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: This study estimates HIV prevalence among men who have sex with men (MSM) in Jamaica and explores social determinants of HIV infection among MSM. An island-wide cross-sectional survey of MSM recruited by peer referral and outreach was conducted in 2011. A structured questionnaire was administered and HIV/STI tests done. We compared three groups: MSM who accepted cash for sex within the past 3 months (MSM SW), MSM who did not accept cash for sex (MSM non-SW), and MSM with adverse life events (ever raped, jailed, homeless, victim of violence or low literacy). HIV prevalence among 449 MSM was 31.4%, MSM SW 41.1%, MSM with adverse life events 38.5%, 17 transgender MSM (52.9%), and MSM non-SW without adverse events 21.0%. HIV prevalence increased with age and number of adverse life events (test for trend P < 0.001), as did STI prevalence (P = 0.03). HIV incidence was 6.7 cases/100 person-years (95% CI: 3.74, 12.19). HIV prevalence was highest among MSM reporting high-risk sex; MSM SW who had been raped (65.0%), had a STI (61.2%) and who self identified as female (55.6%). Significant risk factors for HIV infection common to all 3 subgroups were participation in both receptive and insertive anal intercourse, high-risk sex, and history of a STI. Perception of no or little risk, always using a condom, and being bisexual were protective. HIV prevalence was high among MSM SW and MSM with adverse life events. Given the characteristics of the sample, HIV prevalence among MSM in Jamaica is probably in the range of 20%. The study illustrates the importance of social vulnerability in driving the HIV epidemic. Programs to empower young MSM, reduce social vulnerability and other structural barriers including stigma and discrimination against MSM are critical to reduce HIV transmission.
    PLoS ONE 02/2015; 10(2):e0117686. DOI:10.1371/journal.pone.0117686 · 3.53 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