INCREASE ACCESS TO HIV SERVICES IN THE CARIBBEAN

[00:00:01] Speaker A: The best insight, instant feedback, accountability. The all new Talk Radio Freedom 106.5. [00:00:08] Speaker B: There's been a battle ongoing for quite some time when it comes to HIV aids. There have been many advancements and this morning we'll be speaking about increased access to HIV services in the Caribbean. And joining us this morning is the director of UN AIDS Caribbean, and that's Dr. Richard Amenia. Did I get that correct? I did, yeah. Yes. Good morning to you and welcome to our program. Nice to have you with us here. Let's begin by allowing you the opportunity to familiarize the listener with yourself. Okay, tell us a bit about yourself and some of the things that you're involved in. [00:00:50] Speaker A: Oh, thank you. Thank you very much. It's indeed a great pleasure to be in Trinidad and Tobago. Richard Amenia is my name. I'm the head of UNAIDS in the Caribbean region. Our office is based in Jamaica. And the mandate of UNAIDS is to help the world end aids. You know, so ending HIV as a pandemic globally is what we do. And why we do that is because we want to save precious lives of people. And so our work globally is to engage with our political leaders, policy people, work with communities and civil society groups, and also work with donors to put in resources to be able to end this epidemic as a public health threat. And so we support countries in terms of understanding the dynamics of HIV epidemic in their countries, how to characterize them, provide technical assistance to countries and also help them to have a policy direction in terms of what to do, strategic planning of the response and doing robust advocacy with member states about the need for putting HIV on the political agenda and the development agenda of countries, and also helping countries to also mobilize resources from private sector, also from multilateral agencies and bilateral agencies. So basically that is our job in terms of a UN agency and we work in partnership with other UN agencies. We have co sponsors that we work with, like the UNICEFs, you know, the powerhouse and who's, you know, UNFPA that, you know, UN women as, you know, UNODC that deals with drugs, UNHCR that deals with issues around migrants and refugees and all that, and a whole host of agents, ILO and UNESCO and all that. So basically it's the whole UN force that works to address issues around HIV globally. [00:03:12] Speaker B: I know that it's a work in progress and it's been going on for quite some time. At one point in time there was increase, there was immense concern about the Caribbean and about the spread, the prevalence, the issue of AIDS in the Caribbean I remember that clearly us being identified as, I don't want to say a hotspot, but one of the areas that needed drastic attention. How have we been doing? Have we been making progress? What's the situation? [00:03:39] Speaker A: Thank you for bringing that up. Outside of sub Saharan Africa, the next region with the highest HIV prevalence is the Caribbean. We have a prevalence of about 1.2%. So globally we are the next highest region with this epidemic. And we have close to around 340,000 people living with HIV in the Caribbean region. Even though this concept gets about 1% of the global HIV burden of close to 40 million people, it is quite significant based on the size of the Caribbean. And so in the Caribbean, what we see is that one in three persons living with HIV is not on treatment. So we have about 100,000 people who are yet to get onto treatment. Seven out of 10 persons living with HIV are on treatment, which is wonderful, you know, and we have close to six out of 10 people who really have suppressed their viral load because they have access to treatment. And so we still have a gap. So even though we've made progress, we still have close to three out of 10 that are not yet on treatment. And that is why our advocacy is how do we ensure that everybody has access to these life saving drugs? Because in this day and age no one should die of AIDS because you have hiv, you know, and so that is our quest. And so on, well, days day, our advocacy out there to Caribbean government is that let's put HIV back onto the agenda. We are off track because we definitely need to make sure we close that gap on people who are not yet on treatment and that 100,000, there's a lot that we can do. There are people who belong to the marginalized key population group. There are migrants. They are also men, you know, men and boys and equally women and girls. We have close to around 55% of the new infections that they happened in 2023 occurring among men and boys, 55%, 45% of that were females and 55% were among males. And it is important that we have a conversation among males. What do we need to do to make sure that we avail ourselves for testing for HIV and also for those who are positive. How do we get onto treatment? Women have access because the health facilities are friendly to women. They go in for easy checkup. The health seeking behaviors of women is far better than we the men. And we think some of those things are important. But we are highlighting the issue of human rights as a key reason for ending this epidemic, because health is a human right. And so to end it, we definitely need to protect the rights of people. What is the barrier to some people from accessing HIV testing or prevention services and treatment? And we think that there are some people who are also in conflict with the law. Gay persons, sex workers, people who inject drugs, trans people. We know that some of these groups, by law, they are not recognized. And it is important that we look at how to address their needs in terms of health needs. So we are using the human face as an approach to say to leave no one behind. If we want to end AIDS as a public health threat globally, then we don't need to leave anybody behind. So how are migrants faring? Are they having access to HIV prevention services or testing services, or if