Order Code RL32001
CRS Report for Congress
Received through the CRS Web
AIDS in the Caribbean and Central America
Updated November 17, 2003
Mark P. Sullivan
Specialist in Latin American Affairs
Foreign Affairs, Defense, and Trade Division
Congressional Research Service ˜ The Library of Congress

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AIDS in the Caribbean and Central America
Summary
The AIDS epidemic in the Caribbean and Central America has begun to have
negative consequences for economic and social development, and continued
increases in infection rates threaten future development prospects. In contrast to
other parts of Latin America, the mode of transmission in several Caribbean and
Central American countries has been primarily through heterosexual contact, making
the disease difficult to contain because it affects the general population. The
Caribbean countries with the highest prevalence or infection rates are Haiti, with a
rate over 6%, and the Bahamas, with an adult infection rate of 3.5%.
Three
Caribbean countries — Guyana, the Dominican Republic, and Trinidad and Tobago
— have rates between 2-3%, while three others, Suriname, Barbados, and Jamaica,
have rates over 1%. In Central America, Belize has the highest prevalence rate of
2.2%, while Honduras, Panama, and Guatemala have prevalence rates of 1% or more.
The response to the AIDS epidemic in the Caribbean and Central America has
involved a mix of support by governments in the region, bilateral donors (such as the
United States, Canada, and European nations), regional and multilateral
organizations, and nongovernmental organizations (NGOs). Many countries in the
region have national AIDS programs that are supported through these efforts.
The U.S. Agency for International Development has been the lead U.S. agency
fighting the epidemic abroad since 1986. USAID’s funding for HIV/AIDS in Central
America and the Caribbean region rose from $11.2 million in FY2000 to $24.8
million in FY2002. An estimated $27.8 million will be provided in FY2003, and the
FY2004 request is for $41.2 million. Assistance to the Caribbean for HIV/AIDS is
expected to increase because of the inclusion of Guyana and Haiti in the
Administration’s Emergency Plan for AIDS Relief announced in January 2003.
In May 2003, Congress approved the United States Leadership Against
HIV/AIDS, Tuberculosis, and Malaria Act of 2003, H.R. 1298 (P.L. 108-25), which
authorized $3 billion per year for FY2003 through FY2008 to fight the three diseases
worldwide. The President’s initiative and the legislation focus on assisting 12
African countries plus Guyana and Haiti, although the legislation notes that other
countries may be designated by the President. Some Members of Congress want to
expand the list of Caribbean countries in the legislation. Both the House-passed
FY2004-FY2005 Foreign Relations Authorization Act, H.R. 1950 (Section 1818),
and the Senate Foreign Relations Committee’s reported FY2004 Foreign Assistance
Authorization Act, S. 1161 (Section 519), have provisions that would add 14
Caribbean countries to those listed in the May 2003 legislation.
This report, which will be updated periodically, examines the characteristics and
consequences of the HIV/AIDS epidemic in the Caribbean and Central America and
the response to the epidemic in the region. For additional information, see CRS
Report RS21181, HIV/AIDS International Programs: Appropriations, FY2002-
FY2004, and CRS Report RL31712, The Global Fund to Fight AIDS, Tuberculosis,
and Malaria: Background and Current Issues.

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Contents
Characteristics of the Epidemic in the Region . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Consequences of the Epidemic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
Response to the Epidemic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
U.S. Policy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
List of Tables
Table 1. HIV/AIDS in Latin America and the Caribbean, 2001 . . . . . . . . . . . . . . 2
Table 2. USAID Funding for HIV/AIDS in Central America and the
Caribbean, FY2000-FY2004 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

