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The Status Of The HIV Epidemic In The Caribbean: Implications for research, surveillance and priority setting at country level

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Title: The Status Of The HIV Epidemic In The Caribbean: Implications for research, surveillance and priority setting at country level


1
The Status Of The HIV Epidemic In The Caribbean
Implications for research, surveillance and
priority setting at country level
  • Morris Edwards-PANCAP Coordinating Unit (PCU)
  • Franka Desvignes-Caribbean Health Research
    Council (CHRC)
  • Nassau, The Bahamas, 18 November 2011

2
  • Presentation Outline
  • Context of the report
  • Characteristics of the Caribbean epidemic at
  • end of 2009
  • Regional trends in the last decade
  • Implications for regional research
  • Summary of epidemic
  • Conclusion

3
  • Context of the report
  • PANCAP 10th AGM targets (2015)
  • Reduce new HIV infections by 50
  • Elimination of Mother To Child
  • Transmission Of HIV
  • Increase access to care, treatment and
  • support to 80
  • Accelerate the agenda to achieve human
  • rights for persons living with HIV

4
  • Characteristics of the Caribbean epidemic at end
    of 2009
  • Prevalence varies from 0.1 (Cuba) to 3.4
  • (Bahamas), averaging 1.1
  • The Caribbean continues to be the second most
  • affected region
  • An estimated 240,000 PLH in the region
  • Vast majority (83) of PLH were in four
    countries
  • Haiti, The Dominican Republic, Jamaica,
    Trinidad and
  • Tobago

5
  • Gender distribution
  • varies
  • Equal in Guyana
  • More males- Barbados,
  • Cuba, Suriname,
  • Trinidad Tobago
  • More females
  • Bahamas, Belize, Dom.
  • Republic, Haiti

HIV by Gender by country (UNAIDS 2010)
6
  • Characteristics of the Caribbean epidemic...
  • Most affected age group - 15-24,
  • prevalence varying from 0.02 (Cuba) to
  • 3.2 (Bahamas).
  • Most at risk populations have prevalence
  • significantly higher than in general
  • population
  • MSM - 6.7 (Suriname) 32 (Jamaica)
  • FSW 4.8 (Dom. Republic) 24
  • (Suriname)

7
  • Regional trends in the last decade
  • Belize, the DR, Jamaica, Suriname
  • have demonstrated a 25
  • reduction in new HIV infections
  • PMTCT coverage has increased
  • from lt30 - almost 60
  • ART coverage has seen an
  • almost 7 fold increase
  • Retention on ARV at 82
  • Increased life expectancy of
  • PLH

PMTCT coverage 05 - 09
8
Implications for research
  • Despite the increase in HIV-related data
    available from annual and biannual reports, many
    research questions remain unanswered
  • HIV research in the Region needs to be
    prioritized, supported and strengthened

9
Health Research Agenda for the Caribbean
  • In 2011, CHRC developed the Health Research
  • Agenda for the Caribbean guided by Caribbean
  • Cooperation in Health (CCHIII) adopted by the
  • CARICOM Ministers of Health
  • Inclusive process
  • HIV/AIDS, STIs and Tuberculosis
  • A sub-priority of Communicable Diseases Area

10
(No Transcript)
11
HIV/AIDS, STI, Tuberculosis Research Priorities
  • HRAC 1. Adherence with Anti-retroviral
    Treatment
  • PANCAP Focus Area 3 Increased access to
    treatment to 80
  • HRAC 2. Evaluation of prevention programmes
  • HRAC 4. Prevention in most-at-risk
    populations
  • PANCAP Focus Area 1 50 reduction in new HIV
    infections
  • PANCAP Focus Area 2 Elimination of
    mother-to-child t-mission
  • HRAC 12. Stigma and discrimination in HIV
  • PANCAP Focus Area 4 Accelerate the agenda to
    reduce stigma and discrimination

12
National HIV Evaluation and Research Agendas
  • In 2011, CHRC produced a report Status of
  • Monitoring and Evaluation in the Caribbean
  • Using the 12-components approach
  • Evaluation and Research being one of the 12
  • required components

13
HIV Evaluation and Research Agenda
  • Successes
  • The Caribbean Research Agenda has been
  • adopted by CARICOM Health Ministers
  • Building of research and ME capacity
  • Growing recognition of value of ME
  • Large number of HIV papers published and
  • presented at CHRC annual meeting

14
HIV Evaluation and Research Agenda
  • Challenges
  • Updating the comprehensive inventory of HIV
  • research and evaluation studies conducted in
  • the region
  • No clear structure for disseminating and using
  • information generated from various research
  • and evaluation studies carried out in the
  • Caribbean.
  • Unclear how these results influence policy
  • and programmes, if at all

15
Towards 2015
  • Many areas of research required to
  • deepen our understanding of the epidemic
  • Challenges of funding and human resources
  • Need for increased coordination and
  • effective partnerships at the regional level
  • (e.g. RHIs, Universities, PANCAP, NGOs)

16
Towards 2015
  • Critical for a regional research strategy to
  • be implemented
  • Research translated into policy
  • Interface between research and policy
  • needs to be strengthened

17
  • Summary
  • Epidemic has at least stabilized, reversing in
  • some countries
  • Four countries bear the brunt of the epidemic
  • Greater burden of disease in teens and young
  • adults
  • MARPs more disproportionately affected than
  • the general population
  • Successes in areas of
  • PMTCT
  • Reducing mortality by increasing access to care
    and treatment and
  • retention on ARV.

18
Conclusion
  • Engagement of researchers and funding
  • agencies critical to implementing research
  • projects
  • Research and ME crucial to making
  • progress in the four focus areas Reduction
  • in new HIV infection Elimination of mother-
  • to-child transmission increased access to
  • treatment and, reducing stigma and
  • discrimination.
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