they have hiv, do they have access to treatment? And these are things which policy people need to understand and in place mechanisms to address the HIV needs of such people. We also know in some countries there are some punitive laws and policies and practices. How can we go around those to be able to make sure that what prevents people from accessing the services can be eliminated? We know that the issue of stigma and discrimination is big. As I speak with you, in the next one minute, somebody out there in the world will die of AIDS in the next one minute, in the next 24 hours, we have about 14 people in the Caribbean that will lose their lives to AIDS in the next 24 hours. That is a concern. In the next 24 hours, up to 41 people in the Caribbean will become infected. So if we want to end AIDS as a public health threat in the Caribbean, we want everybody to imagine a world where no one is infected with hiv. Imagine a world where no one dies or fades because they have access to treatment services, and that nobody is discriminated upon or stigmatized against simply because you have hiv. And so you were right in saying that. Look, what is it that is happening that we could highlight as a way of creating opportunities for people to avail themselves to accessing services? Our concern is that in the Caribbean, up to 27% of the new infections in 2023 were contributed by young people 15 to 24. And even in Trinidad, we look at the data, about 16% of young people, 15 to 24, were accounted for within the newly infected people. And that is a concern. The future of this country is based on the strength and power of its young people. And so if we see that the epidemic is having an impact also on young people, that is a concern. 66% of the new infections that happened in Trinidad was between the ages of 20 and 44 years. This is the labor force of your country. And so HIV should not be off the agenda. HIV should be at the center of the response. And that is why we think that we need to make this known. [00:10:37] Speaker B: Well, it seems, and you correct me if I'm wrong, it seems as though the vociferous manner in which HIV AIDS was addressed, from, I don't want to say a marketing standpoint, but from a PR standpoint that seems to have waned for some time. It's not in your face as it was. It's not all over the place. I would shut it. I think that there are some people who walking around not necessarily aware, because desensitization, the marketing campaign, the education drive, all these things don't seem to be as much as they were. Maybe because, I don't know, maybe because we were making such advancements that we focused on the technology and treatment and all these things, and we forgot that. Listen, we still need to tell people that this thing is there. Is that one of the reasons why you have younger people who are there engaging in more risky behavior? And you spoke about 55, 45. Is that a normal statistic? Is it an increase in men? And if so, why? What is leading to these trends? [00:11:42] Speaker A: So, thank you very much. That's a very good observation. Because a lot of people now are saying, is AIDS still a problem? You know, but UNAIDS is telling the world aid is not over. We should not be complacent because of the successes and the progress that we have made. As I told you, in the Caribbean, 7 out of 10 are on treatment. And so people think, oh, well, once you get infected, we will just get onto treatment. But that is not the issue. What we are saying is that we need everybody to be knowledgeable about the risks of HIV policy. People should know what the vulnerabilities are, and that's why we are highlighting the vulnerabilities. Punitive laws and policies and practices make people vulnerable. The inequalities that we see in our society makes people vulnerable in the sense that it is either sociocultural, it's either economic, you know, inequalities. It's driving the epidemic. And so you can have the medications available in the facilities, which is for free. And we are very grateful to the government of Trinidad and Tobago for making antiretrovirals available. Available for anyone who needs it. Now the question is, how do we ensure that everybody who needs it has access? And that is where we see some element of Barrier, stigma and discrimination is a huge concern. And so we are highlighting that as an issue. As I speak with you now, we are working with the communities of, and networks of persons living with HIV to do what we call the Stigma Index Survey. Stigma Index Survey. It's about having conversations and interviews with persons living with HIV and asking them about what their experiences have been in terms of how they relate to people or people relate to them in relation to letting them know they have HIV or whether they've disclosed their status to people and whether they are accessing services. What are the key barriers? This is going to be the first time we are doing this in Trinidad and Tobago, and we think it's going to give us very useful data points for action, you know, at the policy realm and also for programming. Because why will you know that you have HIV, which if you don't do anything about within 10 years, it will kill you? So why will you stay with the disease and not avail yourself to free treatment that government has out there? And so we want to be able to understand the psychology of people. And talking about psychology, a lot of people are burdened with the trauma of living with hiv. Even those who have access to treatment, they are burdened with the trauma of having to take pills every day. They are burdened with the fact that they can't talk about HIV, even at home, because once they tell even their relatives that they have hiv, people deal with you differently, let alone at your workplace. You can't even tell your peers that you have hiv. They will not sit on seats that you are sitting on. They will not use the same cup or cutlery that everybody uses in their office space. And so those are things that let people feel that if I have