An overview of AIDS in the Caribbean

Due largely to their close geographic locations, the Caribbean is usually grouped with Latin America in discussions about HIV and AIDS, but the epidemics in these regions are very different. Even within the Caribbean, each country faces a unique situation. The diversity of the region – which is apparent in terms of politics, languages spoken, geographic location and wealth – is reflected in the significantly different ways that countries are affected.

At one extreme, the Bahamas has the highest HIV prevalence in the entire western hemisphere (3%); at the other, Cuba has one of the lowest (0.1%). Haiti (2.2%), Trinidad and Tobago (1.5%) and Jamaica (1.6%) are all heavily affected, while Puerto Rico is the only Caribbean country apart from Cuba where it is thought that less than 1% of the population is living with HIV. ² Other factors, such as AIDS mortality rates and transmission patterns, also vary across countries and areas. ³ See our Caribbean statistics page for more data.

Recent developments have given cause for optimism, with an overall stabilisation in the region. A small number of countries in the Caribbean have even shown signs of a decline in prevalence. In the Dominican Republic prevalence fell from 1% in 2002 to 0.8% in 2007. HIV infection levels have also decreased in Haiti, which has been partly attributed to an increase in condom use and changes in sexual behaviour. ⁴ However, HIV surveillance in the Caribbean is generally considered inadequate, so these reported trends are only vague indicators. Both HIV prevalence and AIDS cases are thought to be widely underestimated in the region. ⁵

Reflecting global patterns, heterosexual sex is now the main route of transmission throughout the region, and it has been established that women and young people are particularly vulnerable. ⁶ Little is known about the role that sex between men plays in the region’s epidemics – it has been estimated that men who have sex with men account for 12% of infections, but it is thought that the actual proportion is higher than this, since the rampant homophobia that exists throughout the region has led to denial and under-reporting.⁷

Despite differences between countries, the spread of HIV in the Caribbean has taken place against a common background of poverty, gender inequalities and a high degree of HIV-related stigma. Migration between islands and countries is common, contributing to the spread of HIV and blurring the boundaries between different national epidemics. ⁸ Additionally, poor availability of HIV and AIDS data makes it difficult to gain a clear picture of each country’s situation.