Being small has its advantages. In most Caribbean countries, a local clinic or hospital isn’t very far away. Strong primary health-care systems and high levels of health-care access for pregnant women are at the heart of the region’s success in preventing new HIV infections among children. Seven Caribbean islands have been validated by the World Health Organization as having eliminated mother-to-child transmission of HIV. They range from the British overseas territory of Montserrat, with a population of 5000, to Cuba, home to more than 11 million people.
Antigua and Barbuda received its elimination of mother-to-child transmission of HIV validation in 2017. According to its Chief Medical Officer, Rhonda Sealey-Thomas, the Ministry of Health devised strategies to make certain that all pregnant women feel empowered and supported to start antenatal care as early as possible. The twin-island state employs a community nursing model in which district nurses conduct home visits to encourage women to go to health centres near the start of their pregnancies and to keep their appointments. The country uses its 26 community clinics to ensure that every woman had easy geographical access to antenatal care.
In the Bahamas, the Ministry of Health and the wider AIDS response are working towards validation. It was among five Caribbean countries that achieved 100% coverage for early infant diagnosis in 2018.
Nikkiah Forbes, Director of the National HIV/AIDS and Infectious Disease Programme at the Bahamas Ministry of Health, points to the importance of having a robust health-care system with available and free antenatal care and strong laboratories. Antenatal care is universal in the Bahamas and available at community clinics throughout the island chain. Mothers are encouraged to access care as early as possible and an HIV test is offered during the first visit. Laboratory screening is repeated at 32 weeks. Dedicated nurses ensure that all mothers and infants are retained in care and receive the additional support they need.
“You have to get out in the field if you are going to provide HIV care. We go to clinics to meet the women so we can provide support and counselling. We go into the field and test their partners. We really follow up to ensure they come to the clinic, feel comfortable and are expedited. We ensure they are getting their medication, all their labs are in and that they have nutrition support. If they don’t come to us,” one nurse explained, “we go to them.”
But a small population size also comes with challenges. For migrants, there is often the added vulnerability of standing out when accessing services. Antigua and Barbuda provides health care to all migrants. “Services in the community health clinics are free of cost. Nationality does not matter. If migrants are not afforded health care, it costs more in the long run. By protecting the health of migrants, you are indirectly protecting the health of your own population,” Ms Sealey-Thomas explained.
In the Bahamas, there are also mechanisms for Haitian migrants to access care. “We have translators that speak Haitian Creole at a one-stop-shop clinic. Translations of education materials are also available in Haitian Creole,” said Ms Forbes.
But for citizens who are members of close-knit communities, special care had to be taken to strengthen confidentiality and address stigma and discrimination in health-care settings. Throughout the region, health-care providers have received anti-stigma and discrimination training to address issues that include unconscious bias and confidentiality.
Still, in any Caribbean country the likelihood of people knowing or recognizing others where they access care is relatively high. It’s a challenge that countries must overcome in order to accelerate results across the continuum of care, for adolescents, women and men alike.