Aids In The Caribbean Free Essays

1. Joint United Nations Programme on HIV/AIDS (UNAIDS). 2008 Report on the Global AIDS Epidemic Geneva, Switzerland: World Health Organization; 2008

2. AIDS Surveillance in the Americas: Biannual Report Washington, DC: Pan American Health Organization, World Health Organization; 2002

3. Calleja JM, Walker N, Cuchi P, et al. Status of the HIV/AIDS epidemic and methods to monitor it in the Latin America and Caribbean region. AIDS 2002;16(suppl 3):S3–S12 [PubMed]

4. Joint United Nations Programme on HIV/AIDS. Caribbean AIDS Epidemic Summary: Regional Summary Geneva, Switzerland: World Health Organization; 2008

5. HIV/AIDS in Latin America and the Caribbean [editorial]. Lancet 2008;372(9635):263. [PubMed]

6. Conway D. The new tourism in the Caribbean: reappraising market segmentation. : Gayle D, Goodrich J, editors. , Tourism Marketing and Management in the Caribbean London, England: Routledge; 1993:167–173

7. Momsen JH. Tourism, gender, and development in the Caribbean. : Kinnaird V, Hall D, editors. , Tourism: A Gender Analysis London, England: John Wiley & Sons; 1994:106–120

8. Padilla M. Caribbean Pleasure Industry: Tourism, Sexuality, and AIDS in the Dominican Republic Chicago, IL: University of Chicago Press; 2007

9. Wilkinson PF. Tourism Policy and Planning: Case Studies From the Commonwealth Caribbean Elmsford, NY: Cognizant Communications; 1997

10. Estadísticas Seleccionadas del Sector Turístico Santo Domingo, Dominican Republic: Asociación Nacional de Hoteles y Restaurantes Inc; 1995

11. Banco Central de la República Dominicana. Report: Llegada Mensual de Pasajeros, Via Aerea, Por Nacionalidad, 2000-2001 Santo Domingo, Dominican Republic: Departamento de Cuentas Nacionales y Estadísticas Económicas; 2001:Table 6

12. Green L, Richard L, Potvin L. Ecological foundations of health promotion. Am J Health Promot 1996;10(4):270–281 [PubMed]

13. McLeroy KR, Bibeau D, Steckler A, Glanz K. An ecological perspective on health promotion programs. Health Educ Q 1988;15(4):351–378 [PubMed]

14. Waldo CR, Coates TJ. Multiple levels of analysis and intervention in HIV prevention science: exemplars and directions for new research. AIDS 2000;14(suppl 2):S18–S26 [PubMed]

15. Weiss RA, McMichael AJ. Social and environmental risk factors in the emergence of infectious diseases. Nat Med 2004;10(suppl 12):S70–S76 [PubMed]

16. Coates TJ, Richter L, Caceres C. Behavioural strategies to reduce HIV transmission: how to make them work better. Lancet 2008;372(9639):669–684 [PMC free article][PubMed]

17. Padilla MB, Castellanos D, Guilamo-Ramos V, Matiz-Reyes AE, Sanchez-Marte LE, Arredondo-Soriano M. Stigma, social inequality, and sexual risk disclosure among Dominican male sex workers. Soc Sci Med 2008;67:380–388 [PMC free article][PubMed]

18. Phillips JL. Tourist-oriented prostitution in Barbados: the case of the beach boy and the white female tourist. : Kempadoo K, editor. , Sun, Sex, and Gold: Tourism and Sex Work in the Caribbean Lanham, MD: Rowman and Littlefield; 1999:183–200

19. Press CM. Reputation and respectability reconsidered: hustling in a tourist setting. Caribbean Issues 1978;4(1):109–119

20. O'Connell Davidson J. Sex tourism in Cuba. Race Cl 1996;38(July/September):39–48

21. O'Connell Davidson J, Sanchez Taylor J. Fantasy islands: exploring the demand for sex tourism. : Kempadoo K, editor. , Sun, Sex, and Gold: Tourism and Sex Work in the Caribbean Lanham, MD: Rowman and Littlefield; 1999:37–54

