The Caribbean is a multi-ethnic region with many different cultural differences. The majority of the population is of African descent, but there are also other ethnic groups present such as Indians, Chinese, Syrians and Europeans. The Caribbean region is influenced by countries such as the USA, Great Britain, France and Holland. The countries of the Caribbean have a serious problem with HIV infection and AIDS. The epidemiology of HIV infection in this region, is different from most other parts of the world in that the mode of spread does not easily fit into any of the three WHO patterns. This review shows that the infection initially started in the homosexual/bisexual community, but since then, it has moved to the heterosexual population and this form of contact is now the main mode of transmission of the virus. The Governments of the Caribbean countries have realized the extent of the problem and have taken measures to try to control the epidemic.
BalarajanRRaleighLV.The ethnic populations of England and Wales: The 1991 Census. Health Trends1992;24:113–16.
2.
NarainJPHullBHospedalesCJMahabirSBassetCD. Epidemiology of AIDS and HIV infection in the Caribbean. PAHO Bulletin1989;23:42–9.
3.
BartholomewCRajuCPatrickAPencoFJankeyN.AIDS in Trinidad. Lancet1984;i:103.
4.
BartholomewCRajuCJankeyN.The Acquired Immuno-Deficiency Syndrome in Trinidad: A report of 2 cases. West Indian Med J1983;32:177–80.
5.
PapeJLiautaudBThomasF.Characteristics of AIDS in Haiti. N Engl J Med1983;309:945–50.
6.
GayleCFarleyJ.Trends in patterns of transmission over 10 years of the AIDS epidemic in the English-speaking Caribbean and Surinam. IX International Conference on AIDS/IV STD World Congress, Berlin, 1993. Abstract PO-C06–2710 CAREC Epidemiological Notes and Reports. West Indian Med J1990;39:128–30.
7.
KorstLMMartinezSNievesERullanJHoranJDiazT.Increasing Heterosexual Transmission of Acquired Immunodeficiency Syndrome in Puerto Rico, 1988–91. VIII International Conference on AIDS/III STD World Congress, Amsterdam, 1992. Abstract PuC 8118.
8.
QuinnTCFernandoRZacariasRKSt JohnRK.HIV and HTLV-1 infection in the Americas: A regional perspective. Medicine1989;68:189–209.
9.
CameronDWD'CostaLJNdinya-AcholaJOPiotPPlummerFA.Incidence and risk factors for female to male tansmission of HIV. Fourth International Conference on AIDS, Stockholm, Sweden, 1988.
10.
KreissJKKoechDPlummerFAAIDS virus infection in Nairobi prostitutes. Spread of the epidemic to East Africa. N Engl J Med1986;314:414–18.
11.
MannJMNzilambiNPiotPHuman Immunodeficiency viral infection and associated risk factors in the female prostitutes in Kinshasa, Zaire. AIDS1988;2:255–60.
12.
PiotPPlummerFAReyMARetrospective seroepidemiology of AIDS virus infection in Nairobi populations. J Infect Dis1987;155:1108–12.
13.
QuinnTCMannJMCurranJWPiotP.AIDS in Africa: An epidemiologic paradigm. Science1986;234:955–63.
14.
KoenigREPittalugaJBogartMPrevalence of antibody to HIV in Dominicans and Haitians in the Dominican Republic. JAMA1987;257:631–4.
15.
Centers for Disease Control. HIV infection in the USA: A review of current knowledge. MMWR1987;36:1–48.
16.
BoulosRHalseyRisk factors for HIV infection in pregnant Haitian women. Fourth International Conference on AIDS, Sweden, 1988.
17.
Centers for Disease Control. Provisional public health services inter-agency recommendations for screening donated blood and plasma for antibody to the virus causing acquired immuno-deficiency syndrome. MMWR1985;34:1–5.
18.
HoffRBerardiVPWeiblenBJMahoney-TroutLMitchellMLGradyGF.Seroprevalence of human immunodeficiency virus among childbearing women. Estimation by testing samples of blood from newborns. N Engl J Med1988;318:525–30.
19.
