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Published on January 7, 2008

Author: Noormahl

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The National HIV/AIDS/STI Program in Jamaica Critical challenges & priorities:  The National HIV/AIDS/STI Program in Jamaica Critical challenges & priorities J. Peter Figueroa Chief, Epidemiology & AIDS March 2007 National HIV/STI Program in Jamaica :  National HIV/STI Program in Jamaica Outline HIV/AIDS epidemic in Jamaica National response Socio-economic determinants of HIV Challenges & plans Slide3:  The second highest HIV prevalence rate in the world after sub-Saharan Africa. HIV prevalence – 1.6% (range 1.1% - 2.7%) The leading cause of death among persons aged 15–44 years. An estimated 300,000 persons living with HIV/AIDS HIV/AIDS in the Caribbean  Source: UNAIDS Dec 2005 Adult HIV Prevalence in Selected Caribbean Countries:  Adult HIV Prevalence in Selected Caribbean Countries HIV/AIDS IN JAMAICA:  HIV/AIDS IN JAMAICA Sero-prevalence among adults 1.5% Estimated No. with HIV/AIDS 25,000 Est. No. unaware of HIV status 15,000 No. of persons in need of ARV 5,000 No. of persons currently on ARV >2,500 Slide6:  JAMAICA HIV Seroprevalence among Antenatal Clinic Attendees: 1989 - 2005 Source: National HIV/STI Control Program, MOH, Slide7:  AIDS & HIV (non-AIDS) Cases by Year 1980 – 2005 Number of Cases AIDS definition includes advanced HIV disease in 2005 AIDS HIV non-AIDS Slide8:  Jamaica AIDS Cases & Deaths Reported Annually in Jamaica (1982 to 2005) AIDS definition includes advanced HIV disease in 2005 Slide9:  Jamaica Annual AIDS Case Rates by Sex (Per 100,000 population): 1982 - 2005 AIDS definition includes advanced HIV disease in 2005 Slide10:  JAMAICA AIDS CASE RATE PER 100,000 POPULATION* BY AGE AND SEX: 1982 - 2005 Slide11:  Jamaica Paediatric AIDS Cases & Deaths (1982 - 2005) Slide12:  Jamaica Annual AIDS Case Rates in Jamaica, St. James & Kingston/St. Andrew (Rate per 100,000 Population) 1982 - 2005 AIDS definition includes advanced HIV disease in 2005 Reported Risk Behaviour among Persons with AIDS in Jamaica 1982-2005 (n=7,542):  Reported Risk Behaviour among Persons with AIDS in Jamaica 1982-2005 (n=7,542) Commercial sex is readily available:  Commercial sex is readily available HIV among Substance Abusers in Jamaica:  HIV among Substance Abusers in Jamaica HIV Sero-Prevalence among Those Most at Risk - Jamaica:  HIV Sero-Prevalence among Those Most at Risk - Jamaica Slide17:  JAMAICA HIV Seroprevalence among STD Clinic Attendees: 1986, 1990 - 2005 Source: National HIV/STI Control Program, MOH, Jamaica’s Response:  Jamaica’s Response 20 years old (1986) Led by the National HIV/STI Control Programme within the Ministry of Health Partners – National AIDS Committee, JN+, NGOs, CBOs, FBOs, private sector, Gov’t sector, media, UN agencies, donor agencies HIV/STI Control in Jamaica Achievements:  HIV/STI Control in Jamaica Achievements National HIV Policy & Plan and Sector Policies Comprehensive program in place Prevention programs including media campaigns Prevention of Mother-to-child Transmission Public access program for ARV treatment Reduced HIV stigma and discrimination Decline in syphilis & gonorrhea Supported staff training, facility improvement, laboratory services, LIS, & waste management Slowed HIV spread Averted over 100,000 HIV infection Primary & Secondary Syphilis :  Primary & Secondary Syphilis STI Control - Challenges:  STI Control - Challenges No STI post at national level STIs remain an important problem Congenital syphilis ~20 cases each year Chlamydia is common ~12% of ANC, FP No recent STI prevalence data Inadequate supervision of contact investigators We need to integrate STI/HIV control and ensure specific measures to control the STIs Despite the achievements: HIV and AIDS continue to spread in Jamaica For the past 10 years: 24% of men & 34% of women having sex with a non-regular partner do not use a condom. Behaviour change has reached a plateau:  Despite the achievements: HIV and AIDS continue to spread in Jamaica For the past 10 years: 24% of men & 34% of women having sex with a non-regular partner do not use a condom. Behaviour change has reached a plateau Factors Driving the Epidemic:  Factors Driving the Epidemic Social, Cultural, Behavioural, Economic Early initiation of sexual activity Limited life-skills and sex education Multiple sex partners Gender inequity and gender roles Men having sex with men & homophobia Insufficient condom use Substance abuse: crack/cocaine, alcohol Poverty and unemployment Commercial and transactional sex Population movement Stigma and Discrimination Median Age at First Sex has declined between 1996 and 2004:  Median Age at First Sex has declined between 1996 and 2004 Multiple Partners among Men:  Multiple Partners among Men No. of Reported Sex Partners by Interview Technique (PLACE RCT May 06):  No. of Reported Sex Partners by Interview Technique (PLACE RCT May 06) Transactional Sex in Jamaica:  Transactional Sex in Jamaica National KAP Survey 2004 Challenges:  Challenges Continued stigma and discrimination Slow progress with social policy & legislation HIV prevention/interventions must be scaled up Universal access to anti-retroviral drugs Build regional and parish