Macroeconomics and Health (CMH)

MacroHealth Newsletter

No. 5 July 2003

The HIV/AIDS epidemic in the Caribbean

It comes as a surprise to many to learn that the Caribbean has a prevalence rate for HIV/AIDS second only to sub-Saharan Africa. It is estimated that in the wider Caribbean there are almost half a million people living with HIV/AIDS, and the adult prevalence rates exceed one per cent in almost every country. About one quarter of these cases can be found in the Caribbean Community countries. Furthermore, in almost every country about 40 per cent of the adult infected persons are women--a number that is increasing--and in some countries, HIV prevalence rates among girls are about five times higher than in boys. The epidemic shows no signs of easing and is now firmly and predominantly heterosexual in its mode of transmission.

The economic implications of the epidemic are enormous. Studies have shown that if unchecked, the total cost to Caribbean Community countries excluding Haiti could reach $US 80 million by the year 2020, and there will be significant reductions in the GDP of the countries. As in other places, the epidemic affects the most economically active sections of the population and, in addition, is a potent driver of poverty. Not only does the illness produce economic instability and impede overall economic growth, but it prevents families from escaping the poverty trap into which they fall because of the expense of the illness and the reduced earnings of the family breadwinner.

The Heads of Government of the Caribbean recognize the short- and long-term social and economic impacts of the epidemic and are developing mechanisms to address it. These consist not only in establishing national and regional plans and the machinery to coordinate a Pan Caribbean response but also, in several cases, countries have provided increased resources from their own budgets and from loans from multi-lateral financial institutions such as the World Bank.

When they met in Nassau in 2001 for their 21st Conference, the Caribbean Community Heads of Government declared that “the Health of the Region is the Wealth of the Region” and tasked the Pan-Caribbean Partnership against HIV/AIDS to set in place actions to address the economic consequences of the epidemic. These included the formation of a Caribbean Commission on Health and Development which will take forward some of the recommendations made by the WHO Commission on Macroeconomics and Health as they are applicable to the Caribbean. The Caribbean Commission has already been fortunate to secure support from the WHO Macroeconomics and Health initiative and will commence its activities shortly. HIV/AIDS and its economic impact will figure among the issues to be addressed.

Sir George Alleyne
Special Envoy for HIV/AIDS, The Caribbean Region

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Macroeconomics and Health pushes ahead in the Caribbean states

The 15 member states making up the Caribbean Community have recently committed to setting up a Caribbean Commission for Health and Development and have obtained external donor support for their budget. Sir George Alleyne, former Director of the WHO Regional Office for the Americas, has agreed to chair the Commission. This commitment follows heightened political attention to health issues as evidenced by the 2001 Nassau Declaration, which stated that “The Health of the Region is the Wealth of the Region.”

The Secretariat of the Caribbean Community noted that many of the arguments used for establishing macroeconomic and health frameworks and seeking intersectoral synergies are of direct relevance to the Caribbean. The region is currently undergoing an epidemiological transition from predominantly communicable diseases to non-communicable diseases as the main causes of death and illness, and the region continues to struggle to find ways of dealing effectively with both types of disease. While maternal and infant mortality have fallen and vaccine-preventable diseases have been controlled, the Caribbean is second only to sub-Saharan Africa in the increasing incidence of HIV/AIDS. Tuberculosis has also re-emerged as a major health challenge. In addition, increasing gaps in income and social inequalities are leading to widening mortality differentials, so particular attention needs to be paid to health investments that have a positive impact on the poor.

The new Commission has developed an 18-month timeline to create a policy framework and provide guidance on establishing priorities for health financing. The framework, together with locally developed evidence, will be used to help the Caribbean member states structure their health and development agendas in an interrelated manner, focusing on providing pro-poor health services. An important outcome for the Commission is partnership building, which will be advanced through multi-sectoral workshops in member states.

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