Posters hang on the concrete walls of a busy public hospital here pushing a simple message to expectant mothers: If you’re HIV positive, get treatment.
In an impoverished country in which one-in-four teenage girls has either given birth or is currently pregnant, the most important information on the poster is that treatment is free.
The message is the same at hospitals across the country. It is part of an ambitious goal: eliminate the infection of HIV and AIDS for newborns by focusing on their mothers.
It’s a target within reach across the Caribbean, where countries have improved testing of pregnant women, treated them with antiretroviral medications, provided cesarean surgeries, and offered alternatives to breast milk for newborns.
As a result, the Caribbean is on the verge of becoming the first region in the world to eliminate mother to child HIV and AIDS transmissions by 2015.
The Caribbean’s remarkable milestone comes amid a shifting landscape in the three-decades-old battle against the diseases in which the islands have become a symbol of the worldwide success in combating the diseases. The region remains second only to sub-Saharan Africa in infection rates as a percentage of the population, but thanks to an influx of foreign funding it has led the world in the reduction of deaths from the disease and in cutting the spread of infection.
Some are concerned that that success is set to be challenged as international funding dries up and nations reduce foreign aid amid global economic uncertainty. That leaves cash-strapped Caribbean governments seeking ways to continue health programs while reaching key groups of people, such as sex workers and gay men, with testing and treatment.
Caribbean wants to be 'free'
Just decades ago, a diagnosis of AIDS or HIV was a death sentence. AIDS has killed more than 25 million people since it was first detected more than 30 years ago, according to the United Nations.
Yet, new cases of HIV/AIDS among children and adults have dropped by one-third across the globe since 2001, according to a UN report released earlier this year.
Nowhere has that been more pronounced than the Caribbean, which led the world with a 42 percent reduction in the rate of new infections, the UN says.
The Caribbean’s success has been achieved through an expansion of treatment to patients, who are now offered universal access to antiretroviral drugs in some countries. The islands have also made testing free and easy for much of the population.
Suriname and the Dominican Republic led the world in cutting new HIV infections, with reduction of 86 percent and 73 percent, respectively, from 2001 to 2011, the UN says. Six other Caribbean countries reduced infections by one third or more during that time period.
Outside of the hospital in downtown Santo Domingo, a young woman says she was unaware she had HIV until she was tested while pregnant with her second child.
“I’m receiving pills that I take every day and the doctors said I will have a cesarean,” she says, requesting her name be withheld because family members are not aware of her health status. "I haven’t had to pay anything for it.”
Last year, the Dominican government launched the program, which provides cost-free testing and treatment to those who can’t afford it.
“By 2015, we want to say that we’re free of mother to child transmission of HIV,” says Dr. Luis Ernesto Feliz Báez, who oversees the Dominican Republic’s response to the diseases.
The UN set 2015 as a target for the worldwide elimination of the transmissions, which is defined as reducing the transmission of HIV and AIDS to 5 percent or less of births from mothers who carry the disease.
“A number of Caribbean countries are already there and some countries are going to get there in coming years,” says Dr. Michel de Groulard, regional program advisor for UNAIDS in the Caribbean, the UN agency that works on halting the spread of HIV/AIDS. “We will very likely be the first.”
A drop in funding
Many programs have been instituted thanks to a crush of funding from international donors.
In the past decade, the Caribbean has received $1.6 billion in international funding to combat HIV/AIDS, making some countries among the highest per capita recipients of funding in the world.
“Over the past 10 years, the Caribbean has benefited from a lot of attention from the international community,” Dr. de Groulard says. “But most donors are pulling out and countries don’t have the financial resources to sustain that level of investment.”
International donors targeted the Caribbean due to its high infection rates and the possibility that their dollars could affect change due to the region's relatively small population.
But now many governments are scaling back on foreign aid as the worldwide economy continues to sputter. It's not just the Caribbean that is expecting a reduction in funding for HIV and AIDS. In recent weeks, leaders from sub-Saharan Africa and Asian countries have voiced concern about the potential impact of planned funding cuts on their programs.
A few major donors, including the US President's Emergency Plan for AIDS Relief (PEPFAR) program and the international Global Fund to Fight AIDS, Tuberculosis, and Malaria, remain committed to the Caribbean, officials said.
Officials say they still do not know how much funding will be cut. But countries will be forced to do more with less, meaning they will have to concentrate on the most cost-effective treatment and education programs.
Meanwhile, HIV and AIDS-related deaths remain one of the leading killers of adults in the Caribbean, despite the strides made in the past decade.
“It is important to remember that the epidemic is still present in the region,” says Ruth Ayarza, the Latin America and Caribbean regional manager for the International HIV/AIDS Alliance, which supports member organizations in the Caribbean. “People are acquiring HIV through sex and it is affecting a larger proportion of gay men and men who have sex with men.”
Several countries in the region still have laws against sodomy on the books – holdovers from colonial buggery acts – which help stigmatize gay men who already face deep-seated discrimination.
Dereck Springer, director of the Pan Caribbean Partnership Against HIV/AIDS (PANCAP) coordinating unit, based in Guyana, says civil society has been able to reach at-risk populations, including sex workers and gay men, with education campaigns and information about treatment.
“We’re getting more people to come forward and get tested and get treatment,” Mr. Springer says.
PANCAP is also introducing model legislation that would push countries to pass anti-discrimination bills and do away with laws against sodomy, Springer says.
“If we are going to meet UN targets by 2015, we have to tackle the stigma that is present in the Caribbean,” he says.