Accelerating the Response to HIV/AIDS in the Caribbean
(June 12, 2003)

http://www.worldbank.org/

HIV/AIDS is the leading cause of death in the 15 to 44 year age group in the Caribbean. By the end of 2001, more than a half million people in the region were infected with the disease. The distinguished panel, which included the Prime Minister of St. Kitts and Nevis, Dr. Denzil Douglas, who is also Chairman of the Pan Caribbean Partnership Against HIV/AIDS (PANCAP) and US Health and Human Services Secretary Tommy Thompson, who is also the Chairman of the Board of the Global Fund to Fight AIDS, Tuberculosis and Malaria, discussed Accelerating the Response to HIV/AIDS in the Caribbean. The panel sought to focus on the role of the Caribbean Community (CARICOM) and its partners in reducing and controlling the spread of the disease. Panelists focused on analyzing current trends, resources and methods being utilized to address the epidemic, as well as the future of the Pan Caribbean Partnership (PANCAP) as a coordinating network in the fight against HIV/AIDS.

Caroline Anstey, Country Director for the World Bank's Latin America and Caribbean region, opened the panel with introductory remarks. She noted Prime Minister Douglas has taken a leadership role in this effort, as have many other regional political leaders. The Prime Minister said the region faces enormous challenges in addition to HIV/AIDS, including significant population migrations and managing health systems without adequate budgets. Some countries in the region are highly developed, others undeveloped, and the Prime Minister noted the gross national income of most countries is less than $1 billion. As a result, partnerships are needed to stem the epidemic as individual countries do not have the financial means. The population in the region is highly mobile, traveling extensively within the region, which exacerbates the epidemic's risks. He noted that the region is experiencing a growing sex industry and sex tourism, in part spurred on by economic difficulties. As the economies of countries in the region become increasing service oriented and informal, few workers have access to health services and other safety nets, increasing their vulnerability. Prime Minister Douglas said a public education response was imperative and collective regional strategy, started in 2001, is being implemented. He stressed that heterosexual relationships are the primary cause of the spread of the disease in the Caribbean. Half a million people are infected and there have been 42,000 deaths and a quarter million children orphaned. Infection rates range between 1 percent and 6 percent for countries in the region. The impact of the disease has enormous economic implications. In some countries, GDP is predicted to be reduced by 4 percent because of the disease. The Prime Minister cited ongoing negotiations with pharmaceutical companies as a major event in the disease's future impact. Efforts are ongoing to mobilize the donor community and the Global Fund on HIV/AIDS to address the region's problems. Some countries have come to the World Bank for loans to take on the burden internally, but the financial need remain great. He discussed signatories of PANCAP, and said the International Development World Bank would soon become a partner as well, based on his meetings with them the day before.

Dr. Edward Greene, Assistant Secretary General of CARICOM, spoke next about the workings of PANCAP. He called the partnership a network of institutions designed to mobilize support to procuring funds. The partnership exists because no one country in the region could reduce the epidemic without help. PANCAP, has 61 signatories, and includes country government, people living with the disease, intergovernmental organizations, private sector, religious organizations, and academic organizations to build awareness, provide information and monitor programs. Areas of focus include mother-to-child transmission, capacity building to manage and care for people infected with the disease and communications.

Sir George Alleyne, UN Special Envoy for HIV/AIDS in the Caribbean, and former Director of the Pan American Health Organization (PAHO), described the challenge facing the international community to address the region's needs. He called AIDS an epidemic like none other the region has seen before and demands a different kind of approach. Sire Alleyne  said the Caribbean AIDS problem should be part of the international community's global work on the issue, not separated in any way. He also described the ties between AIDS and the region's escalating poverty rates. Sir Alleyne  said the financial flows from the donor community had been insufficient to fully addressed the crisis. Human resources for project management, better information and sharing of best practices are also necessary components the international community can provide. He noted there are some positive developments as mother-to-child transmissions have decreased in a number of countries, new programs have been put in place, and some countries have borrowed specifically for the prevention and treatment of the epidemic. He also cited the political leadership of the region as being responsive to the problem. He noted malaria and cholera have become almost nonexistent in the region when they had once been plagues.

Patricio Marquez, a health specialist in the World Bank's Latin America and Caribbean region, said CARICOM is setting an example that other global regions are examining. He said AIDS is a major impediment to the World Bank's mission of a world without poverty. The World Bank has launched the HIV/AIDS Prevention and Control Program with $155 million in funding for the region. Under this program, six country projects have begun in the last two years. Additional, a $2.9 million grant was provided to Haiti. Regional monitoring and surveillance facilities will be upgraded with program funding as well.

US Health and Human Services Secretary Tommy Thompson said he had been to Sub-Saharan Africa and Guyana to examine the effects of the epidemic, and cited some of the epidemic's toll. His travels led him to develop, within his department and with the National Institutes of Health, a mother-to-child transmission program that was supported by the President. The Caribbean Regional Epidemiological Center in Trinidad administers the funding for the program. The initiative, part of the $15 billion AIDS package targeted mostly to Sub-Saharan Africa, seeks to reverse current growth trends for new infections, treat up to three million on anti-retroviral drugs, and care for up to 10 million living with the disease. Secretary Thompson noted the US could not lead alone, and cited the Global Fund to fight AIDS, tuberculosis and malaria as a essential mechanism to organizing the international community. The fund has helped 37 countries. Haiti was the first country to receive disbursements from the fund. He added a cautionary note that the next round of funding was projecting a $500 to $800 million shortfall and said he had met with global business leaders to see if the gap could be eliminated. He said, that failing to wage a war on the epidemic, will lead to the destabilization of some developing countries and will ultimately have an impact on the entire globe.