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The Caribbean’s Worst Plague: HIV/AIDS

Anthony T. Bryan (1)
Dante B. Fascell North-South Center, University of Miami

AIDS will soon surpass the Black Death or bubonic plague as the world’s worst pandemic if a vaccine is not found and the 40 million people living with HIV/AIDS do not receive the necessary anti-retroviral drugs that could prolong their life. Public health experts point out that if global access to treatment for HIV/AIDS is not improved in the next 10-15 years, the death toll could rise as high as 65 million people.

As the AIDS pandemic enters its third decade, the available global statistics are alarming. By December 2001, 40 million persons worldwide were living with HIV/AIDS. In 2001 alone, five million more people were infected with HIV, and three million AIDS-related deaths were reported throughout the world. Since the beginning of the epidemic in the late 1970s, 21.8 million persons have died. While new AIDS cases have begun to level off or decrease in developed nations, the infection rate is on the rise in sub-Saharan Africa, Southeast Asia, the former Soviet Union, and the Americas. By December 2000, 25.3 million people in sub-Saharan Africa were living with AIDS, accounting for two-thirds of HIV/AIDS cases reported globally. The United Nations Program on HIV/AIDS (UNAIDS) estimates that up to 25 percent of the population in some African countries have succumbed to the disease.

The Caribbean Profile

Sub-Saharan Africa is not the only region where AIDS is becoming a crisis. The Caribbean now ranks second in the world for the number of cases per capita of HIV/AIDS. Although the exact number of persons in the Caribbean who are HIV-positive is difficult to ascertain, due to a lack of standardized reporting, a World Bank report estimates that, as of December 2000, there were 390,000 persons living with AIDS. 60,000 adults and children contracted the virus in that year alone. According to recent studies, almost two in every 100 Caribbean residents between the ages of 15 and 50 are infected with HIV, and a growing number of cases are occurring among individuals who are between 15-44 years of age, the most labor-productive segment of the population.

However, as the UNAIDS report on HIV/AIDS in the Caribbean shows, there are important national differences in the Caribbean profile. Hispanola, with 87 percent of all AIDS cases in the Caribbean, is the epicenter of the epidemic. It is estimated that 5 percent of the population in Haiti is living with HIV/AIDS. With a population of 7 million, the country accounts for only 24 percent of the Caribbean population but has 61 percent of the region’s AIDS cases and one of the world’s highest infection rates. More than 140,000 people are living with HIV/AIDS in the Dominican Republic, where the infection rate is as high as 46 percent among sex workers and 2 percent in the overall population. Four percent of the adult population are infected in the Bahamas, and nearly 40 percent of young male deaths in St. Vincent and the Grenadines are attributed to AIDS.

Social and Economic Impacts

The Caribbean AIDS crisis has serious implications for the region’s labor supply and life expectancy as well as for the survival of its orphaned youth. The region’s economic growth in sectors such as education, health, tourism, agriculture, and business is also being threatened by the disease. While poverty and inequity have been suggested as major factors in the spread of the disease, HIV/AIDS is itself becoming a threat to economic growth in relatively prosperous countries, such as Trinidad and Tobago and Jamaica, which can expect serious reductions in productivity if infection rates are not controlled. Estimates from the Health Economics Unit at the University of the West Indies predict that in 2005 over 4 percent of the gross domestic product (GDP) in Trinidad and Tobago and 6 percent in Jamaica could be lost due to AIDS. That same year, savings could decline by more than 10.3 percent in Trinidad and Tobago and 23.5 percent in Jamaica. Investment in Trinidad and Tobago could drop by 15.6 percent and by 17.4 percent in Jamaica. Estimates by the Global Network of People Living With Aids (GNP+) predict that the Caribbean region, as a whole, could lose 5 percent of its GDP because of AIDS in 2005.

The Gender Differential

Increasingly, Caribbean women are being affected with HIV/AIDS in greater numbers than men. Indeed, women are more vulnerable to the disease largely because of their socio-economic status and a culture of male domination. In Haiti and the Dominican Republic, HIV/AIDS affects women and men equally. However, in other countries, the female/male ratio shows a clear disparity. In Dominica, for example, the ratio is 3.6:1; Barbados, 2.8:1; and 2.4:1 in Trinidad. In Puerto Rico, the percentage of infected women has nearly doubled from 11 to 21.6 percent over the last decade. Since the population most infected with HIV/AIDS is between 15-44 years old, the childbearing age, there is also an increase in the number of cases among pregnant women. In Haiti and Guyana, the infection rate among pregnant women is 7-8 percent. Between 25-30 percent of infected mothers transmit the virus to their children in utero, during delivery, or through breast-feeding (“AIDS in the Caribbean,” Sun-Sentinel, June 10, 2001). Although administration of anti-retroviral drugs, among other measures, can prevent transmission of the virus from mothers to their babies, the cost of these medications puts them out of reach of poor women in developing countries.

