The Global AIDS Response Report for Barbados 2014, released by the Ministry of Health in the wake of World AIDS Day and Barbados AIDS Awareness Week 2014, ???noted the sustained achievements made by the Government???s expanded response to HIV since 2002???.

However, the report has expressed concern about the number of people living with HIV in Barbados who are not accessing care and treatment.

The report noted: ???Initiation and long-term maintenance of life-saving antiretroviral treatment is an important public health measure that cannot be overlooked.

“Retention in care for people living with HIV is critical, as these patients are more likely, through ongoing monitoring, to be prescribed antiretroviral medication, have a reduction in viral load, and ultimately, improved mortality.???

About 130 cases of HIV are diagnosed in Barbados each year, and since the introduction of Antiretroviral Therapy in 2002, there was a dramatic decline in AIDS-related deaths. According to the report, deaths among persons with HIV dropped from 101 in 2001, to 30 in 2012.

Since the first diagnosis in 1984 to the end of 2012, Barbados had a cumulative total of 3,697 HIV cases, and 1,673 deaths amongst people with HIV. At the end of 2013, HIV prevalence was highest in the 30 to 39 and 40 to 49 age groups at 1.18 and 1.34 per cent of the population, respectively. The estimated prevalence among the group considered most productive, aged 15 to 49, was estimated at 1.2 per cent of the population.

Surveillance information available for 2012 revealed that men outnumbered women two to one in terms of newly-diagnosed cases. In that year, there were 138 new cases of HIV and 78 cases of AIDS. Men represented the two-thirds of the new HIV cases compared to 33.3 per cent for women. Similarly, men represented 65.4 per cent of the AIDS cases, compared to 34.6 per cent for women.

According to the report, one of the key determinants for this could be the cultural norm which associates masculinity with multiple sex partners and risky sexual behaviour, all dynamics which could contribute to the higher proportion of men with HIV.

Among females, the cultural norm associated with the ???sugar daddy syndrome??? is also believed to be responsible for the finding that the only time females outnumber males in terms of infection is in the 10 to 19 adolescent group.

Research conducted by Professor Christine Barrow of the University of the West Indies (UWI) suggests that most at risk are those girls involved in sexual relationships with older men. The girls in the research study agreed that transactional sex was exchanged for money, jewellery and brand name goods.

The major mode of HIV transmission in Barbados was determined to be heterosexual contact. Behavioural data provided by the Ladymeade Reference Unit, which is a specialised unit for HIV management, revealed that 46.7 per cent of the men seeking treatment there disclosed their sexual preference as heterosexual, while 34.7 per cent was homosexual and 14.7 per cent bisexual.

Barbados established a Prevention of Mother-to-Children Transmission Policy in 2009, which mandates the provision of antiretroviral drugs to HIV-positive pregnant women. This programme has been highly successful, with no reported cases of mother-to-child transmission of HIV in the five year period 2008-2012.

HIV testing is offered free of cost throughout the public and private health care sectors, as well as through community outreach. HIV rapid testing was introduced in 2010, and is carried out at the Ladymeade Reference Unit, Winston Scott Polyclinic, Branford Taitt Polyclinic, and at community outreach events.

This forms an integral part of Government???s HIV Testing and Counselling programme, and includes the placement of counsellors in all eight polyclinics and a collaboration with the UWI on a HIV/STI initiative, which offers students testing for HIV, syphilis, chlamydia and gonorrhea.

The report stated that provider-initiated testing was also being rolled out in keeping with the HIV Testing Policy and another important strategy was HIV testing for persons deemed to be more vulnerable to HIV.

The Ministry of Health has identified the key populations most at risk for HIV diagnosis as heterosexual men, men who have sex with men (MSM) and male and female sex workers. A national MSM survey was done and a behavioural study of female sex workers will begin shortly, the document revealed.

The report notes that ???despite over two decades of efforts to reduce the incidence of HIV in Barbados, there are still complex challenges in relation to effectively addressing risky behaviours and sexual practices.???

It stated that intervention had not resulted in the expected behaviour change necessary to avert new infections. For example, while the majority of young people (15 to 29) had knowledge of major risk factors, instances of early sexual initiation, multiple partners and inconsistent condom use were still very high.

The Ministry of Health stressed that promoting behavioural change and maintaining acceptable standards of care, treatment and support for those in need, will continue to be the priority of Government and specifically the Ministry of Health and the National HIV/AIDS Commission under the Ministry of Social Care.

The initiative for countries to prepare Global AIDS Response Progress Reports came out of a 2011 United Nations General Assembly High-Level Meeting on AIDS held in New York. Member states adopted a new Political Declaration which contained new targets to effectively respond to the AIDS epidemic.

The 2011 Political Declaration mandates UNAIDS to support countries in reporting back on progress made towards achieving the new commitments.

The 2014 publication provides an update on the monitoring of progress towards the targets set in the 2011 Political Declaration on HIV/AIDS. This report, along with similar progress reports from other countries, formed the basis of the UN Secretary-General???s 2014 End of Year Report on the Global AIDS Epidemic.

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