By Key Correspondent Pauline Ngunjiri
The Caribbean region has the highest incidence of HIV in the Americas and the second highest prevalence in the world after Sub-Saharan Africa. Within the small-island nations of the Eastern Caribbean, the HIV epidemic is believed to be concentrated among certain high-risk populations.
In Kitts and Nevis, the estimated prevalence rate was 0.46 in 2009. The most common route of transmission is unprotected sex, particularly in concurrent relationships. But lack of data makes it difficult for the government to determine the size, determinants and distribution of the epidemic and target an appropriate response.
The response to HIV is threatened by a lack of sustainable financing, on-going stigma and discrimination and the limited capacity of civil society to aid in the response.
Direct donor funding for HIV response-related activities has largely ended in St. Kitts and Nevis. A World Bank funded project on HIV prevention and control ended in 2009, having disbursed US$3.4 million to St. Kitts and Nevis. Along with the other OECS (Organization of East Caribbean States) countries, St. Kitts and Nevis also benefited from a multi-country Global Fund Round 3 grant that ended in 2010. The grant was used for prevention, care and treatment with particular emphasis on voluntary counselling and testing as well as behavior change campaigns. Global Fund support that provides free antiretrovirals in the eastern Caribbean is estimated to end in 2012.
The government of St. Kitts and Nevis has made significant progress in addressing the challenges of HIV over the last decade, but weaknesses in the health system threaten these successes. A Health Systems and Private Sector Assessment conducted by USAID in May 2011 highlighted these challenges including sustainable health financing, stigma and discrimination, and weak civil society engagement.
It is also unlikely that domestic spending on HIV will be able to replace previous levels of donor funding in the near future. There is lack of information about costs and expenditures in the health sector, essential for rational financial sustainability planning.
While funding is one limiting factor, the national HIV response is also hindered by stigma and discrimination. Within the small community of St. Kitts and Nevis (population 50,000), maintaining confidentiality of HIV status or stigmatized behavior is difficult. Non-discriminatory laws currently do not exist to protect people living with HIV or vulnerable groups like men who have sex with men (MSM) and sex workers.
Doctors fail to record AIDS-related deaths to protect families. Few commercial businesses have HIV workplace policies, and not a single grievance has been filed with the Human Rights Desk for HIV in its three years of existence. Further, private practitioners report that their HIV-positive clients avoid referral to the public sector HIV program or clinical care team, preferring to remain with their private physician for confidentiality reasons.
Civil society organizations and private sector entities, including non-profit organizations and provider associations, can play a valuable role in the countries’ response to HIV. They may provide direct services for people living with HIV, outreach to marginalized populations, advocacy for programs to meet their needs or additional financial resources.
In St. Kitts and Nevis, better civil society and private sector engagement are particularly needed as Ministry officials are overstretched. Civil society organizations for health, while welcomed by the government to provide input, currently do not have the capacity to play a supporting role in decision-making or planning. Little external support is available for non-profit groups. The Ministry does not have formal mechanisms for communicating and collaborating with private sector providers.
These challenges must be addressed to ensure the needs of people living with HIV, and those at a higher risk of getting it, in St. Kitts and Nevis are met.