HIV- AIDS

By: Tracey Thompson

Twenty-six year old Michelle was elated. She was about to join her husband in the United States. All that was left was the results from the medical test. But her joy soon turned to sorrow as her medical showed that she was HIV positive.

“When I went to pick up my medical and I was told that I was HIV positive I just could not believe it. I felt I was going to die. I cried. I screamed. I felt anger at my husband who had given it to me,” she relates to JIS News.

Now six year since her diagnosis Michelle is divorced, still living in Jamaica but living a full and healthy life thanks to support from her mother and doctor.

Bright, ambitious, attractive and healthy looking, Michelle belies the stereotypical image of the HIV carrier. She is not a poor uneducated prostitute, a needle sharing drug user or a homosexual male. But she, like most of the estimated 15,000 Jamaicans now afflicted with HIV, the virus that causes AIDS, just did not think that her partner was infected and never sought to protect herself from the disease.

“Now I speak to young people about the disease and the first thing they say is that I don’t look sick and that is the problem. You can’t tell by looking. You have to protect yourself,” she says.

And, that is the message that the country’s Health Ministry has been trying to get across to the population since the first case of AIDS was reported in the island in 1982. Jamaica is one of the larger islands in the Caribbean with a population of 2.5 million. The disease has now become the second leading cause of death in the country for men and women in the age group 30-39 years, with approximately 1.5 per cent of the adult population estimated to be HIV positive. In the year 2000, 12 persons were reported to have died of AIDS in Jamaica every week.

Statistics indicate that the disease is most prevalent in the heterosexual population, which accounts for about 61 per cent of all infections, 25 per cent of transmission have not being determined, 6 per cent credited to the homosexual population, while there are no reports of transmission from intravenous drug use. Health workers have also found a high infection rate among commercial sex workers and persons with a history of sexually transmitted infections.

Since 1995, new infections have been increasing sharply among adolescent females who have three times higher infection rate than males of the same age group. Researchers claim that poverty, ignorance, early sexual experience with older men and embarrassment to seek advice on protection is responsible for the increase among adolescent females.

GOVERNMENT MEASURES

With so much of the young and productive population afflicted with the deadly disease the Government, from as early at 1988, put a number of measures in place to stem the transmission of the disease, including the establishment of a National HIV/Sexual Transmitted Disease (STD) Prevention and Control Programme, which is a comprehensive integrated disease prevention, health promotion programme directed towards behaviour change in individuals.

Emphasis is placed on strengthening the provision of health care services to those affected and to intensify the campaign to promote prevention. In this effort, a wide scale educational programme targeting high-risk behaviour groups and individuals in schools, workplaces and in communities have been adopted and the surveillance and evaluation component of the programme tracks the epidemic trends. A periodic assessment on behaviour change is conducted to see the outcomes of the interventions targeted towards different groups.

A variety of educational materials and tools were developed, thousands of persons trained including peer educators and outreach workers, targeted intervention conducted among prostitutes, inner city communities and STD clinic attendees.

Innovative cultural approaches are being used to get the message across including the use of community drama, radio drama, music plays, cultural events and mass media programmes including advertising and regular media briefings.

Reports from the programme are that awareness of the disease is very high, and there has been a significant increase in condom use as a means of preventing infection. Self-reported condom use at last sex among men increased from 54 per cent in 1992 to 77 per cent in 1996 and 80 per cent of teenaged boys between 15-19 reported condom use at last sex in 1994. Condom use at last sex among women was 43 per cent in 1992 and 73 per cent in 1996.

There has been significant decline in STD infections including syphilis and congenital syphilis and the country has succeeded in maintaining a lower rate of infection than initial projections.

The Government has also established a national HIV reference lab in Kingston and a HIV testing facility in Montego Bay. The STD clinic facilities has been increased and strengthened in all parishes and a cadre of contact investigators trained.