the disease, I better keep it to myself and not tell anybody. And once you don't tell people, even if you are engaged in risky behavior, you'll be spreading the virus without people basically knowing that you have hiv. And those are the barriers we want to break in society. That if we want an inclusive society, let's talk openly about HIV and the opportunities that exist, especially in preventing hiv, and that if you even have it, there are ways of receiving the emotional support that you need, psychological support that you need, because it's no longer a death sentence. So if we are able to pass this message on through the media, through peers and all that people can feel more comfortable about HIV and avail themselves to testing, and if they know, they can then access treatment. [00:16:19] Speaker B: Yeah, I know that one of the real challenges getting people tested, because in order to Treat with a problem. You need to identify that there is a problem. I've spoken to a number of persons in the medical field and so on. Getting people to get tested for various things, HIV and others, is difficult simply because too many people are scared of what the results will be. And as a result of that, they shy away. Now, I know that there are requirements for certain things that when you're going through specific procedures, you have to get an HIV test and that helps build the database, I'm assuming, of people who. But where are we? Are people coming forward to be tested? Or do we still have a challenge in getting people to that stage? Because treatment and access to treatment comes after you realize, oh, you've been diagnosed. Where are we in getting people tested? [00:17:16] Speaker A: You know, HIV is a human rights issue. And so we also make sure that we don't put in place mechanisms for mandatory testing of people. So no government out there should do mandatory testing of people. We need to engage people, to give consent. There has to be counseling because this is a disease that has no cure. This is a disease that has no vaccines. And it is important that we talk openly about it. That when people know that, look, we are talking about an epidemic that has some intervention in terms of treatment. We are talking about an epidemic that you have a way of protecting yourself. Because when you do the test, you either test positive or you test negative. And if it is negative, are you out of the wood? You need to be educated on how you remain negative. You know what interventions are available for you to remain negative and whether you are strictly sticking to your partner or you are abstaining or you are just reducing the number of sexual partners so that you don't put yourself at risk. And there are also biomedical interventions that support prevention in the sense that you can take antiretroviral drugs in terms of pre exposure prophylaxis. Now we even have injectables that you take two shots in a year that can protect you from getting hiv. So the frontiers of prevention is changing and we really want governments to take advantage of medical innovations out there and ensure that we have those medications available for our people to prevent them from getting hiv. We want as unh, to see a world where nobody gets infected with hiv. So you need to give people the various options that are available for young people. Let's give messages that are tailored to their age and ensure that it is accurate enough and getting them to understand why they need to protect their themselves. Let's make sure that people from the key populations have access to information that they need to protect themselves. Let's make sure migrants have information that will help them to protect themselves so they don't get infected. It is better to prevent people from getting infected than treating them with medications for the rest of their lives. So in some parent, they will tell you prevention is better and cheaper than cure or treatment. And in this case, even when you have the virus, the medications we have are helpful because once you stay on the medications that become virally suppressed, you are not able to transmit to your sexual partner. So these are the benefits that we think we need to promote in our education to societies and communities out there, that HIV is no longer a death sentence. If you have it, there is something that can be done, you also be empowered not to have it in the first place, you know, and that is why we need to talk about sexual reproductive health for everyone that people are knowledgeable as. How do I protect myself? You know? And so we want that human element to be part of the response. And that is why we say taking the right path is the way to go to end this epidemic. Ending this epidemic means that people are not going to get infected if we are able to get them to know what to do. Ending this epidemic also means that if we get everybody who has the virus in the country and we put them on treatment and they are retaining care, they will become virally suppressed and not transmit that they are infected. That is how we end this epidemic. Ending this epidemic is also about protecting the human rights of everyone, because protecting the rights of everyone is to protect everyone's health. And that is where UNAIDS coming in. And in collaboration with government and civil societies and communities, we think we can end this epidemic in our lives, lifetime. And we need people like you with your, with your loud voice on the air to be able to get people to know HIV is real, get tested, and once you are negative, remain negative for the rest of your life. But if you are positive, there is something that can be done. And we need that voice from you and everyone. And that is how we get committed to ending is as a public health threat. [00:21:56] Speaker B: I know that for world AIDS healthy, there's a lot that goes on and there are a lot of programs, sensitization, education and all these other things, increased access to care and treatment and services. What does that manifest