Caribbean

AIDS activists in Haiti

HIV is ravaging the populations of several Caribbean island states. Indeed some have worse epidemics than any other country in the world outside sub-Saharan Africa. In the most affected countries of the Caribbean, the spread of HIV infection is driven by unprotected sex between men and women, although infections associated with injecting drug use are common in some places, such as Puerto Rico.

The Bahamas is the worst affected nation in the region, with a prevalence of 3%. Haiti, where the spread of HIV may well have been fuelled by decades of poor governance and conflict, has also been hard hit by the AIDS epidemic. An estimated 2.2% of Haitian adults were living with HIV at the end of 2007, though rates vary considerably between regions. HIV transmission in Haiti is overwhelmingly heterosexual, and both infection and death are concentrated in young adults. Many tens of thousands of Haitian children have lost one or both of their parents to AIDS. Among pregnant women in urban areas, HIV prevalence appears to have fallen by half between the mid-1990s and 2003-2004. Probably much of this decline is due to an increase in the AIDS death rate, though behaviour change might also have played a part. There is still an urgent need for intensified prevention efforts in Haiti.

On the Caribbean coast of South America, Suriname and Guyana had adult HIV prevalence rates of 2.4% and 2.5% respectively at the end of 2007. There are only limited data on HIV in Guyana, but it appears the country has a rapidly growing epidemic, which is becoming established within the general population.

The heterosexual epidemics of HIV infection in the Caribbean are driven by the deadly combination of early sexual activity and frequent partner exchange by young people. A study published in 2005 found that in Trinidad and Tobago, HIV infection levels are six times higher among 15-19 year old females than among males of the same age. In another survey in Barbados, one quarter of 15-29 year old women said they had been sexually active by the age of 15, and almost one in three men aged 15-29 years reported multiple sexual partnerships in the previous year.

AIDS is now high on the agendas of many governments in this region, as they are beginning to notice the significant impact of the epidemic on their medical systems and labour force. Cuba's comprehensive testing and prevention programmes have helped to keep its HIV infection rate below 0.2%, and the country provides free AIDS treatment to all those in need. In Barbados and Bermuda, wider access to antiretroviral treatment has cut AIDS deaths in half. Other countries are now seeking to emulate such successes.