The HIV programmes in the Dominican Republic are currently facing several challenges and disruptions, primarily due to shifts in US funding and political dynamics. Here are the key points:

PEPFAR-Funded Programmes:

PEPFAR-funded HIV programmes, which were stopped, are now being resumed. For instance, while services for people living with HIV have already been opened, including services offered by civil society, community support, and support for human resources at the government level among others, the opening process has been slow. And while PEPFAR-funded HIV care programmes are resuming, other activities such as PrEP for key populations and Community-Led Monitoring remain on hold.

Furthermore, the new Global Fund grant started in January 2025 has not yet been implemented at the site level.

Service Disruptions:

The PEPFAR program in the country is mainly focusing on the Haitian migrant population and therefore, the suspension of funding has raised concerns regarding Haitian migrants not having access to their treatment programmes.

The absence of USAID-funded staff and the suspension of transportation services that helped patients reach healthcare centers may impact service accessibility.

There have been debates in the media about the need to maintain internationally funded HIV programs, particularly those targeting Haitian immigrants.

Ingrid Bretón learned that she was living with HIV when she was 19 years old. It was 1994 and HIV treatment was not yet available in the Dominican Republic.

“I lasted almost five years alive, but dead inside,” she remembers. “I went through every denial process that a newly diagnosed person goes through. Health centres did not want to assist me. I lived every kind of stigma and discrimination.”

In her town, La Romana, she was known as “the AIDS girl”.  It was impossible to find work.  

HIV treatment helped changed the trajectory of her life. With the guidance of her doctor, José Román, she became the first woman living with HIV in La Romana known to have given birth to an HIV-free baby. As she continued treatment it occurred to her that she was perfectly healthy and could live a more meaningful life.

“I thought to myself, “I am not getting sick, my hair is not falling off, I do not have sores, I do not have AIDS. I want to do things,”” Ms Bretón remembers.

In 2002 she formed the Paloma Group Foundation (La Fundación Grupo Paloma), which provides psychosocial support, legal assistance and job opportunities for people living with and affected by HIV in the eastern region of the country. The organization also plays a key advocacy role, bringing visibility to issues such as treatment adherence, prevention and stigma and discrimination.

One of the foundation’s innovations is an agriculture project that employs people living with HIV.

“It’s a beautiful process,” Ms Bretón says while walking through the sunny, red earth fields, past tomatoes, papayas and bananas. “The idea is that people living with HIV are able to move forward, working and providing for their families.”

The families with whom the Paloma Group Foundation works have been directly affected by the COVID-19 pandemic. The work of the foundation has been critical during this time. Its volunteers do home deliveries of food, medicine and clothing. The foundation is a source of connection and emotional support at a time when communities living with HIV are more isolated than ever due to social distancing measures.

The first Rapid Survey on the Needs of People Living with HIV in the Dominican Republic in the context of COVID-19 found that while 92% of respondents received their antiretroviral therapy, roughly one in six had less than one month’s supply left. Thanks to the advocacy of the UNAIDS Country Office for the Dominican Republic, protocols have now been amended so that people living with HIV and accessing treatment through the public health system can receive a three- to six-month supply of their medicine at one time.

The country office has urged the government to strengthen comprehensive care programmes, including through alliances with civil society. For example, the Paloma Group Foundation provided assistance to people living with HIV at the Francisco Gonzalvo Provincial Hospital during a five-month period in 2020 when medical personnel were not available at the La Romana facility.

The UNAIDS Country Office for the Dominican Republic has also called for particular attention to be given to the social protection and food security needs of people living with HIV who are in economically fragile situations. The office responded quickly to the fallout of COVID-19, offering support to the Paloma Group Foundation and other community organizations contributing to the national HIV response. UNAIDS’ comprehensive response included the provision of personal protective equipment and information specifically for the community of people living with HIV. The second stage of their response included mobilization of nutrition support.

