The challenge of HIV/AIDS in the Caribbean at the dawn of a new millenium

ABSTRACT

The Caribbean region continues to experience an expanding HIV/AIDS epidemic. Population HIV-1 prevalence in this region is second only to that in sub-Saharan Africa, reaching 5-6 percent in Haiti and up to 3 percent in Guyana and the Bahamas. While AIDS deaths are declining in developed countries, death rates from AIDS have continued to rise in the Caribbean because of the general unavailability of newer combination therapies. Over the past decade we have witnessed the rapid transition from HIV-1/AIDS in so called risk groups such as gay men and intravenous drug users to spread within the general heterosexual community. This transition has been fuelled by the concurrence of factors which enhance HIV risk such as high rates of partner exchange and poorly or untreated concomitant sexually transmitted diseases, particularly ulcerative diseases. In countries such as Trinidad and the Bahamas an epidemic of crack cocaine use in the eighties provided a fertile milieu for rapid HIV transmission through sexual activity. Each Caribbean territory has its own version of the epidemic, but the commonalities are striking. At the dawn of a new millenium the region continues the struggle against HIV/AIDS in the face of the many problems of crumbling infrastructures a generation after independence, marginal economies, inadequate public engagement in the face of competing priorities, lack of treatment and inadequate research. Recent advances in HIV-I vaccine development may hold some promise for checking the major public health crisis facing the Caribbean at this time.(AU)