Advertisement

Current HIV/AIDS Reports

, Volume 11, Issue 2, pp 158–167 | Cite as

Review of HIV in the Caribbean: Significant Progress and Outstanding Challenges

  • J. Peter Figueroa
The Global Epidemic (S Vermund, Section Editor)

Abstract

This paper reviews the recent literature on HIV in the Caribbean and discusses the challenges faced. HIV incidence in the Caribbean has declined by 49 % in the past decade, coverage of persons living with HIV among those eligible for antiretroviral treatment as per national guidelines was 70 % in 2012, and some countries are meeting the target of virtual elimination of mother-to-child transmission. HIV prevalence in the Caribbean is 1 % with features of both a generalized and concentrated HIV epidemic. HIV prevalence among female sex workers has declined but remains unacceptably high among men who have sex with men. Social and cultural factors, gender norms, and strong stigma associated with HIV and homosexuality contribute to the continued spread of HIV. Caribbean countries and their partners have invested significant resources, creative effort and impressive research in strengthening the HIV response nationally and regionally. However, in order to control the HIV epidemic, leaders at all levels, and the people, must address fundamental structural barriers in society that deny marginalized persons their rights, undermine public health goals, and impede universal access to HIV prevention, treatment, and care.

Keywords

HIV AIDS HIV/AIDS STI Caribbean Sex worker MSM Adolescent Youth Sexual behavior Risk behavior Risk factor Drug user Prison HIV stigma Social factors Gender Social vulnerability Violence Research Barbados Dominican Republic Guyana Haiti Jamaica Global epidemic 

