Overview of the HIV Epidemic in Jamaica

In 2008, 2.7 million persons resided in Jamaica with approximately 53% of the population between 15 and 49 years old. The majority of Jamaicans who living with the virus and who are at highest risk of contracting same, constitute this age cohort. First detected in 1982, HIV is present in all of Jamaica’s parishes, but Kingston, St. Andrew, and St. James – the three most urbanized parishes – have the highest prevalence rates. Jamaica continues to experience features of a generalized and concentrated epidemic with an estimated 1.6 % of the adult population infected with HIV and higher HIV prevalence identified among vulnerable populations such as Men Who Have Sex With Men (MSM) (31.8%), Sex Workers (SW) and informal entertainment workers (4.9%), inmates (3.3%), and crack/cocaine users (4.5%) (Ministry of Health Jamaica, 2008; Figueroa et al, 2008). Despite widespread scaling up of HIV testing, approximately 50% of HIV infected persons remain unaware of their status and 14,000 persons are in need of treatment.

Behavioral surveillance of People Living with HIV (PLHIV), confirms that the main factors driving the epidemic since 1982, have been multiple partnerships, early sexual debut, high levels of transactional sex and inadequate condom use. For example, a 2008 national survey of the general population revealed that 38.9% sexually active respondents had multiple partner in the last 12 months,37% of sexually active persons participate in transactional sex and the median age at first sex has trended down for girls from 17.2 years in 2004 to 16.9 years in 2008 (Hope Enterprises Limited, 2008). This is also reinforced by data on persons reported with AIDS between 1982 and 2008, in which 23.1% of persons with HIV report having sex with a sex worker and more than 80% report having multiple partners. No high risk behaviour was reported by approximately 20% of reported HIV cases and this may represent persons who report having one sex partner who was HIV infected by another

In 2008 alone, 925 persons with AIDS were reported to the Ministry of Health (MOH); young people 15-24 years old continue to comprise one third of the statistics, with a prevalence rate of 1.7% reflected among young males and 0.9% among females comprising this age cohort. HIV continues to be primarily transmitted through sexual intercourse, with 90% of reported cases reporting heterosexual practice.However, the sexual practice of 40% of men with AIDS is unknown and may reflect an unwillingness to reveal sexual orientation. HIV/AIDS surveillance data is also limited by incomplete reporting from private sector sources.

The Jamaica National HIV response consists of more than 100 stakeholders from the
government of Jamaica, government ministries, non‐governmental organizations, private sector groups and international development partners. These stakeholders have identified 4 priority areas which are detailed in the 2007‐2012 National Strategic Plan:
• Prevention
• Treatment care and support
• Enabling environment
• Empowerment and governance

Under these priority areas, Anti-retroviral treatment(ARV) have been made available to 49% of persons with advanced HIV. Thousands of members of our vulnerable populations (youth, MSM, SW and inmates)have been educated about prevention of HIV transmission, vertical transmission from mother to child have reduced from 25% to < 5%, novel sites have been adopted for condom distribution, mechanisms for tracking and addressing HIV related discrimination have been developed, and engagement of political leadership have improved the policy environment for matters related to HIV and vulnerable populations.Antiretroviral treatment was introduced in 2004 and the number of persons with AIDS and AIDS deaths decreased by 17% and 40%respectively between 2004 and 2008. This is also reinforced by the finding in our public sector treatment sites that show the 12 month survival of persons initiating treatment in 2006 and 2007 was 80% and 91% respectively.

Expansion of HIV programmes has also resulted in testing for 95% of pregnant women attending public clinics in 2009 and provision of anti‐retrovirals HIV testing reduced mother to child transmission of HIV and a decline in paediatric AIDS from 61 in 2004 to 32 in 2008. The coverage of pregnant women is further reflected in a national Knowledge, Attitude, Behaviour and Practices (KABP) survey (2008) that revealed over 91% of pregnant women completed VCT during their most recent pregnancy.This survey includes a mix of women who have received both private and public sectorantenatal care.

Despite scaling up of prevention and treatment programmes, the percent of young people, 15 – 24 years old, who are HIV positive, has shown no significant change over the last decade (1.3% in 2004, 1.0% in 2009). Additinally, stigma and discrminition against vulunerable populations continue to retard the progress that the country's HIV response has been working to achieve.