AIDS around world - Caribbean

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.

Haiti, where the spread of HIV may well have been fuelled by decades of poor governance and conflict, is the worst affected nation in the region. In some areas, 13% of anonymously tested pregnant women were found to be HIV-positive in 1996. Overall, around 8% of adults in urban areas and 4% in rural areas are infected. HIV transmission in Haiti is overwhelmingly heterosexual, and both infection and death are concentrated in young adults. It is estimated that nearly 200,000 Haitian children had lost one or both of their parents to AIDS by the end of 2001. Haiti has been traumatised by decades of almost continual mass-unemployment, brutal governments, and conflict. With this as a background, the spread of HIV has largely been undisturbed. The danger is that Haiti will eventually solve it's social issues, only to find that HIV has already devastated the 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. In Saint Vincent and the Grenadines, where the prevalence of sexually transmitted diseases is high for the region, a quarter of men and women in a recent national survey said they had started having sex before the age of 14, and half of both men and women were sexually active at the age of 16. In a large survey of men and women in their teens and early twenties in Trinidad and Tobago , fewer than a fifth of the sexually active respondents said they always used condoms, and two-thirds did not use condoms at all.

A mixing of ages, which has contributed to pushing the HIV rate in young African women to such a high levels, is common in this population too. Whilst most young men had sex with women of their own age or younger, over 28% of young girls said they has sex with older men. As a result, HIV rates are five times higher in girls than boys aged 15-19 in Trinidad and Tobago, and at one surveillance centre for pregnant women in Jamaica, girls in their late teens had almost twice the prevalence rate of older women.

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. It remains to be seen if action can and will be taken rapidly enough to avert a crisis.