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(Editor’s note: This is the second part of an occasional series about the AIDS epidemic in the Caribbean. The May 2001 issue of AIDS Alert featured a story about the new Pan-Caribbean Partnership and a story about the factors driving the HIV epidemic in this region of the world.)
HIV prevalence remains high in many Caribbean nations as testimony to early mistakes made by governments that did not fully appreciate and respond to the threat the epidemic posed.
The Caribbean has one of the highest rates of new AIDS cases among women in the Western hemisphere, which is partially a result of Caribbean women having little power to negotiate safe-sex practices. High rates of sexually transmitted diseases (STDs) also help fuel the epidemic. Meanwhile, many Caribbean governments and religious leaders have made it difficult for HIV prevention efforts to provide honest, useful information about how youths, women, and others can avoid HIV infection.
Under the guidance of a new partnership in the region, the Pan-Caribbean Partnership, officials with UNAIDS and other nongovernmental organizations hope the region’s nations will devote more time and money to preventing HIV infection, particularly among youths.
"What we want to see happen has to be translated into in-country action," 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. "Prime ministers go and sign all sorts of agreements, but it’s what they do when they go back to their country that matters, and ministers of finance are extremely important because funding is needed," del Prado says.
The strategies of UNAIDS in the Caribbean are driven by priorities set in the "Regional Strategic Plan on HIV/AIDS (2000-2005)," prepared by the Caribbean Task Force on HIV/AIDS. The plan’s strategies cover these areas: political commitment and action; greater involvement of people living with HIV/AIDS; national strategic planning for HIV/AIDS; resource mobilization and addressing vulnerable populations, including youths; government capacity building; prevention of mother-to-child transmission of HIV; and access to treatment.
"Good public health is stifled in most of the Caribbean by a lack of resources, and not in the least by rampant hypocrisy when it comes to human sexuality," del Prado says. "The age of initiation of sexual intercourse is declining significantly and is initiated in the majority of cases by the same older men and women who oppose honest and open discussion on sexuality in schools."
Other problems fueling the epidemic are the rising sex tourism trade, the taboo on masturbation, and the fact that male-to-male sexuality is a criminal offense. Nonetheless, international organizations and Caribbean governments are putting more resources into prevention programs. Here’s a brief look at some of the prevention efforts and plans in the Caribbean:
• Health and family life education: The Health and Family Life Education initiative is a partnership of more than 10 organizations. It provides a proactive approach to the epidemic through prevention education directed at young people. Educators teach students skills, values, attitudes, and knowledge about HIV, sexual health, substance abuse, environmental health, safety, and nutrition. Role-playing is one of the classroom techniques designed to promote behavior change.
• Training health care workers: The University of the West Indies, which has campuses in Jamaica, Trinidad, and Barbados, has plans to implement a long-term effort to expand the skills base of health care workers. The university’s medical school has a new program that offers post-graduate research and training in the medical aspects of HIV/AIDS, prevention approaches, public health relations, and economics.
The medical school will design new modules at medical undergraduate and postgraduate level in HIV/AIDS/STD diagnosis and management for nurses and physicians, and the university’s department of psychology will develop a course on behavioral modification for risk reduction. Also, the university will support a special course for journalists on HIV/AIDS.
• Suriname: A former Dutch territory, Suriname has integrated sexual education into its school system. The country is different from most of its Caribbean neighbors in that it has fewer taboos surrounding sexuality, and homosexuality is not criminalized, del Prado says. "The overall stigma surrounding HIV/AIDS is much less than in most of the rest of the Caribbean," del Prado says.
However, the country has suffered severe setbacks in its national HIV/AIDS prevention and control efforts because of a reduction in financial support to the National AIDS Programme in the late 1990’s, del Prado says. With limited resources, the program has maintained and improved a level of general HIV/ AIDS awareness nationwide, he says.