22. Le Franc E, Wyatt GE, Chambers C, et al. Working women's sexual risk taking in Jamaica. Soc Sci Med 1996;42(10):1411–1417 [PubMed]

23. Mullings B. Globalization, tourism, and the international sex trade. : Kempadoo K, editor. , Sun, Sex, and Gold: Tourism and Sex Work in the Caribbean Lanham, MD: Rowman and Littlefield; 1999:55–80

24. Pruitt D, LaFont S. For love and money: romance tourism in Jamaica. Ann Tourism Res 1995;22(2):422–444

25. Technical Assessment of AIDS in the Dominican Republic. A Report to the US Agency for International Development Santo Domingo, Dominican Republic: AIDS Control and Prevention (AIDSCAP) Project, Family Health International; 1993

26. Centro de Estudios Sociales y Demográficos. República Dominicana: Encuesta Demográfica y de Salud Calverton, MD: Macro International Inc; 1997

27. Gallardo Rivas G. Buscando la Vida: Dominicanas en el Servicio Doméstico en Madrid Santo Domingo, Dominican Republic: Centro de Investigación para la Acción Femenina; 1995

28. Trafficking in Women From the Dominican Republic for Sexual Exploitation Budapest, Hungary: International Organization for Migration; 1996

29. ¿Quiénes Somos? Santo Domingo, Dominican Republic: Movimiento de Mujeres Unidas; 1997

30. Brennan D. What's Love Got to Do With It? Transnational Desires and Sex Tourism in the Dominican Republic Durham, NC: Duke University Press; 2004

31. Cabezas AL. Pleasure and Its Pain: Sex Tourism in Sosúa, the Dominican Republic [PhD dissertation] Berkeley: University of California, Berkeley; 1998

32. De Moya EA, Garcia R, Fadul R, Herold E. Report: Sosua Sanky-Pankies and Female Sex Workers: An Exploratory Study Santo Domingo, Dominican Republic: La Universidad Autonoma de Santo Domingo; 1992

33. De Moya A, Garcia R. Three decades of male sex work in Santo Domingo. : Aggleton P, editor. , Men Who Sell Sex: International Perspectives on Male Prostitution and AIDS London, England: Taylor & Francis; 1998:127–140

34. Padilla MB. “Western Union daddies” and their quest for authenticity: an ethnographic study of the Dominican gay sex tourism industry. J Homosex 2007;53(1–2):241–275 [PubMed]

35. Ruiz C, Vásquez RE. Características psicosociales y motivación para la prevención del SIDA en trabajadores sexuales homotrópicos Santo Domingo, Dominican Republic: Universidad Autónoma; 1993

36. Vásquez RE, Ruíz C, De Moya EA. Motivación y uso de condones en la prevención del SIDA entre muchachos de la calle trabajadores sexuales Santo Domingo, Dominican Republic: Universidad Autónoma de Santo Domingo, el Programa para el Control de Enfermedades de Transmisión Sexual y SIDA; 1990

37. Kerrigan D, Ellen JM, Moreno L, et al. Environmental-structural factors significantly associated with condom use among female sex workers in the Dominican Republic. AIDS 2003;17:415–423 [PubMed]

38. Tabet SR, de Moya EA, Holmes KK, et al. Sexual behaviors and risk factors for HIV infection among men who have sex with men in the Dominican Republic. AIDS 1996;10(2):201–206 [PubMed]

39. Caribbean Tourism Organization Individual country statistics: Dominican Republic. Available at: http://www.onecaribbean.org/statistics/2007stats/default.aspx. Accessed September 16, 2009

40. Transnational Applied Research and Service Collaborative to Address the HIV/AIDS Needs of the Dominican Community in Santo Domingo and New York City Discussion Document New York, NY: HIV/AIDS Transnational Collaborative; 2003

41. Centro de Estudios Sociales y Demográficos. Encuesta sobre Conocimientos, Creencias, Actitudes y Prácticas acerca del SIDA/ETS en Trabajadoras Sexuales y Hombres Involucrados en la Industria del Sexo en las Localidades de Puerto Plata, Sosúa y Monte Llano Puerto Plata, Dominican Republic: Comité de Vigilancia contra el SIDA; 1996