With figures showing that there have been 414 peadiatric cases between 1992 to 2000 and that one in every 15 pregnant woman is afflicted with the disease, the Ministry also instituted a programme to prevent mother to child transmission. Under the programme, which was introduced as a pilot in four parishes, free HIV testing is provided to all mothers and the anti-HIV drug, Nevirapine is given to the babies of infected mothers at the time of delivery and after birth.

Replacement feeding for the babies of infected mothers for a period of up to six months is also part of the approach. A total of 8000 pregnant women were recruited to participate in the programme, which is being implemented as part of routine activities at the antenatal and postnatal clinics.

The Government also spent US$250,000 (J$11,250,000) earlier this year to implement a programme to address public health issues in the islands prisons, including the speared of
HIV/AIDS.

INTERNATIONAL COMMUNITY JOIN IN THE EFFORT

The international community has also been assisting in the effort. The United States Government through the United States Agency International Development (USAID) has been the country’s lead international partner, supporting the national programme with both financial and technical assistance.

Other funding agencies such as the German Technical Cooperation (GTZ), Canadian International Development Agency (CIDA) United Nations Global Programme on AIDS, the Pan American Health Organisation/World Health Organisation (PAHO)/(WHO), Caribbean Epidemiology Centre (CAREC), United Nations Fund for Population Activities (UNFPA), United Nations Educational Scientific and Cultural Organisation (UNESCO) have played significant roles in the development and progress of programmes.

Jamaica has also worked collaboratively with Caribbean governments to strengthen the region’s response to the epidemic, including the Caribbean Partnership Against HIV/AIDS, the Caribbean Regional Strategic Plan for Action, which was recently adopted to promote the widest participation among actors and stakeholders to contribute and respond to the spread of the epidemic.

The efforts of Jamaica and the region to combat the disease should be buoyed by the World Bank's commitment to provide US $155 million to the region to fight the scourge. World Bank President, James Wolfensohn, who made the announcement recently, says the funding is in response to the leadership shown by Caribbean Governments. "It will help them to intervene quickly to prevent the spread of AIDS, with programmes focused on high risk groups as well as treatment of those living with AIDS," he states.

Health Minister, John Junor who led a delegation to the United Nations Special Session on HIV/AIDS in New York recently, is calling on the global community to support the Caribbean in its effort to fight HIV/AIDS. He notes that the region had the second highest rate of infection after sub-Saharan Africa and the disease has become a major threat to the most productive segment of the population.

"The potential for undermining the productive capacity of crucial sectors such as education, health, agriculture and business is very real and formidable challenge to the sustainable development of these small economies," he says.

STRAIN ON COUNTRY’S SCARCE RESOURCES

Like other counties in the region the spread of HIV/AIDS is putting a strain on Jamaica's limited economic resources and health facilities.

Dr. Yitades Gebre, Director of the National HIV/STD Prevention and Control Programme informs that the Government has been expending significant amounts to tackle HIV related infections, hospitalizations and screening of donated blood.

Average length of stay in hospital for an HIV infected or AIDS patient is 14 days and 469 persons with HIV/AIDS were admitted to hospital in 2000. Hospital bed occupancy rate due to HIV/AIDS doubled in 1999 compared to 1998.

He divulged that HIV/AIDS had resulted in 7,000 illness days and millions of dollars in losses each year.

It took about US$777,777 ($J35 million) in 1998 to treat 200 patients with an average length of stay in hospital of 12.6 days. The daily cost per patient was about US$308 ($J13, 890) and medical cost billed to the patient was about US $64 (J$2,900) per day.

The capital expenditure for HIV/STD control through the Epidemiology Unit alone was approximately US$266,666 ($J12 million) per annum for 94/95, US$388,888 ($J17.5 million) $95/96 and US$ 382,222 ($J17.2 million) for 96/97. Much more is spent on HIV/AIDS control each year. For instance HIV testing of blood donors cost in the region of US$77, 777 ($J 3.5 million) per annum. Other HIV testing in the public sector cost about US $ 111,111 ($J5 million) per annum. The cost of treating AIDS and in particular hospitalization is considerable. About US$1.1million ($J50 million was spent on hospitalization in 1996 alone.

