HIV/AIDS in the Caribbean

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The Caribbean is the second-most affected region in the world in terms of HIV prevalence rates. [1] Based on 2009 data, about 1.0 percent of the adult population (240,000 people) is living with the disease, which is higher than any other region except Sub-Saharan Africa. [2] Several factors influence this epidemic, including poverty, gender, sex tourism, and stigma. HIV incidence in the Caribbean declined 49% between 2001 and 2012. [3] Different countries have employed a variety of responses to the disease, with a range of challenges and successes.

Contents

According to The World Factbook, the Bahamas has an HIV/AIDS prevalence rate of 3.3%, [4] which is the highest rate outside of Africa.

Overview

Although the exact origin of the disease is unknown, the HIV epidemic in the Caribbean most likely began in the 1970s. The first reported AIDS case occurred in Jamaica in 1982, followed by eight cases among gay and bisexual men in Trinidad and Tobago. In the early days of the epidemic, more men were affected than women. [5] : page: 196  By 1985, HIV/AIDS was becoming a general population issue and was no longer a disease solely of gay or bisexual men. [6]

Contrary to popular belief, the primary mode of HIV transmission in the region is heterosexual sex. [1] The number of new HIV infections among women became and continues to be higher than those among men. [1] Currently, the Caribbean is the only area outside of Sub-Saharan Africa where women and girls outnumber men and boys living with HIV. [2]

Prevalence

Among adults aged 15–44, AIDS is the leading cause of death. [1] Between 2001 and 2009, new infections slightly declined. [2] There is a large degree of variation of HIV prevalence between the 21 Caribbean countries. As of 2011, there are two countries where the national prevalence is over 2 percent, those being the Bahamas, and Belize. [7]

In Jamaica and Haiti, the HIV rate is estimated to be about 1.8 percent. In Trinidad and Tobago the rate is 1.5 percent. In the region, the rate in Guyana and Suriname is between 1 and 1.1%. In Barbados and the Dominican Republic, the rate is 0.9% and 0.7% respectively. Cuba has the lowest rate, which is under 0.2 percent. [5] : page: 106  The HIV/AIDS epidemic in Caribbean appears to have been overshadowed by the seemingly more severe problems in Sub-Saharan Africa, Asia, and the countries with more active and highly visible activism. [8]

Causes and spread

Social factors

A variety of social factors have perpetuated the spread and worsened the severity of HIV/AIDS in the Caribbean. Many persons are at increased risk of HIV infection because of their social vulnerability, arising from poverty, illiteracy or limited education, unemployment, gender inequity, and sexual orientation. [5] : page: 199  HIV/AIDS can weaken the national education system, perpetuating the spread of the disease by hindering efforts to educate the public about the disease. Furthermore, a weak political response by the government can result in ineffective programs. [9]

Public policies in some countries openly discriminate against HIV-positive people, placing the burden of responsibility on the family of the infected individual. Discrimination also takes place in housing, employment, and public accommodations, and currently little is able to be done. [10] Because of these factors, many have less knowledge, skills, and motivation to practice safe-sex and avoid the disease.[ citation needed ]

Risk groups

Women

Gender plays an important role in the spread of HIV. Young women are more likely than men to contract HIV in the Caribbean, and most of these women are between 24–44 years old. [6] In developing countries in general, women are at an extreme disadvantage in terms of the prevention and treatment of HIV. The gender hierarchies found within many societies contributes to the correlation of women and HIV. [11] One of the factors that put women most at risk is sexual violence. The first sexual experience of a girl is often forced, and during unprotected vaginal intercourse, women are more likely than men to contract HIV, because HIV-infected semen has a higher viral concentration than vaginal secretions. [12]

The Capability Approach, outlined by Nussbaum's Central Capabilities, lists bodily health and bodily integrity as crucial components of human dignity, and both of these are violated in the case of HIV transmission through rape. [13] Furthermore, sexual relations between older men and younger women during transactional sex possibly explain why more teenage girls than boys are HIV-positive in the Caribbean. [5] : page: 199 

