At the end of 2005, an estimated 330,000 people were living with HIV and AIDS in the West Indies. Some 37,000 people were newly-infected during 2005, and there were 27,000 deaths due to AIDS.

Contributed photos - Haitian Joseph Jeune (right) holds up a laptop showing a picture of himself taken in 2003 before he received anti-retroviral drug therapy and was placed on a food programme.

In three of the seven countries in this region - the Bahamas, Haiti and Trinidad and Tobago - more than two per cent of the adult population is living with HIV. Higher prevalence rates are found only in sub-Saharan Africa, making the Caribbean the second-most affected region in the world. More than half the adults living with the virus are women.

leading cause of death

AIDS is now one of the leading causes of death in some of these countries, with Haiti being the worst affected. An estimated 16,000 lives are lost each year to AIDS in Haiti, and tens of thousands of children have been orphaned by the epidemic.

The predominant route of HIV transmission in the Caribbean is heterosexual contact. Much of this transmission is associated with commercial sex, but the virus is also spreading in the general population, especially in Haiti. Cultural and behavioural patterns (such as early initiation of sexual acts, and taboos related to sex and sexuality), gender inequalities, lack of confidentiality, stigmatisation and economic need are some of the factors influencing vulnerability to HIV and AIDS in the Caribbean.

Haiti's prevalence levels have been very high since the late 1980s (the estimated rate in 2005 was 3.8 per cent). With very low condom use among young people, and about 60 per cent of the population under 24, much scope exists for renewed growth in Haiti's mainly heterosexually transmitted epidemic. On the other side of Hispaniola Island, in the Dominican Republic, previously high prevalence has declined due to effective prevention efforts that encouraged people to reduce their number of sexual partners and increase condom use.