A nurse checks on a patient in a Port-au-Prince health center. © A.Waak/Pan American Health Organization.

HIV/AIDS clouds the Caribbean

A new joint effort by the nations of the Caribbean Community could help to contain the most serious AIDS crisis outside of Africa

By Joanne Nanton

The beautiful beaches, sunny climate and cultural diversity of the Caribbean islands can make it easy to overlook a troubling fact: according to the latest figures, this region has the world’s second highest rate of HIV infection after Sub-Saharan Africa.

A recent report by the Joint United Nations Program on HIV/AIDS (UNAIDS) and the World Health Organization estimates that approximately 360,000 people carry HIV in the wider Caribbean–an alarming figure for an area with a total population of around 32 million. HIV/AIDS is one of the leading causes of death in this relatively small region, where the virus is spreading mainly through heterosexual relations between people in the 15–44 age group. Until quite recently, however, a variety of social pressures undermined efforts to openly talk about AIDS as a public health problem or development issue.

Now, Caribbean heads of state are committing their governments to a more aggressive response to the spread of AIDS. In February of this year, leaders of the Caribbean Community countries, in an unprecedented move, formed a new Pan-Caribbean Partnership against HIV/AIDS. In an interview with IDBAmérica this June, Dr. Peter Piot, Executive Director of UNAIDS, said the partnership indicated "a major increase in awareness" of the importance of the issues, but he was quick to add that this step was only "the beginning of a vigorous response."

Although the overall figures are astounding, the rate of infection varies considerably among Caribbean countries. Haiti is the hardest hit. Estimates indicate that around 4 percent of all adults aged 15–49 in rural areas, and approximately 8 percent of those in urban areas have HIV/AIDS. The epidemic is also a serious concern in the Dominican Republic. In the smaller territories in the Eastern Caribbean, studies show that fewer than one pregnant woman in 500 has HIV/AIDS.

According to the UNAIDS report, heterosexual transmission of HIV in the Caribbean is a result of early sexual activity and multiple partner relationships. Survey data has shown that in some countries, approximately 25 percent of the adults reported being sexually active before the age of 14. Fifty percent had started having sex before the age of 16. The prevalence of sexual activity between young women and older men also propels the epidemic in the Caribbean. In Trinidad and Tobago, HIV rates are five times higher in girls in the 15–19 age group than in boys of the same age.

The epidemic is now being addressed at the highest political levels. A strategic plan to reduce the number of new infections, provide better public health tools, and adopt a more integrated approach to treating those with HIV/AIDS is being put in place by the new partnership. But underlying these good intentions is the sobering reality that the region lacks the resources to intensify its response to the spread of AIDS. A study conducted by the University of the West Indies estimates the cost of an effective response at $260 million per year, 10 times more than current funding.

Yet there is still reason for some optimism. The successful approaches in prevention employed in Uganda prove that countries with limited resources can successfully control the epidemic. In Uganda, where the rate of new infections has been significantly decreased, strong community partnerships and political commitment drove the struggle against HIV.

If the goals of the new coalition are attained, by 2005, 90 percent of young people aged 15–24 would have access to services to help reduce their vulnerability to AIDS, and HIV prevalence among people aged 15–24 years would be reduced by 25 percent. Mother-to-child transmission should also be reduced by 50 percent by 2003.

This would offer hope for a significantly enhanced quality of life in the region and make it possible to begin rebuilding communities heavily affected by an epidemic that could erode development gains for decades to come.