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AIDS
& Caribbeans |
New York, October 2001: Trinidadian Faye Gonzalez volunteered for injections of an experimental vaccine against HIV after a close friend died from the virus last year.
"If by helping to develop a vaccine I could spare somebody else that pain, then I want to be part of that," Gonzalez, 35, said recently after receiving one in a series of test shots.
Preventative programs, treatment and ways to improve the lives of those battling HIV and AIDS were key topics at the 10th Annual International Conference for People Living with HIV/AIDS, which took place in Trinidad and Tobago from October 26 to 31.
This year's conference was held in the Caribbean to reach out to the region's HIV-infected people, said Stuart Flavell, of the Netherlands-based Global Network of People Living with HIV/AIDS.
"My hope is that this will shatter the conspiracy of silence in the Caribbean about the reality of HIV and AIDS," said Trinidadian Yolanda Simon, the conference's chairwoman.
Caribean Epidemic
Nine of the world's 12 hardest-hit countries, measured by the incidence of HIV/AIDS, are in the Caribbean In fact the Caribbean now has the world's highest rate of HIV infection outside sub-Saharan Africa. An estimated 2 percent of the region's population is infected with the AIDS virus -- around half a million people - and the virus has killed about 8,000 in the region, according to the Caribbean Task Force on HIV/AIDS
One-third of the victims are women. A growing number are children - an estimated 85,000 children have been orphaned by the disease. In 1999 alone, it was reported that some 57,000 adults and children were newly infected. Of even greater concern is that the epidemic is more prevalent in younger age groups. Seventy percent of the diagnosed cases are between 15 and 44 years old, with 50 percent of that number between 25 and 34.
Two-thirds of those diagnosed with HIV in the Caribbean die within two years and AIDS is the leading cause of death in the region for people aged 15 to 45. The number is growing at an "exponential" rate, according to Caribbean Epidemiology Center Director James Hospedales.
In Jamaica, HIV prevalence is growing fastest among youth between 15 and 25.
"Incest and rape are huge in this country," says Jan Lopez, who coordinates a peer education program for Addiction Alert, a nonprofit organization that works with teens on AIDS prevention in Jamaica's inner-city neighborhoods. "Getting correct information to adolescents is crucial. We don't have adolescent-friendly services at all."
Now entering its third decade under the brunt of the epidemic, Haiti is the epicenter in the Caribbean's struggle with AIDS. Officials with the Joint United Nations Programme on HIV/AIDS (UNAIDS) estimate that early this year as many as 330,000 were infected with the AIDS virus - 12 percent of the urban population and 5 percent of rural inhabitants. And during the past two decades, an estimated 300,000 Haitians have died of the disease. It's by far the largest toll in the Caribbean or Latin America.
But as large as its problem is, Haiti is not the only country seriously threatened by the epidemic. The disease also is becoming a major problem in Trinidad and Tobago, Guyana, Jamaica and other places as well. In the Bahamas, 4.1 percent of adults are infected with the virus.
More alarming, some experts say, is the increase of infection among expectant mothers. In Haiti and Guyana, 7 percent to 8 percent of expectant mothers are HIV-positive, a staggering rate that indicates the scale of contagion. As the disease strikes down its first generation of women, it is gnawing away at the key pillar of these societies: the family. A father dies, the mother soon follows. The children must fend for themselves.
Impact
One study by the University of the West Indies estimates an AIDS-linked decline of about 5 percent in the gross national products of Trinidad and Jamaica in five years. Already, an estimated five years has been shaved off the average life span in Haiti and Guyana - to 47 for men and 51 for women in Haiti, and to 57 for men and 62 for women in Guyana.
Guyana's social progress made over the last decade has begun to erode significantly because of the high percentage of HIV/AIDS in its population according to Minister of Health, Dr Leslie Ramsammy.
Jamaica is projected to experience sharp declines in savings, investment, employment, labour supply and gross domestic product if the spread of HIV/AIDS is not stymied, a regional study conducted by the University of the West Indies (UWI) and the Caribbean Epidemiology Centre (CAREC) has shown.