MarwickC.HIV antibody prevalence data derived from study of Massachusetts infants. JAMA1987;258:171–2.
20.
BraddickMKriessJEmbroseJVertical transmission of HIV in Nairobi. Fourth International Conference on AIDS, 1988. Stockholm, Sweden.
21.
FreidlandGHKleinRS.Transmission of the human immunodeficiency virus. N Engl J Med1987;317:1125–35.
22.
MokJQGiaquintoCDeRossiAGrosh-WornerIAdesAEPeckhamCS.Infants born to mothers seropositive for human immunodeficiency virus. Preliminary findings from a multicentre European study. Lancet1987;1:1164–8.
23.
RogersMF.AIDS in children: A review of the clinical, epidemiologic and public health aspects. Fed Infect Dis1985;4:230–6.
24.
RyderRWNsaWBehetsFPerinatal HIV transmission in two African hospitals: One year follow-up. Fourth International Conference on AIDS, 1988. Stockholm, Sweden.
25.
SempriniEAVucetichAPardiGCossuMM.HIV infection and AIDS in newborn babies of mothers positive for HIV antibody. BMJ1987;294:610.
26.
The European Collaborative Study. Mother to child transmission of HIV infection. Lancet1988;2:1039–42.
27.
LandesmanSMirtkoffHHolmannSMcCallaSSijinO.Sero-survey of human immunodeficiency virus infection in parturients. Implications for human immunodeficiency virus testing programs of pregnant women. JAMA1987;258:2701–3.
28.
BartholomewCSaxingerWCClarkJWTransmission of HTLV-1 and HIV among homosexual men in Trinidad. JAMA1987;257:2604–8.
29.
De TheGGessainA.Seroepidemiologic data on viral infections (HTLV-1 and LAV/HTLV-3) in the Caribbean region and intertropical Africa. Ann Pathol1986;6:261–4.
30.
GuerinJMMalebrancheREueRAcquired immune deficiency syndrome: Specific aspects of the disease in Haiti. Ann NY Acad Sci1984;437:254–63.
31.
PapeJWLiautaudBThomasFThe acquired immunodeficiency syndrome in Haiti. Ann Intern Med1985;103:674–8.
32.
GenserSGRatnerMJ.‘Sex-for-crack’ as an AIDS risk behaviour: An ethnographic study. VIII International Conference on AIDS/III STD World Congress, Amsterdam, 1992. Abstract WeC-1032.
33.
CleghornFJackNEdwardsJMurphyJBartholomewCBlattnerW.Risk factors for HIV-1 among STD clinic clients in Trinidad. IX International Conference on AIDS/IV STD World Congress, Berlin, 1993. Abstract PO-C03–2617.
34.
BartholomewCCleghornF.Retroviruses in the Caribbean. PAHO Bulletin1989;23:76–80.
35.
GomezMPBainRReadS.Seroprevalence of HIV infection in the Commonwealth of the Bahamas. VIII International Conference on AIDS/III STD World Congress Amsterdam, 1992. Poster PoC-4045.
36.
DerenSShedlinMMillerKDavisWRClattsMBalcortaS.HIV risk behaviours in three groups of Latina Prostitutes: Dominican, Mexican and Puerto Rican. IX International Conference on AIDS/IV STD World Congress Berlin, 1993. Abstract PO-C14–2902.
37.
ColonHRoblesRMatosTSahaiH. and National AIDS Research Consortium. HIV transmission and travel patterns of Puerto Rican drug injectors. IX International Conference on AIDS/IV STD World Congress Berlin, 1993. Abstract PO-C15–2958.
38.
AlegriaMVeraMRiveraCRoblesR.Differences in risk profile and HIV infection rates among brothel and street workers in Puerto Rico. VIII International Conference on AIDS/III STD World Congress Amsterdam, 1992. Abstract PuC-8003.
39.
BinillaLPorterJMendezS.Condom use in low income island and mainland Puerto Rican populations. VIII International Conference on AIDS/III STD World Congress Amsterdam, 1992. Poster PoD-5138.
40.
