Dear Editor,

For years Jamaica’s HIV response has been framed by progress — fewer new infections; strong public health systems; and international recognition. But behind the headline figure, an estimated 28,000 people living with HIV, is a more complicated story; one that raises a simple but urgent question: What happens next? Because knowing the number is only the beginning.

Public health experts often talk about the “cascade of care”, which is a step-by-step journey from diagnosis to treatment and, ultimately, viral suppression. In Jamaica, that journey remains uneven. According to the Ministry of Health and Wellness, of the approximately 28,000 people living with HIV, around 90 per cent know their status, reflecting years of investment in testing and outreach.

However, gaps emerge in the next stages of care. According to UNAIDS, 54 per cent of those diagnosed are on treatment, and viral suppression remains a challenge, with 50 per cent of those on treatment achieving suppression — the point at which the virus is so low in the body that it cannot be passed on through sex. That gap is not just a statistic. It represents thousands of Jamaicans who are falling out of care, delaying treatment, or struggling to stay on medication. And that is where the real risk lies.

HIV today is not the diagnosis it once was. With consistent treatment, people living with HIV can live long, healthy lives. But treatment does more than protect the individual; it protects everyone. The science is clear: Undetectable = untransmittable (U=U). When someone achieves viral suppression, they cannot pass HIV on to a sexual partner. That means every person who starts and sticks to treatment becomes part of the prevention effort. But getting there takes consistency, which looks like daily medication, regular check-ins, and support systems that recognise that life does not always make adherence easy.

Health officials point to several reasons people fall out of the cascade. According to the 2024 journal article, ‘Intersecting Stigma and the HIV Care Cascade: Qualitative Insights from Sex Workers, Men who have Sex with Men, and Transgender Women Living with HIV in Jamaica’, published in AIDS and Behaviour, stigma remains one of the biggest barriers. For some, getting tested still feels like a risk — not medically, but socially. For others, starting treatment means confronting a diagnosis they are not ready to accept. According to a 2017 journal article, ‘Barriers and Facilitators to HIV Testing Among Young Men Who Have Sex with Men and Transgender Women in Kingston, Jamaica: A Qualitative Study’, published in Journal of The International AIDS Society, there are also practical barriers: transportation, work schedules, mental health challenges, and the quiet but persistent fear of being recognised at a clinic. So, while the system is reaching people, it is not always keeping them.

At Jamaica AIDS Support for Life (JASL) Kingston Chapter, the numbers tell a different story. One of what is possible when care is consistent and community-driven.

In 2024, the JASL treatment team was recognised for having the best HIV care cascade. Out of 572 people on their register, 532 were retained in care, and 469 achieved viral suppression. By June 2025, those numbers had grown: 588 on register, 536 retained, and 478 virally suppressed.

Behind those figures is a multidisciplinary team of case managers, adherence counsellors, nurses, social workers, psychologists, clinicians, and community facilitators all working together to support each client beyond the clinic visit.

It is a reminder that success in HIV care is not just about medication. It is about relationships, trust, and follow-through.

Jamaica has already shown what is possible. In 2024, the country achieved certification for the elimination of mother-to-child transmission of HIV and syphilis, a major public health milestone. And under the National Strategic Plan (2023–2030), there is a renewed push to reduce new infections by 40 per cent and close the gaps in treatment and viral suppression. But targets alone will not get the country there. The cascade only works if people move through it.

The answer, public health experts say, starts with simple, consistent action: Get tested and test regularly, use condoms, start treatment if diagnosed, and stick to the treatment plan as viral suppression is achievable and life-changing.

Kimberley Hibbert

Communications manager

Jamaica AIDS Support for Life

khibbert@jasforlife.org