Review of HIV in the Caribbean: Significant Progress and Outstanding Challenges
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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.
KeywordsHIV 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
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.
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
- 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.
- 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.UNAIDS Keeping Score II 2008. Accessed on 23 December 2013 at http://data.unaids.org/pub/Report/2008/20081206_keepingscoreii_en.pdf.
- 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.
- 12.UNAIDS http://www.unaids.org/en/regionscountries/countries/ Accessed on 22 December 2013.
- 13.UNAIDS Fact Sheet. Accessed on 22 December 2013 at http://www.unaids.org/en/resources/campaigns/globalreport2013/factsheet/.
- 14.UNAIDS Global Report 2012. Accessed on 22 December 2013 at http://www.unaids.org/en/resources/publications/2012/name,76121,en.asp.
- 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.•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.••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.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.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.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
- 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
- 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.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.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.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
- 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
- 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
- 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.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.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.Barrow C. Sexual Identity, HIV and Adolescent Girls in Barbados. Soc Econ Stud. 2008;57(2):7–26.Google Scholar
- 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.•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
- 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.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.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.Anderson P. Measuring Masculinity in an Afro-Caribbean Context. Soc Econ Studies Nov 2011.Google Scholar
- 55.Boxill I, at al. Tourism & HIV/AIDS in Jamaica & The Bahamas. Arawak Publications 2005.Google Scholar
- 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
- 59.Forbes MA. Music, Media & Adolescent Sexuality in Jamaica. Arawak Publications 2010.Google Scholar
- 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.••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.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
- 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
- 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.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
- 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.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
- 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.
- 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
- 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
- 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.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