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(Editor’s note: This is the first in an occasional series about the AIDS epidemic in the Caribbean, which is fueled in part through tourism by travelers from the United States and other industrialized nations. Future AIDS Alert International sections will feature more about the Pan-Caribbean partnership and various HIV prevention efforts, as well as profiles of the epidemic in various Caribbean nations and how their governments and private organizations are coping with the challenge.)
While the consciences of industrialized nations are awakening to the AIDS pandemic in sub-Saharan Africa, most people, even in the United States, are unaware that the Caribbean has the world’s second-highest prevalence of HIV infection. A new Pan-Caribbean Partnership, formed earlier this year, is designed to bring attention to the Caribbean’s HIV epidemic, and it will help Caribbean governments and organizations meet the challenges of treating HIV-infected people and preventing HIV infection.
About 2% of the Caribbean population is infected with HIV, and nine of the 12 countries with the highest HIV prevalence in the Americas are in the Caribbean.1 In Haiti, the epidemic reaches sub-Saharan Africa proportions, as an estimated 12% of the urban population and 5% of the rural population are living with HIV/AIDS.1 It’s estimated that 100 people in Haiti die of AIDS each day.1 The Dominican Republic’s prevalence rate is estimated to be just under 2%, although some surveys have shown that the prevalence rate among pregnant women in one town is 8%.1
The partnership was formed out of the Regional Caribbean Task Force on HIV/AIDS, and it will be coordinated by the Caribbean Community (CARICOM), which comprises all of the independent states and dependencies of the Caribbean, with the exception of Cuba.
"A decision was made in December in Barbados to expand the task force to become a partnership with participation by donors and lenders in the Caribbean, including UNAIDS," says Ruben F. del Prado, MD, MPH, acting team leader for the Caribbean and UNAIDS InterCountry Programme Advisor & Technical Network Development for the Caribbean in Trinidad and Tobago, West Indies. "The partnership is nothing more than an extended forum to generate the needs and the resources into the same room," del Prado says.
One of the partnership’s challenges will be to encourage political commitment and assist in designing actions when the countries participating have such diverse cultures and governments. For instance, unlike South and Central America, the Caribbean does not have one predominant language or religious influence, so any action involving religious leaders would have to accommodate multiple religions and beliefs, including Islamic, Protestant Christian, Rastafarian, and Catholic.
"We need a more active religious leadership," del Prado says. "They have to stop the hypocrisy and acknowledge there is HIV/AIDS. Although we have multiple religious cultures, we have to make one faith when it comes to HIV/AIDS."
Religion not only influences the people of the Caribbean nations and their beliefs, but it is a main influence on political decisions. "What is important to note here is that socioeconomic, political, and religious influences are decisive in the course of all epidemics in the pan-Caribbean," del Prado says. "Every country and territory is different in that aspect, hence the diversity."
Del Prado says it’s sheer hypocrisy for political leaders, religious leaders, and parents to say their children should abstain from sexual activity. Children as young as 11 and 12 are having sex and are getting pregnant, and everyone knows this. "Abstinence is UNAIDS’ message, but when people are not abstaining and are having sex, then you have to offer them protection," del Prado says. "These are human rights, and children have rights too."
Caribbean children and youth are at greater risk for HIV infection because they are more likely to be exposed to sexual abuse and sexual exploitation. Surveys show that as many as 21% of boys and 18% of girls may have been sexually abused before age 16.2 Another survey of adolescent youth in four English-speaking Caribbean countries showed that more than 40% of youth said their sexual debut had occurred before the age of 10.2 Sex tourism involving minors also is on the rise in Belize, Haiti, and the Dominican Republic. With one-third of the Caribbean population under the age of 15, these statistics signal dire consequences with regard to HIV risk.
However, the main factor driving the epidemic is poverty, which is pervasive in the Caribbean. Poverty has given a boost to the Caribbean’s sex industry, which is linked to tourism in the islands. Young girls and boys, as well as married and single women and men, trade sex for school fees, food, and money. There also is a growing trend of male prostitution in the form of "beach boys" across the Caribbean.2 (See "Factors driving the HIV epidemic in the Caribbean," in this issue.)
Political leadership addressing HIV prevention must begin at the top, del Prado says. "Having administrators hidden somewhere, pushing documents and printing out posters and leaflets with education about HIV and AIDS, is not how you run a national program," del Prado says. "You need a strong unit under a vice prime minister or prime minister, which will have the broad-based coordination that is necessary."
1. HIV/AIDS in the Caribbean: Addressing the challenges and opportunities for strengthening the national and regional response to the epidemic. Prepared by the Caribbean Task Force on HIV/AIDS with support from the Joint United Nations Programme on HIV/AIDS - UNAIDS. June 2000.
2. The Caribbean regional strategic plan of action for HIV/AIDS. Prepared by the Caribbean Task Force on HIV/AIDS. September 2000.
3. CAREC strategic plan for the prevention and control of the HIV epidemic in the Caribbean, 2001-2005. Final version. Produced by the Caribbean Epidemiology Centre, the Pan American Health Organization, and the World Health Organization. December 2000.