Photo Caption: Karl Theodore of the Centre for Health Economics at The University of the West Indies in St Augustine, Trinidad (from left); Ernest Massiah, UNAIDS Caribbean Regional Support Team Director; Alan Whiteside, professor at the Health Economics and HIV/AIDS Research Division of the University of KwaZulu-Natal, South Africa, Amalia Del Riego, Senior Adviser at the Pan American Health Organisation (PAHO) HIV Caribbean Office, Trinidad; Warren W. Buckingham III, Director of the Office of Global Health and HIV, The Peace Corps, United States. Credit: Steve Shapiro/2011 Caribbean HIV Conference
Speakers at the 2011 Caribbean HIV Conference’s second plenary on sustainability called for evidence-based prevention strategies, increased efficiency, private sector support and for regional governments to allocate fixed proportions of their annual budgets to the HIV effort.
Moderated by UNAIDS Caribbean Regional Support Team Director, Dr. Ernest Massiah, the discussion was central to the November 18 – 21 meeting which was themed “Strengthening Evidence to Achieve Sustainable Action”. Held in the Bahamas, the Conference brought together researchers, policy-makers and advocates to agree upon a viable path that can be maintained in the future regional HIV response. This conversation comes in the context of a global financial crisis, a dip in international funding in 2010 and warnings of donor fatigue.
“We’ve reached the peak in resources and probably global interest,” noted Alan Whiteside, a professor at the Health Economics and HIV/AIDS Research Division of the University of KwaZulu-Natal in South Africa. Whiteside applauded the region’s organised and shared response to HIV but said that despite the good work being done to put more people on treatment, the Caribbean urgently needed to scale up effective prevention methods. It must also find effective approaches for fostering behaviour change like fewer sexual partners, fewer concurrent partners and reduced substance abuse. Whiteside concluded that the Caribbean needed to finesse the tough job of setting priorities and spending money on strategies that are proven to be effective.
Amalia Del Riego, Senior Adviser at the Pan American Health Organisation (PAHO) HIV Caribbean Office based in Trinidad noted several of the region’s successes—its progress on eliminating mother to child transmission, the reduction of mortality, an overall lowering of new reported infections and scaled-up testing, treatment and care. The HIV response, she said, had revolutionised public healthcare.
Yet there are several inefficiencies and gaps to be addressed. Del Riego noted that in some countries between 30 and 40 percent of money assigned to the HIV response was being swallowed by administrative costs. It remains “extremely difficult” for men who have sex with men (MSM), sex workers and young people to access services. And she added that many of the activities under the prevention umbrella couldn’t be linked to concrete results.
She set out several key priorities to ensure a sustained and successful response. In order to ramp up early detection, care and treatment Del Riego said the region would have to pursue public/private partnerships with an emphasis on reaching key populations. Prevention interventions should be limited to those that are evidence-based. And care should be taken to prevent HIV drug resistance. She also called for the decentralisation and integration of HIV services and for renewed emphasis on the surveillance of new infections.
Professor Karl Theodore of the Centre for Health Economics at The University of the West Indies in St Augustine, Trinidad made several bold, broad suggestions.
“This region has always been in a position to finance its AIDS response,” Theodore said, insisting that the issue boiled down to political will. Using numbers for the region as a whole he said that the Caribbean would have to spend 0.3 percent of its income to address the epidemic. The countries currently present a mixed bag in terms of the proportions of their budgets being assigned to HIV. The economist called for a regional pool of resources so that “countries that are worse off will not be left behind”.
“Donor support is going to be cut by at least half,” he cautioned. “It will be good for us to start behaving like that. We have to get private and public domestic sources to raise resources.” He further suggested that Caribbean countries undertake to fund their entire prevention efforts on their own, assigning donor funds to treatment and building capacity. Finally, Theodore proposed that the AIDS movement team with those responding to non-communicable diseases to lobby governments together for a one percent budget allocation.
The theme of sustainability was woven into each of the conference’s five program tracks. The meeting included sessions on partnering with business, the challenges and opportunities of small island states, funding for community-based organisations and sustaining the Caribbean HIV Conference.