“This was of great value to families given the economic crisis caused by COVID-19,” Ms Bretón says.

“Civil society plays the leading role of bringing awareness to communities and advocating on their behalf,” says the UNAIDS Country Director for the Dominican Republic, Bethania Betances. “As we respond to two pandemics—HIV and COVID-19—is it vital that they are at the decision-making table to help shape an effective, humane response.”

Watch: The extraordinary story of a woman living with HIV in the Dominican Republic

Image from an initiative by people living with HIV in the Dominican Republic launched to draw attention to the fact that the availability of generic drugs has significantly reduced treatment prices in the global market.

The Dominican Republic is one step closer to ensuring that all people living with HIV access treatment. The country’s National Social Security Council has established a commission to look into the technical, financial and operational implications of including antiretroviral therapy (ART) in the Basic Health Plan.

The establishment of the commission comes after a financial feasibility study about covering people living with HIV under the country’s family health insurance. The study was done in 2011 by the United Nations Development Programme (UNDP), United Nations Children’s Fund (UNICEF), Pan American Health Organisation (PAHO) and the Joint United Nations Programme on HIV/AIDS (UNAIDS).

The newly-established commission—whose membership includes several national health system offices in addition to regional and global partners such as PAHO and UNAIDS—is set to complete its work during the last quarter of 2012.

According to UNAIDS Country Coordinator, Ana Maria Navarro, the development comes at a critical time and is a direct consequence of a feasibility study elaborated by United Nations agencies in the Dominican Republic. “This resolution brings us nearer to securing the sustainability of the AIDS response,” said Dr Navarro.

The Dominican Republic is classified as a middle-income country even though there are marked inequalities in income distribution. At present access to HIV treatment is completely financed by international donor agencies. While more than 20 000 people are currently receiving HIV treatment, more than 2 500 individuals known to be living with AIDS do not have access to life-saving drugs.

This is despite a guarantee of universal access to treatment for people living with HIV made in the country’s 2007 – 2015 National Strategic Plan on HIV and AIDS. The treatment gap also contradicts the principles of universality and equity that informed the 2001 reform of the Social Security System. Moreover, a new HIV law introduced last year provides for the comprehensive healthcare of people living with HIV.

But a 2002 regulation for the operationalization of the Basic Health Plan excludes coverage of antiretroviral drugs on the basis of their high cost. A primary objective of the feasibility study was to provide evidence that HIV treatment is not as expensive as local authorities believed.

“This is one giant step for the Dominican Republic,” said UNAIDS Caribbean Director, Ernest Massiah. “It is a step towards ensuring that treatment is maintained, and lives of Dominicans living with HIV are saved. People living with HIV can continue to work, support their families and participate in the simple joys of life to which we are all entitled. This is about respect, dignity and life.”

In April 2012, people living with HIV in the Dominican Republic launched an initiative to draw attention to the fact that the availability of generic drugs has significantly reduced treatment prices in the global market. The Dominican Network of People Living with HIV (REDOVIH+), Alianza Solidaria de Lucha contra el SIDA (ASOLSIDA), Fundación Grupo Paloma and Grupo Clara jointly launched a petition which called for the 2012 presidential candidates to address the financial sustainability issues related to their treatment ahead of elections at the end of May.

The Miller School of Medicine of the University of Miami and the Fogarty International Training Programme on AIDS and TB organized in collaboration with UNAIDS the ‘Health Research in the Americas V’ Conference on 7 and 8 May 2009, in Miami, Florida.

The aim of the conference was to highlight current evidence on HIV prevention, discuss the sustainability of comprehensive HIV prevention efforts as well as to debate how HIV prevention is situated within the broader discussion of ‘health in the Americas’ and other international development strategies.

Sir George Alleyne, Special Envoy of the United Nations Secretary General for HIV/AIDS in the Caribbean, was invited as a keynote speaker on the second day of the conference.

