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Overview of the epidemic in the Caribbean

July 17, 2007 - Outside of Africa, the Caribbean has the highest rates of HIV infection in the world. Indeed, many of the same factors contributing to the quick spread of HIV through sub-Saharan Africa—extreme poverty, malnutrition, poor health care, and high rates of migration—also afflict the Caribbean and Latin America. Haiti, the poorest country in the region, has the highest prevalence rate; in 2005, 3.8 percent of the adult population was living with HIV/AIDS. In the Bahamas, the rate of HIV infection is 3.3 percent, and in the Dominican Republic, 1.1 percent of the adult population is HIV-positive. The Joint United Nations Programme on HIV/AIDS (UNAIDS) estimates that there are 330,000 adults and children living with HIV/AIDS in the Caribbean.



High rates of HIV infection occur among men who have sex with men (MSM) and injection drug users (IDUs) on some islands, but HIV is spreading mainly through heterosexual transmission. The early start of sexual activity, frequent partner exchange, and age mixing—younger women having sexual relationships with older men—are facilitating the rapid spread of HIV. On some islands, the HIV rate among girls aged 15-16 is up to five times that of boys in the same age group. It is believed that more than half of all new infections in the region are among young people.


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“The islands with the tourism are the ones that don’t want to talk about it very much.” —Peggy McEvoy, former Team Leader, UNAIDS Caribbean
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Several factors are fueling the epidemic in this region. Poverty and economic disparity are forcing men and women into commercial sex work, often with tourists. And migration between rural and urban areas is further facilitating the spread of HIV. Moreover, HIV/AIDS is still highly stigmatized in the region and there is a lack of adequate education and information on HIV/AIDS prevention. With their economies highly dependent on the tourism industry, many Caribbean countries have been reluctant to implement HIV/AIDS public information campaigns for fear of driving away tourists. Sexuality and AIDS are not openly discussed and the stigma and misunderstanding surrounding AIDS prevent people from disclosing their HIV status.

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“I don't know where the next generation will come from. There are only 60,000 of us now, and a lot of people have got the disease.”—Resident of Tobago
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National responses to HIV/AIDS are varied. Cuba has the lowest prevalence rate in the Caribbean, largely due to the highly controversial AIDS program it implemented in the early stages of the epidemic, which required all HIV-positive individuals to live in government-run sanitariums. But in many other countries in the Caribbean, AIDS is devastating the education, health, agriculture, and business sectors. And unless significant preventive measures are taken, many public health experts fear that the Caribbean will follow in the path of Sub-Saharan Africa, where infection rates are close to 40 percent in some countries. Caribbean governments have been late in responding to AIDS and critics claim that it was not until it was clear that AIDS was primarily affecting heterosexuals that political leaders made concerted efforts to curb the spread of HIV.


However, recent initiatives suggest Caribbean governments are committed to controlling the epidemic. In September 2000, a conference was held in Barbados to galvanize a multinational and multi-sectoral response to the epidemic in the Caribbean, and in February 2001, the Pan-Caribbean Partnership against HIV/AIDS was launched. Through this partnership, Caribbean countries are jointly negotiating with suppliers and other governments for more affordable prices for antiretroviral drugs and coordinating other efforts to improve treatment and care of people living with HIV/AIDS.

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10 basic facts on HIV and AIDS

It is your right to know...

  • AIDS is caused by HIV.
    AIDS is caused by HIV, the human immunodeficiency virus, which damages the body's defense system. People who have AIDS become weaker because their bodies lose the ability to fight all illnesses. They eventually die. There is no cure for HIV.
  • The onset of AIDS can take up to ten years.
    The onset of AIDS can take up to ten years from the time of infection with the HIV virus. Therefore a person infected with HIV may look and feel healthy for many years, but he or she can still transmit the virus to someone else. New medicines can help a person stay healthier for longer periods of time, but the person will still have HIV and be able to transmit HIV.
  • HIV is transmitted through HIV-infected bodily fluids.
    HIV is transmitted through the exchange of any HIV-infected bodily fluids. Transfer may occur during all stages of the infection/disease. The HIV virus is found in the following fluids: blood, semen (and pre-ejaculated fluid), vaginal secretions, breast milk.
  • HIV is most frequently transmitted sexually.
    HIV is most frequently transmitted sexually. That is because fluids mix and the virus can be exchanged, especially where there are tears in vaginal or anal tissue, wounds or other sexually-transmitted infections (STIs). Girls are especially vulnerable to HIV infection because their vaginal membranes are thinner and more susceptible to infection than those of mature women.
  • People who have Sexually Transmitted Infections (STIs) are at greater risk of being infected with HIV.
    People who have STIs are at greater risk of being infected with HIV and of transmitting their infection to others. People with STIs should seek prompt treatment and avoid sexual intercourse or practice safer sex (non-penetrative sex or sex using a condom), and inform their partners.
  • The risk of sexual transmission of HIV can be reduced.
    The risk of sexual transmission of HIV can be reduced if people do not have sex, if uninfected partners have sex only with each other or if people have safer sex -- sex without penetration or using a condom. The only way to be completely sure to prevent the sexual transmission of HIV is by abstaining from all sexual contact.
  • People who inject themselves with drugs are at high risk of becoming infected with HIV.
    HIV can also be transmitted when the skin is cut or pierced using an unsterilized needle, syringe, razorblade, knife or any other tool. People who inject themselves with drugs or have sex with drug users are at high risk of becoming infected with HIV. Moreover, drug use alters people's judgment and can lead to risky sexual behaviour, such as not using condoms.
  • Contact a health worker or an HIV/AIDS centre to receive counselling and testing.
    Anyone who suspects that he or she might have been infected with HIV should contact a health worker or an HIV/AIDS centre in order to receive confidential counselling and testing. It is your right. (Article 24 of the Convention on the rights of the child).
  • HIV is not transmitted by everyday contact.
    HIV is not transmitted by: hugging, shaking hands; casual, everyday contact; using swimming pools, toilet seats; sharing bed linens, eating utensils, food; mosquito and other insect bites; coughing, sneezing.
  • Everyone deserves compassion and support.
    Discriminating against people who are infected with HIV or anyone thought to be at risk of infection violates individual human rights and endangers public health. Everyone infected with and affected by HIV and AIDS deserves compassion and support. (Article 2 of the Convention on the rights of the child).
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