Men who have sex with men

Sexuality has also had a significant impact on HIV/AIDS in the Caribbean. The prevalence of HIV among men who have sex with men (MSM) seems to be high, though reliable, current data is lacking. The HIV prevalence rate across the Caribbean between MSM varies, ranging from 11.7 percent in the Dominican Republic (1996) to 18 percent in Suriname (1998) to 33.6 percent in Jamaica (1996). [5] While unprotected sex between men is undoubtedly a major contributing factor to the epidemic, it remains largely hidden in the data. In many Caribbean countries, gay sexual relations remain illegal. This has led to a heavy stigma associated with same-sex relationships. [2]

This stigma and widespread discrimination are definite factors in the spread of HIV. [14] In Trinidad and Tobago, one in five MSM were HIV positive, and out of those, one in four said they also have sex with women. [2] Because of the stigma and discrimination, these men hide their same sex behavior and become involved with women who do not know about their sexuality. [5] : page: 199  This has created a bridge for HIV to pass from the gay community to the general population. [5] : page: 199 

Cultural factors

Several factors within Caribbean cultures play a role in HIV transmission. Firstly, sexual patterns exist in several countries that foster the spread of the disease. There is a high level of sexual activity among the youth, as evidenced by the 22 to 32 percent of persons in six eastern Caribbean states reporting having sex before age 15. [5] : page: 199  Furthermore, having multiple sexual partners within the past year is relatively common throughout the Caribbean. [5] : page: 199 

The commercial sex industry, transactional sex, and sex tourism in the Caribbean are likewise important factors. HIV infection rates for commercial sex workers are high, ranging from 4.5-12.4 percent in the Dominican Republic (2000) to 9 percent in Jamaica (2005) to 30.6 percent in Guyana (2000). [5] : page: 197  One possible explanation is that the use of condoms in transactional sex is less likely. [5] : page: 199  In addition to the specific industry of sex tourism, studies have shown that the general tourism industry is positively correlated with the HIV epidemic. [15] The perceived connection exists in that there are aspects of the environment of a tourist area that foster higher risks for HIV infection. These include riskier behaviors on the part of locals and tourists, as well as employees of the tourism industry engaging in relations with the tourists. [15]

Intravenous drug use also plays a small role in perpetuating the spread of the disease, though it is not very common in many countries. However, two notable exceptions are Bermuda and Puerto Rico. In Bermuda, the prevalence rate is around 43 percent, while in Puerto Rico almost 80 percent of HIV infections arise from drug injection. [1]

Economic factors

The economies of the Caribbean influence the spread of HIV/AIDS as well. Firstly, the cost of HIV on many facets of life, outside of simply human well-being, was underestimated in the past. [16] The disease hindered both the growth and the development of the island nations that make up the region. Because of rising mortality and falling productivity due to illness, the labor force in several industries has been negatively affected. [16] Several aspects on individual economies will also experience negative impacts of HIV, from agriculture to tourism to finance. [14] There have also been observed correlations between condom use and economic security, with those in more impoverished situations being less likely to practice safe sex. [17]

Studies have tried to identify a relationship between poverty and susceptibility to HIV.[ citation needed ] Many have indicated that HIV/AIDS can have a negative impact on socioeconomic status, as well as the level of overall employment in a given country.[ citation needed ]

Examples by country

Haiti

Haiti, a nation that shares the island of Hispaniola with the Dominican Republic, has been greatly affected by HIV. As of 2014, the adult prevalence rate of HIV is estimated to be 1.93%. [18] For some time, Haiti had highest rate in the Americas and the highest outside of Sub-Saharan Africa. [1] Like many other countries, the disease began as being associated with men who have sex with men, specifically men in Haiti who engaged in commercial sex with male tourists. Later, the disease crossed over into the heterosexual community, with the main areas of risk being sex with female sex workers, casual sex with partners infected with AIDS, and blood transfusions. [1]

The course of the disease in Haiti has been rapid and aggressive, compounded by high rates of tuberculosis and other diseases of poverty. A large number of children were born to HIV-positive mothers before proper treatment was available, leading to a spike in infant mortality. Negative effects have been observed in Haiti, one being the impact on the economy due to a shrinking tourism industry. The response of the healthcare in Haiti has been fairly effective. Due to swift identification of the disease, a coordinated response was undertaken relatively quickly. [1]

