Of the middle-income Caribbean countries, only Jamaica will be spared from cuts, but under strict conditions. Far fewer people living with HIV in Jamaica receive treatment than in the other upper-middle income Caribbean countries, and estimates are that more than 3 in 10 Jamaican men who have sex with men are HIV positive.
PEPFAR’s moves now increase the burden on regional governments to bring their HIV/AIDS epidemics under control, even as public finances in several of the affected countries are already stretched. With the exception of Haiti, which will retain its PEPFAR funding entirely, a complete regional pullout would leave a US$9m gap¹ in financing for the Caribbean’s response to HIV and AIDS, based on PEPFAR’s 2014/15 expenditure levels.
Despite some progress, the picture of the Caribbean’s HIV/AIDS response is mixed. Prevention messages that focus on abstinence and condom use are mainstays of national health campaigns, and costly interventions such as drug prophylaxis to prevent HIV infection are off the radar for most. Moralistic views and discrimination against the LGBT community are effective barriers to healthcare, and the prevalence of HIV among these marginalised groups can often run times higher than in the general population.
Strong progress and adoption of international best practices, such as Barbados’ decision to treat all people living with HIV, regardless of the stage of their disease, have been largely supported by PEPFAR funds. Central governments will now have limited time to ensure sustainability of these gains and to finance gaps after the departure of US aid.
While PEPFAR’s Directors made no explicit link between their decisions and President Trump’s dictates to cut America’s levels of foreign aid, the repeal of PEPFAR’s reach in the Caribbean follows the administration’s decisions to cut funding to the United Nations Food and Population Fund, as well as its removal of federal dollars from Planned Parenthood and other international development programmes.
The US Congress recently passed the US-Caribbean Strategic Engagement Act, which an analysis featured in this publication deemed to be an important opportunity for advancing the Caribbean’s interests to the Trump administration. As at press time, sources tell Antillean that health and social development imperatives were not among the priorities advanced by CARICOM for the shaping of the future US engagement policy, despite CARICOM’s ambassadors in Washington and New York being briefed on PEPFAR’s decisions.