DR. ARUN KASHYAP // Caribbean Regional Meeting on Strategic HIV Investment and Sustainable Financing

May 29, 2013

• All protocol observed Honourable Dr. Fenton Ferguson Minister of Health, Ms. Densie Herbol, USAID Mission Director, Mr. Ernest Massiah, Regional Director, UN AIDS;
• Colleagues from Barbados, Belize, Cuba, Dominican Republic, Guyana, Haiti, Jamaica, and Trinidad and Tobago.
• My UN colleagues, distinguished Ladies & Gentlemen, a very good morning to all of you.

On behalf of the United Nations, it is a pleasure for me to be here with you at the Caribbean Regional Meeting on Strategic HIV Investment and Sustainable Financing - a joint effort between UNAIDS and PEPFAR.  I would like to welcome our colleagues from the ten Caribbean countries who have joined us at this meeting.  A very warm Jamaican welcome to all of you

The message of the recent UNAIDS report that there has been over a 50% reduction in new HIV infections across 25 low- and middle-income countries is very encouraging.  And, equally heartening is the evidence that globally the pace of the progress in confronting the HIV/AIDS problem has quickened - what used to take a decade can now be achieved in 24 months. This increased progress can be attributed, in part to a greater commitment demonstrated by these countries in accepting shared responsibility including by improving domestic outlays – at times, in a rather difficult macroeconomic and financial climate.

Needless to say, there is a compelling need for new and innovative partnerships and greater efficiency in mobilizing and in the use of resources, especially for HIV response that has historically received significant external funding.   For instance, in 2010/2011, external funding accounted for nearly 67% of the funding for the National HIV response in Jamaica. Challenges faced by Jamaica to warrant financial sustainability of the HIV response comprise increasing cost of providing HIV services, particularly to treat new infections and scaling up of treatment for persons on second tier Antiretroviral Therapy (ART) medication, and diminishing external funding options. 

The largest component of HIV/AIDS spending in Jamaica - guided by the National HIV/AIDS Strategic Plan (2012–2017) – has focused on Prevention.  The amount has ranged from J$630m in 2009-10 to J$555m in 2010/11 inclusive of strategies incorporating “communication for social and behavioural change”.  Other priority components include the treatment and Care element to improve the quality and length of life for persons living with HIV/AIDS (it also provides same-day voluntary counseling & testing as well as supportive interventions to reduce mother-to-child transmission of HIV); and the Enabling Environment & Human Rights component creates conditions for an open, tolerant and supportive society towards HIV/AIDS issues and assuring respect for the rights of persons living with HIV/AIDS (PLWHA).  The national policy and legal framework provides priority treatment to people living with HIV AIDS while reducing stigma and discrimination and creating a supportive environment for those affected by the virus. 

Of the estimated (2010) 32,000 persons are living with HIV in Jamaica nearly 50% are unaware of their status. As per the National HIV/STI Epidemical Update 2012, HIV continues to be the leading cause of death for persons in the 20-49 age group in the country.   We are aware that greater access to antiretroviral therapy has been a powerful force in the saving of lives of HIV Positive persons.  In the last 24 months, the numbers of people across the world accessing treatment has increased by 63%.  And, as a result there were nearly half a million fewer deaths in 2011 than in 2005.  In going forward our government will need to ensure that with reduced availability of international funding, reasonable cost of drugs must be negotiated including through PPPs.  It is also to be ensured that appropriate laws are in place to enhance access to generic medication.

Data since 2008 from the National HIV STI Programme has shown that there is an increase in the number of women with HIV AIDS in Jamaica.  A contributing factor – again as per the Jamaica Reproductive Health Survey 2008, has been the increasing level of gender-based violence in the society. It is important to further strengthen Jamaican laws to ensure that the constitutional rights and freedoms for these most vulnerable persons in the population are protected to prevent the spread of HIV.

All these factors are strong evidence of the critical need to combat HIV AIDS to ensure sustainable and inclusive economic development in Jamaica.  

I am delighted at the timeliness of this regional meeting with an objective to encourage Caribbean countries to invest in HIV and Health to improve efficiency to optimize sustainable results.  Thank you to all of you for joining this important meeting.
Over the next two days it would be essential to arrive at a framework to put in place the an effective investment framework for a regional HIV Funding.  Ideally it should be based on a shared responsibility that is premised on a greater country ownership to develop a sustainable – financially sustainble national strategic HIV response.   Also as I mentioned earlier, the framework must incorporate effective and creative partnerships amongst diverse stakeholders including the private sector.

UNDP’s recent Human Development Report (2013) titled "The Rise of the South: Human Progress in a Diverse World” chronicles the recent, rapid expansion of the middle class in the developing world. It predicts that over the next two decades growth in the so-called "Global South" will dramatically shift economic and political power away from Europe and North America.   It is therefore important that the discussion on regional and national HIV investment and sustainable financing strategies also builds upon south-south partnerships including learning from lessons on what works while accessing cost effective medications.

As we prepare a Roadmap that “charts a practical course” based on technical suport plans to develop HIV investment cases at country level to improve the strategic allocation of resources within the context of national health priorities and strategies, I would like to assure Jamaica of the support of UN agencies that continue to make substantial contributions to assisting the government in different programmatic areas relating to HIV/AIDS.

As we strive to reach the Millennium Development Goals, and the 2015 targets of the UN Political Declaration on HIV/AIDS, we have an opportunity to frame the HIV/AIDS strategy within the context of the post 2015 development strategy to ensure sustainability beyond 2015. It is critical that the Jamaican society, International donors and the Government actively become a part of the combined efforts to re-examine all the hindrances to ensure that we can successfully eradicate HIV/AIDS and achieve the shared vision of ‘zero new HIV infections, zero discrimination and zero AIDS-related deaths’.

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