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AIDS in the Caribbean and Central America
Characteristics of the Epidemic in the Region
Although the AIDS epidemic in the broader Latin America and Caribbean
region is not as pervasive as in Africa, an estimated 1.94 million people were living
with HIV/AIDS in the region in 2002, including 1.5 million in Latin America and
440,000 in the Caribbean.1 Moreover, the adult prevalence rate in several countries
in the Caribbean and Central America are among the highest outside of sub-Saharan
Africa, with 12 countries in these subregions having adult infection rates of 1% or
more (see Table 1).
In terms of sheer numbers, Brazil accounts for about one-third of those living
with AIDS in Latin America, but its prevalence rate of 0.7% is low compared to
many countries in Central America and the Caribbean. Furthermore, Brazil’s active
prevention efforts have lowered prevalence among the high risk groups —
intravenous drug users and homosexuals — and the government’s extensive
antiretroviral treatment program has lowered death rates.2 In contrast, the mode of
transmission in several Caribbean and Central American countries has been primarily
through heterosexual contact, which makes it difficult to contain the epidemic
because it affects the general population.
The Caribbean countries with the highest prevalence or infection rates are Haiti,
with a rate over 6%, and the Bahamas, with an infection rate of 3.5%. Three
Caribbean countries — Guyana, the Dominican Republic, and Trinidad and Tobago
— have rates between 2-3%, while three others, Suriname, Barbados, and Jamaica,
have rates over 1%. Haiti and the Dominican Republic, with a combined 380,000
adults and children living with HIV/AIDS, account for about 84% of the infected
Caribbean population. USAID notes that Haiti’s poverty, conflict, and unstable
governance have contributed to the rapid spread of AIDS; in some urban areas, HIV
infection rates are almost 10%. In the Dominican Republic, there are indications that
the epidemic could be stabilizing; HIV infection rates among pregnant women have
stabilized or begun to decline.3 Moreover, the Dominican Republic’s adult HIV
prevalence rate fell from 2.8% in 1999 to 2.5% in 2001.
1
Joint United Nations Program on HIV/AIDS (UNAIDS) and the World Health
Organization (WHO), AIDS Epidemic Update, December 2002, p. 39.
2 UNAIDS, Report on the Global HIV/AIDS Epidemic 2002, July 2002.
3 UNAIDS/WHO. AIDS Epidemic Update. December 2002, p 20.

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CRS-2
Table 1. HIV/AIDS in Latin America and the Caribbean, 2001
Adults/Children
AIDS
Adult Prevalence
Area
Living with
Orphans
(%)
HIV/AIDS
(0-14)
Caribbean
Haiti
6.1
250,000
200,000
Bahamas
3.5
6,200
2,900
Guyana
2.7
18,000
4,200
Dominican Rep.
2.5
130,000
33,000
Trinidad & Tobago
2.5
17,000
3,600
Suriname
1.2
3,700
1,700
Barbados
1.2
2,000
— -
Jamaica
1.2
20,000
5,100
Cuba
<.1
3,200
1,000
Central America
Belize
2.2
2,500
950
Honduras
1.6
57,000
14,000
Panama
1.5
25,000
8,100
Guatemala
1.0
67,000
32,000
El Salvador
0.6
24,000
13,000
Costa Rica
0.6
11,000
3,000
Nicaragua
0.2
5,800
2,000
Mexico
0.3
150,000
27,000
South America
Argentina
0.7
130,000
25,000
Brazil
0.7
600,000
130,000
Venezuela
0.5
62,000
— -
Peru
0.4
51,000
17,000
Uruguay
0.3
6,300
3,100
Colombia
0.4
140,000
21,000
Ecuador
0.3
20,000
7,200
Chile
0.3
20,000
4,100
Paraguay
0.1*
3,000*
— -
Bolivia
0.1
4,600
1,000
* 1999 statistics.
Source: UNAIDS, Report on the Global HIV/AIDS Epidemic 2002, July 2002.