BassettDCNarainJP.Changing Pattern of HIV transmission in the Caribbean. PAHO Bulletin1989;23:134–7.
41.
Surveillance Unit, Dept. of Health of Bermuda. AIDS Update1988. Hamilton, Bermuda.
42.
VieiraJFrankESpiraTJLandesmanSH.AIDS in Haitians: Opportunistic infection in previously healthy Haitian immigrants. N Engl J Med1983;308:125–9.
43.
PitchenikAEFischlMADickinsonGMOpportunistic infections and Kaposi's Sarcoma among Haitians: Evidence of a new acquired immunodeficiency state. Ann Intern Med1983;98:277–84.
44.
Update: AIDS-USA. MMWR1984;32:688–91.
45.
PapeJWLiautaudBThomasFRisk factors associated with AIDS in Haiti. Am J Med Sci1986;291:4–7.
46.
MosesPMosesJ.Haiti and the Acquired Immuno-deficiency Syndrome. Ann Intern Med1983;99:565.
47.
DeMoyaEAPenaCForsytheSGomezEColemanE.Deficits in blood supply and transfusion of HIV unscreened units in the Dominican Republic. VIII International Conference on AIDS/III World Congress Amsterdam, 1992. Poster PoD-5169.
48.
St CatherineL.Pers. comm., PAHO Bulletin, 1988.
49.
LangeRWKreiderS.(Letter)JAMA1987;258:3387.
50.
WojcikMMartinTClosenMIsaacmanS.An outside critique of Cuba's AIDS program. IX International Conference on AIDS/IV STD World Congress Berlin, 1993. Abstract PO-D28–4238.
51.
CAREC Epidemiological notes and Reports. West Indian Med J1989;38:187–9.
52.
SchupbackJKalyanaramanVSSarngadharanMGBlattnerWAGalloRC.Antibodies against three purified proteins of the human type-C retrovirus, human T-cell lymphoma/leukaemia virus in adult T-cell lymphoma/leukaemia patients and healthy blacks from the Caribbean. Cancer Res1983;43:886–91.
53.
De-TheGGessainAGazzoloLComparative seroepidemiology of HTLV-1 and HTLV-3 in the French West Indies and some African countries. Cancer Res1985;45:4633–6.
54.
GessainAJouanelleAEscarmantPCallenderASchaffar-DeshayesLDeTheG.HTLV antibody in patients with non-Hodgkin's lymphomas in Martinique. Lancet1984;i:1183.
55.
HaradaSKoyanagiYYamatoN.Infection of HTLV-3/LAV in HTLV-1–carrying cells MT-2 and MT-4 and application in a plaque assay. Science1985;229:563–6.
56.
KoyanagiYHaradaSYamamotoN.Correlation between high susceptibility to AIDS virus and surface expression of OKT-4 antigen in HTLV-1 positive cell lines. Jpn J Cancer Res1985.
57.
DeRossiAFranchiniGAldoviniADifferential response to cytopathic effects of human T-lymphotrophic virus type-3 (HTLV-3) superinfection in T4 (helper) and T8 (suppressor) T-cell clones transformed by HTLV-1. Proc Natl Acad Sci USA1986;83:4297–301.
58.
HarperMEKaplanMHMarselleLMConcomitant infection with HTLV-1 and HTLV-3 in a patient with T8 lymphoproliferative disease. N Engl J Med1986;315:1073–8.
59.
SickevitzMJosephsSHDukovichMPefferNWong-StaalFGreeneWC.Activation of the HIV-1 LTR by T-cell mitogens and the trans-activator protein of HTLV-1. Science1988;239:4510.
60.
SodroskiJGRosenCAHaseltineWA.Transacting transcriptional activation of the long terminal repeat of human T-lymphotrophic viruses in infected cells. Science1984;225:381–5.
61.
JaffeHWDarrowWWEchenbergDFO'MalleyPMGetchellJP.AIDS in a cohort of homosexual men: A six year follow-up study. Ann Intern Med1985;103:210–14.
62.
LuiKJDarrowWWRutherfordGW.A model-based estimate of the mean incubation period for AIDS in homosexual men. Science1988;240:1333–5.