42. De Moya EA, Ferreira F, Rosario S, Bello A. Empowerment against AIDS in the sex industry. Paper presented at: International Conference on AIDS; August 7–12, 1994; Yokohama, Japan: Abstract 348D

43. Guerrero E, Quinones M, Spegman D, et al. Sexual practices and STDs in female Dominican sex workers. Paper presented at: International Conference on AIDS; June 20–24, 1990; San Francisco, CA: Abstract F.C.736

44. Herold ES, Corbesi B, Garcia R, DeMoya T. Canadian tourists and sexual relationships. Paper presented at: International Conference on AIDS; July 19–24, 1992; Amsterdam, Holland: Abstract PoD 5226

45. Herold ES, Van Kerkwijk C. AIDS and sex tourism. AIDS Soc 1992;4(1):1, 8 [PubMed]

46. Kerrigan D, Moreno L, Rosario S, Sweat M. Adapting the Thai 100% condom programme: developing a culturally appropriate model for the Dominican Republic. Cult Health Sex 2001;3(2):221–240

47. Moreno L, Bello A, Ferreira F, Rosario S. Monitoring AIDS preventive action in the sex industry. Paper presented at: International Conference on AIDS; August 7–12, 1994; Yokohama, Japan: Abstract PD0483

48. Rosario S, Moreno L, Gomez B, De Moya EA, Fox L. Changes in condom use among Dominican sex workers. Paper presented at: International Conference on AIDS; August 7–12, 1994; Yokohama, Japan: Abstract PD0449

49. Proyecto Hotelero Puerto Plata, Dominican Republic: Centro de Promoción y Solidaridad Humana (CEPROSH); 1997

50. Forsythe S, Hasbun J, Butler de Lister M. Protecting paradise: tourism and AIDS in the Dominican Republic. Health Policy Plan 1998;13(3):277–286 [PubMed]

51. Carballo-Dieguez A, Remien RH, Dolezal C, Wagner G. Unsafe sex in the primary relationships of Puerto Rican men who have sex with men. AIDS Behav 1997;1(1):9–17

52. DiClemente R. Psychosocial determinants of condom use among adolescents. : DiClemente R, editor. , Adolescents and AIDS: A Generation in Jeopardy Newbury Park, CA: Sage Publications Inc; 1992:34–51

53. Lear D. Sexual communication in the age of AIDS: the construction of risk and trust among young adults. Soc Sci Med 1995;41(9):1311–1323 [PubMed]

54. Sobo EJ. Inner-city women and AIDS: the psycho-social benefits of unsafe sex. Cult Med Psychiatry 1993;17(4):455–485 [PubMed]

55. Martis J. Tourism and the sex trade. : Kempadoo K, editor. , Sun, Sex and Gold: Tourism and Sex Work in the Caribbean Lanham, MD: Rowman & Littlefield; 1999:201–215

56. Hochschild AR. Emotion work, feeling rules and social structure. Am J Sociol 1979;85(3):551–575

57. Hirsch JS, Meneses S, Thompson B, Negroni M, Pelcastre B, del Rio C. The inevitability of infidelity: sexual reputation, social geographies, and marital HIV risk in rural Mexico. Am J Public Health 2007;97(6):986–996 [PMC free article][PubMed]

58. Smith DJ. Modern marriage, men's extramarital sex, and HIV risk in southeastern Nigeria. Am J Public Health 2007;97(6):997–1005 [PMC free article][PubMed]

59. Stevens PE, Galvao L. “He won't use condoms”: HIV-infected women's struggles in primary relationships with serodiscordant partners. Am J Public Health 2007;97(6):1015–1022 [PMC free article][PubMed]

60. Wardlow H. Men's extramarital sexuality in rural Papua New Guinea. Am J Public Health 2007;97(6):1006–1014 [PMC free article][PubMed]