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CRS-3
Sex tourism is reportedly a factor contributing to rising HIV infection rates in
some Caribbean countries. Officials in Trinidad and Tobago have expressed concern
about the growth of sex tourism, the so-called “beach bum” phenomenon, and the
link to the spread of AIDS.4 In Jamaica, the resort town of Montego Bay has the
highest HIV infection rates in the country.5 In the Dominican Republic, AIDS
activists are concerned about child prostitution in resort areas and the spread of HIV.6
In Central America, Belize (which is considered by many as a Caribbean nation
because of its linkages to the region) has the highest prevalence rate of 2.2%, while
Honduras, Panama, and Guatemala have prevalence rates of 1% or more. The
epidemic in Central America is reportedly fueled by the combination of unequal
socioeconomic development and high population mobility; it is concentrated among
the poor who migrate in search of work and income.7 In Honduras, the Garifuna
community (descendants of freed black slaves and indigenous Caribs from the
Caribbean island of St. Vincent) concentrated in northern coastal communities has
been especially hard hit by the epidemic, with an estimated 8-10% of the population
infected.8
Unprotected heterosexual sex has been the main mode of HIV transmission in
most countries in Central America, with the exception of Costa Rica, where
homosexual and bisexual sex has accounted for some 60% of the transmission of
HIV.9 According to UNAIDS, a major factor in the increasing feminization of the
epidemic in Latin America and the Caribbean is that sexual identities are more fluid,
with widespread, but often hidden, bisexual behavior among men.10 A World Bank
study maintains that the epidemic in Central America is concentrated in several high-
risk populations: men who have sex with men, commercial sex workers, prisoners,
and in Honduras, the Garifuna population.11
4 “Sex Tourism Cause of HIV Spread, Says T&T Minister,” The Weekly Gleaner (Jamaica),
February 19, 2003. The commercial sex industry linked to tourism reportedly is well
established in the Caribbean, with increasing male prostitution by so-called “beach boys.”
See: “The Caribbean Regional Strategic Framework for HIV/AIDS,” Pan Caribbean
Partnership on HIV/AIDS and CARICOM, March 2002, p. 7. Also see: Annan Boodram,
“The Beach Bum Phenomena,” Caribbean Voice, August 3, 2002, and Julie Bindel, “The
Price of a Holiday Fling,” Guardian (London), July 5, 2003.
5 “Rising Rate of AIDS in the Caribbean,” All Things Considered, National Public Radio,
July 2, 2003.
6 “AIDS Activists Worried Over Child Prostitution in Dominican Republic,” Boston Haitian
Reporter, January 31, 2003.
7 UNAIDS/WHO. AIDS Epidemic Update. December 2002, p 21.
8 Interview with Dr. Angel Coca, USAID Mission, Tegucigalpa, Honduras, November 27,
2001.
9
UNAIDS/WHO, Epidemiological Fact Sheets on HIV/AIDS and Sexually Transmitted
Infections, Costa Rica, 2002 Update, p. 6.
10 UNAIDS/WHO. AIDS Epidemic Update. December 2002, p 22.
11 World Bank, “HIV/AIDS in Central America: An Overview of the Epidemic and Priorities
(continued...)

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Consequences of the Epidemic
The AIDS epidemic in the Caribbean and Central America has begun to have
negative consequences for economic and social development in the region. The Pan
American Health Organization (PAHO) maintains that the AIDS epidemic threatens
to undo many of the health gains made in Latin America and the Caribbean.12 Life
expectancy and infant mortality have already been affected in some countries. In
Haiti, life expectancy is almost 6 years lower than it would be without the epidemic,
and in the Bahamas and Guyana, the number of deaths among 15-34 year olds is two
and one half times higher because of the epidemic.13 As the epidemic continues,
already-strained health systems will be further burdened with new cases of AIDS.
As a result of the epidemic, there are some 250,000 AIDS orphans in the Caribbean
(with 200,000 of those in Haiti) and some 73,000 AIDS orphans in Central America
(see Table 1).
According to the World Bank, continued increases in HIV prevalence in the
Caribbean will negatively affect economic growth. The epidemic, according to the
Bank, will have a negative impact on such economic sectors as agriculture, tourism,
lumber production, finance, and trade because of lost productivity of economically
active adults with the disease. In particular, the labor market in the region will be
dealt a shock because of deaths from AIDS. The Prime Minister of St. Kitts and
Nevis, Denzil Douglas, maintains that the epidemic threatens to cripple the labor
force just as the region needs to become more competitive in world markets amid the
momentum toward hemispheric free trade.14 Looking ahead, the World Bank warned
in 2001 that “what happened in Africa in less than two decades could now happen
in the Caribbean if action is not taken while the epidemic is in the early stages.”15
The U.S. government views the AIDS epidemic not only as a humanitarian
crisis, but also as a national security issue because of its negative impact on economic
development and political stability abroad. In February 2002, State Department
Under Secretary of State for Global Affairs Paula Dobriansky warned that the disease
was spreading in regions close to home, particularly Central America and the
Caribbean.16 In June 2002, Scott Evertz, then Director of the White House Office of
11 (...continued)
for Prevention,” October 2003.
12 Pan American Health Organization, “AIDS Threatens to Undo Health Gains,” September
7, 2001.
13 UNAIDS, Latin America and the Caribbean Fact Sheet, July 2002.
14 “Caribbean Leaders Call AIDS ‘Single Biggest Threat’ to Development, Announce Push
for Low-Cost Antiretrovirals”, Kaiser Daily HIV/AIDS Report, July 8, 2003
15 World Bank, HIV/AIDS in the Caribbean: Issues and Options, March 2001, p.xii.
16
Senate Foreign Relations Committee, Testimony by Paula Dobriansky, February 13,
2002, Federal Document Clearing House.

