Tony Fraser Reporting from Port-au-Spain

	Dr Sealy says treatment costs are too expensive for countries

Why? Because while in 2007, 10,000 new persons living with HIV/AIDS were put on antiretroviral drugs, over the same period another 20,000 contracted the virus.

“We cannot treat ourselves out of this epidemic, it’s not going to be possible when more people are becoming infected than there are people on treatment,” said UNAIDS Director for the Caribbean, Dr. Karen Sealey at the recent launch of the 2008 UNAIDS report for the region, dubbed 'Keeping Score 11'.

“With infected persons having to be on treatment for the rest of their lives, that’s a cost no country in the world can bear far less small economies like we have in the Caribbean,” warns Dr. Sealey.

Key messages

The report outlines the requirements for transformation of traditional sexual patterns which are driving the epidemic:

"Prevention programmes require a comprehensive and rapid scale-up to achieve an increase in knowledge about HIV.

"Caribbean people need to reduce the number of sexual partners they acquire.

"Effective use of condoms in casual sex has to become the norm. And, young people should be encouraged to delay becoming involved in sexual activity," states the report.

Emblazoned on the cover of the 90-page document is a picture of an unknown batsman in West Indian ODI colours driving through the offside.

Trinidad and Tobago’s social development minister, Dr. Amery Browne provocatively noted at the launch of the report that the batsman represents the best and worst possibilities of modern day West Indian society.

The ball is not in the picture so we are not sure if it went to the boundary or has rattled the stumps, observed Dr. Browne.

Inside its glossy cover, the report has 15 key messages, the ineffectiveness of the prevention programme being a major one of them.

Another notes that while reporting on HIV/AIDS has improved, “most countries do not yet truly know their epidemic".

The report notes that domestic and international spending on AIDS has increased in the Caribbean yet it still does not match the need.

The good news though is that Caribbean leaders seem to be grappling with the nettle of the epidemic and so are mustering the political will to counter HIV/AIDS.

One resulting positive outturn is that all Caribbean countries bar two have achieved 100 per cent coverage of screening donated blood.

In the instances of Antigua/Barbuda and Grenada, where full screening has not been achieved, “we feel certain that will happen soon,” says the UNAIDS Caribbean director.

Caribbean people need to reduce the number of sexual partners   UNAIDS report

Notwithstanding the continuing gap between persons who are in need of anti-retroviral treatment (ART) and those who are receiving it, the numbers who are being treated have increased from a mere 4,000 in 2003 to 30,000 at the end of 2007.

However, other than Cuba with 95 per cent coverage, Barbados, 73 percent, and Trinidad and Tobago, 58 percent, all other countries are treating below 50 per cent of persons who require the ART to survive and live quality lives.

“Although the immediate regional target for ART is 80 percent and the average is not yet 50 per cent, we do appear to be moving somewhat in the right direction,” says Dr. Amery Browne, who was once technical director of Trinidad and Tobago’s national AIDS programme.

The report identifies the importance of increasing and sustaining the momentum on increases in ART.

Decentralizing the points where the services are given, and the number of persons to be put on the drug therapy are outstanding goals.

Reduce infection rates

To achieve the objective of HIV-free and AIDS-free generations into the future, the Caribbean needs to reduce prevalence among women, especially young females and girls, states the UNAIDS report.

To reach even close to the above 2010 goal, “every single pregnant woman should be tested for HIV antibodies and the few found HIV-positive should be provided with the full ART regimen,” states the report.

The treatment regime for pregnant women is known to have an over 90 per cent effectiveness in keeping mothers from passing on the virus to their babies.

	Report recommends that all infected pregnant women receive treatment

The report lists the Bahamas, Barbados, Belize, the Dominican Republic, Guyana, Haiti, Jamaica, Suriname and Trinidad and Tobago as priority countries for the prevention of mother to child transmission programme.

As has been known for some time, HIV is quite widespread amongst high risk groups for the disease: men who have sex with men, female sex workers, young people, particularly young females (15-24) and crack cocaine users are the most vulnerable, states the report.

The epidemiological data indicate that almost "18 percent of crack cocaine users are living with HIV – mainly in Jamaica, Trinidad and Tobago and St. Lucia".

To counter such a method of spread of the disease, UNAIDS is recommending the collection of information among crack cocaine users.

However, health officials are concerned that not enough information is available on how orphans and children are contracting the disease.

“Too many people are dying of AIDS, too many people are being infected with HIV and clearly the vulnerable population groups are being disproportionately infected with and affected by HIV,” says Dr. Sealey.

Not effective

For the UNAIDS director among the major conclusions of the report is that “stigma and discrimination and inadequate emphasis on human rights remain serious negative factors for an effective national response”.

Dr. Sealey has been saying that Caribbean governments and societies need to think seriously about decriminalizing sexual activity between consenting male adults as well as sex workers, to encourage such persons to be tested, counselled and treated.

On the prevention programmes Dr. Sealey says they are not being as effective as possible “because they are not reaching the most at-risk populations in the Caribbean”.

The bottom line is: “more resources are going to be needed to sustain the response in five years time,” says Dr. Sealey.

Other imperatives of the report are the participation of civil society in developing the way forward.

For Dr. Browne while the infection rate for the Caribbean seems to be stabilizing, the 1.1 percent infection rate of the sexually active adult population is “too high”.

The UNIADS report estimates that 230,000 are living with HIV/AIDS, with high epidemics in the Bahamas (3 percent), Guyana (2.5percent), Suriname (2.4 percent), Haiti (2.2 percent).

Cuba has the lowest infection rate in the region, with 0.1 percent.

HIV was first discovered in the region in the early 1980s.