The Youngest Victims

Babies and young children who must fend for themselves are the youngest victims of AIDS. Worldwide, since the beginning of the epidemic until the end of 2000, there have been 13.2 million AIDS orphans. AIDS orphanages have been established in Haiti, Trinidad, and other Caribbean countries with serious AIDS problems. Many of these orphans are HIV-positive. In order to support themselves and their siblings, some children in these Caribbean countries resort to prostitution. Studies by the United Nations Children’s Fund (UNICEF) report 50,000 child prostitutes in the Dominican Republic alone. The Jamaican Ministry of Health registry lists 200 children who are HIV-positive and homeless (“AIDS in the Caribbean,” Sun-Sentinel, June 10, 2001).

Risk Factors

Some of the risk factors of HIV/AIDS in the Caribbean include poverty, unemployment, and inadequate access to basic services and social inequities. However, various social and cultural factors also increase the chances of contracting HIV, such as having multiple sexual partners, socio-economic dependence of women on men, early sexual activity and frequent partner exchange by young people, and the failure to use condoms, even when available. Young men and women are also vulnerable to the sex tourism trade. Sex tourism draws persons of both genders and several age groups into the trade. The new sex workers are part-timers who use sex to supplement falling incomes. “Beach boys” or “rent-a-dreads,” young men who are part of the sex trade, have become staples throughout the Caribbean. (North-South Agenda Paper Fifty-Two, “Caribbean Tourism: Igniting the Engines of Sustainable Growth”).

A Shared Global Solution

International organizations such as the World Health Organization (WHO) and the United Nations are taking actions to redress the spread of HIV/AIDS. These  measures include the development of strong leadership in government, active participation of civil society and the private sector, and the development and implementation of multi-sectoral national strategies and financing plans for combating HIV/AIDS at the national and regional levels. The Pan-Caribbean Partnership Against HIV/AIDS is one such initiative.

Caribbean countries have also joined together to mobilize more resources. In April 2001, at the Summit of the Americas in Quebec, World Bank President James Wolfensohn presented plans to devote up to US$150 million to fight HIV/AIDS in the Caribbean. The bank also proposed a conditional loan package of up to $100 million to help fight the disease. The second phase of the European Commission/Caribbean Community and Common Market (CARICOM) HIV Project is also providing a $1.063-million initiative, and the government of the Netherlands has also agreed to provide $2.5 million to combat HIV/AIDS in the Caribbean. These funds will be used to address some of the priorities outlined in a regional plan of action. For example, the government of Trinidad and Tobago already has been able to negotiate a reduction of more than 90 percent on the cost of anti-retroviral drugs, effectively reducing the price for individuals of the necessary triple therapy treatments from US$12,000 to US$1,184 annually.

Retroviruses do not respect international borders, and many developed nations express growing concern about the rising infection rates among developing nations. To be truly effective, responses to the AIDS crisis must be shared and comprehensive. The loss of productivity among family wage earners; the related political, social, and economic instability; and emerging and re-emerging diseases associated with HIV/AIDS present large and growing public health and public policy dilemmas.

In sum, the spread of AIDS has become a threat to regional development and regional security in the Caribbean. After years of prevention and control efforts, the regional response in some countries has made progress in some countries, albeit with limited resources. However, further advances will require international cooperation. Such assistance should include the support of public and private partnerships to improve access and availability of HIV/AIDS treatment; increased access to reliable and appropriate educational material for HIV/AIDS prevention using evidence-based research; and increased awareness of HIV/AIDS through training and outreach of health professionals at the community, national, and regional levels.

April 8, 2002

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1) Anthony T. Bryan, Ph.D.: Director of the Caribbean Studies Program at the North-South Center. He is also a senior research associate of the Center for Strategic and International Studies in Washington, D.C.

He received a Ph.D. in Latin American History from the University of Nebraska at Lincoln.  He is the author of more than 100 scholarly articles and the author/editor of 11 books and monographs on  Caribbean and Latin American affairs. He has published widely on trade and integration, smaller economies, international relations, small state diplomacy, sustainable tourism, and regional security issues.

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