Several measures were taken, such as giving the Haitian Red Cross complete control of the blood bank, launching a national awareness campaign, and setting up local health units that provide HIV treatment with antiretroviral drugs. Although Haiti has undergone civil unrest for several years, a priority was placed on the HIV/AIDS epidemic, and strong relationships were formed with the private health sector. Through both prevention and care, Haiti continues to manage the spread of the disease. [1]

Barbados

Currently, the adult prevalence rate of HIV in Barbados is estimated to be 1.5 percent. [5] : page: 196  When HIV first struck Barbados, the island nation was completely underprepared to handle such a significant and detrimental disease. [1] The first case was recognized in 1984, after which those infected with AIDS were heavily stigmatized. In contrast to system in Haiti, much of the healthcare response in Barbados was carried out by the public sector. Several successes of Barbados in its fight against HIV include universal screening, confidentiality, an AIDS information center and hotline, and special attention focused on at-risk groups. Overall, the achievements should undoubtedly be praised, especially considering the fact that these responses were carried out during an economic depression in the 1990s, as well as during a period of severe stigmatization of HIV-positive people. [1]

Jamaica

Jamaica is another island nation that has been hit hard by the HIV/AIDS epidemic, with an adult prevalence rate of around 1.5 percent. [1] Currently, AIDS is the leading cause of death among two at-risk groups, young children aged 1–4 and young women aged 20–29. Both the public and private health sectors have played important roles in the response to the epidemic. From providing healthcare to seeking international funds, instituting educational programs to providing condoms, the Jamaican government has done much in prioritizing the HIV crisis. [1]

Notably, as part of their strategic plan. Jamaica has set of goal of normalizing HIV as part of normal societal discourse. This would undoubtedly help to reduce stigma towards HIV-positive individuals. The relative successes of the Jamaican program are also notable, as the country has managed to secure its blood supply, expand STI treatment centers, introduce proper surveillance of HIV, and make condoms widely available. Jamaica still seeks to strengthen its response, especially in terms of reducing discrimination and expanding prevention and intervention programs. [1]

Cuba

The current HIV adult prevalence rate in Cuba is estimated to be about 0.07 percent, one of the lowest in the world and certainly the lowest in the region. [1] Three of the major modes of transmissions in other nations, mother-to-child transmission, transmission through blood transfusion, and through intravenous drug use, are virtually non-existent in Cuba. Instead, sexual contact accounts for approximately 99 percent of all cases. In terms of sexuality, Cuba has followed a trajectory nearly opposite of the norm. Most of the first cases diagnosed were heterosexual men, but the disease then crossed over into the gay community as male-to-male sexual contact began to spread the disease. Today, men who have sex with men (MSM) are one of the most at-risk groups, making up for around 86 percent of men infected with HIV in Cuba.[ citation needed ]

With the establishment of the Working Group for Confronting and Fighting AIDS, the government and nongovernmental organizations created comprehensive measures to fight the disease. Firstly, Cuba banned the importation of all human blood products and destroyed potentially infected supplies, effectively eliminating transmission of HIV through blood transfusions. Next, the country provided wide-scale HIV testing for Cubans who had travelled abroad and potentially brought the disease back into the country. The most important measures served to prevent sexual transmission, namely through education programs, medical examinations, and admittance of HIV-positive individuals into specialized health centers called sanatoria. These sanatoria were somewhat controversial, especially in terms of possible human rights violations. Although severely isolated in the late 1980s, the program has since improved significantly, providing outlets for social integration and multiple levels of care. [1]

Responses

The responses to the HIV/AIDS epidemic in the Caribbean have varied over time and across countries. In the 2001 Nassau Declaration on Health, the Caribbean Community (CARICOM) declared the HIV/AIDS crisis to be a priority for the region. As part of their response, the Pan-Caribbean Partnership Against AIDS (PANCAP) was formed. Today, this partnership is made up of over 80 members, including Caribbean countries, AIDS organizations, and nongovernmental organizations (NGOs). Sources of funding include the World Bank, UNAIDS, and the Global Fund for AIDS, TB, and Malaria. [5] : page: 198  Three principles that are crucial to the effective control of HIV are the inclusion of HIV positive persons, prevention and treatment programs that are carried out simultaneously, and the reduction of stigma. [19]

