CASTRIES St. Lucia, March 23rd, 2012  --  First the good news: some Caribbean countries are close to achieving targets for the elimination of mother-to-child HIV transmission. Now for a reality check: stronger efforts are needed if those nations are to maintain high service coverage and if others are to catch up.

A special meeting of regional Chief Medical Officers (CMOs) held earlier this week in St. Lucia offered an opportunity for stock-taking as well as joint action toward positive and sustainable results.

Facilitated by the Pan Caribbean Partnership Against HIV and AIDS (PANCAP) and the Pan American Health Organisation (PAHO), the meeting aimed to secure consensus from the senior physicians on integrating responses to HIV and other Sexually Transmitted Infections in national healthcare services. 

PAHO presented findings from health system evaluations of HIV responses throughout the region. In many countries HIV services continue to be provided in a stand-alone way.

“It still feels like a vertical approach. You might have HIV counsellors in clinics but these counsellors are still under the National AIDS Program and they are not fully integrated into the structures of the health centre. Many AIDS programs are funded externally. If that funding disappears, the service goes too,” illustrated Dr. Sonja Caffe, PAHO’s HIV/STI Prevention Adviser.

From the point of view of sustainability the mandate for integration is clear. As international donor funding steadily slows, Caribbean countries are on a race to ensure that HIV responses don’t disintegrate in their wake.

There are also benefits of integration for the individual person living with HIV (PLHIV). Caffe stressed that they will have access to a broader range of services, with better health and social outcomes.

For example, more PLHIV also have non-communicable diseases. Health systems must become more adept at addressing this spectrum of needs with the same human and technical resources. Caffe isn’t oblivious to the concerns about integration, though.

“The design of integrated services needs to be carefully considered. We do need to take into account the stigma around HIV,” she admitted.

“There are still people who don’t want to go for services either at all or in their usual setting because of this. But there are different things that can be done. Ministries of Health in some countries are open in their condemnation of stigma and discrimination.

You can set up measures for clients to have redress at some level. There is also the question of training health workers, some of whom are still fearful. On the other hand, you need to organise services in such a way that confidentiality is guaranteed so that those (healthcare workers) who do not need to know will not come across that information.”

Such measures, she says, should reduce anxiety about either real or perceived discrimination.

A policy brief developed at the meeting will be discussed further at the Special Meeting of the Council for Human and Social Development (COHSOD) next month. The form integration takes and the level of investment required to make it a reality will vary from country to country.
 
“What’s been valuable is for countries that have taken the steps toward integration to share their experiences so we could learn from good practices and not duplicate mistakes,” Caffe stressed.

“We anticipate that through political will and the good organisation skills of people already in the health sector, every country will come up with resource and service models that suit their needs”.

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