61. de Zalduondo B, Bernard JM. Meanings and consequences of sexual-economic exchange: gender, poverty and sexual risk behavior in urban Haiti. : Parker R, Gagnon JH, editors. , Conceiving Sexuality: Approaches to Sex Research in a Postmodern World New York, NY: Routledge; 1995:157–180

62. Kempadoo K. Continuities and change: five centuries of prostitution in the Caribbean. : Kempadoo K, editor. , Sun, Sex, and Gold: Tourism and Sex Work in the Caribbean Lanham, MD: Rowman & Littlefield; 1999:3–33

63. Kreniske J. AIDS in the Dominican Republic: anthropological reflections on the social nature of disease. : Bond C, Kreniske J, Susser I, Vincent JG, editors. , AIDS in Africa and the Caribbean Boulder, CO: Westview; 1997:33–50

64. Broring G, Van Duifhuizen R. Mobility and the spread of HIV/AIDS: a challenge to health promotion. AIDS Health Promot Exch 1993;(1):1–3 [PubMed]

65. Caldwell J, Anarfi J, Caldwell P. Mobility, migration, sex, STDs, and AIDS: an essay on sub-Saharan Africa with other parallels. : Herdt G, editor. , Sexual Cultures and Migration in the Era of AIDS: Anthropological and Demographic Perspectives New York, NY: Oxford University Press; 1997:41–51

66. Lansky A, Nakashima AK, Diaz T, et al. Human immunodeficiency virus infection in rural areas and small cities of the southeast: contributions of migration and behavior. J Rural Health 2000;16(1):20–30 [PubMed]

67. Organista KC, Organista PB. Migrant laborers and AIDS in the United States: a review of the literature. AIDS Educ Prev 1997;9(1):83–93 [PubMed]

68. Smith CJ, Yang X. Examining the connection between temporary migration and the spread of STDs and HIV/AIDS in China. China Rev 2005;5(1):109–137

69. Bronfman M, Minello N. Sexual habits of Mexican temporary migrants in the USA: practices involving risk of HIV infection. : Consejo Nacional de Prevención y Control del SIDA, editor. , SIDA en Mexico: Migracion, Adolescencia y Genero Cuernavaca, Mexico: Informacion Profesional Especializada; 1995

70. Wallace R. Social disintegration and the spread of AIDS: thresholds for propagation along “sociodemographic” networks. Soc Sci Med 1991;33(10):1155–1162 [PubMed]

71. Wallace R. Traveling waves of HIV infection on a low dimensional “socio-geographic” network. Soc Sci Med 1991;32(7):847–852 [PubMed]

72. Wallace R. Social disintegration and the spread of AIDS, II: meltdown of sociogeographic structure in urban minority neighborhoods. Soc Sci Med 1993;37(7):887–896 [PubMed]

73. Wallace R, Huang YS, Gould P, Wallace D. The hierarchical diffusion of AIDS and violent crime among US metropolitan regions: inner-city decay, stochastic resonance and reversal of the mortality transition. Soc Sci Med 1997;44(7):935–947 [PubMed]

74. UNAIDS, Institute of Medicine Migration and AIDS. Int Migr 1998;36(4):445–468 [PubMed]

75. Demographic and Health Survey, 2007 Santo Domingo, Dominican Republic: Centro de Estudios Sociales y Demográficos, Macro International Inc; 2008

76. Sistema Nacional de Vigilancia Epidemiológica VIH/SIDA/ITS de Segunda Generación Santo Domingo, Dominican Republic: Secretaría de Estado de Salud Pública y Asistencia Social, Dirección General de Control de las Infecciones de Transmisión Sexual y SIDA; 2007

77. World Health Organization, Pan American Health Organization. Informe Estimaciones Nacionales de la Epidemia VIH/SIDA en la República Dominicana Santo Domingo, Dominican Republic: UNAIDS and Collaborating Organizations; 2007

78. Joint United Nations Programme on HIV/AIDS. AIDS Epidemic Update Geneva, Switzerland: World Health Organization; 2007