63.
MedleyGFAndersonRMCoxDRBillardL.Incubation period of AIDS in patients infected via blood transfusion. Nature1987;328:719–21.
64.
CleghornF.Proceedings of the London Conference on Global impact of AIDS, 1988:55.
65.
BishopJ.Family life in the Caribbean: Socio-cultural issues which affect AIDS prevention strategies. Presented at the CAREC workshop on preventive counselling. July, 1988.
66.
JagdeoTP.Myths, misconceptions and mistakes: A study of Trinidad adolescents. The Family Planning Association of Trinidad and Tobago, 1986.
67.
Centers for Disease Control. MMWR1988;37:1–3.
68.
Health Education Authority and Public Health Laboratory Service AIDS Centre, United Kingdom. A quarterly epidemiological briefing on AIDS/HIV in the United Kingdom. Issue 1, March 1988.
69.
PerezJTorresRMartinezAHIV infection in Cuba. VIII International Conference on AIDS/III STD World Congress Amsterdam, 1992. Poster PoC-4067.
70.
The Miami Herald news, Feb 14, 1987:A1.
71.
UbellRN.High-tech medicine in the Caribbean: 25 years of Cuban Health care. N Engl J Med1983;309:1468–72.
72.
Perez-StableEJ: High-tech medicine in the Caribbean: 25 years of Cuban Health care. N Engl J Med1984;311:60.
73.
CurranJWJaffeHWHardyAMMorganWMSelikRMDonderoTJ.Epidemiology of HIV infection and AIDS in the United States. Science1988;239:610–16.
74.
RosarioSReynaldoP.VIU International Conference on AIDS/III STD World Congress Amsterdam, 1992. Poster PoD-5653.
75.
TaylorNO'NeilCFitzpatrickLFrancisC.Involving the Caribbean media in AIDS prevention. VIII J International Conference on AIDS/III STD World Congress Amsterdam, 1992. Poster PoD-5817.
76.
KreigerNMargoG.Section on AIDS: The politics of survival. Int J Health Serv1990;20:583–8.
77.
KambonA.Media use in Trinidad and Tobago and its implication for AIDS communication strategies in the developing world. VIII International Conference on AIDS/III STD World Congress Amsterdam, 1992. Poster PoD-5545.
78.
HelquistMSchneiderAFrancisCMiddlestadtSEEustaceMA.Policy and controversy in condom marketing campaigns. VIII International Conference on AIDS/III STD World Congress Amsterdam, 1992. Poster 5144.
79.
HerrasmeLBelloAMorenoLRosarioSFoxL.Commercial sex workers in AIDS prevention activities in the Dominican Republic, 1989–1992. Vlll International Conference on AIDS/III STD World Congress Amsterdam, 1992. Poster PoD-5630.
80.
CastroLAEspinoY.Impact of Gay Organisation practice on AIDS preventive behaviour in a Homophobic Society. VIII International Conference on AIDS/III STD World Conference, Amsterdam, 1992. Poster PoD 5177.
81.
SantiagoWBlumWTorresMRodriguezD.Puppetry, Stories and Games: a two year program for HIV prevention aimed at young children. VIII International Conference on AIDS/III STD World Congress Amsterdam, 1992. Poster PoD-5033.
82.
ForsytheSSchvartzEJanowitzBMeasuring costs and benefits of Targeted Condom distribution programs in Latin American and Caribbean countries. VIII International Conference on AIDS/III STD World Congress, Amsterdam, 1992. Poster PoD-5403.
83.
GomezERamirezAPenaCGarrisIPerezJ.Sentinel seroprevalence surveys for HIV-1 infection in the Dominican Republic. VIII International Conference on AIDS/III STD World Congress Amsterdam, 1992. Poster PoC-4066.
84.
ZorrillaCRomagueraJDiazCHillyerJVOrtizIAdamsonsK.Decreasing prenatal HIV seroprevalence: effect of a comprehensive OB-GYN HIV program. VIII International Conference on AIDS/III STD World Congress Amsterdam, 1992. Poster PoC-4804.