itself in? How do I have access to these things? Tell us. [00:22:21] Speaker A: Okay, so if I walk into a health facility and I want to have an HIV test done, it should be possible for me to get a test done. And if you, you see a healthcare worker that you have challenges, health challenges, and they go through your history, your story, and they think that you need an HIV test done. That health worker should be able on your story. It is important that there are some risk elements that we are seeing that you need to have an HIV test done, you know, and so you will go through counseling and then be being able to be offered the test. So you can either go in voluntarily, just by yourself to request for the test, or a health worker, any interaction you have with the healthcare system. You can also have the test done if you've heard it on air or you've heard it from a friend, or you are just saying, I want to live a healthy life and so I want to know my HIV status. So that is how you can have access to the test. You can also have access to prevention tools. Anytime you access the health facility. At times they have condoms available. And those are some of the tools we have to protect people, especially people who are sexually active. You know, we have condoms that are available and then we also have other biomedical interventions in the form of antiretroviral drugs that in some countries they make it available for people who are at high risk. You know, and as I said, now we have long acting injectables that people can just take two shots in a year and you'll be protected. So UNH is asking that because governments are using the limited resources they are having to buy the drugs for people. Let's find ways of making sure that we educate the masses out there so that they use prevention interventions and they don't get infected in the first instance. So if they are not infected, then the limited resources we have to put in drugs, it will be for those who really need drugs to be able to protect themselves. And that is the type of dialogue we really want to have with Caribbean governments that AIDS is not over. Let's put AIDS onto the development agenda of every country and make a commitment. Yesterday we were in a program by the NAC and Trinidad All Stars Yard, you know, and I think it is to mobilize young people and ensure that through drama and music we are able to connect with young people and to educate them about the rakes out there and what they need to do. That is a good start. I mean, in terms of addressing and empowering people with information and how to use drama and music to communicate to their peers that they need to protect themselves. We need to protect our young people. We need to protect our youth because they are the future of this country. And I'm glad that Government decided to partner with those young people as a way of getting the message there. And we want to encourage more of such interactions to be able to get to get this epidemic down once and for all. Every week. You have about eight persons in Trinidad coming down with HIV every week. That is a concern. And we think that we need to talk about it as a country, we need to talk about it as policy people to be able to protect all Trinidadians and Tobagans simply because HIV is a development issue and if it is there, it is a concern for everyone. [00:26:32] Speaker B: Let's, as we end our interview here this morning, let me allow you the opportunity to tell people why they should take that first step, which is to get tested. [00:26:40] Speaker A: Get tested? Get tested. It starts with testing because if you, you know what your status is, then you want to guard it. So if I am negative, I go and test and I'm negative and majority of people will be negative. And that is, that is important. So, but you need to know, so when you go and test and you are negative, you need to remain negative. What are the things that I should avoid doing not to become infected? There are people who suffer gender based violence, for instance. You have no control, you know, sexual violence where women are abused and in some cases even men and boys can also get abused. And so how do we protect such people? Within 72 hours when you report to the health facility, there are ways of helping you not to actually get the virus, even though maybe the person who had violated you probably has the virus. So there are mitigation measures that are available. So talk to a counselor when you have this, so that they can have that intervention for you to prevent you from getting infected. We want to use every opportunity to protect the citizenry from getting infected. It is better not to be infected than to be on drugs for the rest of your life. And that is where we think we need to put human rights at the center of this response, so that we can address issues of stigma and discrimination, so that any laws and policies that are there that prevent people from accessing services, we can dismantle those laws. Parliamentarians should look at their laws. The punitive ones should be repealed and they should enact laws that are non discriminatory, that are protective, that are inclusive. This is how we garner social justice within our country, for the development of the country. [00:28:44] Speaker B: This is where we're going to have to leave our interview here this morning. But I want to thank you for being with us and sharing this information. This information is valuable. Thank you for many reasons and I do hope that persons who are listening in to us take that step, if they've not taken it already. And that's the ultimate goal. Go out, ladies and gentlemen, get yourself tested and take these steps to ensure that you can live as best a life as you can, because there are so many advancements in treatment and technology and everything else that it's amazing. Once again, thank you for being with us here this morning. Thank you so much. [00:29:20] Speaker A: The best insight, instant feedback, accountability, the all new Talk Radio Freedom 106.5.