Broadly, increased political will, affordable and accessible antiretroviral drugs, stronger NGOs, and the generous aid of donors have combined to improve access to treatment. [8] Testing pregnant women for HIV and providing antiretroviral drugs has significantly reduced the rates of mother-to-child transmission. [5] : page: 197  Improving awareness of safe sex practices through HIV education and prevention programs, as well as increasing contraceptive distribution, can reduce the rates of sexual transmission. [5] : page: 200 

Specifically, childhood sex education is important in helping kids to develop lifelong safe-sex practices like consistent condom usage and reducing risk by delaying sexual activity. [19] Although it does play a minor role in the Caribbean, IV drug use still contributes to the spread of the disease. There is evidence that the harm reduction model, including needle and syringe exchange, is effective at preventing HIV with no other harmful effects. [19] Other responses include screening blood banks to reduce transmission through blood transfusion, increasing HIV screening and testing, and advocacy to establish responsive governmental policies.[ citation needed ]

Challenges

Several challenges have hindered the response to the HIV crisis. First, many countries have weak national capacities in terms of their ability to manage, control, and address the epidemic. [5] : page: 199  This management also presents technical challenges for developing countries with varying levels of technological advancement. Because of the many regional governments and international aid agencies, the response to the spread of the disease is often uncoordinated and less effective than it could be. [5] : page: 200  Political factors that affect the response include inattention to or a lack of concern about HIV and incomplete or slow information flow. [10]

The stigma associated with both HIV-positive people and the perceived connection to the gay community is often crippling, resulting in discrimination, low use of testing facilities, and increased transmission of the disease. [6] While this is certainly improving, there is still also a lack of information regarding how HIV/AIDS affected specific groups, like commercial sex workers, men who have sex with men, and IV drug users. [6] Without substantive and concrete information, it remains difficult to completely address the needs of the groups. Lastly, it remains difficult to fully implement HIV interventions in several areas, and in-depth research is needed to truly understand how these interventions function to help HIV-positive individuals. [1]

See also

Related Research Articles

<span class="mw-page-title-main">HIV/AIDS in Africa</span>

HIV/AIDS originated in the early 20th century and has become a major public health concern and cause of death in many countries. AIDS rates vary significantly between countries, with the majority of cases concentrated in Southern Africa. Although the continent is home to about 15.2 percent of the world's population, more than two-thirds of the total population infected worldwide – approximately 35 million people – were Africans, of whom around 1 million have already died. Eastern and Southern Africa alone accounted for an estimate of 60 percent of all people living with HIV and 100 percent of all AIDS deaths in 2011. The countries of Eastern and Southern Africa are most affected, leading to raised death rates and lowered life expectancy among adults between the ages of 20 and 49 by about twenty years. Furthermore, life expectancy in many parts of Africa is declining, largely as a result of the HIV/AIDS epidemic, with life-expectancy in some countries reaching as low as thirty-nine years.

HIV/AIDS has been a public health concern for Latin America due to a remaining prevalence of the disease. In 2018 an estimated 2.2 million people had HIV in Latin America and the Caribbean, making the HIV prevalence rate approximately 0.4% in Latin America.

Since the first HIV/AIDS case in Laos was identified in 1990, the number of infections has continued to grow. In 2005, UNAIDS estimated that 3,700 people in Laos were living with HIV.

Angola has a large HIV/AIDS infected population, however, it has one of the lowest prevalence rates in the Southern Africa zone. The status of the HIV/AIDS epidemic in Angola is expected to change within the near future due to several forms of behavioral, cultural, and economic characteristics within the country such as lack of knowledge and education, low levels of condom use, the frequency of sex and number of sex partners, economic disparities and migration. There is a significant amount of work being done in Angola to combat the epidemic, but most aid is coming from outside of the country.

