Aids Alert International-Growing rate of HIV/AIDS gets little notice on islands
As tourism thrives in the Caribbean, so does HIV
The HIV/AIDS epidemic continues to exact a heavy price among the Caribbean islands that are chiefly known for cruise ship ports and vacation beach getaways made popular by affluent Americans.
Ironically, it's precisely because of these islands' popularity among tourists, particularly those engaging in sexual tourism, that the epidemic has penetrated the islands to the extent that it has, an HIV expert in the region says.
In Haiti, where HIV still is spreading out of control, the epidemic was brought to the island by homosexual tourists some two decades ago, says Peggy McEvoy, DrPH, a team leader for UNAIDS Caribbean in Port of Spain, Trinidad and Tobago.
The theory that tourism is largely responsible for the high prevalence rate would seem to be supported by Cuba's HIV statistics. That one Caribbean nation, which has not been a favored or easily accessible tourist spot since Fidel Castro's revolution, has an HIV prevalence rate of 0.02%. This is the only Caribbean country where virtually every case of HIV is counted. This compares to the Caribbean's overall HIV/AIDS prevalence rate of 1.96% of all adults, which is second only to sub-Saharan Africa.
Other factors contributing to the Caribbean's high HIV infection rate are:
• societal pressures for homosexuals to have heterosexual relationships;
• authorities continuing to deny that sexual activity is going on in prisons;
• commercial sex work among school girls and housewives;
• poor partner communication on sexual needs and concerns;
• women's emotional and socioeconomic dependence on men;
• substance abuse of alcohol and drugs.
While official estimates suggest 360,000 people in the Caribbean territories have HIV/AIDS, experts say that number is too conservative.
"When we look at a mathematical modeling based on other countries, it has to be well over half a million people with HIV," McEvoy says.
Haiti has the worst problem in the region, and it's estimated that there will be between 240,000 and 330,000 Haitians with HIV by the end of 2000, McEvoy says.
Here are other estimates:
• In Haiti, 12% of the urban population and 5% of the rural population have HIV/AIDS.
• An estimated 150,000 people in the Dominican Republic have HIV/AIDS.
• A sentinel surveillance in the Dominican Republic found an HIV/AIDS incidence rate among pregnant women in one town to be 8% positive.
• In Guyana, 13% of people seeking treatment for sexually transmitted diseases were found to be HIV-infected, and HIV prevalence was 3.2% among blood donors in that country.
• Urban sex workers in Guyana, surveyed in 1997, showed a 46% infection rate.
• Nearly 40% of hospital admissions in Kingston General Hospital of St. Vincent and the Grenadines were due to HIV/AIDS-related conditions.
• In Trinidad and Tobago, there has been a drain on manpower caused by the epidemic, and this is expected to reach 20% within five years.
The Caribbean, while identified as one group, consists of 24 countries with four different national languages: Spanish, French, Dutch, and English. What most of the islands have in common is a general lack of health care resources and prevalent poverty, McEvoy says.
Except for Cuba, the Caribbean has the same problem as Southern Africa — no health care infrastructure. There is too little money for medications to treat opportunistic infections or for antiretroviral drugs to treat HIV.
Also, the Caribbean governments have not put resources into stopping mother-to-child HIV transmission, which now accounts for 6% of reported AIDS cases in the Caribbean. Pilot programs, funded through UNAIDS and UNICEF, have helped with treatments to prevent vertical transmission, but these efforts are not enough to stop the transmission, McEvoy says.
"Ultimately the governments have to take over, and there's a lot involved, because it's not just giving one shot or some pills," she adds. "They have to give counseling and teach mothers not to breast-feed."
Moreover, the disease's stigma is a major problem.
"People living with AIDS are so stigmatized that in some countries they're not allowed in the health system," McEvoy says.
Like Africa, the Caribbean has a problem with orphans due to the epidemic. An estimated 83,000 children under the age of 15 are without families, and there are expected to be as many as 25,000 orphans in Haiti by the end of 2000.
Caribbean children also are at risk for becoming infected with HIV at very young ages. A recent Caribbean adolescent survey, conducted in English-speaking countries, found that of 8,096 school children surveyed, 42% had engaged in sex before the age of 10. Another 20% had sex before age 12. Broken down by gender, it was more than two boys for every girl who first had intercourse at a very young age.
Both girls and boys are at risk for having sex in exchange for money to pay for schoolbooks and living necessities, McEvoy says.
Some statistics show that seven out of eight youths ages 10 to 19 who are infected with HIV are female.
"It's driven by economics," McEvoy says. "Young school girls need books and have sex with men, and there is a lot of rape, which is politely called date rape in the States."
Another problem is that social taboos — and, in some of the nations, religious mandates — prevent sexual education in schools or the distribution of condoms, she adds.
Nonetheless, there are a few good prevention programs under way, McEvoy says, including the following:
• Jamaica has formed national AIDS councils at every parish level. These councils meet regularly and work with church groups, rotary groups, in schools, and with street theater groups on how to prevent HIV infection.
• In Haiti, there is work being done with adolescent clinics that teach young people about reproductive health.
• Both the Bahamas and Jamaica offer counseling services, and counseling is offered in the Dominican Republic through health clinics.
• The Dominican Republic has a public health care program that tests female sex workers each month, providing them with medications for sexually transmitted diseases.
"But everywhere across the board there is a need for training and counseling and confidential testing, especially in smaller countries," McEvoy says.
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