Notes

Compliance with Ethics Guidelines

Conflict of Interest

J. Peter Figueroa declares that he has no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    UNAIDS Report on the Global AIDS Epidemic 2013. Accessed on 23 December 2013 at http://www.unaids.org/en/media/unaids/contentassets/documents/epidemiology/2013/gr2013/UNAIDS_Global_Report_2013_en.pdf.
  2. 2.
    Figueroa JP. The HIV, epidemic in the Caribbean: meeting the challenges ofc achieving universal access to prevention, treatment and care. West Indian Med J. 2008;57(3):195–203.PubMedGoogle Scholar
  3. 3.
    UNAIDS Keeping Score III The Voice of the Caribbean People. UNAIDS 2011. Accessed on 23 December 2013 at http://observatoriovihycarceles.org/es/caribe.raw?task=download&fid=210.
  4. 4.
    UNAIDS Keeping Score II 2008. Accessed on 23 December 2013 at http://data.unaids.org/pub/Report/2008/20081206_keepingscoreii_en.pdf.
  5. 5.
    Ministry of Health, Barbados. The Barbados HIV/AIDS Surveillance Report 2010. Ministry of Health, Barbados 2012. Accessed on 23 December 2013 at http://www.colesxmedia.com/flipbooks/HIV/files/assets/basic-html/#toc.
  6. 6.
    Anderson T. HIV/AIDS in Cuba: Lessons and Challenges. Rev Panam Salud Publ. 2009;26(1):78–86.CrossRefGoogle Scholar
  7. 7.•
    Binns LA. An Unassuming Revelation: Cuba’s Social Policy toward the AIDS Epidemic. West Indian Med J. 2013;62(4):368–73. Cuba’s success in controlling their HIV epidemic needs to be recognized and better understood.PubMedGoogle Scholar
  8. 8.
    Halperin DT, de Moya EA, Pérez-Then E, Pappas G, Calleja JMG. Understanding the HIV epidemic in the Dominican Republic: a prevention success story in the Caribbean? JAIDS. 2009;51:S52–9.PubMedGoogle Scholar
  9. 9.
    Gaillard EM, Boulos L-M, Cayemittes MPA, Eustache L, Van Onacker JD, Duval N, et al. Understanding the reasons for decline of HIV prevalence in Haiti. Sex Transm Infect. 2006;82 suppl 1:i14–20.PubMedCentralPubMedCrossRefGoogle Scholar
  10. 10.
    Figueroa JP, Duncan J, Byfield L, Harvey K, Gebre Y, Hylton-Kong T, et al. A comprehensive response to the HIV/AIDS epidemic in Jamaica: a review of the past 20 years. West Indian Med J. 2008;57(6):562–76.PubMedGoogle Scholar
  11. 11.•
    Figueroa JP. The critical role of locally conducted research in guiding the response to the HIV epidemic in Jamaica. West Indian Med J. 2012;61(4):387–95. This paper reviews how locally conducted research contributed to controlling the HIV epidemic in Jamaica.PubMedCrossRefGoogle Scholar
  12. 12.
    UNAIDS http://www.unaids.org/en/regionscountries/countries/ Accessed on 22 December 2013.
  13. 13.
    UNAIDS Fact Sheet. Accessed on 22 December 2013 at http://www.unaids.org/en/resources/campaigns/globalreport2013/factsheet/.
  14. 14.
    UNAIDS Global Report 2012. Accessed on 22 December 2013 at http://www.unaids.org/en/resources/publications/2012/name,76121,en.asp.
  15. 15.
    Mathers CD, Boerma T, Ma FD. Global and regional causes of death. Br Med Bull. 2009;92(1):7–32.PubMedCrossRefGoogle Scholar
  16. 16.
    Duncan J, Beckford Jarrett S, Harvey K. Using estimation and projection package and Spectrum for Jamaica's national HIV estimates and targets. Sex Transm Infect. 2010;86(suppl II):ii43–7.PubMedCentralPubMedGoogle Scholar
  17. 17.•
    Rojas P, Malow R, Ruffin B, Rosenburg R. The HIV/AIDS Epidemic in the Dominican Republic Key Contributing Factors. J Int Assoc Providers AIDS Care (JIAPAC). 2011;10(5):306–15. This article reviews HIV/AIDS epidemiological data and recent research conducted in the Dominican Republic, with a focus on explaining the variability in estimated seroincidence and prevalence within the country.CrossRefGoogle Scholar
  18. 18.•
    UNAIDS, Jamaica National HIV/STI Program. Modes of HIV Transmission in Jamaica. Distribution of new HIV infections in Jamaica for 2012: Recommendations for efficient resource allocation and prevention strategies. 2013. This is the modes of transmission study for Jamaica 2012.Google Scholar