Kenya has a severe, generalized HIV epidemic, but in recent years, the country has experienced a notable decline in HIV prevalence, attributed in part to significant behavioral change and increased access to ARV. Adult HIV prevalence is estimated to have fallen from 10 percent in the late 1990s to about 4.8 percent in 2017. Women face considerably higher risk of HIV infection than men but have longer life expectancies than men when on ART. The 7th edition of AIDS in Kenya reports an HIV prevalence rate of eight percent in adult women and four percent in adult men. Populations in Kenya that are especially at risk include injecting drug users and people in prostitution, whose prevalence rates are estimated at 53 percent and 27 percent, respectively. Men who have sex with men (MSM) are also at risk at a prevalence of 18.2%. Other groups also include discordant couples however successful ARV-treatment will prevent transmission. Other groups at risk are prison communities, uniformed forces, and truck drivers.

<span class="mw-page-title-main">HIV/AIDS in Mozambique</span>

Mozambique is a country particularly hard-hit by the HIV/AIDS epidemic. According to 2008 UNAIDS estimates, this southeast African nation has the 8th highest HIV rate in the world. With 1,600,000 Mozambicans living with HIV, 990,000 of which are women and children, Mozambique's government realizes that much work must be done to eradicate this infectious disease. To reduce HIV/AIDS within the country, Mozambique has partnered with numerous global organizations to provide its citizens with augmented access to antiretroviral therapy and prevention techniques, such as condom use. A surge toward the treatment and prevention of HIV/AIDS in women and children has additionally aided in Mozambique's aim to fulfill its Millennium Development Goals (MDGs). Nevertheless, HIV/AIDS has made a drastic impact on Mozambique; individual risk behaviors are still greatly influenced by social norms, and much still needs to be done to address the epidemic and provide care and treatment to those in need.

UNAIDS has said that HIV/AIDS in Indonesia is one of Asia's fastest growing epidemics. In 2010, it is expected that 5 million Indonesians will have HIV/AIDS. In 2007, Indonesia was ranked 99th in the world by prevalence rate, but because of low understanding of the symptoms of the disease and high social stigma attached to it, only 5-10% of HIV/AIDS sufferers actually get diagnosed and treated. According to the a census conducted in 2019, it is counted that 640,443 people in the country are living with HIV. The adult prevalence for HIV/ AIDS in the country is 0.4%. Indonesia is the country in Southeast Asia to have the most number of recorded people living with HIV while Thailand has the highest adult prevalence.

HIV/AIDS in Jordan is characterized by a low prevalence rate compared to other regions, but the situation remains a concern due to potential for increase and the social and economic consequences that could result. As of 2007, the UNAIDS estimated that there were approximately 380 people living with HIV/AIDS (PLWHA) in Jordan. Despite the relatively low numbers, the country faces challenges in addressing the epidemic, including inadequate surveillance systems, limited adoption of preventive practices, and persistent stigma and discrimination against PLWHA.

<span class="mw-page-title-main">HIV/AIDS in Nepal</span>

The first HIV/AIDS cases in Nepal were reported in 1988. The HIV epidemic is largely attributed to sexual transmissions and account for more than 85% of the total new HIV infections. Coinciding with the outbreak of civil unrest, there was a drastic increase in the new cases in 1996. The infection rate of HIV/AIDS in Nepal among the adult population is estimated to be below the 1 percent threshold which is considered "generalized and severe". However, the prevalence rate masks a concentrated epidemic among at-risk populations such as female sex workers (FSWs), male sex workers (MSWs), injecting drug users (IDUs), men who have sex with men (MSM), Transgender Groups (TG), migrants and male labor migrants (MLMs) as well as their spouses. Socio-Cultural taboos and stigmas that pose an issue for open discussion concerning sex education and sex habits to practice has manifest crucial role in spread of HIV/AIDS in Nepal. With this, factors such as poverty, illiteracy, political instability combined with gender inequality make the tasks challenging.

Since HIV/AIDS was first reported in Thailand in 1984, 1,115,415 adults had been infected as of 2008, with 585,830 having died since 1984. 532,522 Thais were living with HIV/AIDS in 2008. In 2009 the adult prevalence of HIV was 1.3%. As of 2016, Thailand had the highest prevalence of HIV in Southeast Asia at 1.1 percent, the 40th highest prevalence of 109 nations.

HIV/AIDS in Bolivia has a less than 1 percent prevalence of Bolivia's adult population estimated to be HIV-positive. Bolivia has one of the lowest HIV prevalence rates in the Latin America and Caribbean region.

