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Wednesday, December 2, 2009

Bahamas: HIV/AIDS program ups focus on prevention

By JIMENITA SWAIN ~ Guardian Senior Reporter ~

With great emphasis placed over the years on treatment of people living with HIV/AIDS, greater focus must now be turned to prevention in the fight to reduce numbers, according to a local expert.

Director of the National AIDS Program Dr. Perry Gomez said yesterday that in addition to prevention more needs to be done when it comes to people at greatest risk. He spoke about the HIV issues in the country moments after attending the annual church service in observance of World AIDS Day held under the theme "Universal Access and Human Rights".

Gomez said that two weeks ago consultants from the Pan American Health Organization (PAHO) reviewed the health system's response to the HIV epidemic and what has been done by the national program which he heads.

"They of course spoke about the positive things we have done, but we also more importantly identified gaps in the program that we need to address more diligently," Gomez said. "We have to do much more in prevention."

Many Bahamians with HIV/AIDS are receiving treatment, which in his view placed a dent in the epidemic, with reduced numbers of deaths and an almost complete elimination of mother-to-child transmission.

Gomez said transmission from infected mother to child is only seen in pregnant women who do not go to the clinic for treatment.

"Our response to that is we have to do more to get people in, make sure all pregnant women come to clinic...and look into the reasons why people don't come," he said. "The investment mustn't all be in treatment because we can't keep up with that, because the cost of treatment is so high. We must balance treatment with prevention so the country can afford it in the long run."

Gomez said all countries are being urged to increase prevention as a UNAIDS policy or mandate.

"In particular for us we have not done as good a job in the area of prevention in people at greatest risks," he said.

At risk groups are considered to be men who have sex with men, commercial sex workers, drug users, migrants and youth.

"Prevention must not be generalized. It must now be specific to the group you are targeting and so there is a need to know more about each group. The program can now plan and adjust for those kinds of things," Gomez said.

He pointed out that it was only in recent weeks through a survey conducted two years ago that there is data available on men who have sex with men.

While there has been much success with the national program, there is still much more that can be done, said Dr. Baldwin Carey, a Ministry of Health consultant and the former director of public health who brought remarks on behalf of the minister of health.

"We must ensure that persons living in our Family Islands can access testing, treatment and care in their own communities," Carey said. "The Ministry of Health is committed to ensuring that the most vulnerable to HIV can access treatment and care and we must continue to promote not only medical, but a social and legal environment that is supportive of safe and voluntary disclosure of HIV status."

Dr. Merle Lewis, PAHO and World Health Organization (WHO) country representative to The Bahamas and the Turks and Caicos, said the local program has strengths, but the weaknesses must be corrected.

"There may be certain at risk groups that may get lost when you look at things generally, so we have to actually identify clearly who those groups are and go after them," Lewis said.

In addition, she said, new infections seen in young people means that the youth needs to be targeted.

"The other gap I think we've seen is a gap in treatment in terms of we suspect that there are many more people who are in need of treatment who are not actually receiving treatment at this time."

The Caribbean as a region has the second highest level of adult HIV prevalence in the world outside of sub-Saharan Africa, according to the 2009 AIDS Epidemic Update.

In 2008 there were an estimated 240,000 people living with HIV in the region, up from 220,000 in 2001. However, the number of new infections was stable at about 20,000 last year as compared to the 21,000 infections recorded in 2001.

In an earlier interview, Dr. Gomez said local officials have not been able to tap into the category of commercial sex workers whose test results, when calculated, could drive the number of reported cases in The Bahamas even higher.

There were 6,103 cases of AIDS reported over the past 20 years. And of those cases, just over 4,000 people died from the disease — more than 66 percent of those diagnosed.

In 2008, there were 2,078 people living with AIDS, according to health officials. There were 5,387 people living with HIV.

Gomez said that between January and December of 2008, 263 new HIV cases were reported, compared to 287 cases in 2007. The highest number of reported HIV cases was in 1994 at 657, according to the data.

Gomez also noted there was a slight decline last year in the number of reported cases of full-blown AIDS. There were 185 AIDS cases reported, down 36 cases from 2007 when 221 cases were reported.

The highest number of reported AIDS cases was recorded in 1997 at 387.

December 2, 2009