  19. 19.••
    Figueroa JP, Weir SS, Jones Cooper C, Byfield L, Hobbs M, Mcknight I, et al. High HIV Prevalence among MSM in Jamaica is associated with Social Vulnerability and other Sexually Transmitted Infections. West Indian Med J. 2013;62(4):286–91. This paper reports on a 2007 survey of 201 MSM in Jamaica in which HIV prevalence was 32%. Most of the men were of lower socio-economic status and many were socially vulnerable as well as sex workers. This illustrates the importance of social vulnerability among these MSM and helps to explain the high HIV prevalence reported for Jamaica.PubMedCentralPubMedGoogle Scholar
  20. 20.
    UNAIDS, Consejo Presidencial del SIDA, Direccion General de Infecciones de Transmission Sexual y SIDA. HIV Modes of Transmission Model: Analysis of the distribution of new HIV infections in the Domican Republic for prevention 2010.Google Scholar
  21. 21.
    Figueroa JP, Jones Cooper C, Edwards J, Byfield L, Eastman S, Hobbs M, Weir SS. Understanding the High Prevalence of HIV and other Sexually Transmitted Infections among Socio-economically Vulnerable Men who have Sex with Men in Jamaica. Submitted.Google Scholar
  22. 22.
    Beyrer C, Baral SD, van Griensven F, Goodreau SM, Chariyalertsak S, Wirtz AL, et al. Global epidemiology of HIV infection in men who have sex with men. Lancet July 2012 special issue on HIV in men who have sex with men 19-29.Google Scholar
  23. 23.
    Allen CF, Edwards M, Williamson L, Kitson-Piggott W, Wagner H-U, Camara B, et al. Sexually Transmitted infection Service Use and Risk Factors for HIV Infection among Female Sex Workers in Georgetown, Guyana. JAIDS. 2006;43:96–101.PubMedGoogle Scholar
  24. 24.
    Dechamps MM, Zorrilla CD, Morgan CA, Donastorg Y, Metch B, Madenwald T, et al. Recruitment of female commercial sex workers at high risk of HIV infection. Rev Panam Salud Publ. 2013;34(2):92–8.Google Scholar
  25. 25.
    Duncan J, Gebre Y, Grant Y, Wedderburn M, Byfield L, Bourne D, et al. HIV Prevalence and Related Behaviours among Sex Workers in Jamaica. Sex Transm Dis. 2010;37(5):306–10.PubMedGoogle Scholar
  26. 26.
    Duncan J, Weir SS, Byfield L, Jones-Cooper C, Jarrett S, Figueroa JP. STI prevalence and Risk Behaviours among Club-based and Street-based Sex Workers in Jamaica. Submitted.Google Scholar
  27. 27.
    Jamaica National HIV/STI Program. HIV Epidemic Update Facts and Figures 2011. Accessed 28 December 2013 at http://www.nhpjamaica.org/hiv-epidemic-update-facts-and-figures-2011.
  28. 28.
    Puerto Rico Department of Health. Puerto Rico Statewide Coordinated Statement of Need 2012 and HIV Treatment Comprehensive Plan 2012 – 2015. Accessed on 2 February 2014 at http://www.salud.gov.pr/Programas/ryanwhiteparteb/Documents/StateWide%20Coordinated%20Statement%20of%20Need%202012%20and%20Puerto%20Rico%20HIV%20Comprehensive%20Plan%202012-15.pdf.
  29. 29.
    Gomez MP, Kimball AM, Orlander H, Bain RM, Fisher LD, Holmes KK. Epidemic crack cocaine use linked with epidemics of genital ulcer disease and heterosexual HIV infection in the Bahamas: Evidence of impact of prevention and control measures. Sex Transm Dis. 2002;29:259–64.PubMedCrossRefGoogle Scholar
  30. 30.
    Andrinopoulos K, Kerrigan D, Figueroa JP, Reese R, Gaydos C, Bennett L, et al. Establishment of an HIV/sexually transmitted disease programme and prevalence of infection among incarcerated men in Jamaica. Int J STD AIDS. 2010;21:114–9.PubMedCentralPubMedCrossRefGoogle Scholar
  31. 31.
    Gough E, Edwards P. HIV seroprevalence and associated risk factors among male inmates at the Belize Central Prison. Rev Panam Salud Publ. 2009;25(4):292–9.CrossRefGoogle Scholar
  32. 32.
    Rodríguez-Díaz CE, Reece M, Rivera-Alonso B, Laureano-Landrón I, Dodge B, Malow RM. Behind the Bars of Paradise: HIV and Substance Use among Incarcerated Populations in Puerto Rico. JIAPAC Publ Online. 2011. doi: 10.1177/1545109711398664.Google Scholar
