(CARICOM Secretariat, Turkeyen, Greater Georgetown, Guyana) The 2014 World AIDS Day theme is ‘Closing the Gap’. This theme challenges us as Policy makers, programme managers and implementers to identify and develop strategies and policies for closing the gap in resources to achieve universal access. For the Caribbean, removing the barriers that impede universal access by all members of our society is crucial. The epidemiology of HIV and AIDS in the Caribbean provides strong evidence that the groups most vulnerable to HIV and which have least access to prevention, treatment, care and support services, are members of our key population groups including men who have sex with men, sex workers, persons who use drugs and youth.
Our region has seen significant progress towards elimination of mother-to-child-transmission of HIV. Six countries are ready for validation, and others are moving towards validation. There has been a significant reduction in the number of deaths due to AIDS and substantial returns on HIV investment.
However, we continue to face ongoing challenges, particularly inadequate access to services for those most in need and inadequate access to financial resources to maintain the national and regional gains. Our responses to human rights; gender and gender-based violence; and punitive laws that negatively impact universal access need to be optimised.
Our region remains dependent on diminishing external funding. Inadequate investments in laboratories have serious implications for service provision, and the achievement of new global 90-90-90 targets which would enable 90 percent of people living with HIV to know their HIV status; 90 percent of people who know their status to access HIV treatment; and 90 percent of people on HIV treatment to achieve viral suppression—that is, an HIV viral load persistently below the level of detection. Additionally, insufficient provision of rapid testing and access to point-of-care counselling and testing; less than optimal male counselling and testing; limited strategies for addressing the vulnerability of youth and the dissonance between the age of consent and the age of access to sexual and reproductive services for adolescents are remaining challenges to universal access. Addressing these challenges requires more cost effective and efficient strategies.
Recent events have served as a catalyst for a regional dialogue on stigma and discrimination, significant barriers to universal access. This dialogue must continue to occur at every level of our society but must encompass all forms of discrimination. The Pan Caribbean Partnership Against HIV and AIDS (PANCAP) Justice for All programme, which has so far produced a roadmap with 15 actionable points and a declaration, must be seen as a bold initiative by the Partnership to advance this dialogue and engage in meaningful and dispassionate discussions with all sectors of society including parliamentarians, the judiciary, faith-based organisations, the youth, the media, the private sector, civil society organisations, the military and para military, medical and nursing associations, bar associations and both women’s and men’s groups.
The new Caribbean Regional Strategic Framework on HIV and AIDS (CRSF) 2014-2018, which provides a roadmap for the regional response over the next four years, is geared towards achieving universal access and elimination of HIV. Key to addressing the overarching challenges to universal access is technical and political leadership which are critical to achieving optimal health goals at national and regional levels and ensuring the effectiveness of the partnership at both levels.
This World AIDS Day therefore provides us with an opportunity to reflect on our achievements and to acknowledge the work that is still to be done to achieve universal access for all our citizens, thereby closing the gap.