Re-concentrating on the type of HIV epidemic in the Caribbean
J. Waters Garcia1,2, M. de Groulard3
1Centro de Orientacion e Investigacion Integral (COIN), Medical Director, Santo Domingo, Dominican Republic, 2Caribbean Vulnerable Communities Coalition (CVCC), Focal Point Health Care Working Group, Santo Domingo, Dominican Republic, 3UNAIDS, Senior Regional Program Advisor, Port of Spain, Trinidad and Tobago
Background: Epidemiologic surveillance data in the Caribbean region has been insufficient to capture the critical intricacies of the epidemic. The collection process is characterized by the limitations and prejudices inherent in wider Caribbean society. Overall the epidemic in the region has been classified as generalized with concentrated pockets. This classification has informed decisions guiding our response to HIV in terms of resource allocation and effective programme design.
Methods: This paper reviews recent trends in the epidemiology in the region in relation to certain high risk groups and the population at large, with a view to looking at how this classification has affected our response and better understand the epidemic in the region.
Results: Three phenomena have contributed to the perception of a generalized epidemic in the region:
- A definition of a “generalized epidemic” that is not transmission based.
- An apparent feminisation of the epidemic in the Caribbean.
- An emphasis on heterosexual sex as the major transmission mechanism in the region.
Scrutinizing available information, the paper considers where and why we may have to reconsider some aspects of our thinking.
Conclusions: The under-current to this review article is that the epidemic in the Caribbean has been classified as a generalized epidemic, for reasons that are examined, but need a deeper analysis.
In the resource limited setting of the Caribbean the focus on a generalized epidemic and resultant prevention targeting the population at large, has occurred at the expense of certain high risk groups who are the central focus in the dynamic of the epidemic.
The paper is intended to help shift a paradigm of traditional thought in the region, and facilitate triggering a fresh start when looking at these matters.
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