The HIV epidemic in the Caribbean: meeting the challenges of achieving universal access to prevention, treatment and care.

Ministry of Health, Jamaica, 2 King Street, Kingston, Jamaica.
The West Indian medical journal (Impact Factor: 0.28). 07/2008; 57(3):195-203.
Source: PubMed

ABSTRACT The HIV prevalence in the Caribbean is estimated at 1.0% (0.9% - 2%) with 230,000 persons living with HIV/AIDS. HIV rates vary among countries with the Bahamas, Guyana, Haiti and Trinidad and Tobago having HIV rates of 2% or above while Cuba's rate is less than 0.2%. However throughout the Caribbean, HIV rates are significantly higher among those groups most at risk such as commercial sex workers, men who have sex with men and crack/cocaine users. The Caribbean Community (CARICOM) Heads of Governments declared AIDS to be a regional priority in 2001. The Pan Caribbean AIDS Partnership (PANCAP) was formed to lead the regional response to the HIV epidemic. National HIV Programmes have made definite progress in providing ARV treatment to persons with HIV/AIDS and reducing death rates due to AIDS, decreasing HIV mother-to-child transmission and providing a range ofHIVprevention programmes. However HIV stigma remains strong in the Caribbean and sexual and cultural practices put many youth, women and men at risk of HIV The Caribbean has set itself the goal of achieving universal access to HIV prevention, treatment and care. Several challenges need to be addressed. These include reducing HIV stigma, strengthening national responses, scaling-up better quality prevention programmes with greater involvement of vulnerable populations, more supportive HIV policies and wider access to ARV treatment with better adherence. In addition, there needs to be improved coordination among PANCAP partners at the regional level and within countries.

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    ABSTRACT: Human immunodeficiency virus (HIV) prevalence among men who have sex with men (MSM) is thought to be high in Jamaica. The objective of this study was to estimate HIV prevalence and identify risk factors in order to improve prevention approaches. With the help of influential MSM, an experienced research nurse approached MSM in four parishes to participate in a cross-sectional survey in 2007. Men who have sex with men were interviewed and blood taken for HIV and syphilis tests, and urine taken for gonorrhoea, chlamydia and trichomonas testing using transcription-mediated amplification assays. A structured questionnaire was administered by the nurse. One third (65 of 201; 32%, 95% Confidence Interval (CI) 25.2, 47.9) of MSM were HIV positive. Prevalence of other sexually transmitted infections (STI) was: chlamydia 11%, syphilis 6%, gonorrhoea 3.5% and trichomonas 0%. One third (34%) of MSM identified themselves as being homosexual, 64% as bisexual and 1.5% as heterosexual. HIV positive MSM were significantly more likely to have ever been told by a doctor that they had an STI (48% vs 27%, OR 2.48 CI 1.21, 5.04, p = 0.01) and to be the receptive sexual partner at last sex (41% vs 23%, OR 2.41 CI 1.21, 4.71, p = 0.008). Men who have sex with men who were of low socio-economic status, ever homeless and victims of physical violence were twice as likely to be HIV positive. The majority (60%) of HIV positive MSM had not disclosed their status to their partner and over 50% were not comfortable disclosing their status to anyone. The high HIV prevalence among MSM is an important factor driving the HIV epidemic in Jamaica. More effective ways need to be found to reduce the high prevalence of HIV among MSM including measures to reduce their social vulnerability, combat stigma and discrimination and empower them to practice safe sex.
    The West Indian medical journal 01/2013; 62(4):286-91. · 0.28 Impact Factor
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    ABSTRACT: The Human immunodeficiency virus type-1 (HIV-1) epidemic in the Caribbean region is mostly driven by subtype B; but information about the pattern of viral spread in this geographic region is scarce and different studies point to quite divergent models of viral dissemination. In this study, we reconstructed the spatiotemporal and population dynamics of the HIV-1 subtype B epidemic in the Caribbean. A total of 1,806 HIV-1 subtype B pol sequences collected from 17 different Caribbean islands between 1996 and 2011 were analyzed together with sequences from the United States (n = 525) and France (n = 340) included as control. Maximum Likelihood phylogenetic analyses revealed that HIV-1 subtype B infections in the Caribbean are driven by dissemination of the pandemic clade (BPANDEMIC) responsible for most subtype B infections across the world, and older non-pandemic lineages (BCAR) characteristics of the Caribbean region. The non-pandemic BCAR strains account for >40% of HIV-1 infections in most Caribbean islands; with exception of Cuba and Puerto Rico. Bayesian phylogeographic analyses indicate that BCAR strains probably arose in the island of Hispaniola (Haiti/Dominican Republic) around the middle 1960s and were later disseminated to Trinidad and Tobago and to Jamaica between the late 1960s and the early 1970s. In the following years, the BCAR strains were also disseminated from Hispaniola and Trinidad and Tobago to other Lesser Antilles islands at multiple times. The BCAR clades circulating in Hispaniola, Jamaica and Trinidad and Tobago appear to have experienced an initial phase of exponential growth, with mean estimated growth rates of 0.35-0.45 year-1, followed by a more recent stabilization since the middle 1990s. These results demonstrate that non-pandemic subtype B lineages have been widely disseminated through the Caribbean since the late 1960s and account for an important fraction of current HIV-1 infections in the region.
    PLoS ONE 08/2014; 9(8):e106045. DOI:10.1371/journal.pone.0106045 · 3.53 Impact Factor
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    ABSTRACT: Background: Caribbean women have the highest human immunodeficiency virus (HIV) infection rates among women in the Americas; however, their self-assessment of HIV risk is alarmingly low. This reflects a low perceived risk for HIV. English-speaking Caribbean countries are typically understudied in this area. It is important for health researchers and practitioners to understand the underlying perceptions of women who are now driving this epidemic. This review discusses and critiques the published literature that examines Caribbean women's perceived HIV risks. Methods: Medline, PsycINFO, Global Health, Women's Studies International, and Academic Search Complete databases were searched using various combinations of the following keywords: Caribbean, women, HIV, STD, AIDS, risk, perceived risk, risk perception, and sex. Searches were restricted to English. A total of 69 peer-reviewed studies were obtained from the initial 239 records. The reviewer screened the peer-reviewed articles and excluded 50 studies that did not directly assess perceived HIV risks in Caribbean women. An additional 12 studies were excluded based on the following exclusion criteria: an undetermined proportion or more than 50% of the sample consisted of pregnant women, sex workers, drug users, Latinas, and/or people living with HIV/AIDS. Results: Seven studies on perceived HIV risk in Caribbean women were reviewed. Jamaican women were the most represented ethnic demographic (43%). All studies assessed perceived risk as a subset of HIV psychosocial factors, sexual-risk behaviors, HIV knowledge, attitudes, and beliefs. Four studies used cross-sectional research design and two studies used qualitative methodology. Only one study described items used to measure perceived risk. General findings indicate overall perceptions of invulnerability among Caribbean women, despite high sexual-risk behaviors. Conclusions: Published studies that specifically assess Caribbean women's HIV risk perceptions are currently lacking. Qualitative research is needed to further evaluate and explore perceived risks. This will better inform practical strategies that can enable women to discern between their perceived and actual risks, and invariably reduce sexual risk-taking behaviors.
    04/2014; 2(1):541-554. DOI:10.1080/21642850.2014.905209