The Epidemiology of HIV/AIDS in Anguilla from 1988 to 2011

This study was carried out on the Caribbean Island of Anguilla for the purpose of analyzing surveillance data related to the epidemiology of HIV infection in Anguilla from 1988 to 2011. We retrieved data from the National AIDS Programme office for research purpose. Data on HIV/AIDS in Anguilla were retrieved from 1988 to 2011 and analyzed with particular emphasis on the year 2011. The retrieved data provided key information on new cases, deaths, and treatment of existing cases. Result analysis shows that by December 31, 2011, the cumulative number of all HIV cases diagnosed since the surveillance started in 1988 was 42. Males accounted for 23 (54.8%), while females accounted for 19 (45.2%) of the diagnosed cases. There were 17 cases comprising of 12 males (70.5%) and 5 females (29.5%), HIV-related deaths within the same period. No cases of AIDS were reported in the study period. The year with the highest number of HIV diagnosis was 1996 with 7 confirmed new cases. HIV prevalence in Anguilla is estimated to be 0.19%. The number of tests conducted in 2008 holds steadfast as the highest in the 4 consecutive years from 2008 to 2011. There were 9 clients that received treatment and care from the Clinical Care Coordinator within the period under review. Data provided in this study shows a gradual decline in the incidence of HIV infection in Anguilla since it was first diagnosed in 1988. This is attributable to public awareness, surveillance, and access to antiretroviral treatment (ARVT).


Introduction
the Caribbean countries with the Bahamas rate at 3% and Haiti, Trinidad and Tobago greater than or equal to 2%, while Cuba's rate is less than 0.2% [5]. According to Avert (2019), there were 10,000 AIDS-related deaths in the Caribbean in 2017 [2]. Deaths from AIDS-related illness decreased by 23% between 2010 and 2017 [3].
HIV related disease is the leading cause of mortality in Caribbean people 25 to 44 years of age [1]. Of all AIDS-related deaths, 87% occurred in the Dominican Republic, Haiti and Jamaica [3].
The Caribbean is experiencing a concentrated HIV epidemic, which refers to the idea that HIV prevalence is low in the general population but is much higher among certain groups of individuals [2]. These groups include men who have sex with men, transgender women [2], commercial sex workers, drug users [5], tuberculosis (TB) patients, the homeless population [1] and prisoners [6].
Men who have sex with men accounted for a quarter of new HIV infections in the Caribbean in 2017 [3]. Heterosexual transmission is implicated in approximately 60% to 80% of cases of HIV infection in the Caribbean, with homosexual or bisexual transmission accounting for 10% to 15%, and mother-to-child transmission for 6% to 10% [1]. National HIV programs have made progress in providing HIV/AIDS treatment, reducing AIDS-related death rates and decreasing HIV mother-to-child transmission [5]. Several Caribbean countries have eliminated mother-to-child transmission of HIV: Anguilla, Antigua and Barbuda, Bermuda, the Cayman Islands, Cuba, Montserrat, Saint Kitts and Nevis [3]. In 2017, the rate of mother-to-child transmission in the Caribbean was 13%,

Trends in new HIV cases 1988-2011
In 2011, 2 persons were newly diagnosed with HIV in Anguilla.
The new cases were proportionately distributed between the two sexes, one male (50%) and one female (50%). Hence, males accounted for 50% and females 50% of the new HIV cases in 2011.
The median age of newly diagnosed HIV cases for males was 22 years and that of females was 17 years. This data is illustrated in    This is shown in Figure 3. This is illustrated in Table 4. At the start of treatment, 7 patients were on HAART. However, 4 (57.1%) out of the 7 patients were still on first line therapy and 3 (42.9%) out of the 7 were on second line -therapy. Table 5 illustrates the information of the 9 patients under the care of the Clinical Care Coordinator.   Note: Denotes those on second line antiretroviral therapy.    Republic [3].
The only countries in the Caribbean currently providing preexposure prophylaxis for HIV are the Bahamas and Barbados [3].
Most countries, including Anguilla, provide sexual education in primary and secondary schools; however, Haiti is one of the few countries that do not provide sexual education [3]. There were 8,000 HIV positive women in the Caribbean who gave birth in 2018 [3]. In 2014, a study was performed on pregnant women in Ghana to show the relationship between education and HIV incidence [8]. The study showed an association of a higher incidence of HIV in the lower socioeconomic and less educated class [8]. However, the HIV prevalence in the general Ghanaian population is 1.9%, with 2.9% in the Ghanaian pregnant class; hence, suggesting a need for more education [8]. Access to ARVT across the Caribbean is uneven and far behind many other regions.

Conclusion
The data provided in this epidemiological surveillance of HIV in Anguilla shows a gradual decline in the incidence of HIV infection in

Acknowledgement
We hereby wish to acknowledge the following people that contributed to the success of this project: