(This article is an expanded version of the article that appeared in the October 2000 issue of Population Today.)

(October 2000) He is a 40-year old Antiguan who looks like 80. He has two children and his wife hovers over him praying, “God, please heal my husband.” Even as she prays for the family breadwinner, she says a silent prayer for the results of her second test to return negative, like the first.

Then there is the vibrant, healthy looking 35-year-old Trinidadian who is the fortunate recipient of antiretroviral therapy from foreign institutions and friends and who has been living with HIV for the last 14 years.

They represent the faces of HIV/AIDS in the Caribbean. To better care for them and hundreds of thousands of others suffering from the disease, and to prevent countless others from contracting the virus, the World Bank committed at a recent meeting in Barbados $100 million in funding. The European Union, the Canadian International Development Agency (CIDA) and the United Kingdom Department for International Development pledged another $20 million in grants.

Estimates of Those Living With HIV/AIDS

The funds, and more, are desperately needed. The Joint United Nations Programme on HIV/AIDS (UNAIDS) estimates that 360,000 people are living with the virus in the Caribbean – a region that covers English-, French-, Dutch-, and Spanish-speaking territories, including Cuba, the Dominican Republic, Suriname, and Haiti.

The Caribbean Epidemiological Centre (CAREC), with responsibility for advising governments on policies to combat the disease in 21 countries, says the number of persons affected with HIV/AIDS is closer to 500,000 because of a high level of underreporting of the disease. National plans have sprung from the recommendations of CAREC and UNAIDS, and governments are now getting the message that HIV/AIDS is serious business.

Government Action

To match the commitment of the World Bank, Prime Minister Owen Arthur of Barbados has taken personal charge of his country’s National AIDS Program. This approach may act as a catalyst for other governments. No longer considering HIV/AIDS to be merely a health problem, the Barbados government plans to develop an expanded response to the disease.

All government ministries, agencies, nongovernmental organizations, business organizations, and churches are being pressed to develop an anti-HIV/AIDS plan of action. As of July 2001, the government plans to make a regimen of the drug zidovudine (AZT) available to HIV/AIDS sufferers and to provide a multi-drug therapy to prevent mother-to-child infection.

Trinidad and Tobago is also considering making AZT available. One interesting aspect of that country’s program is the requirement for laboratories and doctors to notify the ministry of health, through a code system, of persons who have tested positive. The code system is meant to protect patient privacy.

CAREC’s most recent report on the spread of the disease in the Caribbean observes “an inexorable trend upward over the last decade.” In the last four years, 8,399 AIDS cases have been reported in the Caribbean-a number similar to the known AIDS cases during the first 14 years of the epidemic in the region.

Hardest Hit Populations

In 1982, the virus was found exclusively in the homosexual population. Today, 64 percent of all AIDS cases are in the heterosexual population. Of particular concern to CAREC is the spread of the virus among women, especially those in the 15-to-25 age group.

“Women are at greater risk of contracting HIV in both biological and sociological terms, as they are both physically more vulnerable and often have little or no power to negotiate safer-sex practices with their male partners,” says CAREC.

The incidence of HIV/AIDS is severest in Haiti, the Dominican Republic, the Bahamas, Guyana, Trinidad and Tobago, and Jamaica. In Haiti, a government report estimates that 12 percent of the urban population and 5 percent of the rural population are living with HIV/AIDS.

“It is estimated that in Haiti alone, there will be between 240,000 and 330,000 people living with HIV/AIDS by the end of this year,” says Dr. Peggy McEvoy of the Caribbean UNAIDS program.

In Guyana, CAREC estimates that at the end of 1998, roughly 92 of every 100,000 persons were carrying the virus. In Barbados, the ratio was 64 of every 100,000. In Trinidad and Tobago, with its population of 1.2 million, the Ministry of Health estimates that 35 to 40 persons are testing positive with the virus every week.

“What is even worse is that we have been averaging 35 deaths per month,” says Chief Medical Officer, Dr. Rawle Edwards, noting that the figures are rising. Young girls in the 15-to-19 age group are contracting the virus at a ratio of 7 females to every 1 male. “At this rate, our young female population of child-bearing age will be decimated,” says Dr. Edwards.

The main mode of transmission of the virus in the Caribbean is through the practice of men and women having multiple sex partners. Unprotected sex and social taboos preventing sex education from being easily taught to young people also account for the spread of HIV/AIDS, says CAREC.

Priorities for the Region

The University of the West Indies (UWI) expects the cost of caring for HIV/AIDS-infected persons in Trinidad and Tobago and Jamaica to consume by 2005 what these governments now spend ($200 million) on health care for their entire populations. “The rising incidence of HIV cases, if left unchecked in the region, will lead to continued negative growth and the eventual destabilization of economies in the Caribbean,” notes the UWI study.

A Caribbean Task Force on HIV/AIDS has identified a number of priorities for the region. They include the development of non-discriminatory policies and legislation; care and support for infected persons, including access to basic and anti-retroviral drugs; and the targeting of high-risk groups, including homosexual men, prostitutes, and youths for counseling in safe-sex practices.

The Bahamas alone among Caribbean states has been reporting a decrease in the incidence of AIDS. The government there is claiming success, reducing by 58 percent the mother-to-child transmission of HIV by using the ACTG 076 protocol — a regime of the AZT drug given to infected mothers after the first 14 weeks of pregnancy and to the baby after birth. Unlike other countries in the region, HIV/AIDS patients in the Bahamas receive treatment with double and triple therapy.

Committed to fighting the contraction of the disease at another level, medical institutions in Haiti, Trinidad and Tobago, and Brazil have formed a consortium to be part of phase two of vaccine trials.

 Tony Fraser is a freelance writer based in Trinidad and Tobago.