79. Kerrigan DL, Moreno L, Rosario S, et al. Environmental-structural interventions to reduce HIV/STI risk among female sex workers in the Dominican Republic. Am J Public Health 2006;96(1):120–125 [PMC free article][PubMed]

80. Gouws E, Mishra V, Fowler TB. Comparison of adult HIV prevalence from national population-based surveys and antenatal clinic surveillance in countries with generalised epidemics: implications for calibrating surveillance data. Sex Transm Infect 2008;84(S1):i17–i23 [PMC free article][PubMed]

81. Kempadoo K. Dominicanas en Curacao: mitos y realidades. Género y Sociedad 1996;4(1):102–130

82. Kempadoo K, editor. , Sun, Sex and Gold: Tourism and Sex Work in the Caribbean Lanham, MD: Rowman & Littlefield; 1999

83. Farmer P. AIDS and Accusation: Haiti and the Geography of Blame Berkeley: University of California Press; 1992

84. Brewer TH, Hasbun J, Ryan CA, et al. Migration, ethnicity and environment: HIV risk factors for women on the sugar cane plantations of the Dominican Republic. AIDS 1998;12(14):1879–1887 [PubMed]

85. Martinez S. Peripheral Migrants: Haitians and Dominican Republic Sugar Plantations Knoxville: University of Tennessee; Press; 1995

86. Global Status Report on Alcohol Geneva, Switzerland: World Health Organization; 2004

87. Parry CDH. Alcohol problems in developing countries: challenges for the new millennium. Suchtmed 2000;2(4):216–220

88. Room R, Jernigan D. The ambiguous role of alcohol in economic and social development. Addiction 2000;95(suppl 4):S523–S535 [PubMed]

89. Fritz KE, Woelk GB, Bassett MT, et al. The association between alcohol use, sexual risk behavior, and HIV infection among men attending beerhalls in Harare, Zimbabwe. AIDS Behav 2002;6(3):221–228

90. Kalichman SC, Simbayi LC, Vermaak R, Jooste S, Cain D. HIV/AIDS risks among men and women who drink at informal alcohol serving establishments (shebeens) in Cape Town, South Africa. Prev Sci 2008;9(1):55–62 [PubMed]

91. Sivaram S, Srikrishnan AK, Latkin C, et al. Male alcohol use and unprotected sex with non-regular partners: evidence from wine shops in Chennai, India. Drug Alcohol Depend 2008;94(1–3):133–141 [PMC free article][PubMed]

92. Morojele NK, Kachieng'a MA, Nkoko MA, et al. Perceived effects of alcohol use on sexual encounters among adults in South Africa. Afr J Drug Alcohol Stud 2004;3(1–2):1–20

93. Jerez H, Moreno L, Rosario S, et al. Compartiendo la reducción del riesgo en el trabajo sexual—incluyendo a los clientes de trabajadoras sexuales en la prevención del VIH e ITS (T4-867). Paper presented at: II Foro de VIH/SIDA/ITS en América Latina y el Caribe; April 7–12, 2003; Havana, Cuba

94. Council on Hemispheric Affairs Hispaniola: the Caribbean's new big leaguers in the drug trafficking trade

KEY POINTS:

• Impressive progress has been made in Latin America in increasing the number of people who know their HIV status and receive treatment. 

• Latin America has shown strong commitment to funding their HIV response, yet services for high risk groups are left out of the national response and are funded by donors.  

• The Caribbean has the second highest HIV prevalence after sub-Saharan Africa.

• The percentage of people in the Caribbean with suppressed viral loads is well below the global average.  

• Of the Caribbean countries 11 out of 16 rely heavily on external funding.

• Violence and stigma towards key affected populations and those living with HIV has remained a barrier to HIV progress in Latin America and the Caribbean 

Explore this page to find out more about the people most affected by HIV in Latin America and Caribbean, HIV testing and counselling programmes, HIV prevention programmes, antiretroviral treatment availability, barriers to prevention, HIV funding and the way forward for Latin America and Caribbean.

