Bahamas Hiv & Aids Overview 2006

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Mission Statement The HIV/AIDS Centre is dedicated to coordinated, comprehensive, compassionate community based, family-centered care for persons living with HIV/AIDS, as well as their families and significant others. This includes inpatient, clinical, follow-up care at hospitals, community health poly-clinics and outreach programs using a multi-disciplinary approach.

Cumulative Number of Reported HIV Infections by Sex st December 31 2005

Vision Statement The HIV/AIDS Centre will continue to distinguish itself as a model for success in the Region and be recognized for providing holistic quality, innovative prevention education, and skilled clinical management through-out the Commonwealth of The Bahamas.

Objective The objective of the National Programme is to reduce the incidence and impact of HIV/AIDS and other STIs by providing a strategic, holistic approach to HIV prevention education; clinical management, care, support, treatment; HIV/AIDS training; HIV/AIDS Research; Focus on Youth initiative; HIV Laboratory Services and CARICOM Youth Ambassador for Positive Living initiative.

Of the 5,243 cases of AIDS, 3,612 (68.99%) have died. Of the total 10,479 infections, 7,661are in young adults between the ages of 55 and 44 years. The ratio of males to females infected with HIV is 1.1:1. Cumulative Number of Reported HIV Infections with Current Status st December 31 2005

1. Background Information The focus of the HIV/AIDS Centre is to prevent and control the spread of STIs/HIV/AIDS in The Commonwealth of The Bahamas and to extend and improve the quality of life for all persons in The Bahamas living with HIV disease. In The Bahamas, the National AIDS programme has monitored the epidemic since the first case was confirmed in 1985. As of December 31, 2005 there had been a cumulative total of 10,479 HIV infections, 5,243 cases of AIDS and 5,236 persons who are non-AIDS HIV infections.

The number of new persons testing HIV positive decreased from 404 in 2000 to 256 in 2004. As a result of a Mass Media Campaign encouraging persons to know their HIV status additional people have come in for HIV testing, this was reflected in the increase by 47 new reported HIV cases totaling 303 new reported HIV infections for 2005. Adolescents and young people account for the fastest growing group of new HIV infections.

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4. Bahamian Infectious Diseases and STI experts documented the connection with genital ulcer disease, HIV infection and cocaine use, causing risky behaviours, which resulted in the spread of HIV.

The prevalence of HIV in antenatal patients is 2%. The overall HIV prevalence rate for The Bahamas is 3%. Prevalence of HIV in Antenatal Women, Blood Donors and STI Clients Bahamas, 1994-2004 of HIV in Antenatal women, Blood Donors, Prevalence

and STI Clients – 1994 - 2004 8 7.5 7 6.5 6 5.5 5 4.5 4 3.5 3 2.5 2 1.5 1 0.5 0

Antenatal Women

Blood Donors

2. Collaboration Between Health Agencies, Units, and Departments In the Response to the HIV/AIDS Epidemic

STI Clients

7.2

5.4 5.2 4.4

4.7 4.2

0.4

1994

4

3.6 3.1

3.3

0.4

1995

0.5

1996

4.8 4.1

3.8 3.6

0.4

0.4

1997

1998

3.3

0.4

1999

3.3 3

0.5

2000

3.1

3.1

2.7

0.4

0.4

2001

2002

3.6 2.9

0.2

0.2

2003

2004

Year

The leading cause of death in the age group 15 to 29 is AIDS.

1.2 Crack Cocaine Epidemic/Genital Ulcer Epidemic and HIV Epidemic 1. The crack cocaine epidemic in the early 1980’s led to an increase in sex for drugs and sex with drugs. The use of cocaine caused impaired judgment, resulting in persons having sex with multiple partners (approximately 30 % of persons with AIDS used cocaine). 2. Following on the crack cocaine epidemic, the STI (Sexually Transmitted Infections) Genital Ulcer Clinic documented an alarming increase in persons with genital ulcer diseases like syphilis, herpes, chancroid, and lymphogranuloma venereum (LGV). 3. The four-fold increase seen in HIV infection at that time was an indication that the three epidemics (crack cocaine, genital ulcer disease and HIV) together caused the Bahamas numbers to increase disproportionately.

From the first reported case in The Bahamas, the problem was seen as a Sexually Transmitted Infection. This fostered the already excellent working relationship between the Infectious Diseases Wards and Clinics of the Princess Margaret Hospital, the Princess Margaret Hospital Comprehensive (S.T.I.) Clinic, the Pharmacy Services, X-Ray, Laboratory Services, Private Physicians, the Department of Public Health, Social Services, other support services and private allied agencies.