All of this adds up to the early stages of "a major developmental catastrophe" that could reverse social and economic achievements of the last 50 years in the Caribbean, according to the World Bank. That would raise serious foreign policy issues for the United States, the destination of choice for refugees from the Caribbean. The region's tourist industry could easily collapse under the weight of the epidemic, leading to political and social disarray.
Barbados Prime Minister Owen Arthur cautions that, "The Caribbean has never lost a generation of its most talented young people because of war or natural disaster. It is in danger of doing so because of the pandemic of AIDS."
Speaking at the UN AIDS conference in New York in June, Arthur said, "We are in danger of losing to HIV/AIDS, one of the most educated and creative generations in the history of the Caribbean. This tragedy would put the promise of 21st century sustainable development beyond our reach," Arthur said.
The epidemic also poses a serious threat to tourism, the backbone of the Caribbean economy.. Executive director of the Barbados Hotel & Tourism Association, (BHTA), Sue Springer, said insurance companies in Britain have labelled some Caribbean destinations as high risk, and made it imperative for tour operators to pay higher insurance claims. In some cases, operators are forced to take their business to "safer" destinations
Not A Caribbean Disease
This doesn't mean that AIDS is a Caribbean disease. Health experts believe that HIV was first introduced to the region decades ago by a tourist who could have come from New York or London. Prostitution was one way that AIDS entered the Caribbean. In the early 1980s, the first victims of the epidemic were young men catering to gay European and North American tourists in Haiti. And in recent years, new forms of what's generally called "sex tourism" have drawn schoolchildren, wives and university students into bartering sex for tuition, rent and food. These new sex workers don't fit the traditional definition of professional prostitutes, experts say, but rather are part-timers who use sex to supplement falling incomes.
Needs
It will take money to control the epidemic. In an interview in New York before he addressed the special session of the United Nations General Assembly on HIV/AIDS in June, Arthur said the Caribbean region as a whole might have to spend at least BDS$500 million annually to grapple with the AIDS crisis.
"That is before people have come into detailed evaluation," he said of the region's costs. "Barbados might be talking about BDS$80 million a year at the start of the programme. You can multiple that across 15 countries in the region."
Currently the region spends only one-tenth of the estimated $260 million a year needed for AIDS treatment and prevention. But some help is on the way.
The World Bank is offering $55 million in loans. The first loans will support national programs in the Barbados, which will get $15.5 million.
The loans will finance activities aimed at the control of HIV/AIDS transmission, including information campaigns, condom distribution, laboratory and blood supply quality control, prevention of mother-to-child transmission, HIV testing, counseling, and surveillance of HIV/AIDS and other sexually-transmitted infections).
Previously, we haven't had much of a presence in the Caribbean,'' Patricio Marquez, the bank's principal health specialist for the Caribbean and Latin America, said. "We now want to be deeply involved in supporting the Caribbean in their fight against HIV and AIDS.''
The money is to be disbursed by the end of this year to counties that also include St. Vincent and the Grenadines, Jamaica, St. Lucia, St. Kitts and Nevis, Dominica, Grenada, Guyana, and Trinidad and Tobago.
The countries will have a five-year grace period on loans and a 25-year repayment period, he said.
The World Bank also is looking for funds to give a grant to Haiti, the poorest country in the Western Hemisphere, Marquez said.
The United Nations is launching a global AIDS fund, with assistance from the United States. The fund is intended mostly for Africa, where the need is the greatest. But it also would provide help for the Caribbean. And, the US Centers for Disease Control in May began providing technical help to prevention and treatment centers in the region.
Drug companies have begun to reduce the cost of antiretroviral drugs in poor countries. In March, New Jersey-based Merck announced it would sell two HIV treatments at no profit in the world's poorest and hardest-hit nations -- including eight Caribbean countries.
"The excuse in the past always has been we can't afford these drugs,'' said Sean Hughes, head of Merck's HIV/AIDS drug initiative in the Caribbean.
