The Tribune

By Jeffarah Gibson

Tribune Features Writer

jgibson@tribunemedia.net

WHEN pharmacist Stephen Kemp talks about HIV work, there is no hesitation in his voice. He remembers the moment he walked into the HIV Treatment Centre more than a decade ago and felt something shift.

“I got bitten by the bug,” he told Tribune Health. It became my passion, and I have been here trying to make a change as best as I can.”

That passion sits at the heart of The Bahamas’ 40-year fight against HIV and AIDS. It is a fight built not only on science or medication breakthroughs, but on the people who quietly hold the line every day. Stephen is one of them. He calls this work “the hill I would die on,” and listening to him talk about his journey, it becomes clear why. He has seen the treatment landscape shift from toxic, high-pill regimens to safe, single-tablet therapy, and he has watched people move from “near death” to full health because of these advancements.

Stephen always knew he wanted to be a pharmacist. “From I was in high school, primary school, beginning out of high school, I always knew I wanted to be a pharmacist. I know that this was my calling.”

When the government launched a partnership programme with the University of Technology in Jamaica, he jumped at the opportunity. He completed two years at home, then finished his bachelor’s degree in Jamaica. Returning to Nassau, he was posted in the Department of Public Health.

“Within the first few months or so, there was an opening here at the HIV center. They assigned me to this unit and I got bitten by the bug.”

Even after working at Doctors Hospital and private pharmacies, HIV care felt different. “There is nothing like here for me,” he said. “I really get to engage with the physicians a lot closely, and that clinical partnership is what I envisioned for myself in pharmacy school.”

HIV care, he explained, requires a deeper level of connection.

“HIV is a little different from the other chronic diseases. It is no longer a death sentence. It is very manageable.”

What keeps him grounded in this particular sphere and is witness clients who adhere to their regimen have full recovery. “You could see people make a complete transformation from near death when they are listed with AIDS, and then with giving them the medication and counseling, you take them on that journey until they are just healthy and back to normal. That is a very rewarding process.”

As The Bahamas marks 40 years of responding to HIV and AIDS, Stephen offers a clear, firsthand picture of how treatment has evolved. His explanation begins long before his own career. “Back in the mid 80s when HIV just came around, scientists and pharmaceutical companies were desperately looking for a drug… because back then it was considered a death sentence.

The first medication, AZT, seemed promising he said. Then later it was the medication was not working as well anymore. Dual therapy came later, but the real shift happened in 1996 he said.

“It was not until 1996 when the groundbreaking triple therapy came about,” he said. “Highly active antiretroviral therapy was when they found that patients received triple therapy and it was maintaining patients for a longer period of time, even decades.”

Those early treatments he saved many  lives but came with tremendous strain.

“The medication was very toxic. Patients were taking somewhere between five to ten tablets a day, sometimes even more.” He described organ impact, saying, “These drugs were causing a lot of hepatotoxicity. The pancreas was being affected. It was helping people, yes, but at the same time it was also hurting people.”

Today the shift is remarkable. “We went from ten tablets a day to current day one tablet a day,” he said. “Way less toxic, way more efficient, way more effective at preventing the replication of HIV.”

Affordability transformed as well, and Stephen gives credit where it is due. He explained that through international partnerships and local leadership, significant price cuts were achieved. “Through the negotiations of the Clinton Foundation back in the day and through the diligence of the Centre now… Dr Nikkiah Forbes played a vital role in getting one of the drugs. She was working with Gilead and was able to negotiate a good price on it.”

He noted the stark difference. “In the States a patient would pay somewhere between seven to eight hundred dollars and we were able to get it for about one hundred a bottle.”

“Even moving forward, we were able to get the generic formulation at a significantly cheaper price of like thirty or thirty five dollars, and that was very recent.

Lower prices he said opened the door for wider access. “If it is too much, it is not practical. Now people can access it.”

“Every year we have been getting more and more patients on it. He believes stigma continues to fall because of education. With education, you could get rid of the stigma. I am a firm believer of that.”

Stephen also described PrEP  (pre-exposure prophylaxis), one of the tools helping prevent new cases. “If they adhere to PrEP properly, meaning take it every single day and come in every three months, there is a very high chance they will not contract the virus.”

He added that PrEP is extremely safe and well tolerated.

In 2024, 100 people accessed the HIV prevention pill through the National AIDS Programme.

“The great majority of people do not experience the rare side effects.”

Medication is only one part of the story. Stephen believes pharmacists are often the missing piece in patient care.

“Traditionally people just look at pharmacists as pill pushers, but we are the connecting dots. We are gatekeepers and we are the drug experts.”

Patients often see multiple specialists, but usually one pharmacist. That puts Stephen in the unique position of seeing the full picture. Sometimes that means catching dangerous problems before they escalate. He shared a recent example involving a patient on seizure medication.

“I found that the seizure medication was increasing the metabolism of the HIV medication and pushing it out of the body.” The patient’s HIV he said seemed to be worsening even though he was taking his pills.

“A lot of times the missing link is the pharmacist.”

Stephen reviewed clinical guidelines, collaborated with the physician and recommended alternatives the patient could afford.

Stories like this explain why Stephen stayed. They explain why HIV work continues to be the place where his passion, training and purpose meet.

Stephen’s story is one person’s experience inside a much larger national effort. Back in July Dr Nikkiah Forbes director of the National HIV/AIDS and Infectious Disease Programme at the Ministry of Health estimated that at the end if 2024 3988 people are living with HIV in The Bahamas, and new infections declined by 47 percent more than 60 percent in the last decade. Among women who receive antiretroviral treatment, mother-to-child transmission has dropped to zero.

New Providence accounted for the majority of new HIV cases at 82 percent, followed by Grand Bahama with ten percent and the Family Islands with eight percent. Men made up 63 percent of new diagnoses, with a median age of 37. The 30-39 age group accounted for 36 percent of new infections, followed by 40-49 at 19 percent, and those aged 50 and older at 17 percent.

Twenty people aged 15-24 were diagnosed in 2024, representing 14 percent of new cases, a 50 percent drop in that age group since 2010.

AIDS-related deaths decreased by 57 percent over the same period.

Currently, about 95 percent of people living with HIV know their status. Among them, 78 percent are receiving antiretroviral therapy (ART), and 91 percent of those on ART have achieved viral suppression. However, five percent remain unaware of their status, and over 20 percent are not accessing the free HIV medications available.

The numbers tell their own story of progress, but Stephen knows the work behind them. Forty years after the first HIV cases appeared in The Bahamas, he continues to stand on the frontline, one  patient, one conversation, and one medication check at a time.