World Aids Day

Today marks World AIDS Day, a day observed worldwide to increase awareness of HIV/AIDS and the importance of education, prevention and testing. The Joint United Nations Programme on HIV/AIDS (UNAIDS) reports that since the start of the epidemic an estimated 78 million people across the world have become infected with HIV and 35 million people have died of AIDS-related illnesses.

According to the UNAIDS Global AIDS Update 2016, there were an estimated 36.7 million people (including 1.8 million children) living with HIV globally in 2015.

With no cure yet available, HIV/ AIDS is the most destructive global pandemic in history.

Despite the small population size, the Caribbean has the second highest HIV prevalence globally after sub-Saharan Africa. Cuba, the Dominican Republic, Haiti, Jamaica and Trinidad and Tobago are the countries that account for 96% of all people living with HIV in the region according to the UNAIDS 2014 report.

The HIV epidemic is intensified by a wide range of factors.

Thankfully, most Caribbean countries have acknowledged the public health necessity and cost saving benefits of initiating treatment earlier and providing increased access to HIV testing, especially for young people. A few countries in the Caribbean have developed policies allowing minors to access HIV testing without parental consent, either allowing it at any age (such as in Guyana) or above the age of 14 (as in Trinidad and Tobago).

New HIV infections globally were estimated at 2.1 million; a decrease by 6% since 2010.

But HIV continues to be a global public health threat as there are still new cases of HIV infections reported. The UNAIDS 2016 reports that the number of new cases has roughly stayed the same across Latin America and the Caribbean between 2010 and 2015. Worryingly, new HIV infection across Eastern Europe and Central Asia increase by 57% and the Middle East and North Africa, which usually has the least reported cases had a 5% increase across the same period.

Despite the advances in public health across the world in the past few decades, infectious diseases remain a major problem to human capital. Ebola, Chikungunya and Zika are just a few worldwide health epidemics that have made headlines in recent years.

In the case of Ebola, the biggest economic consequences were not the direct effects of death, surging health spending or loss of workers, but rather ‘changes in behaviour – driven by fear – which led to reduced employment, income and demand for goods and services. The World Bank Group issued an economic update showing the Ebola crisis continues to cripple the economies of Guinea, Liberia and Sierra Leone, even as transmission rates show significant signs of slowing. The Bank Group estimates that these three countries lost at least US$2.2 billion in forgone economic growth in 2015 as a result of the epidemic.

Appropriate healthcare systems are vital for fighting against these health threats and finance professionals are crucial to their operations and effectiveness.

As a result of recession, many countries have found it difficult to finance their public expenditure programmes from current tax revenues and have had to resort to high levels of borrowing, which is unsustainable in the longer term. This has led many countries to implement austerity policies involving increases in taxation and lower levels of growth and even reductions in public spending – all affecting healthcare budgets.

Although healthcare systems vary enormously between countries in the way they are configured and financed, most face similar challenges, such as changing demographics. The changing medical, demographic, technological and economic conditions are creating additional demands on healthcare services at a time when the public are seeking further improvements in both the quality of services provided and scope of treatments available.

The World Health Organisation defines a well-functioning health system working in harmony that is built on having trained and motivated health workers, a wellmaintained infrastructure and a reliable supply of medicines and technologies, backed by adequate funding, strong health plans and evidence-based policies. Given the different requirements and structures of different countries it is not surprising that a single ‘one system-fits-all’ approach is not tenable.

World AIDS Day is very important because it reminds individuals as well as the government that HIV has not gone away. There’s vital need to raise money, increase awareness, fight prejudice and improve education regarding it. At the same time, new opportunities to predict, prevent, detect and treat diseases are emerging from a better understanding of the social determinants of health and from trends including new technologies in real-time diagnosis, data analysis (including in the field of genomics), biomedical research, the internet and mobile data and communications, often developed outside the traditional health sector. More innovative ideas, partnerships, and ways of working and financing will be critical for containing the dynamic threat of outbreaks in the 21st century.