The discounts were for its HIV drugs Stocrin and Crixivan. Patients in Haiti, Trinidad, the Dominican Republic, Guyana and Suriname would pay around $1,100 for an annual dosage of both drugs, about 85 percent less than the cost in the United States.
In St. Lucia, Jamaica and St. Kitts, patients would pay a little less than $2,000 for a dosage of both.
Not Enough
In a reversal of roles, Merck said the Caribbean wasn't doing enough to provide discounted HIV-fighting drugs to patients. Caribbean authorities, on the other hand are saying that many still could not afford the drugs and that cash-strapped governments also could not easily bankroll treatment programs, even with Merck's discounts.
Part of the problem is that Africa's staggering AIDS problem has overshadowed the Caribbean's. The Washington Post reports that the Caribbean epidemic "has remained shrouded in denial at home and largely ignored by much of the rest of the world, which has not responded with the high-level conferences, pledges of money and cut-price drugs that are being offered in Africa.
Beyond Money
But the problem goes beyond money and drugs. Caribbean leaders must deal with the epidemic's roots, which are ignorance, poverty, promiscuity and cultural and religious taboos. In some Caribbean countries, local governments are reluctant to promote condom use for fear of offending the Catholic Church.
In Haiti many people, despite living with AIDS for two decades, are hesitant to discuss a sexually transmitted disease because of religious beliefs.
There are also lingering fears that AIDS can be transmitted through drinking water, by breathing the same air as an infected person, and through religious rituals involving sorcery.
The international stigma that confronted Haiti early in the epidemic also made matters worse at home. Haitians in the early 1990s were labeled in the "4-H" risk group for AIDS by the U.S. Centers for Disease Control: homosexuals, heterosexual IV drug abusers, hemophiliacs and Haitians. There was also dangerous - and erroneous - speculation in respected medical journals that Voodoo ceremonies might incubate and spread the disease.
A 1998 Caribbean Adolescent Health Survey showed that teenagers were "very vulnerable" to HIV/AIDS. About 40 percent of teens who reported being sexually active had their first sexual experience before age 10 and an additional 20 percent before age 12.
"They think if you're not doing sex, you're not macho enough," says Letisha Scotland, 21, a Jamaican youth counselor with Addiction Alert. "These are kids who are 12 and 13 years old."
More than half the youths surveyed did not use contraceptives the last time they had sex. Older men frequently seek out virgin flesh, thinking it is a cure for venereal disease - a superstition that spread from Britain to the Caribbean in the 19th century and now applies to AIDS. And girls in their mid-teens often seek out older men, attracted by their seeming economic security and the protection of a father figure.
Sex isn't discussed much in the Caribbean in general. The situation fosters misinformation about HIV, experts say, especially since children can't help but see sex all around them.
Because the first incidents of AIDS were linked to gay men in the United States, the notion that HIV is contracted through homosexual sex persists throughout the Caribbean. Even in educated circles a person will question the notion of contracting HIV through heterosexual sex - even though that is the dominant means of transmission in the Caribbean.
But while a decade ago there were seven men infected with HIV for every woman with the virus, today that ratio has shrunk to nearly 1-to-1. It's what AIDS experts refer to as the "feminization" of the epidemic, intensified by the harsh realities of life for women in developing countries.
Also virulent homophobia is embedded in the culture of the Caribbean in general and Jamaica in particular. The latter nation has laws making sex between two people of the same gender a crime. The Jamaica Labor Party's campaign song in the lastt elections advocated the killing and burning of homosexuals.
If AIDS is to be beaten, these attitudes must change.
Regional Initiatives
It is the stigma attached to the virus - the taint of adultery, illicit sex and drug use - that has so crippled efforts to curb its spread. Many of the sick fear for their jobs and families if their illness is discovered, while the young and seemingly healthy who think they are immune from HIV continue its spread.
But some Caribbean nations have started to seriously address the issue. The Trinidad & Tobago Government has lifted its restrictions on the sale of the contraceptive. As part of the government's the approach in its continuing efforts to curb the rising tide of HIV/AIDS cases in the country anyone can now sell contraceptives.
