HIV/STIs

HIV and STIs in Barbados

HIV remains an important public health threat in Barbados with an estimated 1.0% of adults in Barbados is living with this chronic disease at the end of 2022.. The epidemic started in 1984 and from the start there was an immediate response by health authorities to prevent HIV transmission, identify new HIV/ AIDS cases and to manage those who were ill due to HIV. 

In 2001, the national response to HIV in Barbados was expanded to become a robust, multi-sectoral programme designed to mitigate the impact of HIV in Barbados. The health sector aspect of this national response comprises various services and programs which are coordinated by the HIV/ STI Programme Management Unit of the MHW.

At the end of 2022, 4,648 persons were diagnosed with HIV, 2,140 were reported to have died with HIV resulting in 2,508 persons being alive and living with HIV. Historically, males have been disproportionately affected with HIV and are more likely to be diagnosed with AIDS, and die from an HIV related death.

These data are summarized in Table 1 below.

Table 1: Cumulative Number of HIV cases, AIDS cases and HIV deaths by sex, 1984-2022

Sexually Transmitted Infections (STIs) are among the commonest infectious diseases worldwide and contribute largely to the increasing burden on health care systems. According to the World Health Organization (WHO) approximately 340 million new cases of curable STIs occur annually (WHO, 2001). These infections are often asymptomatic and can remain undetected for long periods of time resulting in serious long-term sequelae contributing to morbidity and mortality. Additionally, STIs can increase the risk of transmission of the HIV.

The STI Programme in Barbados was revamped and incorporated into the National HIV Programme in 2006. This improved response to STIs included the creation of a post of physician specialist for STIs. Currently, this officer manages the STI specialty clinic based at the Winston Scott Polyclinic, the island’s largest primary health care facility. This officer is responsible for the management of patients with STIs, development of national protocols and guidelines for the management of STIs and training for healthcare providers. The main STIs of interest are Chlamydia, Gonorrhoea and Syphilis (including congenital syphilis).

Chlamydia and Gonorrhoea

In 2021, the Best dos Santos Public Health Laboratory (BDSPHL) performed Chlamydia trachomatis (CT) and Neisseria gonorrhoea (NG) testing on 1,152 urine samples. There were 21 positive NG cases resulting in a 1.8% positivity rate while the 131 positive cases for CT resulted in an 11.4% positivity rate.

The median age of NG cases was 23 years, with most cases occurring between the ages of 15 and 29 years (71.4%).  The median age of CT cases was 23 years, with most cases occurring between the ages of 20 and 34 years (72.5%).

The rates of CT were highest among the 20-24 age group (39.7%). Similarly, the rates of NG were highest among the 20-24 age group (42.9%).

A greater proportion of females tested positive for both CT and NG (79.4% and 61.9% respectively).

Hepatitis B and C

Infection with the hepatitis B and C virus can produce a potentially life-threatening liver disease and is considered as a major global health problem. Both viruses can cause acute or chronic infection and put people at high risk of death from cirrhosis and liver cancer. Barbados’ new viral hepatitis programme has been integrated into the HIV/ STI Programme as the country moves towards the elimination of these diseases as a public health problems.

The Health Sector Response to HIV and STIs

The Ministry of Health’s HIV/ STI Programme are: Prevention, Treatment, Care and Support, Program Management and Strategic Information.

Prevention: The aim of the prevention programme is to reduce individuals’ risks for transmission of HIV or STIs through a combination approach. There is a focus on reaching key populations deemed to be at higher risk for HIV. The Combination approach entails HIV and STI testing services, condom programming, prevention of transmission (of HIV and syphilis) from mother-to-child, pre-exposure prophylaxis (PrEP) and Post-exposure prophylaxis (PEP) and HIV treatment;

Treatment: The GOB provides Anti-Retroviral Therapy (ART) for all PLHIV at no cost! PLHIV may also receive drugs for the prevention or treatment of opportunistic infections and for the management of other chronic diseases. Most treatment services in Barbados are delivered via the Ladymeade Reference Unit, a specialty clinic for the management of HIV and STIs.

Care and Support: A holistic approach to management of PLHIV is deemed to be an imperative. Therefore, the HIV/ STI programme offers comprehensive psychosocial care and support services that PLHIV may require. This aspect of the programme utilizes the resources of other government and non-governmental agencies or departments.

Programme Management: The programme is managed by the Senior Medical Officer of Health (CD) who reports to the CMO. The Programme Management Unit is responsible for programme and project administration, procurement of goods and services, coordinating research and monitoring and evaluation for HIV and STIs.

Strategic Information: Strategic information for HIV and STI includes disease surveillance, M&E and research. Such information provides empirical evidence upon which planning and programme development and redesign are based.