1. Nassau, The Bahamas 18 November 2011 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. Nassau, The Bahamas 18 November 2011 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. Nassau, The Bahamas 18 November 2011 Context of the report PANCAP 10 th 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. Nassau, The Bahamas 18 November 2011 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. Nassau, The Bahamas 18 November 2011 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. Nassau, The Bahamas 18 November 2011 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. Nassau, The Bahamas 18 November 2011 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. Nassau, The Bahamas 18 November 2011 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. Nassau, The Bahamas 18 November 2011 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 Health Research Agenda for the Caribbean

10. Nassau, The Bahamas 18 November 2011

11. Nassau, The Bahamas 18 November 2011 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 HIV/AIDS, STI, Tuberculosis Research Priorities

12. Nassau, The Bahamas 18 November 2011 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 National HIV Evaluation and Research Agendas

13. Nassau, The Bahamas 18 November 2011 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 HIV Evaluation and Research Agenda

14. Nassau, The Bahamas 18 November 2011 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 HIV Evaluation and Research Agenda

15. Nassau, The Bahamas 18 November 2011 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) Towards 2015

16. Nassau, The Bahamas 18 November 2011 Critical for a regional research strategy to be implemented Research translated into policy Interface between research and policy needs to be strengthened Towards 2015

17. Nassau, The Bahamas 18 November 2011 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. Nassau, The Bahamas 18 November 2011 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. Conclusion