Other measures include funding being provided to CAFRA and Family Planning Association to assist its sensitisation and education activities with commercial sex workers and to conduct activities among the youth in Tobago. And CAREC is implementing a sensitization project for homosexuals.The issue of HIV/AIDS.
Other plans include the establishment of an AIDS ward at the Port-of-Spain General Hospital; the reopening of the ward at the San Fernando General Hospital for the diagnosis and treatment of other sexually transmitted diseases and HIV/AIDS will be established at selected health centers throughout Trinidad and Tobago; strengthening the capacity of laboratories for testing and confirmation of tests for HIV/AIDS; more counsellors will be trained and more testing centres will be established; a comprehensive strategic plan for the management of HIV/AIDS is being developed; all education and sensitisation programmes will continue. One measure to treat with infected people is: treatment of HIV positive patients with anti-retroviral drugs on a phased basis will begin.
In June, researchers testing an experimental HIV vaccine began injecting the first of 40 volunteers in Trinidad, including Faye Gonzalez. The trials are sponsored by the manufacturers and the U.S. National Institute of Allergy and Infectious Diseases.
The volunteers are trying out a vaccine that combines two products, ALVAC manufactured by Aventis Pasteur of Lyon, France, and AIDSVax made by VaxGen of San Francisco.
In Barbados the fight against HIV-AIDS will form an integral part of this year's National Independence Festival of Creative Arts, thereby showing the all-pervasive power of culture.
Chief executive officer of the National Cultural Foundation (NCF), Dr Allyson Roach, noted the AIDS element in NIFCA was an example of how culture could be woven into every sector.
HIV-aids will be highlighted in the form of a multi-dimensional performance of theatre, dance and music at the November 18 gala, featuring performance poet Winston Farrell and dancer Danny Hinds.
The anti-AIDS fight will be incorporated into the NIFCA 2001 play writing and poster competitions. These will be done in association with the Government Information Service and the National HIV-AIDS Commission
And in Haiti thanks to a pioneering effort by a Harvard physician, Haitians here are receiving the same expensive AIDS drugs that are prolonging lives in the United States and Europe.
Using trained counselors, the Clinique Bon Sauveur distributes and monitors the daily drug regimen of AIDS patients scattered in small villages throughout the rugged mountains of the Central Plateau. The drugs are provided free - no one here could afford them - with a regular series of checkups. And as more people are developing full-blown AIDS, the clinic is expanding its efforts to treat them.
It's part of a comprehensive community health-care program run from a modern hospital - a fortress-like stone structure hours from the nearest paved road. Every week its staff provides hundreds of patients with treatment ranging from prenatal care to basic dentistry.
"As far as I know, we're the only ones providing this therapy in Haiti, and that's a scandal," said Dr. Paul Farmer, an associate professor of medicine at Harvard Medical School and a practicing physician. His medical charity, the Boston-based Partners in Health, developed the AIDS program with the help of donations from church groups, foundations and individuals.
Farmer's project is being closely watched by AIDS experts around the world who are searching for a way to provide a complex regimen of drugs to poor, often illiterate patients who live in areas without electricity, running water and sanitation.
And AIDS orphanages are slowly being established around the region. They can be found in Haiti, Trinidad and other countries with serious AIDS problems.
North American Connection
In recognition of the regional problem many initiatives are being launched in North America to help out. New World Creation Resource Center Inc., a non-profit organization, recently held its first annual walk for aids for the Caribbean and pledged to raise $25 million to aide the Caribbean in their fight against the aids epidemic. The group has branches in New York and Washington.
And concerned about the rising number of Caribbean emigrants with HIV and AIDS in New York City, Health and Human Services Secretary Tommy G. Thompson on June 26 proposed establishing a joint U.S.-Caribbean program to fight spread of the disease.
