New data released by UNAIDS show that despite the Caribbean’s 28% decline in new HIV infections since 2010, progress is too slow. An estimated 14 000 people contracted HIV in the region during 2021. That translates to 270 new HIV infections every week!
While the Caribbean has not had the increase in new infections experienced in other places, the rate of decline is far too slow. Thousands of avoidable HIV infections every year are making it harder and more expensive to ensure that the targets to end the AIDS pandemic by 2030 are reached.
Of particular concern is that one-third (34%) of new infections last year were among Caribbean young people ages 15 – 24. There were twice as many young women (23%) contracting HIV as compared to young men (11%). The new data also point to an increased risk for “key populations” including gay men and other men who have sex with men, sex workers, people who use drugs and transgender people. We are facing a prevention crisis. Every new infection is a hole in the HIV response bucket—a requirement for future resources.
Deaths due to AIDS fell by half in the region since 2010. Still, 5700 people died of AIDS-related illnesses in the Caribbean last year. As of the end of 2021, 84% of people living with HIV in the Caribbean were aware of their status.
Eighty-three percent (83%) of all diagnosed people were on treatment. Of these, 87% were virally suppressed. The Caribbean is currently below the global averages for both HIV treatment coverage and viral suppression.
Viral suppression matters. A person living with HIV who sustains an undetectable viral load is unable to pass the virus on to others. It is therefore in everyone’s interest to support people in getting tested, starting treatment early and achieving an undetectable viral load.
The human and financial cost of not ending AIDS by 2030 would far outweigh the cost of the immediate and necessary action to turn the ship around. The good news is that success is possible. We know how.
First, we must address the inequalities that stop people from receiving HIV prevention, testing and treatment services. Even where HIV services are available, intolerance and worry about experiencing injustice can make people fearful to learn their status, make it difficult for them to access treatment and undermine their ability to stay the course. The cost of inaction is too high a price to pay and so leaders in the Caribbean must act now to save lives.
In diverse settings, countries and communities are taking action to end inequalities and close gaps. Building on this momentum, policymakers need to strengthen their understanding of localized epidemics to focus on eliminating the inequalities that are slowing progress against the pandemic. Jamaica became one of the first countries to join the Global Partnership for Action to Eliminate All Forms of HIV-related Stigma and Discrimination. This pioneering partnership between civil society, the State Minister of Health and Wellness and parliamentary leaders is working at the country level to translate this commitment into concrete action.
We must also work to realize human rights for all. Punitive and counterproductive laws and policies must be removed. Just recently Antigua and Barbuda joined Belize, Guyana and Trinidad and Tobago—the growing list of Caribbean countries where discriminatory laws were successfully challenged in the courts.
We need increased commitment by governments to review the legal landscape and remove laws that are a barrier to the HIV response. More must also be done to establish positive protections, such as anti-discrimination and hate crime legislation while working to change prejudiced social attitudes.
We must make a new push for HIV prevention. Countries urgently need to elevate the political and financial prioritization of HIV prevention and move to large-scale implementation of prevention projects so that innovations such as pre-exposure prophylaxis (PrEP) become much more widely accessible, especially to the key populations. (PrEP is daily medicine taken by an HIV-negative person who is at substantial risk to prevent contracting the virus). In the past year, Guyana has shifted its policy, ensuring that PrEP is available nationwide to anyone who needs it, particularly those who are most vulnerable.
As part of this prevention push, we must ensure young people have the education and services they need to stay healthy. After decades of debate and commitments, the region still does not have a comprehensive and consistent strategy for giving all young people the knowledge and support required to stay HIV-free. This entails providing comprehensive sexuality education, youth-friendly sexual and reproductive health services as well as psychosocial support to address the specific needs of at-risk youth.
Ending AIDS is a political and social choice. This is a promise we must keep.
By Richard Amenyah
Director, UNAIDS Multi-country Office for Belize, Guyana, Jamaica, the OECS, Suriname and Trinidad and Tobago.
The 2022 Global AIDS Update, In Danger, is available on unaids.org
