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Is HIV/STD control in Jamaica making a difference?
J P Figueroa1, A R Brathwaite, M Wedderburn
1Ministry of Health, Kingston, Jamaica.
Insights
Jamaica's HIV/STD Control Program has slowed the HIV/AIDS epidemic, with low prevalence in the general population. However, high-risk groups still show concerning rates of unprotected sex.
Area of Science:
- Epidemiology
- Public Health
- Infectious Disease Control
Background:
- The HIV/STD Control Program in Jamaica was implemented in the late 1980s.
- Monitoring the HIV/AIDS epidemic and sexually transmitted infections (STIs) is crucial for public health.
- Understanding trends in high-risk behaviors and condom use is essential for effective prevention strategies.
Purpose of the Study:
- To evaluate the impact of Jamaica's comprehensive HIV/STD Control Program on the HIV/AIDS epidemic.
- To analyze trends in HIV and syphilis prevalence across various population groups.
- To assess changes in sexual behaviors and condom use over time.
Main Methods:
- Utilized AIDS case reports and HIV testing data from diverse groups including blood donors, antenatal clinic attendees, food service workers, STD clinic attendees, female prostitutes, and homosexuals.
- Monitored primary, secondary, and congenital syphilis cases.
- Conducted national knowledge, attitude, and practice (KAP) surveys in 1988, 1989, 1992, 1994, and 1996.
Main Results:
- Annual AIDS incidence rates showed a marginal increase, while HIV prevalence remained low (around 1%) in general populations.
- Elevated HIV prevalence was observed in high-risk groups: 6.3% in STD clinic attendees, up to 21% in female prostitutes, and 30% in homosexuals.
- Syphilis rates declined, and condom use significantly increased across various demographics, alongside a rise in condom distribution.
Conclusions:
- HIV/STD control measures have demonstrably slowed the HIV/AIDS epidemic in Jamaica.
- Despite progress, a notable proportion of individuals in high-risk situations continue to engage in unprotected sexual activity.
- Sustained public health interventions are necessary to address ongoing risks and further reduce transmission.
Objective:
To assess the impact of the comprehensive HIV/STD Control Program established in Jamaica since the late 1980s on the HIV/AIDS epidemic.
Methods:
AIDS case reports, HIV testing of blood donors, antenatal clinic attenders (ANC), food service workers, sexually transmitted disease (STD) clinic attenders, female prostitutes, homosexuals and other groups were used to monitor the HIV/AIDS epidemic. Primary and secondary syphilis and cases of congenital syphilis were also monitored. National knowledge, attitude and practice (KAP) surveys were conducted in 1988, 1989, 1992, 1994 and 1996.
Results:
The annual AIDS incidence rate in Jamaica increased only marginally in the past three years from 18.5 per 100000 population to 21.4 in 1997. HIV prevalence in the general population groups tested has been about 1% or less. Among those at high risk, HIV prevalence rates have risen to 6.3% (95% confidence interval 5.0-8.0) in STD clinic attenders, around 10% and 21% in female prostitutes in Kingston and Montego Bay respectively and approximately 30% among homosexuals. Syphilis rates and congenital syphilis cases have declined. The proportion of men aged 15-49 years reporting sex with a non-regular partner declined from 35% in 1994 to 26% in 1996 (P< 0.001). Women ever having used condoms increased from 51% in 1988 to 62.5% in 1992 and 73% in 1994 and 1996 (P< 0.001), while condom use with a non-regular partner increased from 37% in 1992 to 73% in 1996 (P= 0.006). Condom use among men was high over the period: around 81% had ever used condoms and 77% used them with non-regular partners. Gay men, inner-city adults and adolescents aged 12-14 years all reported increases in condom use while condom sales and distribution increased from around 2 million in 1985 to 10 million in 1995.
Conclusion:
HIV/STD control measures appear to have slowed the HIV/AIDS epidemic in Jamaica, however a significant minority of persons continue to have unprotected sex in high risk situations.