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CRS-5
AIDS Policy, reportedly warned that AIDS problems abroad could jeopardize the
health of Americans, and described the Caribbean as “our third border.”17
Response to the Epidemic
The response to the AIDS epidemic in the Caribbean and Central America has
involved a mix of support by governments in the region, bilateral donors (such as the
United States, Canada, and European nations), regional and multilateral
organizations, and nongovernmental organizations (NGOs). Many countries in the
region have national AIDS programs that are supported through these bilateral,
regional, and multilateral programs.18 The World Bank has provided significant
support to combat AIDS in Latin America and the Caribbean, with Brazil becoming
the first country in the region to receive such assistance. In June 2001, the Bank
approved a $155 million lending program for the Caribbean to help countries finance
their national HIV/AIDS prevention and control projects.
To date under this
program, the Bank has approved loans to Barbados, the Dominican Republic,
Jamaica, Grenada, St. Kitts & Nevis, and Trinidad & Tobago. The Inter-American
Development Bank has supported HIV/AIDS activities in such countries as
Honduras, the Bahamas, Jamaica, Guatemala, and Nicaragua, and its assistance to
support health infrastructure in the region has been important for HIV/AIDS
treatment and care programs.
The newly established Global Fund to Fight AIDS, Tuberculosis, and Malaria
has begun funding programs in Costa Rica, Cuba, El Salvador, Haiti, Honduras, and
Nicaragua and will be funding additional projects in Belize, the Dominican Republic,
Guatemala, Guyana, and Jamaica, as well as regional programs for the Caribbean
Community (CARICOM) and the Organization of Eastern Caribbean States
(OECS).19 (For more on the Global Fund, see CRS Report RL31712, The Global
Fund to Fight AIDS, Tuberculosis, and Malaria: Background and Current Issues.)
Looking broadly at the entire Latin American and Caribbean region, the
commitment to stem the epidemic has grown considerably, and the region has made
progress in the treatment and care of people infected with HIV/AIDS. Nevertheless,
the quality and scope of surveillance, prevention, and treatment programs in the
region vary because of unequal socioeconomic development and high population
mobility.20 Access to antiretroviral drugs has improved significantly in some
countries, while in other countries these drugs are almost nonexistent. Brazil,
Argentina, Costa Rica, Cuba, and Uruguay provide free public access to these drugs,
17
William Gibson, “AIDS Crisis Spurs U.S. Into Action; Disease Damaging World
Economies, Leaders Determine.” Sun-Sentinel, June 23, 2002.
18 For a listing, see Pan Caribbean Partnership Against HIV-AIDS and CARICOM. “Matrix:
Activities of Agencies in HIV/AIDS in the Caribbean Region,” Guyana, March 2003. The
matrix provides information on bilateral, regional, and multilateral HIV/AIDS programs in
the Caribbean and originally was prepared by UNAIDS in 2000.
19 See the Global Fund’s website at [http://www.globalfundatm.org/].
20 UNAIDS and WHO, AIDS Epidemic Update, December 2002, pp. 19-21.