3. Surveillance Epidemiological surveillance of HIV/AIDS in the Bahamas, spans over a twenty year period 3.1 Statistics are generated in the following ways: Voluntary counseling and testing (VCT) with pre-test and post-test counseling, to the following clients: 1.

Antenatal clinic attendees in New Providence and Family Islands.

2.

STI clinic clients and contacts.

3.

Prisoners during medical assessment on entry to Her Majesty Prison (also VDRL and Mantoux testing).

4.

Contacts of HIV positive clients.

5.

Referrals from Substance Abuse Agencies

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Cumulative Number of Non-Aids, HIV Infections st By Age, Group, & Sex - December 31 2005

AIDS Cases Alive, By Age, Group and Sex - December 31st 2005

1200 1000

Number

800 600 400 200 0

<01

1-4

5-9

10-14

15-19

20-24

25-29

30-34

35-39

40-44

45-49

50-54

55-59

60+

Unk

Male

73

49

21

11

76

293

440

491

357

253

188

91

60

85

105

Females

79

50

26

22

185

429

529

433

312

196

95

73

50

45

119

Total

152

99

47

33

261

722

969

924

669

449

283

164

110

130

224

Current Status of Reported AIDS Cases - December 31st 2005

New Cases of AIDS, By Sex and Year - December 31st 2005 300 250 200 150 100 50 0 198 5-

198

199

199

199

199

199

199

199

199

199

199

200

200

200

200

200

9

0

1

2

3

4

5

6

7

8

9

0

1

2

3

4

200 5

198

Male

173

91

97

142

163

173

204

239

219

224

207

192

181

162

208

204

135

147

Females

101

79

68

78

99

122

111

145

153

158

112

128

132

125

127

143

99

101

Percent Distribution of HIV Infections (AIDS Cases and Non-Cases) Reported Annually, st By Bahamian Status - December 31 2005

Current Non-AIDS HIV Infections, By Sex and st Reported Year - December 31 2005 500 450 400

Number

350 300 250 200 150 100 50 0

19861989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 1988

Male

432

307

243

270

297

285

341

250

210

225

171

170

200

185

162

126

127

141

Female

278

188

207

238

280

280

315

248

219

192

185

172

205

201

168

162

129

162

* Data as at December 31st, 2005

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3.2 Partner Notification & Contact Tracing A major factor responsible for the accuracy of HIV/AIDS statistics is the outstanding skill of the Public Health nurses in counseling, partner notification, contact tracing and maintaining client confidentiality.

4. HIV/Tuberculosis Due to improved clinical management and the DOTS therapy, co-infection of TB and HIV continues to decline.

5. Bahamas National HIV/AIDS Response: In 1985 the National Standing Committee on HIV/AIDS was formed, with the CMO as its Chairperson, and the Infectious Diseases Specialist as Director of the National AIDS Programme. From 1985, AIDS has been a notifiable disease. Staff at the Coconut Grove

This has resulted in increased numbers of persons being named as contacts and being counselled tested and followed up.

3.3 What Statistics/Research tells us: Focus Should Be on HIV Prevention For Teenagers & Young Adults. This Is Supported By: •

Antenatal Statistics showing 2% of pregnant women are infected with HIV.

•

STI/HIV infections in young girls - this is the fastest growing group of persons testing positive.

•

The number of teenagers having babies (unprotected sex) each year is high, approximately 700 - 800.

3.4 Trends Noted •

A decrease overall in new person testing HIV positive

•

A decrease in vertical transmission from 30% to 10% and now to less than 1% in 2005.

•

2% of antenatal clinic clients are HIV positive.

•

A decrease noted in death rate.

•

Increase in HIV infected persons on ARV medication

•

Challenges with compliance with ARVs.

The following strategies were identified: 1. Prevention of sexual transmission. 2. Prevention of transmission through blood/blood products. 3. Prevention of perinatal transmission. 4. Epidemiological Surveillance and research. 5. Reduction of the impact of HIV infection on individuals, groups and society. 6. Development of treatment protocols for HIV/AIDS. 7. Accelerated access to ARV’s. Subcommittees on Epidemiological Surveillance, Public Education, Blood Banking, Treatment and Research were introduced.

5.1 The AIDS Secretariat was developed in 1988 to coordinate HIV/AIDS prevention education related activities. The purpose of the Secretariat was to serve as the coordinating centre for the dissemination of information on HIV/AIDS and Sexually Transmitted Infections education. All information available/provided by the HIV/AIDS Centre is extended to the Family Islands. This role was expanded in 2003 under the HIV/AIDS Centre to include all arms of HIV/AIDS activities under one umbrella.

