By Ezra Fieser for Infosurhoy.com

The disease remains the leading cause of death among men and women between the ages of 20 and 59, according to the World Health Organization.

SANTO DOMINGO, Dominican Republic – The number of deaths caused by HIV and AIDS has fallen dramatically in the Caribbean, raising hopes that a coordinated effort by governments and international health organizations can bring the region closer to its goal of eliminating the disease’s spread.

Though it receives less attention than more populated regions such as Southeast Asia, the Caribbean ranks second behind sub-Saharan Africa for HIV/AIDS infection rates. The disease remains the leading cause of death among men and women ages 20 to 59, the World Health Organization reports.

But a decade after governments and international health agencies began fighting the disease’s spread aggressively and expanding access for treatment, death rates and the number of new infections have declined sharply.

Between 2005 and 2011, deaths from AIDS-related illnesses fell by 48% in the region, according to the 2012 World AIDS Day report by the Joint United Nations Program on HIV/AIDS (UNAIDS). The Dominican Republic saw the steepest decline in deaths, reporting a 61% drop, followed by Guyana, Haiti, Jamaica and Suriname, which all recorded a more than 40% reduction during the time frame.

The Caribbean also led the world in reducing the number of new infections, according to the United Nations. New infections fell by 42% between 2005 and 2011 across the islands, with Surname (86% decline) and Dominican Republic (73%) making the most progress.

“Certainly in the region there has been substantial progress in the past 10 years or so, not only in treatment availability but also in prevention of transmission from mother to child,” Michel de Groulard, a senior program advisor at UNAIDS’s Caribbean office in Trinidad and Tobago, said. “Some countries have switched to university access of treatment and others are on the way to it.”

Representatives from international health organizations lauded Caribbean governments for taking a comprehensive approach to the epidemic by offering more coverage of life-saving anti-retroviral drugs, expanding health coverage for pregnant mothers with HIV to prevent transmission to their children and reaching out to at-risk populations.

“Governments have responded with better access to treatment in the region, that has been clear,” said Ruth Ayarza, the Latin America and Caribbean regional manager for the International HIV/AIDS Alliance, which supports member organizations in the Caribbean. “In many of the countries we’re working in, there definitely has been an increase in support from regional agencies.”

Still, more than 13,000 people became infected with HIV/AIDS in 2011, the most recent year for which data are available, bringing the total number of cases to 230,000 in the region. In 2011, about 10,000 died from complications related to AIDS, according to amfAR, The Foundation for AIDS Research, based in New York.

More work is needed if the region is to reach its goal of eliminating HIV/AIDS deaths and new infections, health workers said.

Experts said they particularly are concerned about homosexual men, a key population in the spread of the disease.

“It is important to remember that the epidemic is still present in the region,” Ayarza said. “People are acquiring HIV through sex and it is affecting a larger proportion of men who have sex with men. Each country needs to know its epidemic and know where the last 1,000 cases happened and who is affected.”

Steeped in Colonial history, several Caribbean countries still have laws on the books making homosexual acts illegal. This homophobia has ostracized groups, making them difficult to reach with messages of prevention or information about treatment.

Health organizations have worked around those limitations with innovative programs. One model program uses a peer-to-peer model, which trains members of the community who, in turn, reach their friends and peers with information about condom use, treatment programs and public health programs.

“You have to be respectful of each country’s traditions and limitations,” Ayarza said, “You have to approach the problem in ways that are contextually appropriate. You can respond with a public health model” even in difficult circumstances.

Innovative programming relying on community and civil society involvement is going to be integral going forward as the region prepares for a downturn in international funding amid cuts in aid.

In the past 10 years, the Caribbean has received a total of about US$1.6 billion in international funding, or an average of $160 million a year. Just how much of that funding will disappear is unknown, Groulard said.

“Most donors are pulling out and most [Caribbean] countries do not have the financial resources to continue with the same programs,” he said.

Groulard said health organizations, donors and government officials have been meeting to discuss how to continue HIV/AIDS programs with less funding.

“The option is to look at how to invest better in responding,” he said. “There has been very good work … we need to figure out how to continue that.”

PHOTO: A Haitian holds a roll of condoms that were distributed as part of a prevention program aimed at cutting HIV/AIDS infection and death rates. The Caribbean has led the world in reducing new infections from the disease. (Courtesy of International HIV/AIDS Alliance)

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