Jamaica Responds to HIV/AIDS

Challenge

In 2008, AIDS and other sexually transmitted infections were the second leading cause of death for young people between the ages of 15 and 24. Although prevalence rates varied across population groups, men who have sex with men (MSM, 20-30%) and female sex workers (FSW, 9%) were the groups driving the epidemic. However, heterosexual transmission was reported by 90% of persons with HIV. 

Risky behaviors included participation in commercial and transactional sex, failure to use condoms with non-regular partners, early initiation of sexual activity, gender inequity and gender roles, poverty, and stigma and discrimination, all of which negatively affected the ability of individuals to improve their health. 

Solution

Between 2002 and 2012, Jamaica has drawn on World Bank funding to support its National HIV/AIDS Response.  Activities supported by the project included increased condom distribution and testing, delivery of integrated treatment to AIDS patients at 23 treatment sites, development of legislation to support an enabling environment, and a strengthened health system through the upgraded capacity of the biomedical waste management plan to treat 83 percent of annual medical waste from public health facilities. 

In 2008, the Jamaica Second HIV/AIDS Project was prepared in eight months as part of the Government’s emergency response to HIV/AIDS and in support of the financing needed to implement the National HIV/AIDS Strategic Plan (NSP).  It included retroactive financing for a seamless transition from the first to the second project. The project pooled Bank funds and other donor funds to allow the Government the flexibility to finance different activities aligned with NSP priorities. This approach proved to be effective particularly when the 2008 global financial crisis hit Jamaica and limited the resources for implementing the NSP. 

Jamaica was able to use the Bank loan as its counterpart funding to meet a condition of a grant from the Global Fund to Fight AIDS, Tuberculosis and Malaria. When funding improved, the Government reallocated funds to allow the project to catch up with delayed activities.

Results

The following results were achieved under the Jamaica Second HIV/AIDS Project.

Prevention

• 91% of female sex workers reporting condom use with their most recent client (target: maintain more than 90%).
• 59.2% of female sex workers who received HIV testing in the last 12 months and who know the results (target: 50%).
• 40,445 female sex workers and 22,145 men who have sex with men reached through prevention activities (target: FSW 14,955; MSM 14,059).
• 19% of prison inmates reached through prevention activities (target: 15%)

Treatment, Care, and Support

• 10,469 men, women and children with advanced HIV receiving antiretroviral combination therapy according to national guidelines (target: 9,000)
• 85.8% of HIV positive pregnant women receiving a complete course of antiretroviral (ARV) prophylaxis to reduce the risk of mother-to-child transmission (target: maintain more than or equal to 80%)
• 1.4% of infants born to HIV infected mothers who are also HIV infected (target: less than 5.0%)
• More than 95% of antenatal clinic clients counseled and tested for HIV (target: maintain more than 90%)

Strengthening Institutional Capacity for Legislative Reform, Policy Formulation, Program Management, Monitoring and Evaluation

• 100% of reported cases of HIV-related discrimination receiving redress (target: 70%)
• 100% of institutions/organizations reached adopting HIV/AIDS policies (target: 93%)

Bank Group Contribution

The Bank’s total investment contributions in support of Jamaica’s response to HIV/AIDS include the first loan for US$15 million, which was implemented between March 2002 and May 2008, and the follow-on Second HIV/AIDS Project for US$10 million, implemented between May 2008 and March 2013. 

Partners

The project was implemented by the Ministry of Health, its four decentralized regional health authorities, four non-health line ministries, civil society organizations, and the Jamaica Business Council.  The project was critical in helping the Government leverage additional donor funds, which included US$44.22 million from the Global Fund and US$26 million from the United States Agency for International Development, President’s Emergency Plan for AIDS Relieve (USAID/PEPFAR).  Based on the sustainability study conducted by the Bank in collaboration with the Government and the United Nations Program on HIV/AIDS (UNAIDS), the Global Fund has provided an additional grant of approximately US$2 million to assist Jamaica during the transition from external to domestic financing of the National HIV/AIDS Program.

Moving Forward

Due to limited fiscal space, the Government has focused on improving program efficiency and cost-effectiveness of interventions. In March 2013, the National HIV/AIDS Program was integrated into the National Family Planning Board to strengthen the link between family planning, HIV, sexually transmitted infections, and sexual and reproductive health, as well as to maximize coverage and health outcomes and optimize the use of scarce resources. This integration is expected to improve the National HIV/AIDS Program’s capacity to attract funding and international assistance, providing a more optimal governance framework for project financing and monitoring. The Bank remains engaged with the Ministry of Health, providing technical assistance for the costing of the Non Communicable Diseases National Strategic Plan. 

Beneficiaries

Project beneficiaries included:

• At-risk populations, particularly men who have sex with men and female sex workers, benefited from the prevention programs.  
• Persons living with HIV/AIDS benefited from better access to treatment, care, and support interventions.
• Pregnant women and newborns benefited from the antenatal and prenatal programs.
• School youth, prison inmates, and drug users benefited from improved prevention services.