Carribean: Fresh challenges accompany progress in AIDS fight
Adult HIV prevalence in the Caribbean is about one percent higher than in any other region outside sub-Saharan Africa.
NASSAU, Bahamas, Nov 21, 2011 (IPS) - Cracey Fernandes, the president of the Guyana Sex Work Coalition, does not hide the fact that he is homosexual.
Fernandes, who goes by the name "Isabella", is also aware that despite efforts to decrease cases of people infected with HIV, the virus that causes the deadly acquired immunodeficiency syndrome (AIDS), he belongs to the group men having sex with men (MSM), considered in the Caribbean among the high risk groups capable of spreading the virus.
"I knew the road was not easy," he told a regional gathering here, recalling his time in prison on a murder-related charge when "male sex workers were targeted for no reason at all".
Marcus Day, who heads the St. Lucia-based Caribbean Drug and Alcohol Research Institute, said the challenge for regional health authorities is to properly monitor male prisoners upon their release, since most of them become infected with the HIV virus while in custody.
"Mechanisms need to be put in place to cater (to) HIV inmates, especially those who are known to be homeless upon release," he told the 2011 Caribbean HIV Conference that ends here on Monday. Day also suggested non-custodial sentences as a means of dealing with the spread of the virus.
Meanwhile, statistics from a new report by the UN AIDS agency (UNAIDS) released Monday concluded that 2011 saw unprecedented progress in the AIDS response, with 46 percent, or 6.6 million, of the estimated 14.2 million people eligible for treatment in low and middle-income countries accessing lifesaving antiretroviral therapy in 2010.
The report shared that overall, fewer people are dying from AIDS and people with HIV are living longer. In addition, new HIV infections have fallen to their lowest levels since the height of the epidemic.
Targeting certain populations
In its 2009 global report, UNAIDS noted that 260,000 people in the Caribbean were living with HIV and that the rate of increase has varied little since the late 1990s.
It noted that one in five men who have sex with men in Trinidad and Tobago was living with HIV, while in Jamaica, an estimated 32 percent of MSM were living with the virus.
"I think the prevention programmes in many countries are not reaching the right people," Michel de Groulards, regional programme adviser of the UNAIDS Caribbean Regional Support Team, told IPS.
One factor, De Groulards believed, may be that after 25 years of providing treatment, some countries have reached a plateau. In other cases, people considered at risk, including MSMs, are not targeted.
Adult HIV prevalence in the Caribbean is about one percent higher than in any other region outside sub-Saharan Africa, according to UNAIDS figures, although new HIV infections there have declined slightly from 20,000 in 2001 to 17,000 in 2009. Still, the HIV burden varies considerably among and within Caribbean countries.
Cuba, for example, has a very low HIV prevalence of 0.1 percent while the Bahamas has an adult HIV prevalence of 3.1 percent, the highest in the region. Overall, AIDS-related deaths in the Caribbean fell from an estimated 19,000 in 2001 to 12,000 in 2009.
What has also changed in the region, De Groulards said, is that 48 percent of the people infected were now receiving antiretroviral drugs. In some countries it is as high as 80 percent.
"That shows it is possible to get (treatment)," he said. He added, however, "it is clear that the decriminalisation of homosexuality will not get the rate down" by itself, noting that the stigma associated with the virus is still very much a factor in the Caribbean.
Only one Caribbean country, the Bahamas, has decriminalised homosexuality between consenting adults. It is also the only regional state to sign the 1994 Paris Declaration, which set global standards for HIV and human rights.
"Still, significant stigma and sometimes discrimination persists. This in turn creates a significant barrier to detection, care and treatment," Prime Minister Hubert Ingraham told the conference.
Leading Caribbean HIV/AIDS researcher Peter Figueroa said that he was "most impressed" with the position adopted by the Bahamas and urged other Caribbean countries to follow.
"The Bahamas has had no adverse consequences and may well have had some positives in relation to their tourism and other relations," he told IPS. "The Bahamas has clearly shown that we can decriminalise men having sex with men."
Figueroa, a professor of public health, epidemiology and HIV/AIDS at the University of the West Indies, said he was certain that other countries, despite their strong religious background, would not have objections to legislation dealing with the situation.
"So I think if we could frame the issue in terms of simple respect for one another and for (an) individual's humanity, then we can take the initiative in terms of the human rights approach and decriminalise men who have sex with men," he said. "We are not talking about imposing a lifestyle on anybody else."
"I think, quite honestly, our leaders are totally late on this question," he added.
Specialised prevention awareness
The non-government organisation Caribbean HIV&AIDS Alliance (CHAA), which studied the vulnerabilities to HIV among gay men in Barbados, said that while MSM are considered a priority in the national HIV response, little is known about their social vulnerabilities and the kind of HIV prevention interventions that can be most effective.
As a result, authorities should capitalise on gay social networks and existing social activities to create opportunities for men to talk about HIV prevention as well as to "help create further awareness among gay men regarding their rights and how to better challenge or respond to stigma and discrimination".
But even as Caribbean politicians, scientists, researchers, academics and other stakeholders continue to examine ways of dealing with the virus, 30 years after the first case was recorded in the region, there is growing recognition that cuts in overseas funding could seriously hamper future success.
However, Karl Theodore, head of the Centre for Health Economics at UWI, believes regional countries should step up and provide one percent of their gross domestic product to address non-communicable diseases in the Caribbean, which he said would need an estimated 180 million dollars annually to support such programmes.
Theodore told IPS that at least one country in the region, which he refused to name, spent 50 million dollars on health, which amounted to .05 percent of its 135 billion dollar income. He called the amount "so close to zero, it is embarrassing".
By Peter Richards