capacities Strengthen the multi-sectoral response Build one unified system for M & E and MIS Need to strengthen leadership and capacity at all levels Controlling the HIV/AIDS Epidemic Reducing Social Vulnerability:  Controlling the HIV/AIDS Epidemic Reducing Social Vulnerability Social programs & opportunities for the poor including education and employment Policies that address critical social needs and rights of vulnerable populations Greater gender equity and reorientation of gender roles Expanding HIV prevention to the youth and those most at risk eg CSW, MSM Safe sex education and life skills in schools National program for better parenting How To Strengthen the Response to the epidemic in order to achieve Universal Access to Prevention, Treatment, Care and Support:  How To Strengthen the Response to the epidemic in order to achieve Universal Access to Prevention, Treatment, Care and Support National HIV/AIDS Program Priorities 2007:  National HIV/AIDS Program Priorities 2007 Strategic Planning & Coordination Build Capacity & Sustainability Expand HIV rapid testing Universal access to ARV treatment Expand the scope, coverage and quality of prevention programs Policy, Human Rights & Stigma Reduction Monitoring & Evaluation Strengthen the Multi-sectoral Response Expand HIV Testing:  Expand HIV Testing All ANC attendees All persons with a STI All adult hospital admissions Vulnerable populations eg CSW, MSM Selective Family Planning clinics Private sector labs on a walk in basis HIV Rapid Testing of Hospital Admissions: Jan - June 2006:  HIV Rapid Testing of Hospital Admissions: Jan - June 2006 No. of PLWHA on ARV Treatment Sept 04 - Nov 06:  No. of PLWHA on ARV Treatment Sept 04 - Nov 06 Public access treatment program supported by Global Fund Prevention of Mother To Child Transmission Jan – June 2006:  Prevention of Mother To Child Transmission Jan – June 2006 Prevention:  Prevention We need a ten fold increase in prevention program coverage & resources: HIV rapid testing & risk reduction counseling Outreach programs to CSW, MSM and sites where persons go to meet new sex partners Workplace and targeted community programs We also need an overall strategy and plan in the education sector to reach the youth We must build capacity and improve quality UNGASS Knowledge Indicator:  UNGASS Knowledge Indicator Prevention at Sites where persons go to meet new sex partners (PLACE):  Prevention at Sites where persons go to meet new sex partners (PLACE) Phase 1 Identify sites where people go to meet new sex partners Phase 2 Investigate sites Phase 3 Interview persons at sites Develop targeted interventions based on the data collected PLACE Montego Bay New Sex Partners in Past 12 Months:  PLACE Montego Bay New Sex Partners in Past 12 Months Critical Policy Issues:  Critical Policy Issues Discrimination against PLWHA HIV testing for employment Sex education and condom access for youth Commercial sex work Crack cocaine use Men who have sex with men Prison health Anti-Stigma Campaign Jamaica:  Anti-Stigma Campaign Jamaica Champions for Change Leaders in reducing stigma & discrimination:  Champions for Change Leaders in reducing stigma & discrimination Promote the National HIV/AIDS policy Speak out against stigma and discrimination & report all cases Discourage loose talk about HIV/AIDS Encourage respect for the rights and privacy of PLWHA Intervene when discrimination occurs Advocate for appropriate legislation National HIV Strategic Plan 2007-2012:  National HIV Strategic Plan 2007-2012 New National HIV Strategic Plan is being developed Series of consultations conducted: National consultation 1-3 Nov 2006 HIV strategic plan for Education Prepare projects to seek funding National HIV Strategic Plan Universal Access::  National HIV Strategic Plan Universal Access: Includes prevention, treatment & care Access to services for all Full coverage of all those in need Adequate quality Acceptable and affordable Use institutional channels Build strategic capacity National HIV Strategic Plan Key Issues:  National HIV Strategic Plan Key Issues Social vulnerability & policy Gender equity and roles Civil society ownership, initiative, empowerment & capacity Youth empowerment Reducing stigma, affirming rights, involving PLWHA & promoting disclosure Effective coordination National HIV Strategic Plan 2007-2012:  National HIV Strategic Plan 2007-2012 Priority Areas: Prevention Treatment, Care and Support Enabling Environment & Human Rights Empowerment and Governance Cross-Cutting Strategy Areas:  Cross-Cutting Strategy Areas Stigma and Discrimination Policy and Legislative Change Behaviour Change Service Quality and Access Capacity Building To Do: Training and Development To Be: Sustainability Communication and Coordination Research, Monitoring, and Evaluation Program is Evidence Driven:  Program is Evidence Driven HIV and STI epidemiological research Formative research in prevention National KAP surveys Condom choice trial (FHI) Site based prevention RCT in Kingston PLACE (Measure) HIV vaccine trial – HVTN Protocol 204 & 502 Sex Worker and MSM surveys Affirming an Effective Response to HIV/AIDS in Jamaica:  Affirming an Effective Response to HIV/AIDS in Jamaica

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