A study conducted in the mid 90s indicate that if the current rate of HIV infection continued then by 2005, gross domestic product (GDP) will decline by 6.4 per cent. Economist and Lecturer at the University of the West Indies, Roger McLean recently cited a 1998 study which predicts that by the year 2005, Jamaica would increase its spending on HIV/AIDS by an astounding 35.4 per cent of its GDP.

The Government is also expending large amounts to help persons access the antiretroviral drugs they need to stay healthy and to keep the disease in check. HIV infected persons in Jamaica like the rest of the region face the challenge of meeting the cost of these drugs, a combination of two or three cost about US $1,022 (J$46,000) per month.

"This is a concern of the Ministry of Health and other partners in health care. It needs a concerted effort to make the antiretroviral drugs available for the treatment of persons with AIDS," Dr. Gebre says.

Jamaica and other Caribbean countries have started to negotiate with pharmaceutical companies to reduce significantly, the cost of these drugs.

STIGMA AND MYTHS

But despite high-level political response and concrete multisectoral approach to combat the disease, the country faces daunting challenges to build capacity and promote sustained prevention, care and treatment. This is as a result of the stigma and myth surrounding how HIV/AIDS in contracted and passed on.

A 2000 study, which sought to garner public knowledge of the disease, highlights the fact that the belief in myths surrounding the transmission of the disease had increased significantly since 1996.
The study found that one in three Jamaican men and one in four women believe that the disease can be contracted from insect bite. Other common myths involve contracting HIV from toilet seats, from casual contact and sharing utensils.

Althea Bailey, Behaviour Change Communications Manager for the HIV/STD Prevention and Control Programme says myths also abound on how to cure the disease, the most common of which was sex with a virgin.

"The only thing that happens is that the disease will spread usually to unsuspecting young women", she says.

Dr. Gebre, noting that over a third of Jamaican men perceive themselves as having little chance of contracting HIV/AIDS points out that one out of four men do not wear condoms with non-regular sexual partners. He informs that men 20 to 29 years old have on average three to four sexual partners and men 30 to 39 years old and male adolescents from 15 to 19 years have two to three partners.

This lifestyle of having multiple partners makes men particularly vulnerable to HIV infection, Dr. Peter Figueroa, Head of the Epidemiology Unit in Jamaica, informs. He says it is important that Jamaican men desist from having simultaneous multiple sexual partners as this contributed to the spread of HIV/AIDS, particularly when a condom is not used.

Dr. Figueroa says compounding the problem is the high level of stigma and discrimination associated with the contraction of HIV/AIDS despite efforts to educate the public on the disease.

“This is because of the nature of the disease, there is no cure for it, the transmission is often associated with drug use, homosexuality, promiscuity, prostitution,” he says.

Dr. Figueroa says that for HIV/AIDS to be contained and eliminated Jamaica has to break the conspiracy of silence on the disease and churches, schools, families needed to confront the disease, which takes the lives of 10 persons per week.

But Ian McKnight, who heads the non-profit organisation, Jamaica AIDS Support feels that the message is slowly getting across to people and things are beginning to change. He says over the last ten years, there has been a shift in attitude moving from public shunning and rejection, churches refusing to bury people, breeches of confidentiality to communities that are willing to help.

“ Some are open and very receptive, only a minority still castigate and isolate people with the virus. People are beginning to realise that this could be me. Most people know someone who had AIDS, whether it’s a brother, sister, cousin, husband, and a parent. The media has also heightened public awareness of the disease and removed the stigma associated with those who contract the disease. People who are living with the disease are also talking about it publicly. Some initial fears, misconceptions are no longer there,” he asserts.