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CRS-6
while Central America nations completed negotiations with five drug companies in
February 2002 to cut the price of antiretrovirals by more than half.21
In the
Caribbean, Barbados is planning for universal treatment and becoming an example
for the rest of the region.22 In Haiti, Partners in Health, a non-profit organization
affiliated with the Harvard Medical School, runs a health center in an impoverished
rural village where AIDS patients receive advanced medical treatment. The project
demonstrates that even in severely impoverished countries with little health
infrastructure, there can be sustained treatment for people with AIDS. Funding from
the Global Fund will allow Haiti to expand programs for the care and treatment of
HIV/AIDS patients.
Regional and multilateral institutions in the Caribbean support a regional
approach in dealing with the epidemic in part because governments are either too
small or too poor to respond adequately.
The minimal infrastructure, weak
institutional capacity and poverty have hampered efforts to respond to the epidemic
in several countries. In order to overcome these difficulties, the Caribbean
Community (CARICOM) has coordinated a regional approach to combat AIDS. In
1998, the CARICOM Secretariat chaired a Caribbean Task Force on HIV/AIDS that
developed a strategic plan for the region. In February 2001, CARICOM launched the
Pan Caribbean Partnership Against HIV/AIDS, a new coalition established to involve
government, business, and the international community in support of the strategic
plan to combat AIDS. In 2002, CARICOM and the Partnership developed a 2002-
2006 strategic framework and a plan of action to respond to the epidemic. The Pan
American Health Organization and its Caribbean Epidemiology Center (CAREC)
have provided technical assistance to help implement the strategic plan, and donors
have included UNAIDS and the World Bank and bilateral donors such as the United
States.
In Central America, there have been several notable regional efforts, including
an initiative to protect vulnerable populations from the epidemic. Various regional
meetings have brought together government officials and non-governmental
organizations. As noted above, Central American nations were also successful in
negotiating significant price cuts with drug companies for antiretroviral drugs.
Although there have been significant efforts to combat the epidemic in the
Caribbean and Central America, the challenges ahead are considerable since the
epidemic continues to grow. HIV prevalence in Latin America and the Caribbean
is expected to continue to grow through 2010, although no country is expected to
exceed 10%.23 Overall challenges in the region include continued surveillance of the
epidemic, an increase in prevention programs that also focus on marginalized
populations that have been overlooked by past efforts to promote safe behavior, and
21 Ibid, p.21; Pan American Health Organization, “Prices of AIDS Drugs in Central America
Cut More Than Half,” Press Release, February 7, 2003.
22 Peter Piot, Executive Director, UNAIDS, Testimony before the Senate Foreign Relations
Committee, February 13, 2002
23 USAID, Leading the Way: USAID Responds to HIV/AIDS, 1997-2000, September 2001,
p. 87.