  33. 33.
    Boisson EV, Trotman C. HIV Seroprevalence Among Male Prison Inmates in the Six Countries of the Organization of Eastern Caribbean States in the Caribbean (OECS). West Indian Med J. 2009;58(2):106.PubMedGoogle Scholar
  34. 34.
    Andrinopoulos K, Figueroa JP, Kerrigan D, Ellen JM. Homophobia, stigma and HIV in Jamaican prisons. Cult Health Sex. 2011;13(2):187–200. doi: 10.1080/13691058.2010.521575.PubMedCentralPubMedCrossRefGoogle Scholar
  35. 35.
    Andrinopoulos K, Kerrigan D, Figueroa JP, Reese R, Ellen JM. HIV coping self efficacy: a key to understanding stigma and HIV test acceptance among incarcerated men in Jamaica. AIDS Care. 2010;22(3):339–47.PubMedCentralPubMedCrossRefGoogle Scholar
  36. 36.
    Anastario MP, Tavarez MI, Chun H. Sexual risk behavior among military personel stationed at border-crossing zones in the Dominican Republic. Rev Panam Salud Publ. 2010;28(5):361–7.Google Scholar
  37. 37.
    Allen CF, Edwards P, Grennari F, Caffe S, Boisson E, Jones S, et al. Evidence on Delay in Sexual Initiation, Multiple Partnerships and Condom Use among Young People: Review of Caribbean HIV Behavioural Studies. West Indian Med J. 2013;62(4):292–8.PubMedGoogle Scholar
  38. 38.
    Devieux JG, Rosenburg R, Saint-Jean G, Bryant VE, Malow RM. The Continuing Challenge of Reducing HIV Risk among Haitian Youth: The Need for Intervention. J Int Assoc Providers AIDS Care. 2013. doi: 10.1177/2325957411418119.Google Scholar
  39. 39.
    Lashley J, Yearwood J. Drug Use and Risky Sexual Behaviour in Tertiary Institutions in Barbados: Personal and ‘Liberal Campus’ Effects. J East Caribb Stud. 2011;36(4):60–90.Google Scholar
  40. 40.
    Andrews B. Sociodemographic and Behavioural Characteristics of Youth Reporting HIV Testing in Three Caribbean Countries. West Indian Med J. 2011;60(3):276–83.PubMedGoogle Scholar
  41. 41.
    Figueroa JP. The Challenge of Sexually Active School Children in the Caribbean in the era of HIV/AIDS. Chapter in Challenging HIV & AIDS: A new role for Caribbean Education, pages 167-173. Ed M Morrissey, M Bernard, D Bundy. Ian Randle Publishers, UNESCO 2010.Google Scholar
  42. 42.
    Morrissey M. Response of the Education System in the Commonwealth Caribbean to the HIV/AIDS Epidemic: A Preliminary Overview. Chapter in Challenging HIV & AIDS: A new role for Caribbean Education, pages 1-13. Ed M Morrissey, M Bernard, D Bundy. Ian Randle Publishers, UNESCO 2010.Google Scholar
  43. 43.
    The CARICOM Secretariat. HIV and AIDS Education Through HFLE for 10-14 year olds. Chapter in Challenging HIV & AIDS: A new role for Caribbean Education, pages 289-303. Ed M Morrissey, M Bernard, D Bundy. Ian Randle Publishers, UNESCO 2010.Google Scholar
  44. 44.
    Barrow C. Sexual Identity, HIV and Adolescent Girls in Barbados. Soc Econ Stud. 2008;57(2):7–26.Google Scholar
  45. 45.
    Plummer D. HIV in Caribbean Schools: The Role of Education in the Second Most Severely Affected Region in the World. Chapter in Challenging HIV & AIDS: A new role for Caribbean Education, pages 14-25. Ed M Morrissey, M Bernard, D Bundy. Ian Randle Publishers, UNESCO 2010.Google Scholar
  46. 46.•
    Challenging HIV & AIDS: A new role for Caribbean Education. Ed M Morrissey, M Bernard, D Bundy. Ian Randle Publishers, UNESCO 2010. This is an important collection of papers exploring the implications of HIV for the education sector in the Caribbean.Google Scholar
  47. 47.
    Hutchinson MK, Kahwa E, Waldron N, Hepburn Brown C, Hamilton PI, Hewitt HH, et al. Jamaican Mothers’ Influences of Adolescent Girls’ Sexual Beliefs and Behaviors. J Nurs Scholarsh. 2012;44(1):27–35. doi: 10.1111/j.1547-5069.2011.01431.PubMedCentralPubMedCrossRefGoogle Scholar
  48. 48.
    Kempadoo K, Taitt A. Gender, Sexuality and Implications for HIV/AIDS in the Caribbean: A Review of Literature and Programmes. UNIFEM and IDRC 2006.Google Scholar
