This re­gion knows how to pre­vent HIV. Now will we?

The Star (St. Lucia) - - REGIONAL - By Dr. Cesar Nuñez

World AIDS Day 2016 comes a year after the com­mu­nity of na­tions com­mit­ted to end­ing AIDS by 2030 as part of the Sus­tain­able De­vel­op­ment Goals and six months fol­low­ing a land­mark Po­lit­i­cal Dec­la­ra­tion to end AIDS. HIV pre­ven­tion is cen­tral to achiev­ing this goal. At this ex­cit­ing mo­ment in his­tory we have at our dis­posal a com­bi­na­tion of new sci­ence, ev­i­dence-based pre­ven­tion strate­gies re­fined over more than 30 years, and the un­der­stand­ing that in or­der to suc­ceed we must en­sure that no one is left be­hind.

Some of the weapons in our ar­se­nal are fa­mil­iar. Con­doms still mat­ter. Our gov­ern­ments have com­mit­ted to en­sur­ing that we have strength­ened na­tional con­dom pro­grammes with suf­fi­cient at­ten­tion to pro­cure­ment and dis­tri­bu­tion. We’ve learned over the last two decades how to use so­cial mar­ket­ing to tar­get spe­cific audiences and to drive de­mand for con­dom use.

Our re­gion also knows how to pre­vent ba­bies from be­ing born with HIV. Through the wide­spread expansion of an­tiretro­vi­ral treat­ment for moth­ers liv­ing with HIV, there have been dra­matic de­clines in HIV trans­mis­sion to chil­dren. In 2015 nine of every ten preg­nant women liv­ing with HIV in Latin Amer­ica and the Caribbean re­ceived an­tiretro­vi­ral medicines.

Cuba led the world by be­com­ing the first coun­try to be val­i­dated last year by the World Health Or­ga­ni­za­tion as hav­ing elim­i­nated this form of HIV trans­mis­sion. The val­i­da­tion process is un­der­way now in 12 Caribbean coun­tries and ter­ri­to­ries in­clud­ing An­tigua and Bar­buda, Barbados, Do­minica, Gre­nada, St. Kitts and Ne­vis and St. Vin­cent and the Gre­nadines. The suc­cess of th­ese coun­tries re­minds us that the elim­i­na­tion of new HIV in­fec­tions among chil­dren is a re­al­is­tic and ur­gent goal.

In 2008 Health and Ed­u­ca­tion Min­is­ters in Latin Amer­ica and the Caribbean com­mit­ted to pro­vid­ing young peo­ple with com­pre­hen­sive sex­u­al­ity ed­u­ca­tion through the “Ed­u­cat­ing to Pre­vent” Dec­la­ra­tion. We’ve long ac­knowl­edged our re­spon­si­bil­ity to give young peo­ple the in­for­ma­tion they need to keep them safe through­out life. We must now ramp up our ef­forts to en­sure that ado­les­cents have that ed­u­ca­tion along with ac­cess to eco­nomic em­pow­er­ment and sex­ual and re­pro­duc­tive health ser­vices.

To­day, hap­pily, we have new tools to bol­ster HIV pre­ven­tion. Pre-ex­po­sure pro­phy­laxis or PrEP—HIV drugs taken by an HIV neg­a­tive per­son on a daily ba­sis— dra­mat­i­cally re­duces the chance of con­tract­ing the virus. The world has agreed to reach at least three mil­lion peo­ple at higher risk of HIV in­fec­tion with th­ese pre­ven­ta­tive drugs. Many Gov­ern­ments in our re­gion have come on­board.

Early HIV test­ing and treat­ment can be gamechang­ers as well. We now know that the sooner a per­son liv­ing with HIV finds out their sta­tus and starts treat­ment, the sooner the lev­els of the virus in their blood can be re­duced, nearly elim­i­nat­ing the risk of in­fect­ing some­one else.

It is on this ba­sis that gov­ern­ments have com­mit­ted to achiev­ing the 90-90-90 tar­gets —90per­cent of peo­ple liv­ing with HIV aware of their sta­tus, 90per­cent of those peo­ple on treat­ment and 90 per­cent of treated peo­ple vi­rally sup­pressed. Over­all an es­ti­mated 55 per­cent of peo­ple liv­ing with HIV in Latin Amer­ica and the Caribbean were on treat­ment in 2015. Achiev­ing this tar­get will re­quire sig­nif­i­cant in­vest­ments and com­mit­ment. As gov­ern­ments and health min­istries strate­gize about how to achieve scale-up, it is im­por­tant to re­mem­ber that th­ese goals are fea­si­ble. Chile has al­ready at­tained the treat­ment and vi­ral sup­pres­sion tar­gets. Barbados is on track to achieve all three goals.

Per­haps the great­est chal­lenge is our on­go­ing fight to elim­i­nate stigma and dis­crim­i­na­tion. Even where we have com­bi­na­tion HIV pre­ven­tion ser­vices avail­able, too many peo­ple do not feel safe or do not have the means to ac­cess them. We have to do more to en­sure that poverty; home­less­ness, sex­ual ori­en­ta­tion, gen­der iden­tity, age and mi­grant sta­tus do not con­tinue to be bar­ri­ers to end­ing AIDS in Latin Amer­ica and the Caribbean. That means sup­port­ing the or­ga­ni­za­tions that are best po­si­tioned to reach th­ese communities. But be­yond that, every cit­i­zen of this re­gion has a part to play in en­sur­ing that all peo­ple are treated with dig­nity and re­spect, re­gard­less of dif­fer­ence.

Dr. Cesar Nuñez is the di­rec­tor of the UNAIDS Latin Amer­ica and Caribbean Re­gional Sup­port Team. He de­liv­ered this mes­sage in recog­ni­tion of World AIDS day ob­served on De­cem­ber 1.

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