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5.2 The HIV/AIDS Centre consists of 6 units: • • • • • •

HIV Prevention Education Unit Clinical Management, Care Support and Treatment Unit Medical Research Unit Laboratory Diagnosis Unit Regional Training Centre Unit Focus on Youth, Youth Ambassadors for Positive Living

The National AIDS Education Programme, which draws on the expertise of volunteers and persons in nongovernment organization, has been successful in making the public aware of the threat of HIV/AIDS to persons not only in The Bahamas but also in the region. Structured Island outreach workshops are held in the island on an ongoing basis.

5.3 National HIV/AIDS Programme Management From the inception, The Bahamas’ National HIV/AIDS Programme Director has been Dr. Perry Gomez, Infectious Diseases Specialist, who was the focal point for all the committees. He was able to coordinate the work of these committees, and attract key experts to assist in various areas of HIV/AIDS interventions.

5.4 Infectious Diseases Ward and Medical Follow-up Clinic From 1985 all HIV/AIDS patients have been admitted to the Infectious Diseases Wards with 20 male, 15 female and 8 pediatrics beds. Outpatient’s clinics are as follows: • • • •

Wednesday: - Medical Follow-up clinic for Adults, Children and HIV+ pregnant women Wednesday: - TB (Mantoux) Clinic Mondays: - Counseling Clinic for newly diagnosed HIV positive persons Fridays: - TB Clinic for all persons with TB and contacts.

5.5 Interventions to Reduce the Spread of HIV/AIDS in Vulnerable Populations; A. Prevention targeted at young people – Specialty programmes for the prevention of HIV/AIDS/STIs in adolescents. e.g. - the expanded Focus on Youth initiative. • Not sexually active / Sexually active • Focus on Youth Programme/ I am special Health and Family Life (HFL) School Programme: HIV prevention/education intervention for grades 6-8. • Annual World AIDS School Competition.

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5.5 Interventions to Reduce the Spread of HIV/AIDS (continued) B. Commercial Sex Workers(CSW) and Men Who Have Sex Sith Men (MSM): trainers working on data collection through focus groups (CSW and MSM). These areas need addition support.

5.8.1 Children with HIV: The Bahamas participated in an open Label Phase three study of ABT-378/Ritonavir in HIV-infected children. 18 children are enrolled and are doing exceptionally well.

C. Institutionalized populations.

5.8.2 Reduction in Vertical Transmission

D. Work with the large Creole speaking population.

Antiretroviral (ARV) Programme - HIV infected women make up approximately 2% of the 6000 annual pregnancies in The Bahamas. Most of these (85%) access antenatal care through the Public Health Community Clinics. All women are counseled and offered HIV testing. More than 90% of women agree to be tested. Those who are HIV positive are referred to the weekly HIV/AIDS special clinic at the Princess Margaret Hospital, where they are further counseled, and offered ARV’s. The babies are followed up at the weekly pediatric HIV/AIDS clinic, which runs concurrently with the antenatal clinic. If they are found to be HIV positive, the babies are followed up monthly. With the ARV programme in place, the Vertical Transmission rate has dropped from 30% to less than 1%.

E. Targeted Intervention for uniformed organizations.

5.6 To Sustain Reduction Of Vertical Transmission; Work With HIV Positive Mothers and Their Children. 1. Provision of ARV to all HIV positive pregnant nd women by the 2 trimester of pregnancy with monitoring of adherence. 2. Prevention of repeat pregnancies 3. Protocols for addressing needs of children of HIV positive mothers 4. Orphans and AIDS - a growing concern and problem.

5.7 Human Rights Issues Work is ongoing to: •

enact policies development and legislation.

•

promote human rights and non-discrimination.

•

National Consultation on HIV/AIDS in the workplace. (August 2000)

5.8 Research Initiatives Bahamian Infectious Diseases expert and STI experts documented the connection with Genital Ulcer Disease, HIV infection and Cocaine use causing risky behaviour which resulted in the spread of HIV. HIV Clinical Research Trial participation with children, adults and pregnant women sponsored by International Research Agencies is ongoing. Other research projects are as follows:

The Bahamas participated in the Neviparine Study. The result showed that Neviparine is an effective ARV therapy for the reduction of MTCT.

5.8.3 Protocol 247: This was a muliti-center, two-arm randomized, double blind controlled trial to evaluate the effect of an increased caloric density infant concentrated formula on growth and nutritional status of HIV-infected infants.

