SENIOR medical officer for the National HIV/STI Control Programme in the Ministry of Health, Dr Kevin Harvey, believes a collaborative approach in combating the spread of HIV/AIDS in the region is not the best way forward, as most CARICOM member states have developed individual programmes to deal with the disease.

“Although all the islands are geographically related, the people and culture are vastly different, and the HIV situation in each country is also different,” Harvey argued.

“Therefore,” he said, “some of the factors driving the epidemic are considerably different and, as such, a broadbrush approach to HIV in the Caribbean will not necessarily be the best approach.”

Turning to the local situation, Harvey noted that, unlike some of its counterparts in the region, Jamaica had one of the most developed programmes in the Caribbean. Consequently, he argued that the island would not be included among the priority group for organisations such as the Pan Caribbean Partnership for HIV/AIDS (PANCAP).

“We [Jamaica] are so advanced and yet we are not doing so well. If we are covering only 50 per cent of our patients who need ARVs and only 10 per cent of the people infected, you can only imagine that the [rest of the] Caribbean is still in a serious position, and that the region needs health infrastructure upgrade not only for HIV, but for everything.

For now, it is not believed that Jamaica should see a great influx of migrant workers under the CSME, but in the event there is, then the ever-present concern that the island, like so many of its counterparts, would not be able to provide the necessary services to persons living with HIV.

“If Jamaica should start having a lot of migrants we would not have the necessary facilities for treatment and care for the ‘unbudgeted’ number of persons,” Harvey said.

“If you are looking at something like the CSME, I find HIV is important, but it does not exist unto itself. We have to look at whether we have a health-care sector that could deal with an influx of additional persons for treatment…that is what we are looking at, not just HIV,” he explained.

With the health sector already unable to deal with Jamaicans, Harvey said the sector would also not be prepared to meet the health needs of those migrants infected with the disease.

“As a country, we have half of the nurses we need and we don’t even have enough medical officers to manage primary care services. Therefore, if you have persons coming with HIV, it is the same already burdened clinics and the same doctors that they would use,” Harvey remarked.

HIV, he said, must be considered a developmental issue.

“It is something which is threatening our development and therefore must be addressed in that way,” he added.

According to Harvey, some structure or mechanism must be put in place to deal with migrant workers moving from one island to the next. In addition, he said some consideration must also be given to whether or not persons living with HIV/AIDS will be allowed access to health services in the countries where such services are free of charge to residents.

“I would not want to see a Caribbean HIV programme as such, but maybe we need to have a funding mechanism through a regional approach whereby the money is for the Caribbean, but the individual programmes must exist to target the various challenges in the different countries,” he suggested.

Further emphasising the point that a collaborative effort might not be the best idea, Harvey argued that there is a need for each country to look at its migration pattern. He said for example, that “people may gravitate more towards Bahamas, Barbados, British Virgin Islands, whereby when you look at Jamaica you may not find that large number of migrant workers.” As such, countries like Jamaica, he intimated, will not have an increased burden on their health sector due to the Caribbean Single Market and Economy (CSME).

There is, however, a need to look at the countries that will have an increased burden on their health system due to migration for facilitation of their development. As such, there should be a budget from the Caribbean funding for migrants in the national HIV programmes for the more sought after countries, he said.

“If you are buying Antiretroviral (ARVs), you would buy some for migrant workers in Barbados or Bahamas, but you may not need to do that in Jamaica,” Harvey added.