Numerous local and national achievements in curbing the epidemic have created a body of evidence about what works, but these successful approaches have not yet been fully applied.

At the conference, scientists, HIV prevention practitioners and policy makers explored scientific and programme experiences for prioritizing comprehensive, evidence-informed HIV prevention approaches and discussed effective solutions that could bridge the interface between HIV and other health and development issues.

The conference was open to behavioral scientists and researchers who work in the area of HIV prevention in the Americas, with a special focus on Guyana, the Dominican Republic, Jamaica, Brazil, Colombia and Peru.

The meeting, supported by UNAIDS and
UNFPA, brought First Ladies and women
leaders from around the region together to
discuss ways of moving the AIDS response
forward.

The Coalition of First Ladies and Women Leaders of Latin America on Women and AIDS held its IV meeting in the Dominican Republic on 27 and 28 March 2008. The meeting, supported by UNAIDS and UNFPA, brought First Ladies and women leaders from around the region together to discuss ways of moving the AIDS response forward. The newly created Caribbean Coalition on Women, Girls and AIDS also participated in the event bringing vital impetus in addressing the challenges faced by women and girls in the Caribbean.

UNAIDS Deputy Executive
Director Deborah Landey
stressed the importance of
speaking on women and
AIDS.

UNAIDS Deputy Executive Director Deborah Landey stressed the importance of speaking on women and AIDS. She said, “You are here because you are ready to speak out and act on issues facing women. This takes courage. It is not always easy to talk about AIDS because it involves talking about issues many people prefer not to mention. So I congratulate you for being prepared to stand up and speak out.”

The Coalition was set up in 2006 under the leadership of the First Lady of Honduras, Mrs. Xiomara Castro de Zelaya, to promote political commitment and mobilization of regional and national resources to strengthen and enhance HIV prevention, treatment and care services and reduce the impact of the epidemic on women and girls.

The meeting in the Dominican Republic was hosted by the country’s First Lady Dr Margarita Cedeño de Fernández. The President of the Coalition and First Lady of Honduras Mrs Xiomara Castro de Zelaya also attended the meeting along with the First Ladies of Guatemala, Sandra Torres de Colom; Surinam, Liesbeth Anita María Venetiaan-Vanenburg and Panamá, Vivian Fernández de Torrijos; as well as representatives of MÉxico, Ecuador, Haití, El Salvador, Costa Rica and Chile.

The meeting in the Dominican Republic
was hosted by the country’s First Lady Dr
Margarita Cedeño de Fernández.

The meeting took place under the theme "Stopping the feminization of the epidemic: Prevention and Care within Family and Community Context ". Sessions included; Women and HIV in the Dominican Republic; Living with HIV within the family and community context; and Cooperation for Development: Generating alliance for stopping the feminization of the epidemic and to obtaining universal access to HIV prevention, treatment, care and support.

A session was also dedicated to discussing the next steps for implementing the Action Platform in the run up to the International AIDS Conference, being held in Mexico in August 2008. The Action Platform is a strategy which was approved at the second meeting of the Coalition held in Buenos Aires in April 2007 which was designed to mitigate the impact of AIDS in the region, particularly focusing on actions to achieve universal access to HIV prevention, treatment, care and support. The platform also aims to promote women rights in a supportive environment, free of stigma and discrimination. The session included an analysis of the Action Platform to assess progress and to identify weaknesses and opportunities for further action.

The Coalition was set up in
2006 under the leadership of
the First Lady of Honduras,
Mrs. Xiomara Castro de Zelaya

A project to implement a system of micro-credits for women living with HIV in the region was presented during the meeting which was an initiative, supported by the Nobel peace prize and UNAIDS Special Representative Mr. Mohamed Yunus. The project focuses on ways of empowering women to stand up to violence, protect themselves against HIV and achieve greater respect among their families and communities.

A study on gender violence and HIV in several countries in the region produced by UNFPA was also presented at the meeting.

Photo credit: UNAIDS