KINGSTON, Jamaica, November 12, 2009--Among the Caribbean nations, Jamaica has the third largest number of people living with HIV or AIDS. There are roughly 25,000 people in Jamaica infected with the AIDS virus. The prevalence of HIV is 1.5 percent among the general adult population, but it is much higher for female sex workers, men who have sex with men, and prison inmates. Overall, the main challenge for Jamaica is to reduce transmission among vulnerable high risk groups and prevent an escalation that would reach epidemic proportions.
APPROACH
The first AIDS case was reported in 1982, and in 1986 the government of Jamaica initiated its National HIV/STI Program, which has been guided by a series of medium term strategic plans. In 2001 the government of Jamaica adopted an ambitious plan for the expansion of prevention and treatment strategies with the support of the World Bank -- the 2002-2006 HIV/AIDS National Strategic Plan (NSP).
The Bank was well-placed to support this operation. In June 2001 it had launched a lending program for HIV/AIDS in the Caribbean. The first phase of that included funds for the Dominican Republic and Barbados. The second phase included support for the Jamaican initiative, which amounted to an infusion of US$15.13 million over a six-year period between 2002 and 2008. The bulk of the funding, or US$10.6 million, came from the World Bank, and roughly a third, or US$4.53 million, came from the government of Jamaica.
In tandem with the World Bank, other entities contributed significant sums to combating HIV/AIDS in Jamaica, notably the Global Fund Tuberculosis, AIDS & Malaria. By mid-2008 when the first phase came to an end, there had been substantial gains in terms of treatment, prevention, capacity and infrastructure. But the problem was far from resolved. Changing certain at-risk behaviors had proven over the years to be a very difficult task.
The government of Jamaica renewed its commitment to fighting HIV/AIDS with the approval of the 2007-2012 NSP, the latest salvo in its 23-year-old National HIV/STI Program. And the World Bank followed suit. It approved another US$10 million loan with co-financing of US$1.5 million from the Jamaican government.
HIGHLIGHTS
The first phase of World Bank assistance tackled the issue on essentially two fronts – prevention and treatment, but the ability to do that also required extensive investments in personnel and equipment. Some efforts were extremely successful, others less stellar, but in the end the World Bank helped Jamaica save hundreds of lives that would have otherwise been lost to the AIDS virus, and it assisted in the creation of an extensive infrastructure capable of addressing the HIV/AIDS problem.
Saving lives: Treatment strategies led to a substantial reduction in the number of AIDS-related deaths from 665 in 2004 to 320 in 2007. This was due in large part to a US$6.6 million grant from the Global Fund that allowed for the purchase of anti-retroviral drugs. Prior to 2003, less than 100 people in Jamaica were on antiretroviral treatment. By the end of the project in mid-2008, that number had reached 4,400.
Testing and treatment of those who tested positive improved dramatically. The entire inmate population was screened for HIV; 95 percent of those who attended prenatal clinics were also screened; of those who tested positive, 85 percent received anti-retroviral drugs, up from 10 percent in 2002.
Training: Thousands of people have received training in an HIV/AIDS-related field. For example, 2,653 people received extensive HIV management training known as Voluntary Counseling and Testing, or VCT; 246 prison guards, 241 inmates, and 174 other members of Jamaica’s security forces were trained to be peer educators; and 120 people were trained to go into night clubs, guest houses, hotels, massage parlors, etc., to work in prevention.
A change in attitude: Anti-stigma campaigns resulted in a more positive attitude toward those infected with the AIDS virus. There was a 10 percent increase in overall acceptance levels from 2004 to 2008; close to 83 percent of respondents said they would be willing to take care of an HIV-infected family member; and 76.4 percent said they would support an HIV-infected female teacher who wanted to teach.
100% Coverage: Jamaica now has 19 HIV/AIDS treatment sites located throughout the country. They serve 360 clinics in the nation’s 14 parishes, and each one has diagnostic and treatment capabilities as well as comprehensive ambulatory care.
LOOKING FORWARD
An intertwined set of cultural, economic, social and behavioral factors are still driving the HIV/AIDS epidemic and will require more extensive prevention campaigns and treatment strategies. But the World Bank and the government of Jamaica, as well as other organizations, are committed to working together to help the nation stem the tide of HIV/AIDS.
