amfAR, The Foundation for AIDS Research

Caribbean

Part of MSM, HIV and the Road to Universal Access: How Far Have We Come?

August 2008

In 2007, some 230,000 people were living with HIV/AIDS in the countries of the Caribbean, where adult HIV prevalence is estimated at 1%, and AIDS is a leading cause of death among people aged 25-44 years. Haiti has the highest HIV prevalence in the region, with 2.2% of those aged 15-49 living with the virus, a total of about 170,000 countrywide. But numbers are difficult to determine because in many countries HIV surveillance systems are inadequate, complicating efforts to track epidemic patterns.

HIV transmission in the Caribbean is mainly due to unprotected heterosexual intercourse, including unprotected sex between sex workers and their clients. To a lesser degree, injection drug use also contributes to the spread of HIV, notably in Bermuda and Puerto Rico. Unprotected sex among MSM is also an important contributor to AIDS epidemics in the Caribbean, with stigma impeding relevant education and prevention efforts. Some estimates suggest that up to one in 10 reported HIV infections result from transmission among MSM.

Review of Country Progress Reports

Caribbean countries reviewed: Antigua and Barbuda, Bahamas, Barbados, Cuba, Dominica, Dominican Republic, Grenada, Haiti, Jamaica, St. Kitts and Nevis, St. Lucia, St. Vincent and the Grenadines, Trinidad and Tobago.

1. Country Reporting: How Many Countries Reported on MSM?

Country reporting of five UNGASS indicators relevant to MSM

Summary: Out of the 13 countries reviewed, three (Antigua and Barbuda, Dominica, and St. Vincent and the Grenadines) did not report on any of the five UNGASS indicators. Eight countries (Barbados, Dominican Republic, Grenada, Haiti, Jamaica, St. Kitts and Nevis, St. Lucia, and Trinidad and Tobago) reported on 1-3 indicators. Two countries (Cuba and Bahamas) reported on 4-5 indicators.

2. Seroprevalence: What percentage of MSM Are Living With HIV?

UNGASS Indicator: Percentage of MSM who are living with HIV

Summary: Six countries (Antigua and Barbuda, Barbados, Dominica, Haiti, St. Lucia, St. Vincent and the Grenadines) did not report on HIV seroprevalence among MSM. Of the countries that did, three (Cuba, Grenada, and St. Kitts and Nevis) reported prevalence below 6%, one (Bahamas) reported a rate of 6-10%, one (Dominican Republic) reported a rate of 11-15%, and two (Jamaica and Trinidad and Tobago) reported HIV seroprevalence rates among MSM of over 15%.

3. Testing: What Percentage of MSM Have Taken an HIV Test in the Last Year?

UNGASS Indicator: Percentage of MSM who received an HIV test in the last 12 months and who know their result.

Summary: Approximately two-thirds (nine) of the countries in the region did not report on HIV testing among MSM (Antigua and Barbuda, Dominica, Dominican Republic, Grenada, Jamaica, St. Lucia, St. Kitts and Nevis, St. Vincent and the Grenadines, and Trinidad and Tobago). One country (Cuba) reported a testing rate of below 40%. One country (Haiti) reported a rate of 40-59% and two countries (Bahamas and Barbados) reported rates of 60% or higher.

4. Knowledge: What Percentage of MSM Know How to Prevent HIV?

UNGASS Indicator: Percentage of MSM who both correctly identify ways of preventing the sexual transmission of HIV and who reject major misconceptions about HIV transmission

Summary: Over three-quarters of the countries in the Caribbean (Antigua and Barbuda, Barbados, Dominica, Dominican Republic, Grenada, Jamaica, St. Kitts and Nevis, St. Lucia, St. Vincent and the Grenadines, and Trinidad and Tobago) did not report on the level of understanding of HIV prevention among MSM. One country (Haiti) reported 0-39% of MSM demonstrate correct knowledge of HIV transmission. Two countries (Bahamas and Cuba) reported rates of 40-59%. None reported rates of more than 60%.