  49. 49.
    Bombereau G, Allen C. Social and Cultural factors driving the HIV epidemic in the Caribbean: a literature review. Caribbean Health Research Council 2008.Google Scholar
  50. 50.
    Figueroa JP. Understanding Sexual Behaviour in Jamaica. In: Horace L, editor. “The African-Caribbean Worldview and the Making of Caribbean Society”. Kingston: University of the West Indies Press; 2009.Google Scholar
  51. 51.
    Anderson P. Measuring Masculinity in an Afro-Caribbean Context. Soc Econ Studies Nov 2011.Google Scholar
  52. 52.
    Lefranc E, Wyatt GE, Chambers C, Eldemire D, Bain B, Ricketts H. Working Women’s Sexual Risk Taking in Jamaica. Soc Sci Med. 1996;42(10):1411–7.CrossRefGoogle Scholar
  53. 53.
    Padilla MB, Guilamo-Ramos V, Bouris A, Reyes AM. HIV/AIDS and tourism in the Caribbean: an ecological systems perspective. Am J Public Health. 2010;100(1):70–7.PubMedCentralPubMedCrossRefGoogle Scholar
  54. 54.
    Padilla MB, Guilamo-Ramos V, Godbole R. A Syndemic Analysis of Alcohol Use and Sexual Risk Behavior Among Tourism Employees in Sosúa. Dominican Repub Qual Health Res. 2012;22(1):89–102.CrossRefGoogle Scholar
  55. 55.
    Boxill I, at al. Tourism & HIV/AIDS in Jamaica & The Bahamas. Arawak Publications 2005.Google Scholar
  56. 56.
    Allen C. Intersections between HIV/AIDS and Violence Against Women: Research to Develop Pilot Projects in Barbados and Dominica. J East Carib Stud. 2011;36(4):39–59.Google Scholar
  57. 57.
    Le Franc E, Samms-Vaughan M, Hambleton I, Fox K, Brown D. Interpersonal violence in three Caribbean countries: Barbados, Jamaica, and Trinidad and Tobago. Rev Panam Salud Publ. 2008;24(6):409–21.CrossRefGoogle Scholar
  58. 58.
    Casado W, Skewes R. Domestic violence in San Jose De Ocoa, Dominican Republic 2008–2011. Inj Prev. 2012;18:A180. doi: 10.1136/injuryprev-2012-040590q.CrossRefGoogle Scholar
  59. 59.
    Forbes MA. Music, Media & Adolescent Sexuality in Jamaica. Arawak Publications 2010.Google Scholar
  60. 60.
    Rowe Y. Vitamin S: Messages, Music and Video – An Analysis of the sexual Content and Perceptions of Sexuality Communicated in Popular Music Videos. Soc Econ Stud. 2013;62(1):227–47.Google Scholar
  61. 61.••
    Barrow C, Aggleton P. Good face, Bad Mind? HIV Stigma and Tolerance Rhetoric in Barbados. Soc Econ Stud. 2013;62(1):29–52. The authors analyse the limits of tolerance as an antidote to stigma and discrimination and call for fundamental “reform of discriminatory laws, along with county-specific mechanisms for stigma elimination, sanctions and redress for discrimination”.Google Scholar
  62. 62.
    Plummer D, McLean A. The Price of Prejudice: The Corrosive Effect of HIV-Related Stigma on Individuals and Society. Chapter in Challenging HIV & AIDS: A new role for Caribbean Education, pages 232-239. Ed M Morrissey, M Bernard, D Bundy. Ian Randle Publishers, UNESCO 2010.Google Scholar
  63. 63.
    Clarke TR, Gibson R, Barrow G, James S, Abel WD, Barton EN. Disclosure of HIV status among HIV clinic attendees in Jamaica. West Indian Med J. 2010;59(4):445–9.PubMedGoogle Scholar
  64. 64.
    Padilla MB, Reyes AM, Connolly M, Natsui S, Puello A, Chapman H. Examining the policy climate for HIV prevention in the Caribbean tourism sector: a qualitative study of policy makers. Dominican Repub Health Policy Plan. 2012;27(3):245–55.CrossRefGoogle Scholar
  65. 65.
    St John A, Mascoll K, Waterman I, Chrichlow S. Ruther Reduction in Mother-To-Child Transmission of HIV in Barbados following intervention with HAART. J East Carib Stud. 2011;36(4):28–38.Google Scholar
  66. 66.
    Christie CDC, Pierre R. Eliminating Vertically-transmitted HIV/AIDS while Improving Acess to Treatment and Care for Women, Children and Adolescents in Jamaica. West Indian Med J. 2012;61(4):396.PubMedCrossRefGoogle Scholar
  67. 67.
