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Imperatives for Achieving Universal Access in the Caribbean Region . 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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Imperatives for achieving universal access in the caribbean region
Imperatives for Achieving Universal Access in the Caribbean Region

Kevin Fenton, MD, PhD, FFPH

Director, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention

Centers for Disease Control and Prevention

10th Annual General Meeting of the Pan Caribbean Partnership Against HIV/AIDS

November 1, 2010



Summary of caribbean hiv aids epidemic
Summary of Caribbean HIV/AIDS Epidemic

  • WHO/UNAIDS estimates in 20081:

    • 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%).

1UNAIDS/WHO 2009 AIDS Epidemic Update


Why is universal access important
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, 2009


Cdc strategic vision of a tiered approach to prevention
CDC strategic vision of a tiered approach to prevention

HIV Rx and Care, PN, Counseling, STD Rx,SEPs PMTCT, condoms

HIV Screening, Drug Rx/Referral, EBIs, STD Rx, condoms

Combination prevention, SDH, DEBIs, condoms

Social marketing, HIV screening, stigma, condoms


High risk hiv individuals access to testing services for most at risk populations
High-Risk HIV+/- IndividualsAccess to Testing Services for Most-at-Risk Populations

1 UNGASS Country Progress Reports 2010 accessed from UNAIDS website


Hiv individuals coverage of art across caribbean
HIV+ IndividualsCoverage of ART across Caribbean

1WHO/UNAIDS/UNICEF. Towards Universal Access: Scaling up Priority HIV Interventions in the Health Sector. Progress Report 2009.


General population coverage of services for pmtct
General PopulationCoverage 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

1WHO/UNAIDS/UNICEF. Towards Universal Access: Scaling up Priority HIV Interventions in the Health Sector. Progress Report 2009.


Current barriers to universal access in the caribbean
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.


Best and promising practices in the region
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


Priorities for action key recommendations for enhancing regional efforts
Priorities for ActionKey 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



Imperatives for achieving universal access in the caribbean region1
Imperatives for Achieving Universal Access in the Caribbean Region

Kevin Fenton, MD, PhD, FFPH

Director, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention

Centers for Disease Control and Prevention

10th Annual General Meeting of the Pan Caribbean Partnership Against HIV/AIDS

November 1, 2010


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