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CRS-7
an expansion of therapy to those in greatest need.24 In the Caribbean, the World
Bank maintains that concerted action by national governments and regional agencies,
in partnership with NGOs and the private sector, and with the assistance of the
international community, will help diminish the adverse impact of AIDS. According
to the Bank, prevention campaigns need to focus on changing risky behavior; making
HIV-testing and condoms more accessible; treating sexually transmitted diseases; and
reducing mother-to-child transmission. Moreover, the Bank maintains that care and
treatment, which is negligible in most countries in the region, needs to be developed
and expanded to serve entire national populations.25
U.S. Policy
Within the federal government, overall U.S. support to combat the HIV/AIDS
epidemic in Latin America and the Caribbean is provided though programs
administered by several U.S. agencies, including the Centers for Disease Control and
Prevention (CDC), the National Institutes of Health (NIH), the Department of Labor,
and the U.S. Agency for International Development (USAID). Most funding for such
programs is included in annual appropriations measures for Foreign Operations and
for the Departments of Labor, Health and Human Services, and Education. (For
more, see CRS Report RS21181, HIV/AIDS International Programs: Appropriations,
FY2002-FY2004.) In addition to support provided by U.S. agencies, the United
States also provides contributions to multilateral efforts to combat AIDS, such as the
Global Fund to Fight AIDS, Tuberculosis and Malaria described above. The United
States is also a major financial contributor to such multilateral institutions as the
World Bank and the Inter-American Development Bank that fund HIV/AIDS projects
in the region.
The U.S. Agency for International Development has been the lead U.S. agency
fighting the epidemic abroad since 1986, including in Latin America and the
Caribbean where it has funded a variety of regional and bilateral programs to combat
AIDS. USAID’s funding for HIV/AIDS in Central America and the Caribbean
region rose from $11.2 million in FY2000 to $24.8 million in FY2002. An estimated
$27.8 million will be provided in FY2003, and the FY2004 request is for $41.2
million (see Table 2).
As part of its Caribbean regional program, USAID has initiated a program
focusing on the smaller Caribbean countries that do not have a permanent USAID
presence. The program, implemented through NGOs, governments, CARICOM, and
CAREC, is aimed at expanding education and prevention programs and improving
the effectiveness of health delivery programs. In the Dominican Republic and Haiti,
USAID has provided support for education and prevention activities aimed at high
risk groups, people living with HIV/AIDS, programs to prevent mother-to-child
transmission, and the marketing of condoms. In Jamaica, USAID provides assistance
to the Ministry of Health in support of a strategic plan to combat the epidemic. In
24 Pan American Health Organization, HIV and AIDS in the Americas: An Epidemic with
Many Faces, 2001, p. 45.
25 World Bank, HIV/AIDS in the Caribbean: Issues and Options, pp . xiv, xvii, and 35-38.

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Guyana, USAID supports a peer education network, a condom program, and
assistance to the National AIDS Program Secretariat.
USAID’s Central America regional program is involved in prevention activities
focused on high-risk groups and mobile populations that cross borders, support for
improved public HIV/AIDS programs, and support for comprehensive care for
people living with HIV/AIDS. In Honduras, USAID supports both the public and
private sector, including support to local NGOs working with populations that have
high rates of HIV prevalence, support for the promotion and marketing of condoms.
In El Salvador, Guatemala, and Nicaragua, USAID supports HIV prevention among
high-risk populations.
Table 2. USAID Funding for HIV/AIDS in
Central America and the Caribbean, FY2000-FY2004
(U.S. $ millions)
FY2003
FY2004
Country
FY2000
FY2001
FY2002
(Request)
(Request)
Dominican Rep.
2.3
3.3
4.0
5.0
6.5
El Salvador
0.3
0.5
0.5
0.5
0.6
Guatemala
—
0.5
0.5
0.5
0.6
Guyana
0.2
0.8
1.0
1.0
2.0
Haiti
1.5
4.4
4.0
4.0
8.0
Honduras
1.4
2.6
3.5
4.9
7.0
Jamaica
1.8
1.3
1.3
1.3
1.6
Nicaragua
0.5
0.5
0.5
0.5
0.6
Central America Program
3.2
3.7
4.0
4.7
7.6
Caribbean Regional Prog.
—
1.5
5.5
5.4
6.5
Total
11.2
19.1
24.8
27.8
41.2
Source: U.S. Agency for International Development.
The CDC’s Global AIDS Program (GAP) (under the U.S. Department of Health
and Human Services) also has collaborative agreements with developing countries
that help support research and formulate preventative and care efforts. It is involved
in three program elements: primary prevention; surveillance and infrastructure
development; and care, support, and treatment. To date in the Caribbean, the CDC
has funded programs in Haiti, Guyana, and a Caribbean regional program supporting