    Morgan ND, Ferguson TS, Younger NOM, Tulloch-Reid MK, Francis DK, McFarlane SR, et al. Prevalence of High-risk Sexual Behaviour in Jamaican Adults and its Relationship to Sociodemographic and Religious Factors: Findings from the Jamaica Health and Lifestyle Survey 2007-2008. West Indian Med J. 2012;61(9):873–80.PubMedCrossRefGoogle Scholar
  68. 68.
    White L, Byfield L, Sutherland S, Reid R. “Pinch, Leave an Inch and Roll” Applying the Communication-for-Behavioural-Impact (COMBI) Approach to the Promotion of Proper Male Condom Use in Jamaica. Caribb Q. 2012;58:43–66.Google Scholar
  69. 69.
    Weir SS, Figueroa JP, Byfield L, Hall A, Cummings S. Suchindran. Randomized controlled trial to investigate the impact of site-based safer sex programmes in Kingston, Jamaica: trial design, methods and baseline findings. Trop Med Int Health. 2008;13(6):801–13.PubMedCrossRefGoogle Scholar
  70. 70.••
    Figueroa JP, Weir SS, Byfield L, Hall A, Cummings S, Suckindron C. The Challenge of promoting safe sex at sites where persons go to meet new sex partners in Jamaica: results of the Kingston PLACE randomized controlled trial. Trop Med Int Health. 2010;15(8):945–54. In the Kingston PLACE randomized controlled trial, 147 sites where persons go to meet new sex partners were grouped into 50 geographic clusters and randomized to receive or not receive a multilevel PLACE intervention during 2006. There was no significant difference between the intervention and control groups in the proportion of men and women who reported new or multiple relationships in the past year and inconsistent condom use. Reasons given for the failure to show an intervention effect included difficulty in implementation, patron mixing among sites, intensity of national education campaigns, delay in conducting the post-intervention survey and evidence of other interventions at some control sites.Google Scholar
  71. 71.
    Anderson C, Gallo MF, Hylton-Kong T, Steiner MJ, Hobbs MM, Macaluso M, et al. Randomized controlled trial on the effectiveness of counseling messages for avoiding unprotected sexual intercourse during STI and reproductive tract infection treatment among female STI clinic patients. Sex Transm Dis. 2013;40(2):105–10.Google Scholar
  72. 72.
    Chin-Quee DS, Wedderburn M, Otterness C, Janowitz B, Chen-Mok M. Bridging emergency contraceptive pill users to regular contraception: results from a randomized trial in Jamaica. Contraception. 2010;81(2):133–9.PubMedCrossRefGoogle Scholar
  73. 73.
    Figueroa JP, Jones-Cooper C. Attitudes towards male circumcision among attendees of a sexually transmitted infection clinic in Kingston, Jamaica. West Indian Med J. 2010;59(4):351–5.PubMedGoogle Scholar
  74. 74.
    Walcott MM, Jolly PE, Ehiri JE, Funkhouser E, Kempf MC, Hickman D, et al. Factors associated with the acceptability of male circumcision among men in Jamaica. PLoS One. 2013;8(9):e75074. doi: 10.1371/journal.pone.0075074.PubMedCentralPubMedCrossRefGoogle Scholar
  75. 75.
    Carter M, Gallo M, Anderson C, Snead MC, Wiener J, Costenbader E, et al. Intraviginal Cleansing among Women Attending a Sexually Transmitted Infection Clinic in Kingston, Jamaica. West Indian Med J. 2013;62(1):56–61.PubMedGoogle Scholar
  76. 76.
    Foster TM, Lee MG, McGaw CD, Frankson MA. Prevalence of Needlestick Injuries and other High Risk Exposures among Healthcare Workers in Jamaica. West Indian Med J. 2010;59(2):153–8.PubMedGoogle Scholar
  77. 77.
    World Health Organization. WHO Consolidated Guidelines on The use of ARV drugs for treating and preventing HIV infection: Recommendations for a public health approach. Geneva: WHO, June 2013: http://apps.who.int/iris/bitstream/10665/85321/1/9789241505727_eng.pdf , accessed 28 January 2104.
  78. 78.
    Duncan J, Grant Y, Clarke TR, Harvey KM, Gibson RC, Barrow G, et al. Sociodemographics and clinical presentation of HIV in Jamaica over 20 years. A comparative analysis of surveillance data. West Indian Med J. 2010;59(4):409–17.PubMedGoogle Scholar