5. Behavior: What Percentage of MSM Used a Condom the Last Time They Had Sex?

UNGASS Indicator: Percentage of men reporting the use of a condom the last time they had anal sex with a male partner

Summary: Six countries in the region (Antigua and Barbuda, Dominica, Grenada, Jamaica, St. Kitts and Nevis, and St. Vincent and the Grenadines) did not report on condom use among MSM. Two countries (Cuba and Trinidad and Tobago) reported condom use rates of 40-59%. Five countries (Bahamas, Barbados, Dominican Republic, Haiti, and St. Lucia) reported condom use rates among MSM of 60-79%.

6. Coverage: What Percentage of MSM Are Being Reached by HIV Prevention Programs?

UNGASS Indicator: Percentage of MSM reached with HIV prevention programs

Summary: Over three-quarters of countries in the Caribbean (Antigua and Barbuda, Barbados, Dominica, Haiti, Grenada, Jamaica, St. Kitts and Nevis, St. Lucia, St. Vincent and the Grenadines, and Trinidad and Tobago) do not know how many MSM are being reached by HIV prevention programs. One country (Dominican Republic) reported reaching less than 20% of MSM. Two countries (Bahamas and Cuba) reported reaching 40-59% of MSM. No countries reported reaching 60% or more.

Case Study: Jamaica

According to Jamaica's 2008 UNGASS progress report, 25,000 people, or 1.3% of the adult population, are currently living with HIV, with two thirds of infected people unaware of their HIV status. Among MSM, HIV prevalence is estimated between 25 and 30%.¹

Jamaica is notorious for its rampant and violent homophobia. There have been accounts of mobs beating, burning, stabbing, and drowning men who are believed to be gay, while the police, who are also infamous for abusing LGBT populations, arrive late on the scene and make no effort to disband the mobs.² In 2007, men suspected of being gay were stoned at a funeral, held hostage by a mob of 200 people demanding their deaths, and told that they had two weeks to leave East Kingston before they would be subject to community action. Health workers are also at risk: In 2005, HIV/AIDS activist Steve Harvey was murdered.³ Recent articles in Time and The New York Times have painted a bleak picture of the country, where LGBT people live in constant fear for their lives. Time's article was entitled "The Most Homophobic Place on Earth?" In the face of this crippling stigma and discrimination, however, local and international actors have somehow managed to begin to implement HIV/AIDS programming for Jamaica's MSM population. "It's not all darkness," says a senior UNAIDS official in Jamaica. "There has been huge movement in this region around addressing issues of stigma and discrimination, especially on a programming level for MSM, [and] there has been clear progress".⁴ One example of an effective program in Jamaica is called PLACE -- Priority for Local AIDS Control Efforts. PLACE involves delivering services in an area where a particularly vulnerable group such as MSM is known to be concentrated -- but without specifically targeting that group. By avoiding mention of its focus, PLACE avoids generating stigma toward the people who access its services. Evaluations of PLACE show that it has a broad outreach in its coverage and is very effective.⁵

Further mobilization has taken place among local, national, and international stakeholders who established the Pan Caribbean Partnership on HIV/AIDS (PANCAP) in 2001.⁶ And in November 2006, the Caribbean Vulnerable Communities Coalition and Caribbean Treatment Action Group agreed on a set of declarations calling on Caribbean governments to remedy their inadequate response to the needs of all groups in their populations with regards to HIV/AIDS.

The success of some interventions in Jamaica, and the beginnings of community mobilization in the face of deep and violent stigma, demonstrate the power of stakeholders to operate within a vehemently homophobic society in order to combat HIV/AIDS among MSM. Legal reforms and social change are obviously desirable, but in their absence, the potential to save lives still exists.

Jamaica 2008 Country Progress Report: UNGASS Indicators Relevant to MSM

Jamaica 2008 Country Progress Report: UNGASS Indicators Relevant to MSM

References

Jamaica National HIV Program: Jamaica 2007 UNGASS Country Progress Report (2008).
Human Rights Watch: "Hated to Death" (2004).
Human Rights Watch: "Map of Recent HIV/AIDS Abuses" (2006).
Interview with Miriam Maluwa, country representative for Jamaica, the Bahamas, and Belize, Senior Advisor, Law and Human Rights -- Caribbean region, UNAIDS office, Jamaica, April 22, 2008.
Ibid.
"Hated to Death."

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This article was provided by amfAR, The Foundation for AIDS Research.

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