In Latin America and the Caribbean, the overall rate of new HIV infections in adults has remained stable between 2010 and 2016. However, this stability masks differences between adults and children and between Latin America and the Caribbean region.1

Among adults, a 3% rise in rates of new HIV infections between 2010 and 2015 contrasted sharply with a 20% decline during the previous decade.2 In 2016, there were an estimated 2.1 million people living with HIV in this region – an infection prevalence of 0.5%. In the same year, there were an estimated 115,000 new HIV infections and 45,000 deaths from AIDS-related illnesses.3

In the Caribbean, new HIV infections among adults rose by 9% between 2010 and 2015, reversing gains made in the previous decade. In 2016, the annual number of new HIV infections in the Caribbean was estimated at 17,000.45Despite its small population size, the Caribbean has the second-highest HIV prevalence globally after sub-Saharan Africa.6

Key affected populations in Latin America and the Caribbean

Though HIV prevalence is generally low, prevalence among key affected populations, such as men who have sex with men and transgender women, is particularly high. 7 These key populations and their sexual partners accounted for nearly two-thirds of new infections in 2014. Young people in the Caribbean are also disproportionately vulnerable to HIV.8

Men who have sex with men in Latin America and the Caribbean

Men who have sex with men (sometimes referred to as MSM) are the group most affected by HIV in Latin America and the Caribbean. In 2014, men who have sex with men accounted for nearly a third of new HIV infections in the region.9 However, HIV prevalence among this group varies greatly between countries. For example, it is as high as 25.4% in Bolivia, falling to 1.8% in Cuba.1011

There are many reasons for high levels of HIV transmission among this group. In 2014, only 51% of men who have sex with men were reported to have access to HIV services, a level which had remained largely unchanged for several years.12 Moreover, HIV testing in the last 12 months among men who have sex with men varied enormously from country to country, ranging from 5% to 70%. This suggests large differences in access to testing services between countries in the region.13

Homophobia and the ‘machismo’ (strong/aggressive masculinity) culture are common throughout the region and sex between men is highly stigmatised. As a result, large numbers of men who have sex with men do not identify as homosexual (or bisexual) and have sex with women as well as men, forming a 'bridge' population.1415

As one civil society worker explains, men who have sex with men are often hesitant to reveal how they became infected with HIV. Many are mistakenly classed as heterosexual:

Unless he’s a total queen, a man will always be [counted as] heterosexual. Plus, people don’t want to be recognised [as homosexual].

- Ruben Mayorga, civil society worker, Guatemala City 16

Transgender women in Latin America and the Caribbean

Transgender women are highly affected by HIV in Latin America and the Caribbean. HIV prevalence among this group is thought to be 49 times higher than the general population.17

In countries where data are collected on this key population, transgender women have some of the highest HIV prevalence rates. Country level data collected between 2011 and 2015 also show much higher HIV prevalence among transgender women sex workers compared to male and female sex workers.18

For example, HIV prevalence among transgender women who participate in sex work is 32% in Ecuador and Panama,19 and between 20-30% in Argentina, Bolivia, El Salvador, Honduras, Paraguay, Peru and Uruguay.20

Research has shown that 44-70% of transgender women have felt the need to leave, or were thrown out of their homes.21 One study from Mexico indicated that 11.4% of transgender women living with HIV were excluded from family activities.22

Moreover, transgender people have fewer educational and social opportunities, often resorting to sex work for an income.23

Transgender people also face high rates of violence. Between 2008 and 2016 more than 1,800 murders of transgender people were reported in Central and South America. The highest number of these murders occurred in Brazil, where 938 were reported.24 Stigma and violence are barriers to HIV services.

Sex workers in Latin America and the Caribbean

In 2013, 6.1% of female sex workers in Latin America were thought to be living with HIV. Male sex workers tend to be much more affected by HIV than female sex workers. For example, in the same year, 69% of male sex workers in Suriname were estimated to be living with HIV, compared to just 4% of female sex workers.25

Testing coverage among sex workers was higher among female sex workers (ranging from 39% to 98%) than among male sex workers (ranging from 17% to 70%). Condom use during their last transactional sex ranged from 57% in Belize to greater than 95% in Panama and Antigua and Barbuda.26

In the Caribbean in particular, and across the region, sex workers experience a range of human rights violations and social injustices, including the denial of access to healthcare, poor working conditions, violence and harassment by law enforcement. Sex workers are also frequently marginalised by social and religious institutions and subject to discrimination. For these reasons, many people who engage in sex work do so covertly.

