KINGSTOWN, St Vincent (World Bank) — In St Vincent and the Grenadines, the national program to control HIV/AIDS implemented a comprehensive prevention, treatment, and care program to address the HIV/AIDS epidemic, led by the public sector with the participation of civil society. Between 2004 and 2010, the annual number of new HIV-positive cases declined by 41 percent from a baseline of 108 to 64.
During the same period, the annual number of new AIDS cases declined by 38 percent from 40 cases to 25. Moreover, the total number of persons tested for HIV through the Voluntary Counseling and Testing program reached 8,927 in 2010, exceeding the project’s target of 2,000.
Challenge
Following the identification of the first HIV-positive case in 1984, the government of St Vincent and the Grenadines established a response program, which eventually led to the development of the National HIV/AIDS and Sexually Transmitted Infections Strategic Plan 2001-2006.
Despite the high level of HIV/AIDS awareness in the country, positive behavioral change remained a challenge. The National HIV/AIDS Strategic Plan 2004-2009, focused on a comprehensive approach. At the time of project appraisal, in 2004, a total of 796 HIV-positive cases had been reported, reaching an annual high of 108 new cases. At that time, 54 percent (431 cases) of the HIV-positive cases had developed AIDS-related diseases and experienced a case fatality rate of 51 percent (405 cases), leaving 391 persons living with HIV/AIDS. Among AIDS cases, the fatality rate was 94 percent. UNAIDS (2006) estimated that HIV prevalence in the country was 1 percent, compared with 2 to 4 percent in the Bahamas, Haiti, and Trinidad and Tobago, suggesting that the government had an opportunity to prevent the epidemic from escalating as it had in other Caribbean countries.
Solution
Project implementation involved mass campaigns and provision of HIV lessons as part of life skills training in all public primary and secondary classes, which have likely contributed to enhanced prevention activities and changes in behavior and attitudes. The project design was aligned with the country’s priority of halting and controlling the spread of HIV/AIDS in a comprehensive manner, while strengthening human and institutional capacity. The project gave equal importance to prevention, treatment, and care activities. The strategy actively involved civil society organizations, line ministries, the Ministry of Health, and the National AIDS Secretariat Project Coordinating Unit. Project components were structured around implementing agencies, which created a clear division of labour. Given the country’s limited human resources, the project drew on and strengthened existing expertise in other World Bank-financed projects. In this case, an existing project coordinating unit had been managing fiduciary aspects of other Bank-financed projects.
Results
The annual number of new HIV-positive cases declined by 41 percent from 108 cases in 2004 to 64 in 2010 (final project implementation year). The project expanded voluntary counseling and training services in all 39 health centers. The project trained more counselors and refurbished and equipped 18 health centers to provide HIV rapid testing. The results of this scale-up of prevention programs was evident from:
• The increased distribution of condoms from 218,900 to 2,017,335.
• The successful counseling and testing of virtually all pregnant women.
• The increase in the number (8,927 compared to the target of 2,000) of those in the general population tested for HIV through the Voluntary Counseling and Testing program, which included pre- and post-test counseling.
• The in the number of patients receiving treatment, from 115 to 474.
• The decline of the number of new AIDS cases by 38 percent, from 40 cases to 25, while the fatality rate decreased from 63 to 13 percent.
Such positive trends may indicate progress in catching patients early in the disease stage and enhancing quality of treatment.
Bank Group Contribution
Financing for the project included a loan of US$2.69 million, a credit of US$1.95 million, and a grant of US$1.87 million. The Bank also provided technical assistance continuously throughout supervision, as well as periodic fiduciary training workshops in Washington DC. The Bank team organized two regional workshops:
• In 2006, a five-day multi-country HIV/AIDS program (MAP) consultation and training workshop for the 10 Caribbean projects.
• In 2008, a two-day policy forum that brought together the Caribbean countries involved in the MAP Adaptable Program Lending.
These workshops provided an opportunity to discuss relevant issues with the governments in the region and a venue to learn best practices from each other.
Partners
During project implementation, there was strong coordination between the Office of the Prime Minister, the Ministry of Health and the Environment, and eight other line ministries. In addition, national civil society organizations implemented key project activities.
The Pan Caribbean Partnership against HIV and AIDS was crucial in developing a baseline survey for community stigma. The project also received technical and financial support from the US President’s Emergency Plan for AIDS Relief, which supported laboratory and health systems strengthening, strategic information, and prevention programs. The Global Fund also supported care and treatment programs.
Moving Forward
After the project, St Vincent and the Grenadines continued to benefit from support from the US President’s Emergency Plan for AIDS Relief and the Global Fund. The European Union is also currently supporting the government. Moreover, the government has proactively transitioned key staff into its permanent structure, thus promoting continuity of key interventions. The challenge moving forward is to retain key staff to manage, coordinate, and implement the program, and to continue engaging and strengthening civil society organizations and line ministries through training, provision of technical assistance and opportunities for networking and coordination.
