Morris Edwards-PANCAP Coordinating Unit (PCU)

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 <30% - 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. 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 Implications for research

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

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 M&E capacity • Growing recognition of value of M&E • 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 M&E 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.