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H.E. President Jagdeo,
Hon Tommy Thompson, Hon Dr Douglas Slater, Chairman of the Council for Human and Social Development of the Caribbean Community and other Ministers of Health, Dr Peter Piot of UNAIDS, Ambassador Godard, and other Member of the Diplomatic Corps and Representatives of Regional and International Institutions, Delegates to this Conference, Members of the Press. It gives me great pleasure to be here this morning to participate in this historic high level meeting on HIV/AIDS. The Caribbean and the USA have a long history of cooperation in several areas of trade, security and fighting crime and drugs. We are involved with the USA in an annual consultation on mutual areas in international relations. In addition our peoples are in continuous movement and interchange for purposes of business and leisure. All these have created a zone of understanding, encompassing a wider spectrum of relations beyond those that are defined by laws and regulations. Turning specifically to the focus of this meeting, it is important to state from the onset that we in the Caribbean have been making every effort to scale up the response to the HIV/AIDS epidemic that is eroding our human resources and therefore our capability to compete in the global arena. It bears repeating that HIV/AIDS is now the main cause of death among the 15-44 age group in the Caribbean, that in some of our countries the high rates of mother-to-child transmission are cause of concern, and that most Caribbean countries are unable to provide adequate access to care and treatment for many reasons; for example, limited public budgets, despite relatively high allocations to health; high debt burdens measured as a percentage of GDP; inadequate human, physical and technological capacity. As a result, the most recent figures on HIV provided by the Caribbean Epidemiological Research Centre (CAREC) show that by comparison with the USA where rates of prevalence and new infections are actually on the decline, these rates in the Caribbean as a whole are on the increase. Preliminary research too from our Health Economics Unit of the University of the West Indies also shows that the impact on productivity, economic growth and hence the Region’s competitive capability are in danger of serious erosion. We must take drastic action now to avert what may escalate into a Sub Saharan phenomenon right here in the Caribbean. Given what we know, we cannot postpone action. We must act now. Follow up to the UNGASS Initiative In my capacity as Prime Minister with responsibility for Health including HIV/AIDS in the Quasi Cabinet of the Caribbean Community, I wish on behalf of the Community to thank Tommy Thompson, Secretary of Health and Human Services for convening this Meeting. I recall the visit of members of the Caribbean delegation to the health facilities in the Flatbush area of Brooklyn, New York in June 2001 at the time of the UN Special General Assembly on HIV/AIDS. We became even more conscious that there are so many of our Caribbean people who have migrated to the USA to live and work and who access health care for diseases including HIV/AIDS. We were conscious too of the role played not only by the official health facilities and the well-staffed and equipped laboratories but by NGOs who are active in the various fields, especially in the area of care and treatment for PLWA. During that visit to Brooklyn we from the Caribbean realized that there are many lessons to be learnt from the approaches taken in the Brooklyn area for both prevention and care. You promised then, Hon Secretary, that you wanted us to work in partnership. We are therefore most gratified that you Secretary Thomas and your delegation have come to us today to discuss our common cause, i.e. the urgent need to check the spread of this devastating disease. We applaud your commitment. We greatly appreciate also the contribution of USAID to our efforts to control the disease. USAID has pledged approximately US$20M to the Pan Caribbean Partnership for HIV/AIDS; it has already committed to funding one of the core positions in the Pan Caribbean Partnership Unit, and is also supporting the Partnership’s efforts along with CIDA, in reducing the stigma and discrimination of PLWA. Heads of Government have requested the CARICOM Secretariat to follow-up on the pledge of an additional $20 M by the US government received during our Heads of Government Meeting in Bahamas, July 2001. Then there is the recent statement by President Bush at Monterrey pledging a further sum in support of the Region’s HIV/AIDS programme. We lament however that access to these funds will not be possible until 2005. Indebted and inability to respond In the meantime, some countries in the partnership like Guyana Jamaica, Suriname and Dominican Republic are stymied in their responses due to high debt burdens which consume up to half or more of their GDP. Others like Haiti actually have GDPs too low to launch any real or meaningful attack. And yet others like the OECS are somewhat crippled in their responses because of small population size which makes it difficult on a per capita basis to absorb the cost of care. In some countries like St Vincent and the Grenadines, the recurrent expenditure in health is as high as 14 per cent of the national budget. What is very clear from a study done by the Health Economics Unit of the University of the West Indies, is that there is a widening gap between the resources available and resources required to adequately deal with minimum estimated costs of prevention care and treatment With further delays in investments this gap will widen further. Human resource attrition through migration, particularly our skilled labour force One of the underlying causes of migration is access to better care. Hence it becomes essential for the Caribbean countries to make every effort to improve its health care services. This cannot be achieved