Barriers to Reaching the United Nations Joint Programme on AIDS “90-90-90: Treatment for All” Targets in the Caribbean

The Caribbean region has the second highest prevalence of people living with HIV/AIDS in the world, with large differences in prevalence between countries. The Caribbean faces many barriers to reaching the UNAIDS “90-90-90: Treatment for All” goals. Identifying these gaps can improve HIV care services and contribute to the UNAIDS goal of ending the HIV epidemic by 2030. The objectives of this essay are to analyze the barriers to care at each step of the HIV care continuum in the Caribbean using the social ecological framework to guide the analysis of best practices and successful policies of other nations in achieving 90-90-90 targets and apply them to the context of the Caribbean. To achieve these objectives the author conducted an issue analysis supplemented by a literature review. The issue analysis focuses on identifying and analyzing standard policies and practices in the Caribbean that relate to HIV care and stigma in the region. Barriers to achieving the UNAIDS 90-90-90 targets occur at policy, community, institutional, interpersonal, and individual levels. These barriers include polices that discriminate against sexual and gender minorities, widespread stigma, gender-based violence, different approaches to testing and linkage to care, and differences in accessibility of preventative measures. Policy change can be implemented in the Caribbean to include removal of discriminatory practices and addressing socioeconomic and structural barriers to HIV prevention, treatment and care to improve access and continuity of HIV care. Understanding barriers to each step of the HIV care continuum in any setting can identify gaps in services where improvements can be made to both reduce new HIV infections and eliminate this disease as a public health concern. Limitations include an overall lack of data and research about HIV in the Caribbean, qualitative data that relied on self-report measures, and inability to access certain data sources. All of these factors could have influenced the results of this analysis. The implications of this project will be to improve public health policy and practice in the Caribbean in areas related to HIV prevention, treatment, and care