HIV AIDS: a predator in paradise: today the Caribbean has the highest prevalence of HIV/AIDS outside of Sub-Saharan Africa. Some Caribbean scholars are taking steps to educate the academy and national leaders about curbing the spread of the disease

Black Issues in Higher Education, Jan 30, 2003 by B. Denise Hawkins

The Caribbean is legendary for the soothing rustle of blowing palm trees, sugar white beaches and breathtaking sunsets. It also is where about 2 percent of the region's adult population is living with HIV/AIDS, and the incidence rate is accelerating at a pace second only to sub-Saharan Africa. The Dominican Republic and Haiti together account for 85 percent of the total number of HIV/AIDS cases in the Caribbean.

In the two decades since the first AIDS case was diagnosed in the Caribbean, the disease has exploded into a global pandemic and catapulted the region to an unwanted place.

AIDS has become the leading cause of death for 15- to 44-year-olds in several English and non-English speaking island nations, and also is responsible for leaving an estimated 80,000 Caribbean children orphaned. Globally, 42 million people are living with human immunodeficiency virus (HIV) infection, epidemiologists at the United Nations and World Health Organization announced in a report released in November. Of the 38.6 million infected adults, 19.2 million are women--slightly less than 50 percent.

But while many Caribbean governments have initiated programs to slow HIV/AIDS, few have scaled up the response to the levels necessary to turn the epidemic around, scholars say.

In the past 20 years, some government and education leaders have found it easier to prepare and protect their people from ravaging hurricanes than they have from the virus that causes AIDS, says Dr. Brendan C. Bain, a professor of community health at the University of the West Indies (UWI) in Kingston, Jamaica. During the early years, on the frontline of fighting and tracking AIDS, Bain and a handful of fellow scholars, epidemiologists and clinicians also played the waiting game when it came to enlisting significant support and resources from national leaders.

UWI, the Caribbean's leading English-speaking university system with campuses in Kingston, Jamaica, Barbados and Trinidad, long has served as consultant and adviser to government leaders on important issues. Providing a response to HIV/AIDS is one of those important matters, Bain says, but he adds that for too long, UWI was silent, in denial and afraid. But the winds of change are beginning to blow, Bain says.

"UWI administrators are beginning to summon the courage to address what others of us have been working on for years"--AIDS, says Bain who late last year was named lead coordinator of the University of the West Indies HIV/AIDS Response Program (UWI HARP), a first-ever multidisciplinary initiative created to contribute to a national and regional response to the disease.

Prompted two years ago by the need to provide and accelerate the university's response to the growing epidemic, UWI HARP began to take shape. Today, the program has a presence on the university's three campuses and is slowly gaining interest from many administrators, students and the wider community.

In the absence of a regional Caribbean HIV/AIDS plan, a program such as UWI HARP is needed now more than ever, says Dr. Farley R. Cleghorn, an assistant professor at the University of Maryland School of Medicine and an AIDS epidemiologist at the Institute of Human Virology, which is affiliated with the medical school as well as the University of Maryland Medical Center. Fledgling understaffed and under-funded non-governmental organizations (NGOs) and community-based programs in the Caribbean also should be cause for alarm because they have been on the frontline of providing care and treatment to people living with AIDS, Cleghorn adds.

"It costs money to have a response to AIDS," Cleghorn says, and few government leaders in the island nations have been willing to shoulder more than "basic medical intervention."

In August, the World Bank issued the Jamaican government a $15 million loan, which today makes up the bulk of its funding to fight HIV/AIDS, says Patricio Marquez, lead health specialist for the World Bank's Latin and Caribbean region. With the loan, coupled with $5 million in matching funds from the Jamaican government, the country is expected to "step up its HIV/AIDS prevention and control efforts and strengthen its ability to monitor the disease, do research and surveillance," Marquez adds. The funds are part of a $155 million multi-country loan program to benefit HIV/AIDS prevention throughout the Caribbean.

"The responses of Caribbean governments (to the spread of AIDS) have been slow and halting," says Cleghorn, who works globally on the AIDS pandemic in his native Trinidad and in other regions of the Caribbean. As the principal investigator of the University of Maryland's HIVNET project, for example, Cleghorn is working in collaboration with the Institute of Human Virology, and the Medical Research Foundation of Trinidad and Tobago, to foster joint AIDS research between clinicians and governments in the United States and in the Caribbean.

GETTING TO THE ROOT OF AIDS

For years, the root of the pandemic interfered with efforts to stop it. In the early phases of the disease--between 1980 and 1985--researchers attributed the majority of new AIDS cases in the Caribbean to the spread of the disease among gay and bisexual men. In the mid-1980s, heterosexual transmissions quickly transformed AIDS rates. Cleghorn says he believes that the culture of the Caribbean, which includes an inability or unwillingness to talk openly in schools or in some healthcare settings about issues of sex and sexuality, greatly hampered efforts to educate the community and halt the early spread of the disease in the region.