Co-Chairs, Thank you for giving me the floor. The HIV/AIDS environment has changed significantly over the past decade. Greater precision in defining the epidemiology of the disease, more targeted interventions aimed at high-risk population groups and unprecedented levels of access to antiretroviral therapy have prevented new infections, saved lives, improved the health of people living with HIV and, for the first time, raised hopes of achieving zero new HIV infections and zero HIV-related deaths. Successive Jamaica National Strategic plans for HIV and AIDS have set time-bound programmatic goals and targets aligned with the United Nations Millennium Development Goals, the United Nations Political Declarations on Commitment to HIV/AIDS and more recently the Sustainable Development Goals. The Jamaica HIV/AIDS Programme has recorded much progress in pursuing the national vision of zero new HIV infections and zero AIDS-related deaths. Already, significant strides have been made in key areas such as reducing the number of new HIV infections, prevention of mother-to-child transmission of HIV and expanding antiretroviral coverage among persons living with HIV, with a concomitant reduction in AIDS-related deaths. These successes have been achieved with significant support from international donor agencies. The economic hardships resulting from the continuing global financial crisis now threaten to undermine these gains. As international funding dwindles in a contracting economic environment, the challenge of averting a reversal of the gains is central to all planning processes. Compounding the sustainability threats, challenges of HIV testing uptake especially among key populations, stigma and discrimination, retention in care and adherence are foremost barriers in ending the AIDS Epidemic in Jamaica. The 2020 targets (90-90-901) form the platform for achieving SDG 3.3. There are however a myriad of challenges being faced by small Upper Middle Income (UMI) countries like Jamaica, where we are experiencing limited economic growth; this is compounded by an environment of reducing, time-limited external funding support. Jamaica like many other vulnerable economies faces a challenge to adequately finance healthcare. These limitations impact on our ability to provide HIV services at the 1 90% PLHIV know their status, 90% PLHIV who know their status on ART, 90% on ART virally suppressed 1
requisite scale. Implementation of evidence-based interventions to end the epidemic is therefore challenged in such a setting. Another major challenge is the dependence of the NGO sector on donor funding; investments over the life of the response have not produced an independent, selfsustaining civil society response for HIV. Private sector involvement has also been limited, in part, by the stigma associated with HIV. In prioritizing limited domestic resources, treatment interventions have received more public resources than prevention and stigma and discrimination/human rights interventions. The adoption of appropriate bio-medical prevention interventions such as Pre-Exposure Prophylaxis (PrEP) is limited not only by resource prioritization (favouring PLHIV) but also by significant adherence challenges and the country’s lack of capacity for HIV Drug Resistance Testing (HIVDR). Gaps in the prevention response for the general population (including adolescents) are evident and key population prevention intervention models are expensive and unsustainable in the medium-term without some donor funding. At the global level, the cost of HIV care has been decreasing; nevertheless, Jamaica’s economic state has not allowed for wholesale absorption of the cost of the HIV response. The cost of vital load testing and second and third line anti-retroviral drugs are still high and are not declining at a rate that fosters rapid cost absorption/ownership at country level. Jamaica therefore highlights the following priority outcomes which would accelerate the end of the AIDS Epidemic: 1. Continued eligibility for donor resources to 2020 (as a minimum) in support of the 2020 targets; 2. Focus on sustainable financing options for both civil society and the Government; 3. Access to sustained, cost effective HIV care supplies; and 4. A (sustained) community mobilization strategy aimed at facilitating legal reform. Jamaica needs the continued support from external partners to scale-up the interventions, whilst allowing the government to incrementally absorb the associated costs of the HIV response. Access to increased financing can enable us to better manage and operate the public health sector in a way that will improve equity, efficiency and health outcomes for all. I thank you. 2