Understanding the HIV Epidemic in the Dominican Republic: A Prevention Success Story in the Caribbean?

Department of Global Health and Population, Harvard University School of Public Health, Boston, MA 02115, USA.
JAIDS Journal of Acquired Immune Deficiency Syndromes (Impact Factor: 4.56). 05/2009; 51 Suppl 1(1):S52-9. DOI: 10.1097/QAI.0b013e3181a267e4
Source: PubMed


To analyze the general dynamics and trends of the HIV epidemic in the Dominican Republic (DR).
Thorough review of available HIV seroprevalence and sexual behavioral data from the DR.
Multiple sources of data suggest that the DR's HIV epidemic has generally declined. Between the mid-1990s and about 2002, HIV-1 prevalence fell among pregnant women in the capital, Santo Domingo, particularly among young women. Declines in prevalence were also observed over the same period among sexually transmitted infection clinic patients, blood bank donors, US entry visa applicants, and female sex workers. National household surveys found 1.0% (confidence interval: 0.9% to 1.1%) adult prevalence in 2002 and 0.8% (0.6% to 0.9%) in 2007. Among largely Haitian immigrant residents of the impoverished former "sugarcane plantations," prevalence was much higher but declined from 5.0% to 3.2% between 2002 and 2007. The DR's heterogeneous epidemic includes an important men-having-sex-with-men (MSM) and bisexual component. The proportion of reported AIDS cases among men remained constant from 1989 to 2006, accounting for about two thirds of both total cumulative and year 2006 cases. Some survey and qualitative data also suggest a considerable occurrence of MSM-related risk behaviors. HIV prevalence remains relatively high in MSM, with no evidence of significant decrease.
As in several other developing countries that have succeeded in slowing HIV transmission, HIV reductions in the DR seem mainly due to changes in sexual behavior, particularly increased condom use, especially for sex work, and partner reduction in men. Similarly favorable HIV declines and reported behavior change have occurred in some other Caribbean countries, including neighboring Haiti. However, of concern is that anal sex, both male-male and heterosexual, remains a taboo yet apparently common practice largely ignored by existing prevention campaigns. And although the DR epidemic has generally stabilized, there is a danger of complacency, and some recent data suggest that HIV prevalence is no longer declining (and may even be increasing) in some populations.

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    • "The HIV epidemic in the Dominican Republic is characterised as concentrated, with a disproportionate burden among specific populations including female sex workers and their sexual partners, men who have sex with men and individuals who use drugs (COPRESIDA 2008; Halperin et al. 2009). Compared to the 0.7% national HIV prevalence among 15–49 year olds, HIV prevalence among female sex workers ranges from 3.3% to 8.4% (COPRESIDA 2008). "
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    ABSTRACT: While men's social networks have been identified as a source of influence on sexual behaviour, less is known about the different types of friendship ties within men's networks. We analysed data from qualitative in-depth interviews with 36 men in Santo Domingo, Dominican Republic who are current or former sexual partners of female sex workers to understand how: (1) men describe trust and communication with different types of friendship ties, (2) characteristics of trust and communication reflect norms of masculinity, and (3) these friendship ties influence HIV-related behaviours. We identified a distinction between amistades, social drinking buddies who are not trusted, and amigos, trusted friends. The majority of men lacked any amigos and some had neither amigos nor amistades. In general, men reflected traditional norms of masculinity and said they did not feel they could discuss their relationships or emotional topics with other men. Trust and communication dynamics, and how norms of masculinity shape those dynamics, should be understood and addressed in the design of HIV prevention efforts with men's social networks as they have implications for the potential effectiveness of such efforts.
    Culture Health & Sexuality 06/2014; 16(8):1-15. DOI:10.1080/13691058.2014.919028 · 1.55 Impact Factor
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    • "There is less information widely available about other sexual health concerns among this population . This is particularly true for MSM in the Caribbean where the study of sexuality in this group can be impacted by the negative perceptions about same-sex practices, homophobia, stigma, and discrimination (Abell et al. 2007; Clatts et al. 2012; Halperin et al. 2009). To contribute to the research among MSM in the region, Colón-López and colleagues shared their findings from a population-based sample in Puerto Rico. "
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    • "These increases coincide with and largely explain the decrease in MTCT observed in the years since the publication of guidelines for use of HAART for pMTCT. They also coincide with some national trends that suggest a possible decline in HIV prevalence and unsafe sex practices, and documented increase in HAART use nationwide [1, 12, 16, 22, 23]. "
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    ABSTRACT: In 1999, prevention of mother-to-child transmission (pMTCT) using antiretrovirals was introduced in the Dominican Republic (DR). Highly active antiretroviral therapy (HAART) was introduced for immunosuppressed persons in 2004 and for pMTCT in 2008. To assess progress towards MTCT elimination, data from requisitions for HIV nucleic acid amplification tests for diagnosis of HIV infection in perinatally exposed infants born in the DR from 1999 to 2011 were analyzed. The MTCT rate was 142/1,274 (11.1%) in 1999–2008 and 12/302 (4.0%) in 2009–2011 ( P < .001 ), with a rate of 154/1,576 (9.8%) for both periods combined. This decline was associated with significant increases in the proportions of women who received prenatal HAART (from 12.3% to 67.9%) and infants who received exclusive formula feeding (from 76.3% to 86.1%) and declines in proportions of women who received no prenatal antiretrovirals (from 31.9% to 12.2%) or received only single-dose nevirapine (from 39.5% to 19.5%). In 2007, over 95% of DR pregnant women received prenatal care, HIV testing, and professionally attended delivery. However, only 58% of women in underserved sugarcane plantation communities (2007) and 76% in HIV sentinel surveillance hospitals (2003–2005) received their HIV test results. HIV-MTCT elimination is feasible but persistent lack of access to critical pMTCT measures must be addressed.
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