- The Washington Times - Monday, March 8, 2004

SANTO DOMINGO, Dominican Republic - The AIDS virus is ripping through the Caribbean region, with a virulence outstripped only in sub-Saharan Africa, claiming 60,000 lives a year and leaving 250,000 orphans in its wake.

Infection estimates, in an area that most Americans think of as a vacation play land of turquoise waters and palm-fringed beaches, run as high as 600,000, with few signs of a significant slowdown in the next few years.

As in most developing countries, a very small minority of those infected know they have HIV probably fewer than 10 percent contributing significantly to the spread of the virus.

As many as 80,000 people became infected in the past year, swelling a base of affected persons that threatens to overwhelm public-health systems, sabotage economic growth and wreak untold social consequences.

Patients with AIDS occupy 25 percent of hospital beds in the Caribbean, where the disease is a major cause of death of people in their prime.

The countries of the region, reeling economically from globalization and trade liberalization, are threatened with a loss of workers from AIDS, Dr. Denzil Douglas, prime minister of St. Kitts and Nevis, warned at a regionwide conference that ended Sunday.

AIDS-related deaths among professionals such as doctors and teachers, he said, are undercutting the ability of some Caribbean countries to fight the epidemic.

“The loss of institutional functionality and institutional knowledge could have a debilitating impact on our countries,” he said.

HIV, or human immunodeficiency virus, which causes AIDS, first made an appearance in the region 20 years ago, but it is only in recent years that policy-makers have realized the fury of the epidemiological hurricane they face and have sought international assistance.

Most Caribbean countries have managed to stabilize, and in some cases even reduce, new infection rates, but they remain high, at about 2.5 percent.

Further progress is expected to be difficult as health professionals seek to modify high-risk behavior, particularly among the young, amid cultural resistance.

The statistics are most alarming in Spanish-, French- and Dutch-speaking countries. The United States sponsored a similar conference in the English-speaking Caribbean fours years ago, and the weekend conference that ended Sunday was a follow-up, said Jack Whitescarver, director of the Office of AIDS Research at the National Institutes of Health.

The recent meeting, co-sponsored by the United States, was held in the Dominican Republic, which shares with Haiti the island of Hispaniola the epicenter of the epidemic, accounting for about 80 percent of infections in the Caribbean.

Haiti, by far the poorest country in the region, is hardest hit, accounting for about 55 percent of the island’s total HIV carriers. But not all the news from Haiti is grim. According to Dr. Jean Pape, a leading anti-AIDS crusader, his treatment centers succeeded in reducing infection rates from 6.2 percent in 1993 to 2.9 percent in the past year.

“This is unprecedented. No other country has done this, and it shows that in a country where there are all kinds of disasters political, social, economic if you focus on the work, you can get results,” he said at the conference. “Many people are coming to Haiti to learn what we are doing.”

With about $66 million from the United Nations Global Fund and more promised by the Bush administration, the U.S.-trained Dr. Pape said he hopes to cut new infections by half again.

“With this new funding, what we did in 10 years we should be able to do within five years that’s what I am shooting for.”

The reduced rate of 2.9 percent still represents 200,000 infections among Haitians and 30,000 deaths in the past year contributing to the country’s 200,000 orphans.

Other researchers point out that despite the toll, the perception of risk among Haitians is lower than it was 10 years ago.

A similar slip in vigilance contributed to 45,000 new infections last year in the United States and Canada, which have a much larger combined population than the 34 million of the Caribbean.

The conference attracted 1,800 professionals from the region almost twice the initial expectations suggesting pent-up demand to exchange experience in coping with the epidemic. Conspicuously absent was Guyana the other country in the region chosen for significant funding from the $15 billion fund recently announced in Washington.

The Dominican Republic has not received any of the $48 million promised by the United Nations in an agreement signed a year ago, according to Ernesto Guerrero Camilo, a representative of the Joint United Nations Program on HIV/AIDS (UNAIDS). Roughly half that money is intended to treat 5,000 Dominicans who need antiretroviral drugs. About 50,000 people are thought to be infected, but only 500 receive treatment.

Last year, the 15-member Caribbean Community, or CARICOM, succeeded in negotiating significant reductions in the cost of these drugs with pharmaceutical companies, and there is talk of seeking additional price cuts.

Experts say the absence of realistic possibilities for treatment discourages people from being tested and prevents officials from learning the extent of the epidemic.

Mr. Camilo of UNAIDS complained that the exclusion of the Dominican Republic from the first round of funding from the Bush administration undermined a more comprehensive islandwide strategy.

Without standardized treatments, one side of the island could develop strains of the virus resistant to treatment in the other half. There are about 1 million Haitians living in the Dominican Republic, and about half the sex workers in Haiti are from that side of the island.

“Whatever happens on one side has repercussions on the other side,” he said.

Other experts said there ought to be better formal coordination with U.S. health authorities, particularly in the New York area where there are large numbers of people from the Caribbean, including more than a million Dominicans.

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