Bringing HIV Care to the Caribbean

During this year’s National Caribbean American HIV/AIDS Awareness Day, we spoke with two HIV healthcare providers in the Caribbean that have worked with the Northeast/Caribbean AIDS Education & Training Center (NECA AETC) to learn about the state of HIV care and access in the Caribbean.  

In September of 2017, Hurricane Maria and Irma, both category 5 hurricanes, made landfall in the Caribbean. In its aftermath, the small group of HIV care providers in the Caribbean were left scrambling to provide what little care they could while balancing their own mental health.  

Debbie Cestaro-Seifer, a nurse by training and consultant with the NECA AETC who has lived and worked in the U.S. Virgin Islands since 2004, but at the time of the hurricane had relocated to Florida vividly remembers the impact the hurricanes had on her community. “It was a historical trauma,” she shared, “There is no other way to describe it.” 

Patients struggled to get access to regular care in the immediate aftermath of the hurricane. Many were sent to the States to obtain needed treatment, where Cestaro-Seifer was located at the time. Staff working at federally qualified health centers and the U.S. Virgin Islands Department o Health reached out to her for assistance in helping their patients access the critical care they needed. 

“I received calls from healthcare staff in the territory. People would say ‘Debbie we have clients traveling to South Florida by ship or by plane, can you help connect them to HIV care?’”  

Utilizing years of experience and connections, Cestaro-Seifer connected patients with other medical establishments and programs in Florida to help navigate their HIV treatment and care.  

“Some of those people are still in touch with me and quite a few returned home to the U.S. Virgin Islands, and they let me know, ‘I’m back in the territory!’”  

The NECA AETC recognized that providers in the Caribbean were also struggling with the mental turmoil following the hurricanes. The Center was eager to provide support and stability to providers and in turn to help those living with HIV in the Caribbean. Through these trainings, healthcare professionals were empowered to improve their own mental health and combat burn-out in ways that allowed them to be able to continue providing quality care to people living with HIV in the region. 

Training healthcare professionals to cope and deal with the fallout of Hurricane Maria and Irma was just one of the many trainings the Center leads.   

In the U.S. Virgin Islands, prior to the 2017 hurricanes, the NECA AETC learned that the one clinician who served 70 patients living with HIV was set leave their position, leaving no other clinicians in the island chain to support these patients with the level of experience they had. In response, the NECA AETC set into motion the AETC Community/Clinical Exchange and Sustained Support (ACCESS) Training, to train two clinicians to provide HIV care.  

Speaking on the ACCESS Training, Cestaro-Seifer said, “The ACCESS program is phenomenal, it allows participants to become a trainer of trainers. If they learn something, then they can teach that to the team they work with, or maybe some of their colleagues who now see them as more experienced in the prevention and treatment of HIV.” 

Outside the ACCESS program, the NECA AETC offers regular trainings to healthcare providers. Dr. Selena M. Rodriguez Rivera is one such healthcare provider that has participated in these training courses in Puerto Rico.  

At the trainings, she noted how varied the composition of those attending the training from the Caribbean was. Social workers, case managers, dentists and more were in attendance helping to support their community and build on outreach to those living with HIV on the island. With the lack of infectious disease specialists to treat HIV, other providers have been stepping up to the plate.  

“I think a lot of what AETC has done over the past year I’ve been involved with them has been to bridge those gaps and provide tools so that providers can start the basics of care, and then know and network with those giving specialized care, so that we can refer appropriately,” Dr. Rodriguez Rivera shares. 

In her many years with the AETC, Cestaro-Seifer worked to build capacity and grow the network of HIV care providers in the region. This growing network of providers, each specialized in different areas, has created more resources for people in need to reach out to notes Dr. Rodriguez Rivera. 

Ultimately, what both had to say came down to this: Training and educating all providers, be it physicians, nurses, dentists, social workers or case managers, about all aspects of HIV care plays a role in improving the health and wellbeing of all peoples in the Caribbean.  

For Dr. Rodriguez Rivera, the NECA AETC providing this training has led to an improvement in the quality of care for patients. 

However, only training providers isn’t all that must be done. Stigma remains a barrier. Building trust and ensuring that the community leads the process of unmasking stigma guarantees people can access care and that the community can continue leading prevention efforts to end the HIV epidemic.  

“There are many cultures that have experienced a lack of trust and with good reason,” Cestaro-Seifer says, “What we want to do is say, ‘Hey, we are concerned about everyone’s health. I may know a lot about HIV and STIs, but it is the people living in the Caribbean who know how best to translate that information into person-centered treatment and care to ultimately improve health outcomes for everyone.’” 

“The main thing I would love people in the Caribbean to know is that we exist,” shares Dr. Rodriguez Rivera. “There are judgement free zones and there is a whole community of people who are working towards the goal of ending the HIV epidemic.” 

Work to end the HIV epidemic in the Caribbean is ongoing and great progress is being made toward this goal, where a 2023 report  found that this region had a 15% decrease in new HIV infections and had a 53% decrease in AIDS-related deaths between 2010 and 2022.  

“People here are doing amazing things,” says Cestaro-Seifer, “And I just sit back and think wow! 10 to 15 years ago we weren’t where we are now, the improvements are here. It’s just a matter of how we keep perfecting the art of providing HIV care that’s inclusive, accessible and culturally relevant to everyone.”