HIV Treatment as Prevention in Jamaica and Barbados

Abstract

This discursive article introduces HIV treatment as prevention (TasP) and identifies various models for its extrapolation to wider population levels. Drawing on HIV surveillance data for Jamaica and Barbados, the article identifies significant gaps in HIV response programming in relation to testing, antiretroviral treatment coverage, and treatment adherence, thereby highlighting the disparity between assumptions and prerequisites for TasP success. These gaps are attributable, in large part, to sociocultural impediments and structural barriers, severe resource constraints, declining political will, and the redefinition of HIV as a manageable, chronic health issue. Antiretroviral treatment and TasP can realize success only within a combination prevention frame that addresses structural factors, including stigma and discrimination, gender inequality and gender-based violence, social inequality, and poverty. The remedicalization of the response compromises outcomes and undermines the continued potential of HIV programming as an entry point for the promotion of sexual, health, and human rights.

HIV testing barriers and intervention strategies among men, transgender women, female sex workers and incarcerated persons in the Caribbean: a systematic review

“…HIV testing rates were examined in 10 studies 21–30. In Barbados, the number of people tested increased significantly from 14 403 tests completed in 2000 to 26 045 in 2010 22.…”

“…Late testing (LT) is defined as being diagnosed with AIDS 1 year after having initially tested positive for HIV; higher HIV transmission is a direct result of LT 31. Two articles reported on LT 21 30. In Barbados, 32% of newly infected persons were critically immunocompromised and men were more likely than their female counterparts to be within this group 21.…”

“…Two articles reported on LT 21 30. In Barbados, 32% of newly infected persons were critically immunocompromised and men were more likely than their female counterparts to be within this group 21. In Puerto Rico, 1582 patient records from year 2000 until 2011 from a retroviral research centre were screened, and it was found that men accounted for 66% of the population while MSM accounted for 29% of those who were late testers for HIV; older men who injected drugs had increased odds of LT 31…”

“…Six studies reported on barriers to HIV testing 21 24 32–35. Structural barriers such as stigma, discrimination, gender inequality, gender-based violence, criminalisation of sexual practices associated with HIV transmission (specifically for sexual minorities), poverty and human rights abuses were all impediments to HIV testing and treatment 21.…”

“I Kept It to Myself”: Young Jamaican Men Who Have Sex with Men’s Experiences with Childhood Sexual Abuse and Sexual Assault

“…The HIV prevalence among Jamaican MSM is estimated at 32% (Budhwani, Hearld, Barrow, Peterson, & Walton-Levermore, 2016;Figueroa et al, 2013), which is significantly higher than the general adult HIV prevalence of 1.7% among persons 15-49 years (Losina et al, 2008;Ministry of Health, 2012). Despite substantial progress in eliminating mother-to-child transmission of HIV, early initiation of antiretroviral therapy (Hutchinson et al, 2007), and promotion of other prevention efforts, the incidence of HIV among Jamaican MSM appears to have remained high for the past two decades (Barrow & Barrow, 2013;Figueroa et al, 2013Figueroa et al, , 2015.…”