by Keiron Audain

Created on: October 28, 2009

The HIV epidemic in the Caribbean has not been given any paramount focus over the years, yet the region has the highest infection rate after Sub-Saharan Africa. In the Caribbean, AIDS is one of the leading causes of death in adults aged 15-44. Despite this, HIV surveillance is not up to standard compared to other regions of the world, and it is an overwhelming view that the epidemic is grossly underreported.

With regards to HIV/AIDS, the Caribbean has significantly diverse rates of infection, as within the region lies the Bahamas, a country with the highest infection rate in the entire Western Hemisphere; and Cuba, a country with the lowest rate. HIV in Cuba has largely been contained by its somewhat controversial plan of providing mandatory HIV testing for at-risk groups such as pregnant women and the prison population. What has been criticised as a violation of human rights has actually resulted in a significant drop in infection rates within the country. Persons testing positive for HIV are taken to sanatoriums, where care and support is provided and their sexual partners identified.

Heterosexual sex has been reported as the main route of transmission, yet sex between men also makes a significant yet inconclusive contribution. Estimations have been made that homosexuality accounts for approximately12% of the region's infection rate, but this figure does not account for the underreporting as owing to denial that exists within this community. Another important factor that fuels the epidemic is sex tourism, but again it has been difficult to report to what extent it contributes.

Available data on behavioural risks or prevention counselling for HIV-infected patients is not as prominent as in other regions, and very few qualified counsellors or social workers work in this particular sector of health care.

Also, owing to the general stigma attached to HIV and AIDS, governments are sometimes reluctant to cooperate in HIV awareness and management, as worries arise regarding the potential impact it will have on tourism, which is a major part of the region's economy.

Yet despite all the problems facing the region, significant progress has been made recently, with respect to training and improving access to treatment. In Haiti, a non-profit organisation called the Foundation for Reproductive Health and Family Education (FOSREF) has provided basic sexual health and HIV/AIDS training to 500 teachers, 6,500 young workers, and 30,000 volunteers who in turn pass on the

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