  79. 79.••
    Koenig SP, Rodriguez LA, Bartholomew C, Edwards A, Carmichael TE, Barrow G, et al. Long-term antiretroviral treatment outcomes in seven countries in the Caribbean. J Acquir Immune Defic Syndr. 2012;59(4):e60–71. doi: 10.1097/QAI.0b013e318245d3c1. HIV treatment outcomes for 8,203 patients starting ART from 1998 to 2008 were studied in 7 Caribbean countries. Mortality was 13% overall with 75% of patients alive and in-care at the end of the study period.PubMedCentralPubMedCrossRefGoogle Scholar
  80. 80.
    Halpern M, Lachmansingh B, Minior T, Hasbrouck LM, Persaud N, Foo A. Implementation of a standardized HIV patient monitoring system in Guyana. Rev Panam Salud Publ. 2010;28(2):107–13.CrossRefGoogle Scholar
  81. 81.••
    Landis RC, Branch-Beckles SL, Crichlow S, Hambleton IR, Best A. Ten Year Trends in Community Viral Load n Barbados: Implications for Treatment as Prevention. PLoS One. 2013;8(3):e58590. Analysis of viral load trends in Barbados showed a significant improvement in viral load suppression in the past decade; from 33.6% of clients achieving the 200 copies/ml threshold in 2002 to 70.3% in 2011 (p<0.001) (80). This translated into an estimated 26.2% viral load suppression at a population level at the end of 2010, which is similar to reports in developed countries that used similar methods.PubMedCentralPubMedCrossRefGoogle Scholar
  82. 82.
    Allen CF, Simon Y, Edwards J, Simeon DT. Adherence to Antiretroviral Therapy by People Accessing Services from Non-governmental HIV Support Organisations in Three Caribbean countries. West Indian Med J. 2011;60(3):269–75.PubMedGoogle Scholar
  83. 83.
    Harvey K, Carrington D, Duncan D, Figueroa J, Hirshorn L, Manning D. Evaluation of adherence to highly active antiretroviral therapy in adults in Jamaica. West Indian Med J. 2008;57:293–7.PubMedGoogle Scholar
  84. 84.
    Ravas G, Jack N, Alonso Gonzalez M, Sued O, Perez-Rosales, Gomez B, et al. Progress of implementation of the World Health Organisation strategy for HIV drug resistance control in Latin America and the Caribbean. Rev Panam Salud Publ. 2011;30(6):657–62.CrossRefGoogle Scholar
  85. 85.
    Duke N, Aboh S, Bosivert N. Analysis of Resistance Testing in Trinidad. West Indian Med J. 2010;59:400–2.PubMedGoogle Scholar
  86. 86.
    Barrow G, Hylton-Kong T, Rodriguez N, Yamamura Y, Figueroa JP. HIV-1 Drug Resistance Testing in Treatment Naïve, Chronically Infected Patients in Jamaica. Antivir Ther. 2013. doi: 10.3851/IMP2869.PubMedGoogle Scholar
  87. 87.
    Machado LY, Dubed M, Díaz H, Ruiz N, Romay D, Váldes N, et al. AIDS Res Hum Retrovir. 2013;29(2):411–4.PubMedGoogle Scholar
  88. 88.
    Hamilton CL, Eyzaguirre LM, Amarakoon II, Figueroa P, Duncan J, Carr JK, et al. Analysis of protease and reverse transcriptase genes of HIV for antiretroviral drug resistance in Jamaican adults. AIDS Res Hum Retrovir. 2012;28(8):923–7.PubMedCrossRefGoogle Scholar
  89. 89.
    Collins-Fairclough AM, Charurat M, Nadai Y, Pando M, Avila MM, Blattner WA, et al. Significantly longer envelope V2 loops are characteristic of heterosexually transmitted subtype B HIV-1 in Trinidad. PLoS One. 2011;6(6):e19995.PubMedCentralPubMedCrossRefGoogle Scholar
  90. 90.•
    Barrow C, Barrow G. HIV Treatment as Prevention in Jamaica and Barbados: Magic Bullet or Sustainable Response? JIAPAC 2013. J Int Assoc Provid AIDS Care 2013 Dec 30. [Epub ahead of print]. This paper discusses the potential and challenges of ARV treatment as prevention in the context of Jamaica and Barbados.Google Scholar
  91. 91.
    Figueroa JP. Turning the Tide toward an AIDS Free Generation: Is It Within Our Reach? West Indian Med J. 2013;62(4):279–81.Google Scholar

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  1. 1.Department of Community Health and PsychiatryUniversity of the West IndiesKingston 7Jamaica

Personalised recommendations