Caribbean reports 20,000 new HIV infections

Nov 26, 2009 News

---

Infection rate high among sex workers in Guyana

 

An estimated 20,000 new cases of HIV were found in 2008, according to new data published by UNAIDS and the World Health Organisation.

The new report, released Tuesday, found that in Guyana, 27 percent of commercial sex workers (prostitutes) are infected with HIV. Civil society monitoring indicates that a relatively small share of external HIV financing in the Caribbean has focused on programmes delivered by sex worker organizations.

Although women are believed to account for the vast majority of sex workers in the Caribbean, emerging evidence suggests that male sex workers who sell their services to tourists in the region may also face considerable risks of acquiring HIV.

The 2009 AIDS epidemic report also pointed out that 12, 000 persons died of AIDS related illnesses in the Caribbean last year. This puts the number of persons living with HIV/AIDS at 240, 000.

Although it accounts for a relatively small share of the global epidemic—0.7% of people living with HIV and 0.8% of new infections in 2008—the Caribbean has been more heavily affected by HIV than any region outside sub-Saharan Africa, with the second highest level of adult HIV prevalence.

The new report shows that AIDS-related illnesses were the fourth leading cause of death among Caribbean women in 2004 and the fifth leading cause of death among Caribbean men.

Although sharp declines in HIV incidence were reported in some Caribbean countries earlier this decade, the latest evidence suggests that the regional rate of new HIV infections has stabilized. An apparent exception to the stability of infection rates is in Cuba, where prevalence is low but appears to be on the rise.

“While behavioral data in the region are sparse, it is difficult to determine whether earlier declines in new infections reflected the natural course of the epidemic or the impact of HIV prevention,” the report states.

However, a recent review of epidemiological and behavioural data in the Dominican Republic concluded that the notable declines in HIV prevalence reported in that country were likely to be due to changes in sexual behaviour, including increased condom use and partner reduction, although the study also highlighted high levels of HIV infection among men who have sex with men. .

The report concluded that additional efforts to improve HIV surveillance in the Caribbean are urgently needed in order to obtain a clearer picture of the epidemic and to inform national strategic planning.

A considerable share (17%) of AIDS cases reported in the Caribbean have no assigned risk category; since many cases are only officially reported long after the diagnosed individual has died, it is often difficult or impossible to carry out epidemiological investigations.

National HIV burden varies considerably within the region, ranging from an extremely low HIV prevalence in Cuba to a 3% [1.9–4.2%] adult HIV prevalence in the Bahamas (UNAIDS, 2008). The Caribbean has a mixture of generalized and concentrated epidemics.

Women account for approximately half of all infections in the Caribbean. HIV prevalence is especially elevated among adolescent and young women, who tend to have infection rates significantly higher than males their own age.

Substantial differences in HIV burden are apparent within many Caribbean countries. There is a nearly sevenfold variation in HIV prevalence between the different regions of the Dominican Republic with HIV prevalence especially elevated in the country’s former sugar plantations in Haiti.

In part, due to collaborative efforts to reduce the price of medications, the Caribbean region has made important strides towards increasing access to HIV treatment.

Whereas only one in 10 Caribbean residents in need of treatment were receiving antiretroviral drugs in July 2004, a treatment coverage of 51 per cent had been achieved as of December 2008, a level higher than the global average for low- and middle-income countries.

Pediatric antiretroviral coverage in the Caribbean (55%) was also higher in December 2008 than the global treatment coverage level for children (38%).

Heterosexual transmission, often tied to sex work, is the primary source of HIV transmission, although emerging evidence indicates that substantial transmission is also occurring among men who have sex with men.

The majority of AIDS cases reported in the Caribbean involve heterosexually transmitted infection.

Although it has the region’s highest HIV prevalence, Haiti has experienced a notable decline in HIV prevalence since the early 1990s; however, this long-term decline has flattened in recent years.

According to a 2004 national behavioural survey in Jamaica, nearly half of young men (aged 15–24) and 15% of young women had more than one sexual partner in the previous 12 months.

Although epidemiological studies involving men who have sex with men are relatively rare in the Caribbean, the few that exist suggest a high burden of HIV infection in this population.

---

---