5.8.4 Penpact 1 (Penta9/Pactg390) A phase II/III randomized, open-label study of combination anti-retyroviral regimens and treatmentswitching strategies in antiretroviral naive children >30 days and <18 years of age.

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5.8.5 Tipranavir 1182.33

7. Care Initiatives

A randomized, open label, active controlled trial to evaluate the antiviral efficacy and safety of treatment with 500 mg Tipranavir plus 100 mg or 200 mg Ritonavir p.o. BID in combination with standard background regimen in comparison to 400 mg Lopinavir plus 100 mg Ritonavir p.o. BID in combination with standard background regimen in antiretroviral therapy naïve patients for 48 with extension up to 156 weeks

Support for PLWHAs.

5.8.6 ATN 024

Clinical management and treatment of HIV/AIDS enhanced at the community level: Indicator: At least 30% of reported persons living with HIV infection receive appropriated clinical management at Community Health Poly Clinics by end 2006.

8. Continuing HIV/AIDS Education for health care providers maintained:

A multicenter, stratified, block-randomized, open-label trial to study the initial and persistent immune response to safety of three hepatitis B vaccination schemas in HIV-infected adolescents 12 to <25 years of age.

Indicator: Approximately 50% of relevant health care providers receive CME certification in HIV/AIDS education and treatment by December 2006.

5.9 HIV/Tuberculosis

Education in island communities is on-going with the Community nurse in charge of the major clinics, which serve as the focal point, and the School Family Life Educators assisting. A range of prevention, support and care activities take place in different Islands, settlements and communities. Prevention efforts are maximized during cultural activities such as regattas, with involvement of Local Government teams.

The Bahamas was one of the first Caribbean countries to document the relationship between HIV infection and Tuberculosis and the Multi-Drug Resistance problem with Tuberculosis.

6. Special Population Groups Empowered/ Educated for HIV prevention, Reduction In Stigma Discrimination & Serving As Partners in care Efforts Include: •

Religious Based Instructions - Churches; their role in prevention, care and support especially home care.

•

Work with Unions, Human Resource Managers.

•

Women’s groups - UNIFEM Project, Zonta, Links Inc, Bureau of Women’s Affairs.

•

Media: Their ongoing role in HIV prevention education.

9. Family Island Initiatives:

10. HIV/AIDS Centre Resource Committee A very active and vibrant multi-Sectoral team of persons from the community, meets monthly. It consists of Public Health Nurses, playwright/ author, cosmetologist, educators, youth and drug prevention officers, Infectious Diseases and STI consultants, representatives from a large utility corporation, Bahamas Family Planning Unions, Ministry of Education and Youth, Community Policing, the AIDS Foundation, the Religious Community, Service Clubs and PAHO/WHO, Legal Department, Banks, Chamber of Commerce and other Non-Government Organizations.

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The HIV/AIDS Resource Centre provides: 1. Information dissemination assistance with school and youth groups. 2. Networking (Red Cross, Girl Guides, Boys Scouts, Governor General Awards Group, Sporting Events, Street Vendors, Narcotics Anonymous, Cosmetology, Professionals, Churches, Schools, Bahamas Family Planning Association, Samaritan Ministries. 3. Presentations 4. Walk-in Counseling 5. PLWHA expansion of CRN + organization

As well as Workshops for the following: • Teachers • Church Leaders

• Guidance

Counselors

• Media: Staff

• Workplace

• Political

• Social Workers

Constituents

• Parents

• Volunteers

• Unions

• Uniform Officers

• Corporations

• Health Fairs

• Sporting Groups

• Youth

• Family Island

• Officers/groups

Regattas

• Family Island

• Crisis Centre

• Community

• Home Coming

Outreach • Communities’

• Health Care

Workers

• Tourism Industry

• Bank Staff

• Decision Makers

• Insurance Staff

• Family Life

• Hotel Workers

11. Areas In Which Current HIV/AIDS Prevention Work Needs To Be Accelerated • • • • • •

• •

• • • •

Work with PLWHAs Work with large and growing Creole speaking community Work with target audience MSM, bisexuals Work with sexually active young people in and out of school Work with parents Work with CSW and with persons who are not generally “considered” CSWs but who regularly have sex for car payments, loan payments etc. Repeat pregnancy prevention for HIV positive persons who have had on child. Structured, sustained work with smaller Evangelical, Pentecostal and Independent Churches. Work with addicted population especially alcoholics Work utilizing sports community Work with men patronizing bars, using bartenders and bar room setting Website development

12. National Non-Government Involvement: 12.1 The Samaritan Ministry Programme began in 1988 and is unique to the region. It has had a positive impact on the care and support offered to those persons with HIV and those living with AIDS. Samaritan Ministers are specially trained lay counselors who work one on one with HIV/AIDS clients and families. Members of The Samaritan Ministry are part of the AIDS Secretariat Resource Committee.