The Dominican Republic has a 0.7 percent prevalence rate of HIV/AIDS, among the lowest percentage-wise in the Caribbean region. However, it has the second most cases in the Caribbean region in total web|url=http://www.avert.org/caribbean-hiv-aids-statistics.htm |title=Caribbean HIV & AIDS Statistics|date=21 July 2015}}</ref> with an estimated 46,000 HIV/AIDS-positive Dominicans as of 2013.

HIV/AIDS in El Salvador has a less than 1 percent prevalence of the adult population reported to be HIV-positive. El Salvador therefore is a low-HIV-prevalence country. The virus remains a significant threat in high-risk communities, such as commercial sex workers (CSWs) and men who have sex with men (MSM).

HIV/AIDS in Jamaica has a 1.5 percent prevalence of the adult population estimated to be HIV-positive. There has been no significant change over the last five years and therefore Jamaica appears to have stabilized its HIV/AIDS epidemic.

In 2016, the prevalence rate of HIV/AIDS in adults aged 15–49 was 0.3%, relatively low for a developing country. This low prevalence has been maintained, as in 2006, the HIV prevalence in Mexico was estimated at around 0.3% as well. The infected population is remains mainly concentrated among high risk populations, men who have sex with other men, intravenous drug users, and commercial sex workers. This low national prevalence is not reflected in the high-risk populations. The prison population in Mexico, faces a fairly similar low rate of around 0.7%. Among the population of prisoners, around 2% are known to be infected with HIV. Sex workers, male and female, face an HIV prevalence of around 7%. Identifying gay men and men who have sex with other men have a prevalence of 17.4%. The highest risk-factor group is identifying transgender people; about 17.4% of this population is known to be infected with HIV. Around 90% of new infections occur by sex-related methods of transmission. Of these known infected populations, around 60% of living infected people are known to be on anti-retroviral therapy (ART).

Nicaragua has 0.2 percent of the adult population estimated to be HIV-positive. Nicaragua has one of the lowest HIV prevalence rates in Central America.

With less than 1 percent of the population estimated to be HIV-positive, Egypt is a low-HIV-prevalence country. However, between the years 2006 and 2011, HIV prevalence rates in Egypt increased tenfold. Until 2011, the average number of new cases of HIV in Egypt was 400 per year, but in 2012 and 2013, it increased to about 600 new cases, and in 2014, it reached 880 new cases per year. According to 2016 statistics from UNAIDS, there are about 11,000 people currently living with HIV in Egypt. The Ministry of Health and Population reported in 2020 over 13,000 Egyptians are living with HIV/AIDS. However, unsafe behaviors among most-at-risk populations and limited condom usage among the general population place Egypt at risk of a broader epidemic.

With 1.28 percent of the adult population estimated by UNAIDS to be HIV-positive in 2006, Papua New Guinea has one of the most serious HIV/AIDS epidemics in the Asia-Pacific subregion. Although this new prevalence rate is significantly lower than the 2005 UNAIDS estimate of 1.8 percent, it is considered to reflect improvements in surveillance rather than a shrinking epidemic. Papua New Guinea accounts for 70 percent of the subregion's HIV cases and is the fourth country after Thailand, Cambodia, and Burma to be classified as having a generalized HIV epidemic.

<span class="mw-page-title-main">HIV/AIDS in Haiti</span>

With an estimated 150,000 people living with HIV/AIDS in 2016, Haiti has the most overall cases of HIV/AIDS in the Caribbean and its HIV prevalence rates among the highest percentage-wise in the region. There are many risk-factor groups for HIV infection in Haiti, with the most common ones including lower socioeconomic status, lower educational levels, risky behavior, and lower levels of awareness regarding HIV and its transmission.

Vietnam faces a concentrated HIV epidemic among high-risk groups, including sex workers, and intravenous drug users. There are cases of HIV/AIDS in all provinces of Vietnam, though low testing rates make it difficult to estimate how prevalent the disease is. The known rates among high-risk groups are high enough that there is a risk of HIV/AIDS rates increasing among the general population as well. People who are HIV+ face intense discrimination in Vietnam, which does not offer legal protections to those living with the condition. Stigma, along with limited funding and human research, make the epidemic difficult to control.

References

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