Published: March 30, 2005
Caribbean Governments and International Agencies Failing to "Turn the Tide:"
Mediocre progress in improving access to antiretroviral medicines means thousands of people living with AIDS in the region still face the worst form of discrimination - imminent suffering and death
by Eugene Schiff*
Every day, 200 people in the Caribbean die from opportunistic infections caused by AIDS. Most die because their governments have failed to provide pills, known as antiretroviral medicine (ARVs), which now cost governments and donor agencies as little as a dollar a day. Many of these 200 people die because they are too poor to pay for these pills themselves, since the same drugs which should be stocked in public hospitals are usually available from private pharmacies and local distributors, but they can cost five to ten times more than prices offered to governments. Others simply may not be aware that medicine is now available that can prolong and improve the lives of people living with AIDS, as countless local education and prevention messages have often and continue to associate acquiring HIV/AIDS with death.
The WHO’s latest “3 x 5” Progress Report, published in January 2005, lists that in Jamaica, 500 people living with AIDS receive ARV treatment out of 2600 who needed it, leaving 82% without access. National data indicates the situation is even worse. In December 2004 Jamaican Ministry of Health sources reported that a total of 8000 Jamaicans needed ARV treatment. With less than 500 receiving medicine from the public sector, the government was only supporting 6.25%, a tiny fraction, of those in need.
Due to a unique and controversial co-payment scheme implemented by the Jamaican Ministry of Health upon recommendation from the World Bank, even those few Jamaicans who receive their medicines in the public sector are asked to contribute to a substantial portion of the cost of the ARV drugs. Unless they obtain special waivers, poor Jamaicans attending public clinics are required to pay up to $204 USD each year out of their own pockets for medicines which the government receives free thanks to support from the Clinton Foundation and the Global Fund. Such fees, which further impoverish Jamaicans living with AIDS, will purportedly support the sustainability of the National AIDS Program in the future. However, in nearly all other countries in the region, rich and poor -- including those where access to medicines is already almost universal like Cuba, the Bahamas, Barbados, and Bermuda -- provide ARV medicines for free in the public sector in order to improve access and adherence to the drugs.
By any measure, there is a public health crisis surrounding lack of ARV medicines for poor Jamaicans. Unfortunately for people living with AIDS in Jamaica, the government often tries to minimize and defend its inadequate response and Jamaica while international agencies provide little public pressure. Jamaica was not even mentioned anywhere in the WHO’s 64 page “3x5” Progress Report on ARV access, except for where Jamaica’s ARV statistics appeared in the list of all countries in the report’s Annex #2.
The Dominican Republic, like Jamaica, was not even mentioned a single time in the WHO report, except for inclusion of its data in the Annex #2 with all other countries. Disgracefully, in the Dominican Republic only 1100 people are currently receiving treatment out of 15,500 who need it, leaving most of the other 93% of those in need with no assistance whatsoever. Even worse, typically, in the Dominican Republic, even today in 2005, important lab tests to monitor the level of the virus and immune system strength like CD4+ and Viral Load remain exorbitantly costly and basically unavailable to most people living with AIDS who are served in the public sector. In addition, like essential lab diagnostics, medicine for treating many opportunistic infections caused by AIDS, are often even more difficult and costly to obtain than the coveted ARV medicines themselves.
Interestingly, neighboring Haiti, the poorest country in the Caribbean and the entire Western Hemisphere, is singled out as one of the success stories in the WHO’s “3 x 5” Progress Report. To its credit, there are an estimated 3000 to 4000 Haitians receiving ARV medicines, an indication of how much more ambitious and efficient the efforts in Haiti have been compared to those of its richer neighbor. Still, the WHO estimates that 42,500 Haitians currently need ARV medicines, meaning that overall, like Jamaica and the Dominican Republic, about 92% of those who need them remain without the lifesaving drugs.
However extraordinary the progress in Haiti has been thus far, the needs and human rights of a huge and incomparably larger portion of Haitians living with AIDS remain completely unfulfilled, placing their lives in immediate jeopardy. Perhaps the wording chosen in Geneva for title of page 21 of the report: “Haiti: Global Fund helping to turn the tide,” is inappropriate and misleading considering the real needs of people living with AIDS and the current economic and social reality in Haiti. Surely there is a more creative and revealing phrase in Creole to depict the suffering of 40,000 Haitians with full blown AIDS lacking ARV treatment and struggling for survival amidst extreme poverty and increasing violence.
In most of the rest of the Caribbean, unfortunately, the situation is little better. According to the WHO “3 x 5” Report, in Belize, 60% of people living with AIDS remain without access to medicines, 72% lack ARV medicines in Guyana, 75% in Suriname lack access, and in Trinidad 84% of those in need lack access to ARVs. Also worrying is the fact that no data is available in the report for ARV access in Antigua, Dominica, St. Kitts and Nevis, St. Lucia, St. Vincent and the Grenadines. Embarrassingly in the smaller islands, it seems that neither CAREC (the Caribbean Region Epidemiology Centre based in Port of Spain, Trinidad) nor national governments bothered to provide the WHO with updated figures on progress or needs of people living with AIDS in the past six months for the “3x5” report, suggesting there is much to hide and still very little if any access to treatment. Sadly for people living with AIDS in these islands, their governments have made far too little independent progress in providing ARV treatment, while the Global Fund project for the Organization of Eastern Caribbean States, like that in the Dominican Republic, has experienced notoriously deadly setbacks and delays.
It is important that we remind ourselves, Caribbean governments and health ministries, the WHO, and the rest of the world that hundreds of thousands of people in the region have died of AIDS since the advent of ARV medicines. Many more continue to die every day because the stigma and discrimination that still surround HIV/AIDS, a primarily sexually transmitted disease, has prevented citizens, health workers, and most governments from rationally responding to this public health crisis. Despite all the resources and attention devoted to HIV/AIDS this stigma has been slow to change.
It is painfully evident that systematic racism and economic inequality in the region means the vast majority who continue dying of AIDS in the Caribbean, without ARV access and without decent health care, are darker skinned, poorer, more vulnerable, marginalized groups – prisoners, sex workers, drug users, alcoholics, sexual minorities, the unemployed, lowly paid, victims of domestic violence, rape, machismo, and discrimination. On the other hand we have also learned and seen how HIV/AIDS neither knows nor respects boundaries like nationality or social class. Most worrying however is that those in high levels of Caribbean governments and society, in practice, still seem to scorn and consider such individuals to be disposable and unworthy of the relatively small investment it would take to save the lives of most people living with AIDS in the region. If there is a human rights crisis in the Caribbean today, this is it.
*Eugene Schiff - Caribbean Region Coordinator
Agua Buena Human Rights Association
809-274-6252 (tel/fax - Santo Domingo)
Richard Stern - Agua Buena Director
San Jose, Costa Rica
Guillermo Murillo - Agua Buena Assistant Director
San Jose, Costa Rica
Mabel Martínez - Agua Buena - Centroamérica; Honduras/Nicaragua
Jaime Argueta - Agua Buena - Centroamérica; Guatemala/El Salvador