"What I'm trying to do is to get a high-level conference of leadership of the Caribbean countries with some people from my department to see how we can develop a better prevention, education, and treatment program for people in the Caribbean," Thompson said as he visited the Caribbean-American Family Health Center in Brooklyn. The Caribbean-American Family Health Center, run by Lutheran Medical Center, has been praised as a model for delivering culturally sensitive care to a diverse immigrant community. It serves more than 15,000 patients a year.
The starting point for action, Thompson said, would be holding a mini-UN AIDS conference in the Caribbean. Then he said, he hoped to develop joint programs with various Caribbean nations in which U.S. doctors would work in the region on AIDS prevention and treatment.
In Brooklyn, more than 10,000 people are living with full-blown AIDS, and about 30 percent are from the Caribbean.
Yvonne Graham, executive director of the Caribbean Women's Health Association, who was at the meeting, said many infected people go back and forth from the Caribbean to New York, almost on a weekly basis. She said many of her clients have confessed to taking medication back home to share with relatives because drugs are scarce there. She urged Thompson to try to involve drug companies in his plan.
And to address the issue of AIDS, the Haitian Centers Council, Caribbean Women's Health Association (CWHA) and the National Black Leadership Commission on AIDS recently sponsored a highly successful Legislative Breakfast and Press Conference, at the Caribbean Grill Restaurant in Brooklyn. The theme of which was "The AIDS Epidemic in the Caribbean-American Community in New York City: Time to Break The Silence and Eliminate the Disparities".
The event culminated with a declaration of a State of AIDS Emergency in Central Brooklyn. At this gathering Community Leaders and Providers were mobilized to examine optimum practice approaches and to formulate strategic and tactical intervention modalities to address the AIDS crisis. Elected public officials proposed Legislative policy initiatives and immediate action plans to foster prevention, Testing, Treatment and Education.
And the Caribbean Women's Health Association circulated a policy paper which calls for a multinational strategy and stated that, "HIV/AIDS is devastating the Caribbean-American community which has the largest number of people infected with HIV (40%) as compared to other immigrants living with AIDS in New York City from other regions of the world. In order to effectively address the upwardly spiraling AIDS crisis in the Caribbean-American community, more intensive AIDS prevention, education and treatment initiatives will be required, not only on the local level, but the efforts must also include the Caribbean region.
The Caribbean poses a great threat of the spread of AIDS to the US due to the geographic proximity of the region, which facilitates frequent circulatory migration flows between the US and the Caribbean. Accordingly, the hemispheric spread of AIDS is a strategic national security matter requiring urgent preventive response. Therefore, US public health officials need to join their counterparts in the Caribbean to design bi-lateral mutual interest action plans to more effectively combat this plague."
Congressman Ed Towns represented by attorney Collin Moore proposed to introduce a Debt Forgiveness Bill in order to leverage AIDS prevention revenue for Caribbean countries.
The forum sponsors urged that there is a need to break the silence on AIDS, particularly on such issues as equal access to treatment and care, improved HIV transmission prevention and community health education and to highlight the crucial need for actions in response. Accordingly, the sponsors called for breaking the silence, which muffles the HIV/AIDS crisis in communities of color and obstructs acceptance and disclosure. The sponsors also indicated that the next steps include an AIDS Prevention Community Education Campaign in the Fall. This includes conducting a series of Town Meetings designed to bring together policy makers, the media, public health officials, providers, elected public officials and community leaders from the various at-risk groups to gain first hand updated information on the issues. It will provide a unique opportunity for participants to dialogue, to examine and analyze the issues as well as to formulate strategies to address the needs. The proposed Town Meetings will be based on the following format: HIV/AIDS in the Haitian American Community; HIV/AIDS in the Panamanian-American Community; HIV/AIDS in Jamaican-American Community, etc.
Leading up to the Town Meetings, the sponsors will conduct a series of on-going collateral activities including, an aggressive community education and mobilization campaign designed to educate at-risk community residents about HIV/AIDS and conduct massive recruitment and referral drive directing at-risk population to be tested at health centers conveniently located in their neighborhoods.