VZCZCXRO9184
RR RUEHGR
DE RUEHBE #0225/01 0881602
ZNR UUUUU ZZH
R 291602Z MAR 07
FM AMEMBASSY BELMOPAN
TO RUEHC/SECSTATE WASHDC 0397
RUEHGT/AMEMBASSY GUATEMALA 0031
RUEHZA/WHA CENTRAL AMERICA COLLECTIVE
RUCNCOM/EC CARICOM COLLECTIVE

UNCLAS SECTION 01 OF 02 BELMOPAN 000225 
 
SIPDIS 
 
SIPDIS 
 
STATE FOR S/GAC, WHA/CEN JASON MACK 
 
GUATEMALA FOR USAID 
 
E.O. 12958: N/A 
TAGS: SOCI EAID PGOV PREL BH
SUBJECT: HIV/AIDS IN BELIZE 
 
 
¶1.  Summary:  A forum on HIV/AIDS funding addressed an overview of 
the epidemic in Belize, a critique of the government's response, and 
an assessment of current challenges.  Donor groups agreed to work 
together to prod the government towards a more effective delivery of 
HIV/AIDS services.  End Summary. 
 
¶2.  On March 27 the Inter-American Development Bank (IDB) hosted at 
Embassy's request a forum on donor coordination for HIV/AIDS funding 
in Belize.  The donors agreed to establish a group to coordinate 
funding and to address the government directly in order to provide a 
more effective delivery of HIV/AIDS services.  The IDB has funded a 
project for consultants to analyze Belize's national response to 
HIV/AIDS and the donors agreed to work together on the report's 
recommendations to strengthen the national response to HIV/AIDS in 
Belize. 
 
------------------------- 
Overview of the epidemic 
------------------------- 
 
¶3.  According to the Ministry of Health, between 1986 and 2006, 
there were 3,865 new cases of HIV infection in Belize out of a 
population of approximately 270,000.  There were steep percentage 
increases reported from 1986 until 2002.  Over the past four years 
the numbers leveled off and Belize has averaged 400-450 new cases 
per year.  Increased reporting capacity and the advent of free 
testing are believe to have impacted the rapid increase and 
subsequent plateau in the real numbers of individuals being infected 
with HIV. 
 
¶4.  Recent prevalence rate estimates were complied by the World 
Health Organization based on data collected in 2003.  According to 
the report, the estimates were based on "very limited" information 
that demonstrated a prevalence rate of 2.4 percent - the highest in 
Central America.  Eighty percent of all cases were reported in the 
Belize district (which includes Belize City, the country's 
commercial capital) where just under half of Belize's population 
resided. 
 
¶5.  The epidemic was generalized and women were currently infected 
on a rate par with men.  This was a drastic change.  Earlier studies 
showed that men were five times more likely to be infected.  Within 
gender, older men (ages 35 and older) and younger women (ages 15-29) 
suffered the highest rates of infection.  While there was little 
information on population groups, it appears that the Garifuna 
ethnic group was hardest hit by the epidemic with prevalence rates 
estimated as high as 8 percent. 
 
------------------------------- 
Government of Belize's response 
------------------------------- 
 
¶6.  The Government of Belize was at the forefront of nations in its 
willingness to address the problem early in an open and 
straightforward manner. The Ministry of Health responded quickly by 
forming a national AIDS program in 1987 and in 2000 the government 
appointed the National AIDS Commission to coordinate and monitor the 
prevention and control of the disease. 
 
¶7.  The Ministry of Health has established twelve voluntary 
counseling and testing centers across the country.  Each center 
employs one nurse and one counselor who provide free testing and 
counseling services.  Additionally, there are numerous private 
hospitals and clinics that also provided testing and counseling. 
The Ministry also provides free access to anti-retroviral therapy 
for those who qualify and currently more than 400 people are 
receiving anti-retroviral treatment. 
 
¶8.  Belize's single largest donor program is the Global Fund which 
has approved $2.4 million of funding.  The USG, through multiple 
sources, is the largest overall donor to Belize. 
 
------------------ 
Current Challenges 
------------------ 
 
¶9.  The information collection system including testing statistics, 
infection rate compilation, and coordination of work being done in 
Belize is incomplete and inconsistent.  Most groups working in this 
area - including government agencies - realize that this has been a 
major challenge. 
 
¶10.  More than half of all funds received by the Ministry of Health 
were spent on "first line" anti-retroviral medications. However, 
Belize currently has no way of monitoring or testing patients 
receiving treatment.  The non-adherence rate is very high and the 
medications have had a low rate of effectiveness.  When the 
 
BELMOPAN 00000225  002 OF 002 
 
 
medication was not taken properly patients developed resistance and 
then needed to move on to "second line" medications, which can be 10 
to 20 times more expensive than the "first line" medications. 
Because the monitoring of the initial treatment was ineffective, 
there has been a scramble for expensive second line medication 
funding that would not have been necessary if effective monitoring 
had been established at the outset. 
 
¶11.  Research has indicated that people are not being tested or are 
not effectively taking treatment due to the stigma associated with 
the disease.  This affects data collection.  In an effort to address 
confidentiality concerns, there are clinics that will conduct 
 
SIPDIS 
testing "off the books" and exclude these tests from their reports. 
The Ministry of Health estimates that, due to stigma concerns, 
approximately two-thirds of all eligible patients have not chosen to 
receive free treatment. 
 
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Comment 
------- 
 
¶12.  Belize tends to emphasize overarching themes, generalized 
solutions, and a "big picture" approach to combating HIV/AIDS. 
While this has resulted in strategic plans and comprehensive 
legislation, it appears to be at the neglect of pragmatic, 
results-oriented service delivery.  There is good work being done 
but the numerical size and scope of the problem should allow for a 
more effective management and coordination of service delivery.  We 
will continue to work with the GOB and other donors to find the most 
effective way to focus U.S. spending where it will do the most 
good. 
 
 
DIETER