacy into action for increased domestic financing and renewed attention to legal and policy barriers that fuel stigma. These public-health milestones have been transformational when measured in lives saved and futures protected.

Partnerships were central to our success. Working closely with governments, PANCAP and CARPHA, civil society, and the private sector, we helped mobilize US$44 million from the Global Fund and PEPFAR.to sustain prevention, treatment, and care programmes in several countries. Through collaboration with entities like CDC and PEPFAR, we enhanced evidence generation on HIV-related stigma and supported initiatives to dismantle human rights barriers in communities and workplaces.

This resulted in partnerships with the Jamaica Manufacturers and Exporters Association (JMEA), the Kingston & St Andrew Municipal Corporation, and others, which ensured that women living with HIV amplified their voices, youth leaders advanced their need for sex education and access to services, and stigma confronted directly in the workplace. We supported strategic litigation and policy dialogue that contributed to tangible improvements in protections and redress for vulnerable communities, including LGBTQ people. Critically, we strengthened the use of data, transforming numbers into actionable insights to close critical gaps, including reaching the more than 90,000 people in the Caribbean who know their HIV status but are not yet on treatment.

As chair of the Programme Coordination Group responsible for monitoring implementation of Country Implementation Plans, across United Nations (UN) agencies, it has been deeply encouraging to witness, firsthand, how the United Nations delivered as one under the Multi-Country Sustainable Development Cooperation Framework, ensuring alignment with national development priorities across the region.

It has been a pleasure to meet with governments and civil society across the region. I recall my visit to Suriname, where I met with the minister of health to advocate for revitalising the national HIV response, and addressed the Parliamentary Committee on Health, pressing for increased domestic funding, decriminalisation of HIV transmission, and stronger measures to uphold human rights while combating stigma and discrimination. I also had the privilege of delivering seminars at The University of the West Indies, engaging deeply on HIV and UN80 reform.

These experiences serve as a powerful reminder of the unfinished work that remains and the need for persistent, sustained political engagement in the corridors of power to drive lasting change.

None of this progress was achieved alone. I am deeply grateful to my team, which has been resilient, principled, and relentless, and delivered under immense pressure, navigating hurricanes, funding uncertainties, and constant change. I also extend my heartfelt appreciation to the dedicated leadership of ministers of health, permanent secretaries, and technical experts; to the unwavering courage of people living with HIV; to the passionate advocacy of civil society organisations; and to the steadfast commitment of donors, private-sector partners, UN resident coordinators, and UN agencies – UN Women, UNDP, PAHO, UNFPA, UNICEF, and UNHCHR. Last, but not the least, I would like to thank the robust partnership with the media for ensuring that key messages reach key stakeholders and the public. It is the unique Caribbean spirit – warm, determined, and deeply collaborative – that has made this progress possible.

WORK STILL AHEAD

Notwithstanding, we must be honest about what remains unfinished. An estimated 340,000 people are living with HIV, with Haiti, the Dominican Republic, Cuba, Jamaica, and Guyana carrying most of the burden. Young people account for more than a quarter of new infections, and HIV prevalence among transgender women reaches as high as 31 per cent.

The treatment cascade remains fragile: only 85 per cent of people living with HIV know their status; 75 per cent are on treatment, and just 66 per cent are virally suppressed. Children are being left behind as only 39 per cent of the 11,000 children living with HIV are receiving treatment, and only 29 per cent are virally suppressed. Advanced HIV disease remains unacceptably high up to 35-40 per cent in some countries.

The funding crisis compounds these challenges in a region constrained by debt and limited fiscal space and vulnerable to external funding shocks. Treatment interruptions, stalled prevention efforts, and weakened community services are real risks. Climate shocks, migration, and ongoing humanitarian crises have amplified the region’s vulnerability. Punitive laws, persistent stigma, and discrimination continue to drive people away from services.

LESSONS AND A CALL TO ACTION

A lot of lessons have been learned on this four-year journey in the Caribbean. Regional collaboration and partnerships work, and improvements in human rights, community systems, and data drive results. Overreliance on external financing is a risk. Integration matters: linking HIV to broader development priorities across the SDGs strengthens sustainability, if rights, quality, and community leadership are never compromised.

As I transition to my next role leading UNAIDS efforts in Kenya, Rwanda, and South Sudan, I carry these lessons with me. The contexts differ, but the imperative remains the same: sustained political commitment is non-negotiable, if AIDS is to end as a public health threat. One thing is certain, my experience in the Caribbean has been phenomenal and deeply enriching. I will carry with me the resilience of the Caribbean people and the unmistakable can-do “we likkle but we tallawah” spirit of Jamaicans.

As this chapter closes, the global and regional context reminds us that the fight against HIV is far from finished. For the Caribbean to be successful in ending AIDS, the path forward is clear. Governments and partners must step up even more now to increase spending on HIV, including community-led services, remove discriminatory and punitive laws, integrate HIV into primary healthcare while safeguarding rights and include people living with and most affected by HIV at the centre of decision-making, service design, and delivery.

As Nelson Mandela reminded us, “It always seems impossible until it is done.” Together, we have transformed lives. Now, we must finish the job. The Caribbean deserves a future free from AIDS, and with sustained leadership and collective action, that future is within reach.

As I take my leave, I extend my heartfelt thanks to everyone who supported and contributed to a successful tour of duty in the Caribbean.

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