Health Care

HIV/AIDS a Leading Cause of Death in Caribbean

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The Joint United Nations Program on HIV/AIDS estimates there are more than 33 million people living with HIV. In advance of World AIDS Day, Dr. Raphaele Dambo, a program officer at the Caribbean Coalition of National AIDS Program Coordinators, talks about the 17,000 new HIV infections in the Caribbean this year.


And we're going to continue our international focus with a conversation on the worldwide spread of HIV/AIDS. As you probably know, this Saturday is World AIDS Day, a day when the international community turns its attention to this epidemic that is worldwide.

The joint United Nations program on HIV/AIDS estimates that there are more than 33 million people living with HIV today. Sub-Saharan Africa is one of the most affected regions of the world. According to the World Health Organization's report, 68 percent of all people infected with HIV live there. In the Caribbean, however, AIDS still remains one of the leading causes of death among persons age 25 to 44 years old.

So we decided to take a look at some of the regions that have a rising number of infections that have gotten less attention from the international community. And we're also going to speak with a top official U.S. charged with helping the world community fight HIV/AIDS, Ambassador Mark Dybul.

But first, Raphaele Dambo. She's a program officer at the Caribbean Coalition of National AIDS Program Coordinators. She joins us on the phone from her office in Trinidad.

Raphaele, welcome. Thanks so much for speaking with us.

Dr. RAPHAELE DAMBO (Program Officer, Caribbean Coalition of National AIDS Program Coordinators): Good morning. Thank you, thank you for having me.

MARTIN: Can you - and welcome, and thank you for coming. According to the joint UNAIDS WHO report - World Health Organization report - there are 17,000 people who were infected with HIV this year in the Caribbean. What are some of the areas where the infection is on the rise?

Dr. DAMBO: If you look at a map of the Caribbean, the most affected countries would be the Dominican Republic and Haiti. These are the two countries where the infection rates are really, really high. Presently, the rates also are quite high in Trinidad and Tobago, Guyana, Suriname, the Bahamas, Jamaica as well.

MARTIN: What are some of the factors behind the spread of HIV in the Caribbean?

Dr. DAMBO: We have quite a few. First, you have a high level of stigma and discrimination that - this prevents people from getting tested and knowing their status, therefore, increasing the risk of infecting other people if themselves are sick. We are also a religious society, very religious society, but there's a clear, disconnect between our morals and beliefs and our actual sexual behaviors. And I say we because I'm from the Caribbean.

(Soundbite of laughter)

Dr. DAMBO: We also have a cultural machismo, where basically men are not considered men if they are gay, and if they don't have at least one woman, or two or three girlfriends, that kind of thing.

MARTIN: So is - I guess, one of the things I'm curious about, is it mainly heterosexual transmission, or is it men who have sex with men who also have sex with women?

Dr. DAMBO: The main way of transmission will be heterosexual intercourse. There is also a homosexual epidemic, I would say, but there is not enough data to assess how much - the importance of that trend, but mainly the transmission is through heterosexual intercourse.

MARTIN: The World Health Organization study also reported that there are more than 15 million women living with HIV worldwide. What do you think are some of the factors for this trend in the Caribbean? I know that you were talking to one of our producers earlier about the whole question of transactional sex, which is different from prostitution. You're saying that sometimes women sleep with men not so much for money, but for help, for, you know, school clothes, things of that sort.

Dr. DAMBO: Over the past few years, there's been some findings about what we call dissemination of the epidemic, which means that more and more women - and especially young women - are getting infected. And this is partly due to the low socioeconomic status of women who are more at risk when they come from a poor background, where they don't have the - and they are not empowered enough. They don't have the economic tools to sustain themselves. And very often, the boyfriend or the husband will be the provider. And it's very difficult for a woman to refuse or to encourage her partner to put a condom on if he decides that he will not wear it…

MARTIN: Mm-hmm.

Dr. DAMBO: …and he will decide that…

MARTIN: Raphaele, I need you to stand by and stay with us to continue this conversation. Raphaele Dambo is a program officer at the Caribbean Coalition of National AIDS Program Coordinators. She's going to stick around, and we're going to continue our conversation with Ambassador Mark Dybul. He's the U.S. Global AIDS coordinator. That's next.

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