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Kevin Fenton, MD, PhD, FFPH Director, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention Centers for Disease Control and Prevention.

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Presentation on theme: "Kevin Fenton, MD, PhD, FFPH Director, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention Centers for Disease Control and Prevention."— Presentation transcript:

1 Kevin Fenton, MD, PhD, FFPH Director, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention Centers for Disease Control and Prevention 10 th Annual General Meeting of the Pan Caribbean Partnership Against HIV/AIDS November 1, 2010 Imperatives for Achieving Universal Access in the Caribbean Region

2 Reflection and Renewal

3 Summary of Caribbean HIV/AIDS Epidemic  WHO/UNAIDS estimates in 2008 1 :  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%). 1 UNAIDS/WHO 2009 AIDS Epidemic Update

4 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, 2009Joint Action for Results, UNAIDS Outcome Framework, 2009

5 CDC strategic vision of a tiered approach to prevention Prevention with HIV positive individuals Prevention with high risk HIV negatives Intensive, targeted community level interventions (geography, ethnicity etc) General population interventions 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

6 High-Risk HIV+/- Individuals Access 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 BarbadosFSW: 73.3% (2005/6 FSW formative survey) Dominican RepublicMSM: 32.9% (BSS survey) Female sex workers: 66.98% (BSS survey) GuyanaMSM: 87.1% (2009 BBSS survey Georgetown) SW: 87.9% (2009 BBSS survey Georgetown) HaitiFSW: 70.9% (2006 BSS Survey) JamaicaMSM: 53% (2007 MSM survey Kingston) SW: 75% (2008 SW survey Kingston) Bahamas, Belize, OECS, Trinidad and Tobago No data available SurinameFSW: 65.7% (2009 FSW survey Paramaribo) 1 UNGASS Country Progress Reports 2010 accessed from UNAIDS website

7 HIV+ Individuals Coverage of ART across Caribbean 1 WHO/UNAIDS/UNICEF. Towards Universal Access: Scaling up Priority HIV Interventions in the Health Sector. Progress Report 2009.

8 General Population Coverage 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, 2004-2008 1 WHO/UNAIDS/UNICEF. Towards Universal Access: Scaling up Priority HIV Interventions in the Health Sector. Progress Report 2009.

9 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.

10 WHO/UNAIDS Recommended Strategies for Achieving Universal Access  Standardization and simplification of service protocols and procedures  Decentralization and integration of health services  Identification of essential package of integrated HIV prevention, treatment, care and support interventions  Strengthening HIV prevention in health-care settings

11 WHO/UNAIDS Recommended Strategies for Achieving Universal Access  Expansion of free HIV testing  Distribution of free antiretroviral therapy (e.g. to citizens and non-citizens)  Patient and community mobilization to promote testing and counseling, prevention, treatment, and adherence support

12 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

13 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

14 Reflection and Renewal

15 Kevin Fenton, MD, PhD, FFPH Director, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention Centers for Disease Control and Prevention 10 th Annual General Meeting of the Pan Caribbean Partnership Against HIV/AIDS November 1, 2010 Imperatives for Achieving Universal Access in the Caribbean Region


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