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CRS-9
the Caribbean Epidemiology Center (CAREC) based in Trinidad and Tobago.26 CDC
Caribbean funding for FY2002 amounted to an estimated $5.5 million, with $1.2
million for Guyana, $1.2 million for Haiti, and $3.1 million for CAREC. For
FY2003, CDC funding for the Caribbean amounted to $6.1 million, with $2.1 million
for Guyana, $2.2 million for Haiti, and $1.8 million for CAREC.
NIH has funded international research efforts worldwide focusing on such areas
as vaccine research, prevention of disease transmission, research on women and
AIDS, prevention and treatment of HIV infection in children, prevention and
treatment of opportunistic infections, and capacity building and training of foreign
scientists. In the Caribbean and Central America, NIH has funded research studies
and/or training programs for most countries in the region.27
The Department of Labor funds HIV/AIDS workplace education and prevention
projects in Belize, the Dominican Republic, Guyana, and Haiti, and is expected to
begin a regional program for several English-speaking Caribbean nations.
U.S. assistance to the Caribbean for HIV/AIDS is expected to increase because
of the inclusion of Guyana and Haiti in the Administration’s Emergency Plan for
AIDS Relief. In May 2003, Congress approved the United States Leadership Against
HIV/AIDS, Tuberculosis, and Malaria Act of 2003, H.R. 1298 (P.L. 108-25), which
authorized $3 billion per year for FY2003 through FY2008 to fight the three diseases
worldwide. The President’s initiative and the legislation focus on assisting 12
African countries plus Guyana and Haiti, two of the poorest nations in the
hemisphere, although the legislation notes that other countries may be designated by
the President.
Some Caribbean leaders and Members of Congress want to expand the
Caribbean countries that would benefit from the assistance, arguing that high
mobility in the region necessitates a regional approach in combating the epidemic.28
They are concerned that only Haiti and Guyana have been identified as countries to
benefit from the Bush Administration’s plans for increased assistance to combat
HIV/AIDS, and that other Caribbean countries will be overlooked. Caribbean
officials maintain that targeting specific countries rather than the entire region could
be disastrous given the significant travel among Caribbean islands, as well as the
annual visits of millions of American tourists.29 Other Members note that the
26 See the CDC’s web site at [http://www.cdc.gov/nchstp/od/gap/].
27
National Institutes of Health. “Global AIDS Research Initiative and Strategic Plan.”
December 2000; The Henry J. Kaiser Family Foundation, “Spending on the HIV/AIDS
Epidemic,” July 2002.
28
David Gonzalez, “As AIDS Ravages Caribbean, Governments Confront Denial,” New
York Times, May 18, 2003; Matthew Hay Brown, “Caribbean Asks U.S. to Widen Plan,”
Hartford Courant, June 5, 2003.
29
Michael Smith, “Islanders Decry AIDS Fund Targeting U.S. Plan Leaves Out Most of
Caribbean,” Miami Herald, June 14, 2003; Also see “The Caribbean Regional Strategic
Framework for HIV/AIDS,” Pan Caribbean Partnership on HIV/AIDS and CARICOM,
March 2002, p. 7.

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CRS-10
legislation does not preclude the President from designating additional Caribbean
countries.
Both the House-passed FY2004-FY2005 Foreign Relations Authorization Act,
H.R. 1950 (Section 1818), and the Senate Foreign Relations Committee’s reported
FY2004 Foreign Assistance Authorization Act, S. 1161 (Section 519), have
provisions that would add 14 Caribbean countries to those listed in the May 2003
legislation. The additional countries are Antigua & Barbuda, Barbados, the Bahamas,
Belize, Dominica, Grenada, Jamaica, Montserrat, St. Kitts & Nevis, St. Vincent and
the Grenadines, St. Lucia, Suriname, Trinidad & Tobago, and the Dominican
Republic. The provision in H.R. 1950 was added during July 15, 2003, House
consideration of the bill; a Rangel amendment (H.Amdt. 247) adding the language
was approved by voice vote. In previous Senate action, during May16, 2003,
consideration of the United States Leadership Against HIV/AIDS, Tuberculosis, and
Malaria Act of 2003, H.R. 1298, the Senate had rejected, by a vote of 44-51, an
amendment offered by Senator Dodd that would have added the 14 Caribbean
countries to the list of 14 African and Caribbean countries listed.

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