ABSTRACT

Objective: To delineate changes in the epidemiology of HIV including morbidity and mortality patterns based on three key time points in Jamaica’s HIV response.

Method: Surveillance data from Jamaica’s HIV/AIDS Tracking system (HATS) were analysed and distribution of cases by age, gender, sexual practice, risk factors and clinical features were determined for three time periods (1988 – 1994: formal establishment of HIV surveillance at the national level; 1995− 2003: introduction of HAART globally; 2004 – June2008: introduction of HAART and HIV rapid testing in Jamaica). Factors that predicted late stage diagnosis (AIDS or AIDS death) were also determined.

Results: 22 603 persons with HIV were reported to the Ministry of Health, Jamaica, between 1988 and June 2008. Between the first and last time blocks, the modal age category remained constant (25−49 years) and the proportion of women reported with HIV non-AIDS increased from 32.5% to 61.4% (p < 0.001). However, the male: female ratio for persons reported with AIDS remained at 1.3:1 between 1995 and 2008. Although heterosexual transmission was the most frequent mode of transmission in each time period, sexual behaviour was consistently under-reported (4769 persons or 21% of all cases ever reported). Late stage diagnosis (AIDS or AIDS death) decreased significantly between the first and last time blocks (16% decline, p < 0.0001) with men, older persons and persons with unknown risk history being more likely to be diagnosed at AIDS or AIDS death.

Conclusion: HIV testing and treatment programmes have improved timely diagnosis and reduced morbidity associated with HIV infection in Jamaica. However, new strategies must be developed to target men and older persons who are often diagnosed at a late stage of disease. Surveillance systems must be strengthened to improve understanding of persons reported with unknown risk behaviours and unknown sexual practices.