HIV and AIDS in the Caribbean: An Assessment of the Risk Environment

• Author: Roger McLean, Karl Theodore, Caroline Allen, Martin Franklin and Christine Laptiste
• Pages: 295-313

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HIV AND AIDS IN THE CARIBBEAN – AN ASSESSMENT OF THE RISK ENVIRONMENT

HIV and AIDS in the Caribbean –

An Assessment of the Risk

Environment

Roger McLean, Karl Theodore,

Caroline Allen, Martin Franklin,

Christine Laptiste

Chapter 15

The Case of Trinidad and Tobago

BACKGROUND AND INTRODUCTION

The current HIV and AIDS crises continue to present unique challenges

to policymakers, international experts, aid-donors and caregivers, alike,

because of their reach and impact on families, communities and entire

societies. The changes spawned have reconfigured long-standing social

and economic structures and now threaten the very social fabric of

countries.

For the countries of the English-speaking Caribbean, early advances

made in the field of health led to the reduction and, in some cases, the

eradication of key infectious diseases thereby significantly enhancing the

quality of life. The spread of HIV and AIDS now threatens to erode

these gains and, ultimately, short-circuit the development processes in

many countries. The epidemics continue to be rooted predominantly

among the young and productive cohorts of the population. In

acknowledging this fact the paper focuses on some of the causal factors

that make this group vulnerable to the disease. Central to the discussion

on vulnerability, specifically as it pertains to HIV and AIDS, is the issue

of the risk environment and those factors that influence this environment.

The chapter will, therefore, begins by examining a conceptual

framework for assessing the vulnerability of persons infected and affected

by, and at risk of HIV and AIDS in Trinidad and Tobago. This entails an

assessment of the risk environment itself, looking specifically at key socio-

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SEXUALITY, SOCIAL EXCLUSION AND HUMAN RIGHTS

cultural and economic drivers. The overall objective is to gain a better

understanding of the dynamics driving the epidemics so as to identify ex-

ante patterns about future trends.

METHODOLOGY

The chapter draws from both primary and secondary data sources.

The latter involves the use of local and international documents and

reports that capture the nature and trends of the HIV and AIDS

epidemics. These include country reports of the National AIDS

Coordinating Committee (NACC) of Trinidad and Tobago and the

National Surveillance Unit of Trinidad and Tobago. With respect to the

primary data collection process of the main tool is a quality of life survey

which was conducted among a cross-section of the community of people

living with HIV and AIDS (PLWHIV). This exercise was led by the

Caribbean Health Research Council (CHRC) and done in collaboration

with the Health Economics Unit of the University of the West Indies,

St. Augustine campus. The quality of life survey was conducted on behalf

of the Caribbean Regional Network for People Living with HIV and

AIDS (CRN+). Primary data were also compiled through a number of

techniques, including key informant interviews and focus group

discussions with stakeholders in Trinidad and Tobago.

A BRIEF EPIDEMIOLOGICAL REVIEW

The Caribbean’s epidemics vary considerably in extent and intensity

with HIV prevalence ranging from three per cent in The Bahamas and

Haiti and two per cent in Trinidad and Tobago, to one per cent and less

in some of the islands of the Eastern Caribbean (CAREC, 2004). Trinidad

and Tobago stands among those countries with the highest rates in the

English-speaking Caribbean with 29,000 persons infected. The epidemic

is also estimated to have claimed between 4,500 and 5,000 lives during

the first 19 years of its existence (CAREC 2004, 170).

The first AIDS cases in Trinidad and Tobago were reported among

homosexual men in 1983. From then to the end of the third quarter of