Effective HIV and AIDS prevention programmes must go beyond individual and interpersonal approaches to the development of strategies which take into account the social context that supports behaviours which place people at the risk of infection. It is important, therefore, that the resources allocated to prevention reflect the nature of the local epidemic. For example, if most infections occur among marginalised youth,  this group should be a primary target of prevention efforts. Behaviour change communication strategies must also take into account issues relating to poverty, gender and other cultural and social norms. The elimination of stigma and discrimination towards people living with HIV and AIDS (PLWHA) must be promoted; and their skills and experiences utilised to provide positive prevention interventions.

HIV and AIDSprevention should be comprehensive, making use of as many proven effective approaches as possible, rather than just implementing one or a few select actions in isolation. Successful HIV prevention programmes not only give information, but also build skills and provide access to essential commodities and services such as condoms, testing and counselling services. It should be remembered that many people do not fit into only one “risk category”.  

 

Main Initiatives Across the Region

Each country in the Caribbean confronts a unique situation. The diversity of the region is apparent in terms of politics, language, geographic location and wealth is reflected significantly in the different ways in which countries are affected by the pandemic. At one extreme, The Bahamas has the highest HIV prevalence in the entire western hemisphere (3%); at the other, Cuba has one of the lowest (0.1%). Trinidad and Tobago (1.5%) and Jamaica (1.7%) are heavily affected. Before Haiti's devastating earthquake in January 2010, an estimated 2.2 percent of the population was living with HIV. Haiti's AIDS epidemic is one of the most severe in the Caribbean.

Most countries have developed National AIDS Commissions (NACs) as well as National Strategic Plans (NSPs) which include Prevention as a priority area. The activities developed to support this priority range from voluntary counselling and testing to the provision of condoms, prevention of mother-to-child transmission, media campaigns, HIV and AIDS education in schools, and behaviour change communication (BCC) and sexual and reproductive health (SRH) programmes targeting the general population.    

There are also several Non-Governmental Organisaitons (NGOs)  implementing prevention-focused initiatives in the region.  One such project is CARISMA 2, where condom, social marketing and sexual and reproductive health programmes are being carried out in 13 PANCAP countries -Antigua and Barbuda, Barbados,  Belize, Dominica, the Dominican Republic, Grenada,  Haiti, Jamaica, Saint Lucia, St. Kitts and Nevis, St. Maarten, St. Vincent and the Grenadines, Suriname and Trinidad and Tobago.  Options Consultancy has been the regional consultant since January 2009. Its partners in implementation are the Academy for Educational Development (AED), PSI Caribbean, PSI Dominican Republic and PSI Haiti. Most projects are scheduled to come to an end in 2012 and target commercial sex workers, men who have sex with men (MSM) and marginalised youth.

The PANCAP Regional Testing Day, which was developed through collaboration between the Caribbean Broadcast Media Partnership (CBMP) and the Bank of Nova Scotia, has over the past two years grown in popularity and effectiveness, during Regional Testing Day 2009, approximately 5,214 people from 14 territories visited a Scotiabank branch to be tested - a 200 percent increase in the number tested in 2008.

Other initiatives include Cuba’s 100% treatment coverage, and the progress made in preventing mother-to-child  transmission (PMTCT) in Barbados and Belize. The Caribbean region, with an estimated 0.9–1.2 percent of HIV prevalence rate in the general population, has the second highest estimated burden of HIV infection in the world. Mother-to-child transmission of HIV constitutes an estimated eight to ten percent of all transmissions in the region.

The Pan American Health Organisation (PAHO) and United Nations Children's Fund (UNICEF) currently have a Towards Elimination of Mother-to-Child Transmission of HIV and Congenital Syphilis in Latin America and the Caribbean Initiative which has been adopted by the entire Americas region and has even gone global. The Caribbean has made firm progress in the development of the Elimination Initiative over the past year..

 

Next Steps

There is still a long way to go before HIV and AIDS are under control in the Caribbean.  Gaps exist in testing, treatment and prevention programmes, and stigma and discrimination are having a devastating effect.  National responses to the crisis need to be improved and strengthened. Research has shown that the weaknesses result very often from inadequate public infrastructure and insufficient human capacity. More and better quality research is needed to make it easier to know and understand the crisis and consequently, focus HIV and AIDS prevention efforts.

The Caribbean has demonstrated public health leadership in the past, and the region has the potential to become the first region in the developing world to achieve the elimination targets.

All of this shows that a great deal can be achieved through evidenced-based, targeted and inclusive prevention programmes.

 

Read more on the Essential Policy Actions for HIV Prevention.

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