Editorial | HIV treatment at crossroads

Dr Richard Amenyah’s warning that some of the global gains against the spread of HIV/AIDS could be in danger because of a cut in funding by the United States and countries for programmes to combat the disease highlights the urgency with which Jamaica and its Caribbean partners ought to find ways to confront this danger.

Or, as Dr Amenyah, the outgoing director of the UNAIDS Multi-Country Office in the Caribbean, puts it in an article in this newspaper, “sustained political commitment (to address the issue) is non-negotiable”.

The fact is, outside sub-Saharan Africa, the Caribbean has the highest HIV-prevalence in the world, estimated at 1,200 cases per 100,000 people. In Jamaica, the incidence rate is estimated at 28.1 per 100,000 population.

With between 350,000 and 590,000 Caribbean people living with HIV/AIDS, the region has an adult HIV prevalence rate between 1.9 per cent and 3.1 per cent, second only to Africa (7.5 per cent and 8.5 per cent). Cuba, the Dominican Republic, Haiti and Jamaica accounted for almost 90 per cent of new infections in the region in 2023.

However, Jamaica has seen progress in the reduction of new infections by 17 per cent between 2010 and 2022, pointing to a key success of a global partnership against a disease that was once considered a death sentence. Today, people with HIV/AIDS who use the appropriate medications can have normal lives.

JEOPARDY

Much of this is now in jeopardy since the US removal of funding for HIV/AIDS prevention around the world. Indeed, a June 2025 survey found that 80 per cent of HIV service organisations in the Caribbean were facing severe disruptions after funding pauses, with capacity-building, social protection and human rights programming hit hardest. Many organisations could not sustain services beyond a few months without alternative resources.

The situation reflects, as Dr Amenyah noted, the region’s past reliance heavy on external financing. It now calls for regional governments to increase domestic spending on fighting the disease, including fully integrating HIV/AIDS response in primary healthcare systems. The design of the new arrangements must also ensure the protection of the rights of people affected by HIV.

Put another way, the gains made in Jamaica and elsewhere in this region can’t be allowed to slip. And there have been gains – like the 62 per cent decline in AIDS-related deaths between 2010 and 2024, the reduction of stigma and discrimination of people living with HIV/AIDS, increased access to sex education, the use of data to narrow gaps in treatment and amplification of the voices of people who have the disease.

In Jamaica, there is a need for the government to establish a dedicated national HIV financing mechanism, protected within the health budget and insulated as far as possible from annual fiscal pressures. This would ensure continuity of treatment, laboratory services and essential support programmes, even when donor funding fluctuates.

INTEGRATED

Further, HIV services – testing and counselling – should be better integrated into primary healthcare. Retention in care, which Dr Amenyah also emphasised, needs a multipronged approach, investment in community health workers, peer counsellors and digital follow-up systems.

New long-acting antiretroviral therapies are important to effective HIV care, and they need to be accessible and affordable. Therefore, Jamaica should work with regional partners to advocate for pooled procurement, regulatory alignment and fair pricing, ensuring that advances benefit people here.

Beyond medical intervention, there must be continued and accelerated work to address social stigma, in circumstances where a 2022 survey showed that over half (53 per cent) of people living in Jamaica with HIV experienced, or enacted or self-stigma. Such attitudes, the survey pointed out, accentuated people’s denial of their HIV status “and could disempower them from accessing treatment services”. Robust anti-discrimination policies, underpinned by strong legal protections and public education are vital.

At the regional level, the existing Caribbean Community (CARICOM) collaboration – in conjunction with the Pan-Caribbean health organisations – should be expanded. It is an effective means of pooling resources and expertise.

In that regard, we echo Dr Amenyah’s words: “The Caribbean deserves a future free from AIDS … Ending AIDS is not only achievable, but within our reach if our commitment does not falter.”