BOGOTA (Thomson Reuters Foundation) - Anti-gay laws and cultural attitudes are preventing the most vulnerable people accessing HIV/AIDS prevention and treatment programmes in parts of the Caribbean, UNAIDS and the Global Fund to Fight AIDS, Tuberculosis and Malaria has said.
With adult HIV prevalence at about one percent of the population, the Caribbean has the second highest infection rate of HIV/AIDS in the world after sub-Saharan Africa, according to UNAIDS. An estimated 250,000 people, including children, are infected with the virus in the Caribbean.
Better access to drugs that can both prevent and treat the incurable human immunodeficiency virus that causes AIDS has cut the death toll and led to a sharp decline in new HIV infections in the Caribbean and worldwide since 2001.
But populations at high risk of getting HIV/AIDS - men who have sex with men, sex workers, transgender people, injecting drug users, homeless people and prisoners - are still not being reached and face obstacles in getting access to antiretroviral therapy because of homophobic attitudes and traditional beliefs prevalent in parts of the Caribbean, experts say.
"When you get 12 countries, mostly in the English-speaking Caribbean, that penalise homosexuality you get a sense of a culture and the nature of a society and how difficult it is to propose prevention of HIV/AIDS in those settings," said Cesar Nunez, head of UNAIDS for Latin America.
Most former British colonies in the Caribbean have anti-sodomy laws dating back to the colonial era, and Belize, Guyana and Jamaica have "very strong legislation against homosexual behaviour," Nunez said.
In Jamaica, for example, the Offenses Against the Person Act makes anal sex a crime, regardless of gender or consent.
Though such laws are rarely put into practice, their continued presence on the books sustains the stigma attached to homosexuality.
"There’s usually a religious and moral tone to the laws too. This has prevented people suffering HIV access to healthcare. Discrimination means that people (with HIV) don’t come back for check-ups and they drop out of therapy,” Nunez told Thomson Reuters Foundation in a telephone interview from Quito, Ecuador.
Traditional beliefs in countries such as Belize and Honduras which hold that HIV/AIDS is a curse can heighten discrimination against people living with the virus, making it harder for them to get life-saving treatment.
"In Belize, HIV/AIDS is seen as some sort of a curse, an evil sent by ancestors as a punishment," Nunez said.
Speaking ahead of a regional meeting with representatives from UNAIDS and the Pan Caribbean Partnership Against HIV/AIDS in Jamaica's capital, Kingston, this week, Silvio Martinelli of the Global Fund said tackling discrimination against the people most at risk from HIV/AIDS was a priority.
"Civil society groups, lawmakers, health ministers and churches will work together to define roadmaps to reform discriminatory laws that are making it hard to put HIV services in reach of vulnerable groups," said Martinelli, Latin America and the Caribbean manager for the public-private fund that accounts for around a quarter of international financing to fight HIV/AIDS.
Accessing more people living with HIV/AIDS with a cocktail of drugs known as antiretroviral therapy, or ART, is important because not only does the treatment suppress the virus and improve wellbeing, it also reduces the chances of HIV transmission to others.
"The next step is to find those people who don’t get treatment and those who don’t know their status," said Martinelli in a telephone interview.
Unprotected sex between men, and between men and women, especially paid sex, are the main ways HIV is spread in the Caribbean, according to UNAIDS.
HIV prevalence among sex workers is considerably higher than in the general population across the Caribbean, the U.N. agency says. In the Dominican Republic, for example, HIV prevalence among sex workers is 4.7 percent compared to the national prevalence of 0.7 percent, UNAIDS figures show.
"The focus needs to be on key populations, the ones with the highest prevalence of HIV. We need to look for where the disease is and not just work in urban areas," Nunez said.
He added the Kingston meeting would also look at how Latin America’s largest economies - Brazil, Argentina and Mexico - could pick up more of the cost of HIV/AIDS treatment and prevention programmes in the Caribbean where national governments cover only a fraction of the costs.