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12.2 The AIDS Foundation (formed in 1992)

12.6 Bahamas Barbers & Cosmetologists:

This non-governmental organization has as its objectives to: • Assist in the establishment of and funding of housing for HIV/AIDS infected persons. • Assist with the education of the public

The Bahamas Barbers and Cosmetologist Association: A past President is an active member of the Resource Committee.

Funding for this important organization is due in large part to the support from a major insurance company and other business organizations. Some of its activities to date include: • sponsored a company of Peer Educators (the Ashe Group) from Jamaica, who through song and dance provided STI and HIV/AIDS information and prevention education to more than 20,000 20,000 Bahamian youth. • sponsored numerous workshops at the national and international level and has co-sponsored various educational and fund raising activities with the Imperial Life Insurance Company, for example, workshops for youth and the extremely successful Red Ribbon Ball. • initial provision of funds to purchase AZT for pregnant mothers infected with HIV. The programme, which now includes triple therapy, is funded by the Government.

The All Saints Camp located on the Lazaretta Road off Carmichael Road west is a Non-Government Organization. It was established under the Direction of Rev. Glenroy Nottage. This institution is home to numerous HIV infected persons. The lovely setting of spotless white cottages along paved pathways, overhanging trees, pets like fish, turtles, and parakeets are only a few of the amenities to make PLWHA feel and look good.

12.3 Bahamas Red Cross The Red Cross: Junior volunteers HIV/AIDS training is ongoing and was recently expanded.

12.4 The Bahamas Family Planning Association The Bahamas Family Planning Association: works in close collaboration with the AIDS Secretariat on a number of projects including training of peer educators, family life educators, students etc.

12.5 Unions The President of the Airport, Airline and Allied Workers Union is a member of the AIDS Secretariat Resource Committee. The Workers Credit Union Executive and members have had sessions on HIV/AIDS.

12.7 The All Saints Camp

12.8 Corporate Bahamas 13. International Non-Government Involvement • • • • • • •

PAHO UNAIDS Med-Pharm Clinton Foundation Wayne State University United States Embassy Hospital for Sick Children

14. The number of persons on ARV’s has significantly increased since October 2002. At the end of December 2005, 1800 PLWHAs had commenced ARVs. 15. An Anti-Discrimination in the workplace Law was recently passed; hopefully this would assist in the prevention of Stigma and Discrimination of HIV/AIDS persons in the workplace. 16. HIV/AIDS Advisory Committee is responsible for the overall policy management, development and implementation of the National HIV/AIDS Programme it is chaired by the Chief Medical Officer and the Director of the National AIDS Programme.

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Management & Staff HIV/AIDS Centre Dr. M. Perry Gomez Dr. Stanley Read Mrs. Rosa Mae Bain Dr. Percival McNeil Ms. Janet Lundy Mrs. Sandra Miller Mr. Terry Johnson Mr. Victor Smith Ms. Lorna Anderson Ms. Shelley Munnings Mrs. Cynthia Johnson Rev. Irene Coakley Ms. Marva Jervis Ms. Indira Martin Mr. Sidney Albury Mr. Lamorn Armbrister

Mr. Thomas Holbert Ms. Claramae Farrington Mrs. Tanya Kelly Mrs. Masie Miller Mr. Solomon Sands Ms. Jessica Stubbs Ms. Mercia Strachan Ms. Marjorie Morley Ms. Vianna Williams Ms. Sandra Stubbs Mr. Emile Lesbott Ms. Mariette Newry Mrs. Thelma Cargill Mrs. Sophia Bethel Ms. Maria Cartwright Mrs. Esther Johnson

Ms. Tami Clarke Ms. Tamazina Farrington Ms. Uvie Johnson Ms. Lorraine Clarke Ms. Ernestine Deveaux Mr. Keith Kemp Mrs. Lynette Deveaux Dr. Sonja Lunn Mrs. Bernadette Saunders Mrs. Shanice Rahming Ms. Chanelle Diggiss Ms. Pamela White Dr. Ismae Whyms Ms. Stephanie Braynen Mr. Keith McConnell Mr. Sean Kennedy

National HIV/AIDS CENTRE Tel: (242) 328-1540 or (242) 323-5968 Fax: (242) 322-6610 Email: [email protected] 2006