AIDS Alert International: Special Report
Factors driving the HIV epidemic in the Caribbean
CAREC develops regional five-year plan
The Caribbean Epidemiology Centre (CAREC), which serves 21 member countries of the Caribbean, developed a strategic HIV prevention and control plan in December 2000 that clarifies the root of the epidemic and offers possible solutions. The "CAREC Strategic Plan for the Prevention and Control of the HIV Epidemic in the Caribbean 2001-2005" summarizes the factors driving the epidemic in this way:
1. Economic
- Poverty and grossly inequitable income distribution
- Unemployment
- Urbanization creating "ghettos"
- Globalization creating internal economic pressures
- Migration and tourism removing social control and providing incentives for risky behavior
2. Social and cultural
- Globalization with cultural penetration distorting value systems, including the fostering of materialism
- Dysfunctional gender relations, including male insecurity, resulting in antisocial behavior
- Lack of general education, and, specifically, sex education
- Marginalization of young people
- Cultural and religious sexual taboos, contrasting with social norms that promote sex
- Discrimination and stigmatization of people living with HIV/AIDS, men who have sex with men, and other vulnerable groups
- Reluctance to provide information and sex negotiation skills to young people
3. Behavioral
- Multiple sexual partners
- Low condom usage and reluctance to promote condom usage
- Low tolerance for men who have sex with men, causing hiding and mixing of partners
- Sex work of various types: full-time (career), part-time (ranging from school girls through employed women to married women)
- Substance abuse leading to risky behaviors
4. Biomedical and access to care
- Presence of other sexually transmitted diseases (STDs)
- Lack of access to health care for certain populations
- Lack of standards of care, treatment, and support procedures for STDs and HIV
- Attitude of health care workers towards people with HIV: judgmental, fear, reluctance to treat
5. Legal
- Illegal status of vulnerable groups, e.g., mobile population, sex workers and men who have sex with men, driving them underground
- Lack of protection for people living with HIV/AIDS, especially in the workplace
- Lack of legislation addressing issues surrounding people with HIV/AIDS
- Lack of legislation to ensure minimum standards of care
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