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Improving Access to HIV Services for Mobile and Migrant ...

Improving Access to HIV Services for Mobile and Migrant ...

Equity. Every resident

Equity. Every resident of Antigua and Barbuda is covered under the primary health care system although with secondary and tertiary care, access to care is often via the United States or the UK with government only providing the airfare and a small stipend. Revenue for the public health care system comes mainly from the Ministry of Health through allocations from the Ministry of Finance; contributions from employers and employees; and from beneficiaries of the Medical Benefits Scheme. The health information system has several challenges and chief among them are the scarcity of financial resources, and the absence of a national health information policy and legislative support for the management and dissemination of health statistics. HIV. In Antigua and Barbuda, since the first case of HIV was diagnosed in 1985 and up to the end of December 2009, the total number of persons who tested positive for HIV was 815, with a male to female ratio of 1:1. The data for the reporting period indicate that the major mode of HIV transmission is through heterosexual contact and that the economically active populations as well as persons in the reproductive age group are most affected. A review of the HIV notification by age clearly indicates that the epidemic is concentrated within the age group 15-49 years. Women outnumber males in the age group 15 – 34years. The number of people who died, stopped treatment or was lost to follow up in 2008 is forty-nine (49). In 2009, there were one hundred and twenty-six (126) adults and children with advance HIV. The number of adults and children with HIV who received and continued ARV’s is ninety eight. The number of people who died, stopped treatment or was lost to follow up is twentyeight (28). Deaths from HIV-related causes are among the eight (8) leading causes of deaths in the age group 20-59 years. The factors that are driving the spread of the epidemic include the following: movement of people because of immigration and migration, sex tourism, commercial sex worker, unprotected sex, gender inequality and transactional sex among the youth seeking additional money because of poverty or the pressure for a fashionable consumer lifestyle. The national response to HIV is under the direction of the Chief Medical Officer and the Permanent Secretary in the Ministry of Health through the functioning of the AIDS Secretariat. This body coordinates all HIV and AIDS efforts and works closely with other government ministries, PLHIV and civil society to implement HIV/AIDS strategies and programmes. It also serves as the focal point for the 6

collection and dissemination of information about HIV and AIDS, other STI and related issues. In keeping with the Strategic Plan for the National Response to HIV/AIDS 2001-2005 and the Business Plan for the Ministry of Health 2008-2010, the National AIDS Programme has been incorporated into the existing public health infrastructure. Several policies and procedural manuals have been developed to guide the operations of the NAP. Provision has been made for the establishment of the Office of an Ombudsman to deal with issues pertaining to workers rights including those associated with HIV and AIDS. HIV Expenditure. As reported in the 2010 UNGASS report Government expenditure was EC$702,000 (USD260,000) in 2008 and EC$700,000 (USD2590,000) in 2009. Global Fund Expenditure between the two calendar years 2008 and 2009 was EC$355,053 (USD131,000). In June 2010 the IMF approved a three-year Stand-By Arrangement (SBA) for US$ 117.8m to support the government’s efforts to restore fiscal and debt sustainability and set the stage for a sustained recovery. The global economic and financial crisis, falling tourism visits and reduced foreign related construction activities triggered a recession and contributed to a sharp decline in government revenue. This has aggravated an already unsustainable fiscal position resulting from longstanding fiscal imbalances and accumulation of a large stock of arrears to domestic and external creditors. The recession from 2009 led to a 20 percent decline in tax revenue. The overall fiscal deficit widened from 6 percent of GDP in 2008 to about 19 percent in 2009, public debt increased to 115 percent and the total stock of arrears rose to about 53 percent of GDP, or 45 percent of the outstanding public debt. The overall response to the fiscal situation was to implement, in 2009 measures which included a 20% increase in petroleum product prices, followed by an expansion in the VAT base, an increase in import duties, and excise tax on alcohol and tobacco for the 2010 budget,. On the expenditure side, there was a series of measures at reducing expenditure especially with salaries in the public sector. The debt restructuring of the public debt to resolve the large stock of arrears required agreements with creditors on a comprehensive restructuring of both domestic and external debt with the aim of achieving interest savings of about 4½ percent of GDP in 2010. In addition in the fiscal area, reforms were implemented related to tax administration, public financial management, social security, and civil service reforms. Specific measures resulting from the IMF agreement include: Consumption tax on oil products, 0.5% of GDP in 2009 and 1.5% of GDP in 2010. This is a specific tax which in 2004 was EC$2.95 for motor spirits and EC$2.89 for diesel oil; import duties 0.6% of GDP in 2010; embarkation tax, 0.2% of GDP in 2010. 7

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