Kevin Fenton, MD, PhD, FFPHDirector, National Center for HIV/AIDS, Viral Hepatitis,
STD, and TB PreventionCenters for Disease Control and Prevention
10th Annual General Meeting of the Pan Caribbean Partnership Against HIV/AIDS
November 1, 2010
Imperatives for Achieving Universal
Access in the Caribbean Region
Reflection and Renewal
Summary of Caribbean HIV/AIDS Epidemic
WHO/UNAIDS estimates in 20081: 240,000 people were living with HIV in the Caribbean
region 20,000 people were newly infected 12,000 people died of HIV-related illnesses
Caribbean region continues to be one of the most HIV affected regions, has been more heavily affected by HIV than any region outside sub-Saharan Africa and has the second highest level of adult HIV prevalence (1.0%).
1UNAIDS/WHO 2009 AIDS Epidemic Update
Why is universal access important?
Social Justice Ensuring adequate coverage, scale and
impact are critical programmatic imperatives for an HIV free generation
Political declaration on HIV/AIDS in 2006 by UN member states to scale up toward universal access to HIV prevention, treatment, care, and support“The achievement of universal access will remain the
fundamental priority for UNAIDS. Universal access goals can become a reality. By achieving these goals,
we can contribute to the broader development agenda.”
Joint Action for Results, UNAIDS Outcome Framework, 2009
CDC strategic vision of a tiered approach to prevention
HIV Screening, Drug Rx/Referral,
EBIs, STD Rx, condoms
Combination prevention, SDH, DEBIs, condoms
Social marketing, HIV
screening, stigma,
condoms
HIV Rx and Care, PN, Counseling, STD Rx,
SEPs PMTCT, condoms
High-Risk HIV+/- IndividualsAccess to Testing Services for Most-at-
Risk Populations Country Percentage of most‐at‐risk populations
that have received an HIV test in the last 12 months and who know their results 1
Barbados FSW: 73.3% (2005/6 FSW formative survey)Dominican Republic MSM: 32.9% (BSS survey)
Female sex workers: 66.98% (BSS survey)Guyana MSM: 87.1% (2009 BBSS survey
Georgetown)SW: 87.9% (2009 BBSS survey Georgetown)
Haiti FSW: 70.9% (2006 BSS Survey) Jamaica MSM: 53% (2007 MSM survey Kingston)
SW: 75% (2008 SW survey Kingston)Bahamas, Belize, OECS , Trinidad and Tobago
No data available
Suriname FSW: 65.7% (2009 FSW survey Paramaribo)1 UNGASS Country Progress Reports 2010 accessed from UNAIDS website
HIV+ IndividualsCoverage of ART across Caribbean
1WHO/UNAIDS/UNICEF. Towards Universal Access: Scaling up Priority HIV Interventions in the Health Sector. Progress Report 2009.
General PopulationCoverage of Services for PMTCT
Percentage of pregnant women with HIV receiving antiretrovirals for preventing mother-to-child transmission of HIV in low- and middle- income countries by region, 2004-20081WHO/UNAIDS/UNICEF. Towards Universal Access: Scaling up Priority HIV Interventions in the Health Sector.
Progress Report 2009.
Current Barriers to Universal Access in the Caribbean
Gaps in testing, treatment, and prevention programs
Stigma against PLHIV and at-risk populations
Public infrastructures and human capacity Poor monitoring of programs and of
epidemic Overcoming the multiple barriers to access
is the preoccupation of the health sector at both the national and regional levels.
Best and Promising Practices in the Region
Monitoring of the epidemic and response Decentralization of services Strengthening related infrastructure Reduction of stigma among healthcare
workers Provider initiated testing Low cost ARV agreement with
pharmaceutical companies Free ART to patients
Priorities for Action Key Recommendations for Enhancing
Regional Efforts Strengthen, decentralize, and integrate HIV
programs with broader health systems Increase access to key HIV/AIDS interventions in
the health sector and ensure higher quality of services Expand availability and utilization of HIV testing and
counseling services Ensure timely access to treatment and enhance
treatment retention and adherence Address legal and structural barriers that increase
HIV vulnerability Devote attention to most-at-risk populations
Reflection and Renewal
Kevin Fenton, MD, PhD, FFPHDirector, National Center for HIV/AIDS, Viral Hepatitis,
STD, and TB PreventionCenters for Disease Control and Prevention
10th Annual General Meeting of the Pan Caribbean Partnership Against HIV/AIDS
November 1, 2010
Imperatives for Achieving Universal
Access in the Caribbean Region