These factors are significant barriers to HIV prevention and successful service delivery for sex workers.27

Violence is a major barrier to HIV prevention for sex workers. One study of female sex workers in Argentina reported that 24.1% had received sexual abuse; 34.7% reported rejection experiences; 21.9% reported having been beaten; while 45.4% reported having been arrested because of their sex work activity. Higher levels of inconsistent condom use were also reported among those who experienced sexual abuse, rejection and police detention.28

People who inject drugs in Latin America and the Caribbean

There are an estimated 721,000 people who inject drugs (sometimes referred to as PWID) in Latin America and the Caribbean. HIV prevalence among this group averages 2% but varies significantly between countries.29

Reliable data for HIV prevalence among drug users are extremely limited. For example, the latest figures from Brazil are from 2009, when HIV prevalence among people who inject drugs was at 5.9%.30

In Puerto Rico, where poor access to sterile injecting material has been identified as a significant contributor to the HIV epidemic, 51% of people who died while living with HIV between 1981 and 2013 acquired the infection via unsafe injection practices.31

Across the region, the popularity of injecting drugs has declined and been replaced by people who favour smoking or inhaling drugs.32 It is now widely acknowledged that drug use in the region mainly comprises the non-injecting of cocaine and its derivatives.33

One systematic review of key affected populations in Brazil detected an HIV prevalence of 23.1% among people who use drugs.34 Another study, from Montevideo in Uruguay, found an increase in HIV risk among cocaine smokers, with an estimated 6.3% HIV prevalence rate.35 This is due mainly to the fact that any form of drug use impairs a person’s ability to engage in safer sex behaviours.

Young people in Latin America and the Caribbean

Young people in Latin America and the Caribbean, especially those who are also members of key populations, are disproportionately at risk of HIV infection. One factor contributing to this is the barriers young people face to accessing prevention services.

Young women are at particularly high risk. Survey data from Barbados, Belize, Costa Rica, Cuba, the Dominican Republic, El Salvador, Guyana, Panama and Uruguay show that between 5 and 16% of young women aged 15 to 24 report that they became sexually active before the age of 15.36

Sexual activity at a younger age has been linked to higher risk of HIV37. Despite these factors, girls in these countries need parental consent or accompaniment to access sexual and reproductive healthcare services.

In nine of 17 countries, minors require parental or guardian consent to take an HIV test and find out the results. A few countries in the Caribbean have developed policies allowing minors to access HIV testing without parental consent, either allowing it at any age (such as in Guyana) or above the age of 14 (as in Trinidad and Tobago).38

In Mexico and Panama, adolescents have to be accompanied by a parent, a legal guardian or other state-recognized individuals responsible for the well-being of adolescents in order to receive their test results. In Paraguay, health staff can request authorisation to conduct an HIV test in the absence of parents or guardians.39

In the Caribbean, the cultural norm of young women having sexual relationships with older men increases their risk of HIV infection. Between 9 and 24% of women aged 15 to 24 years reported having sex with a man at least 10 years older than themselves within the last 12 months. Other risk factors, such as multiple sexual partners and inconsistent condom use, compound the risk of age mixing in these countries.40

HIV prevalence data for young women in this region highlights their vulnerability. In Haiti, for example, HIV prevalence among young women aged 15-19 years is 0.5% – more than double the figure for young men of the same age. Additionally, women aged 20–24 are three times more likely to be HIV-positive than men of the same age.41

HIV testing and counselling in Latin America and the Caribbean

Data on HIV testing coverage is very limited for Latin America and the Caribbean. An estimated 81% of people living with HIV in Latin America knew their status in 2016. While in the Caribbean, an estimated 64% had been diagnosed.42

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