A Deadly Stigma in Caribbean -- As AIDS Rate Soars, Infected Are Shunned

AIDS is already the leading cause of death in the Caribbean for those ages 15 to 45, and the number of cases is growing at an "exponential" rate, "doubling every two to three years," said C. James Hospedales, director of the Caribbean Epidemiology Center (CEC). According to official figures, at least one in every 50 people in the Caribbean, or 2 percent of the population, has HIV/AIDS. In many countries of the region, the rate is significantly higher.

As in Africa, HIV/AIDS patients in the Caribbean are overwhelmingly young and poor, and increasingly female. The majority contract the disease through unprotected heterosexual sex in societies that, according to a report by the UN and regional organizations, tolerate -- and, in the case of men, even encourage -- multiple sex partners and sexual activity at an early age. Far from providing universal antiretroviral treatment, many Caribbean governments, whether from lack of will or resources, do not provide drug therapy for more than a handful of HIV-positive pregnant women to prevent mother-to-child transmission.

In much of the Caribbean, to acknowledge HIV infection often means abandonment by family and friends, job loss, expulsion from school, and sometimes even denial of the scant medical care that is available. Although HIV tests are widely available throughout the Caribbean, "there are not more people coming in for testing," said Nicola Taylor, a program officer in the STD division of the CEC. "In a small country, if you go into a clinic or a hospital to request an HIV test, in two hours everybody knows it."

Secretary of State Colin L. Powell, the son of Jamaican immigrants, rarely fails to mention the Caribbean whenever he is asked about AIDS in Africa and the United States. In April, the World Bank opened a $150 million, low-interest loan window for HIV-related projects, and the CDC announced this month that it would provide increased technical assistance to the CEC. The current situation in the Caribbean might be different, Hospedales said, "if much earlier on we had put in place a strong system of care. But it was always, 'These people are bad. They deserve what they get.'"

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