if our skilled labour force is leaving, and the quality and numbers required to deliver quality health care are compromised. In addition the widening technological gap is creating inequalities in access to “quality” care. For this and other reasons, countries like ours in the Caribbean are at a serious disadvantage. We are at further risk. This vicious cycle, exacerbated by the relatively high debt burdens that many of our countries are experiencing, therefore justifies the consideration of a new formula which will address in a holistic manner these concerns, particularly in light of the rising incidence burden of HIV/AIDS in the Caribbean. At the Meeting of the COHSOD, which was concluded yesterday, a Report from the Regional Nursing Council on the migration of nurses in ever increasing numbers was received with great concern. Since the quality and adequacy of nursing care is a major factor in reducing the levels of morbidity and mortality, the constant attrition of this important resource must inevitably impact negatively on the quality of care which is delivered as well as have a consequent effect on efforts to change the focus from curative to preventative health measures and responses. This also has consequences for the current efforts to link prevention with treatment and care. Some proposals were made which this meeting may also wish to consider. These include the following:
Training and Capacity-Building This is another critical challenge. In this context, we are pleased to have received the proposal by CDC and HRSA for the Caribbean HIV/AIDS Regional Training Initiative (CHART) which is a resource centre for training professionals in the area of HIV/AIDS. While this will not completely address the migration problem, it will significantly improve the Region’s ability to deal with the care and treatment issues. The proposal makes provision for locating these Centers in four countries. The Bahamas, Jamaica, Barbados and Trinidad and Tobago. I stress that all countries require such initiatives but within the region there are several countries such as the Dominican Republic, Guyana, Haiti and Suriname that require urgent attention. We would urge that the current initiative in this area include these countries. Negotiations for Cheaper ARVs More recently, the Caribbean has embarked on regional negotiations with pharmaceutical companies for cheaper ARVs. Our experience teaches us that we must debunk the notion that the pharmaceutical companies assess the ability of countries to afford these drugs, on the basis of their GDP when determining the level of reduction in the price at which they would supply the required ARVs. In this Meeting we make a strong appeal. We need the support of USA in making the case for acquiring drugs on a “budget neutral” approach. This approach assumes that the cost of opportunistic infections is the same as the cost of treatment of HIV/AIDS and that the Public Sector meets the cost of opportunistic infections as a whole. Capacity to Utilize the Available Resources and the Need for Capacity-building The Caribbean’s response has been to develop and strengthen its collective efforts through the Pan Caribbean Partnership. The Pan Caribbean Partnership has already received acclaim as being a model for regional cooperation in the fight against HIV/AIDS. Its operations are guided by a Regional Strategic Plan which focuses on some core areas including prevention, care and treatment, information, communications and public education, advocacy, resource mobilisation. In this regard the focal points for the various core areas CAREC, CRN+, UWI and CHRC, coordinated by the CARICOM, play pivotal roles in linking regional and national responses and ensuring that maximum collaboration results in pooling resources and minimising the duplication of resources while maximizing the impact of the various joint initiatives. Finally I bring to this Meeting, this historic meeting of the US and the Caribbean on HIV/AIDS the Expectations of my colleague Heads of Government. Mr Secretary of Health and Human Services, the next Caribbean Heads of Government meeting will be pleased to learn that this long awaited US/Caribbean dialogue on HIV/AIDS was actually convened. We in the Caribbean fully appreciated the reasons for the delay and take this opportunity to once again express our profound regrets at the events of September 11th 2001 in which so many innocent lives were lost including a relatively high number of Caribbean nationals; and to use the catch phrase of Calypsonian David Rudder, one of our social poets from Trinidad and Tobago, we say “USA we are sorry”. Now that we have actually embarked on a journey intent on addressing our common problem it is my hope, that we would leave these deliberations today with some concrete directions for progress. When we meet here in Guyana for the annual Conference of Heads of Government of CARICOM in July 2002, I would wish to report to my fellow Heads who endorsed my participation at this meeting as a serious expression of the Region’s commitment, that you too have demonstrated your commitment to building a sustainable partnership. I am therefore happy to note that you have anticipated my invitation for the USA to enter into full membership of the Pan Caribbean Partnership for HIV/AIDS by announcing yesterday your intention to sign the Pan Caribbean Partnership Agreement. We applaud you for this visionary step. Let us therefore, take this opportunity, to make history, by doing something concrete, something concrete for the people of the Caribbean the people of the USA. History will ever record an inadequate appreciation of this US/Caribbean high level meeting if we can truly move forward with joint action to reduce the scourge of HIV/AIDS. Anything less would lead to deserved condemnation, not only by this present generation but by generations of Caribbean and US citizens yet unborn. |
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