SIX Caribbean countries will today be validated for having eliminated mother-to-child transmission of HIV and syphilis, but Jamaica is not among them.
In fact, Jamaica might not receive validation from the World Health Organization (WHO) before the year 2020.
Dr Nicola Skyers, senior medical officer of the National HIV/STI/TB Unit, made the disclosure during an interview with the Jamaica Observer yesterday.
“Not before 2019 or 2020 I would postulate at this point in time,” Dr Skyers responded when asked how close Jamaica is to being validated. “You have to meet the targets for two consecutive years. As at the end of 2016, we still had some challenges with the targets, so it would have to be 2017/18,” she said.
“When we get to the end of 2017 we’ll see what the final data is, and if it’s met, then we can advance into 2018 and then apply for validation thereafter. But it has to be two consecutive years that you have met your target before you can apply,” Dr Skyers explained.
According to the WHO, mother-to-child transmission is the transmission of HIV from a HIV-positive mother to her child during pregnancy, labour, delivery, or breastfeeding.
In order for Jamaica to join the countries that have been validated, the country must be certified as having met the regional goal, which is a less that two per cent transmission rate for two consecutive years.
After Jamaica’s Spanish-speaking neighbour Cuba became the first country to be validated for having successfully eliminated mother-to-child transmission of HIV and syphilis in 2015, then Health Minister Dr Fenton Ferguson had told the Observer that Jamaica was on track to being among the first English-speaking countries in the region to achieve the target.
Dr Ferguson said then that Jamaica was in the process of “doing the validation of that, so I believe that Jamaica now stands at a point where we [can] become the first in the English-speaking Caribbean to eliminate mother-to-child transmission”.
Although Jamaica was on the “cusp of eliminating mother-to-child transmissions”, according to Ferguson, two years later Anguilla, Antigua and Barbuda, Bermuda, Cayman Islands, Montserrat, and St Kitts and Nevis are the countries being recognised at a validation ceremony in St Kitts and Nevis today — World AIDS Day.
According to WHO, eliminating mother-to-child transmission of HIV and syphilis is key to the global effort to combat sexually transmitted infections and to end AIDS by the year 2030.
Yesterday, Dr Skyers explained why Jamaica has not yet met the necessary targets.
“At the start of the process they had looked at HIV, and that portion of the elimination is on track; however, the syphilis portion is not on track, and that is what we are trying to sort out, so that is why we have not applied for validation because both sets of targets have to be met before you can apply for validation,” she confirmed.
Skyers told the Observer that the challenges being faced are related to documentation.
“With syphilis, data is recorded in a multiplicity of spaces, and as such it’s sometimes a little bit challenging to put all the pieces together… The HIV data is a little bit more central, so you may have one or two spaces where the data is captured…” she explained.
However, she said systems are being put in place so that Jamaica will be able to meet the target.
Dr Skyers also pointed out that Jamaica’s population size is a major factor in achieving the target.
“Those countries [that are being validated]… the populations are pretty small, so they probably have less than 20 women per year, we have about 400 [women] per year… 400 in relation to HIV and probably more in relation to syphilis,” she said. “So we have… higher hurdles to jump than smaller countries.”
Meanwhile, in his World AIDS Day message, St Kitts and Nevis Prime Minister Timothy Harris, who is the head for human resources, health and HIV for Caricom and chair of Pan Caribbean Partnership against HIV and AIDS, said today’s commemoration shows that the HIV story has changed.
“On this day, the Caribbean signals to the world that our region can be first to end new HIV infections among children,” Harris said in relation to today’s validation ceremony.
“There are an estimated 310,000 people living with HIV in our region. Their prospects are far different than they were in the era when an HIV diagnosis meant certain death, or even the period when HIV medicines were so expensive that very few had access,” Harris said. “From 2000 to 2016, the number of people on treatment in our region more than doubled. In fact, we crossed a boundary in 2016 when, for the first time, more than half of all people living with HIV in the Caribbean were accessing antiretroviral therapy.
“And so we are gathered together on World AIDS Day 2017, not with fear or sorrow, but with the confidence that we have the tools to end this epidemic,” Harris continued.
The 90-90-90 treatment targets are essential to putting and end to the AIDS epidemic by 2030. The goal is to have 90 per cent of people living with HIV knowing their status, 90 per cent of diagnosed people on treatment and 90 per cent of people on treatment, with an undetectable viral load by 2020.
Asked how is Jamaica doing with these targets, Dr Skyers said: “We are doing well in terms of the first 90, as at the end of 2016 we are at 88 per cent, so we have two per cent to go to get to that first 90. The other two 90s we are having challenges with that, and that really relates to persons who are not in care.
“If you are not in care you can’t be on treatment, which is our second 90. So the whole issue around stigma, whether internal or external, discrimination… all of those issues impact whether or not persons remain in care.
“And the third 90 relates to viral suppression and medication adherence… that is a challenge for us as well [because] we are not a pill-taking nation and we do have challenges with persons adhering to medication,” she continued.
Dr Skyers said about 60 per cent of those who are on treatment are virally suppressed.
She also pointed out that people being comfortable in their communities is integral to the thrust to end the AIDS epidemic as key populations, such as men who have sex with men and sex workers, still have to deal with issues of discrimination in their communities.
“There is also the issue of persons being aware that they are at risk [for HIV],” she told the Observer. “For married women or persons who believe that they have one partner — they may have one partner but their partner may not have one partner; so how do we raise that level of consciousness within the community to say, ‘Once you are sexually active you are at risk for HIV’ so that the necessary conversations of protecting yourself and the necessary testing… becomes routine.”
Dr Skyers said there are a host of issues that impact the HIV epidemic in the Jamaican context that need to be addressed.
Source Jamaica Observer