The Pan American Health Organization/World Health Organization (PAHO/WHO) have suggested the short and medium-term actions to improve the response of health systems, preventing and ending AIDS and mass migration.
On November 30, during a meeting convened at PAHO’s headquarters, a range of topics were discussed including epidemiological surveillance, preparation and prevention of outbreaks and ensuring access to health systems and services, among others.
The organization called on people to get tested as an important step towards halting the spread of HIV and ending AIDS. “Know your status” is the campaign slogan for the December 1 World AIDS Day.
HIV testing provides an opportunity to discover HIV status and enables those diagnosed with it to rapidly initiate lifesaving treatment. It also serves as a gateway for those at higher risk of acquiring the virus to access the recommended package of prevention services in order to remain negative.
Over 2.1 million people live with HIV in Latin America and the Caribbean, 1.6 million of whom know their status. Knowledge of HIV status, combined with increased access to antiretroviral treatment in the Region has led to a 12 percent decrease in AIDS-related deaths in Latin America and a 23 percent decrease in the Caribbean from 2010 to 2017.
Despite this progress, however, in Latin America, the rate of new HIV infections remains unchanged at around 100,000 per year – a reduction of just 1 percent since 2010. Progress in the Caribbean has been much faster, with an 18 percent reduction in new infections since 2010. Even so, throughout the Region, key population groups most at risk of contracting HIV continue to miss out on vital prevention and follow-up services.
“The Region of the Americas has made important progress in the fight against AIDS and part of this is down to the fact that over three-quarters of people living with HIV have been tested and almost 80 percent of them are now in treatment,” said Dr. Marcos Espinal, Director of the PAHO/WHO Department of Communicable Diseases and Environmental Determinants of Health. “World AIDS Day reminds us that despite these gains, 1 in 4 people with HIV in the Region still don’t know they have it, have not begun treatment and are therefore at greater risk of dying prematurely and infecting others.”
The majority of new infections in the Region occur in gay men and other men who have sex with men, which represent 41 percent of new cases in Latin America and 23 percent in the Caribbean. Sex workers and their clients, transgender women and people who inject themselves with drugs are also disproportionately affected by HIV.
Currently, one-third of people with HIV in Latin America and the Caribbean only get diagnosed after becoming ill and symptomatic, when their immunity has already been seriously compromised and after exposing their sexual partners to the possible transmission of HIV. Testing is therefore a vital element in preventing further spread of the virus and ensuring that those with HIV have a better quality of life.
“Reducing new HIV infections is key to accelerating the response to HIV/AIDS in the Americas,” Dr. Espinal said. “In order to achieve this, we must address the barriers, such as stigma and discrimination, that prevent key populations from accessing testing and treatment services and fully exercising their right to health.”
HIV prevention in Latin America and the Caribbean
In order to step up efforts towards ending AIDS in Latin America and the Caribbean by 2030, PAHO/WHO, along with UNAIDS, recommends the implementation of combination HIV prevention, which is a person-centred approach that combines biomedical and behavioural interventions with measures that foster an enabling environment to overcome access barriers to health care.
This starts with the provision of testing services, particularly for those at-risk of HIV infection. PAHO/WHO recommends that health systems expand options for HIV testing to include HIV self-tests and lay provider tests, which can be done at home, as well as in places other than health centres, with flexible hours and same-day results. PAHO/WHO also recommends that the age at which young people can take an HIV test without the consent of a parent or guardian be reduced in line with the recommendations of the Convention on the Rights of the Child. This is particularly important given that approximately one-third of new HIV infections occur among young people aged 15- to 24-years-old.
Addressing health needs of migrants
PAHO has committed to develop a regional plan that provides guidance and establishes actions to address the health needs of migrants both at the country level and through bilateral agreements for joint work in border areas and transition zones, as well as through sub-regional mechanisms and initiatives. This plan will be developed in consultation with Member States.
A PAHO Regional Health and Migration Forum will also be established. This will operate as, amongst other things, a portal for health authorities in the Region to share information on, for example, epidemiology, in order to support surveillance. Technical guides will also be shared on how to address certain health issues; protocols for the management of migrants will be established; communication strategies that address rumours and stigmas associated with migration will be discussed; and capacities in border areas will be strengthened. In order to protect and maintain achievements in the Region in terms of disease elimination, access to vaccines and medicines will also be promoted through PAHO’s two joint purchasing mechanisms – the Revolving Fund, for vaccines, and the Strategic Fund for Medicines.