Order Code RL32001
CRS Report for Congress
Received through the CRS Web
AIDS in the Caribbean
and Central America
Updated July 15, 2005
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 of 5.6%; Trinidad and Tobago, with a rate of 3.2%; the Bahamas, with a rate of
3%; Guyana, with a rate of 2.5%; and Belize, with a rate of 2.4%. (Belize and
Guyana are considered Caribbean nations because of their extensive linkages.) Four
other Caribbean countries — the Dominican Republic, Suriname, Barbados, and
Jamaica — have rates over 1%. In Central America, Honduras has the highest
prevalence rate of 1.8%, while Guatemala has a rate over 1%.
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 (USAID) 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 $33.8 million in FY2003. Because of the inclusion of Guyana and Haiti
as focus countries in the President’s Emergency Plan for AIDS Relief (PEPFAR),
U.S. assistance to the Caribbean and Central America for HIV/AIDS increased to $47
million in FY2004 and to an estimated $76 million in FY2005. The FY2006 request
is for almost $91 million, with $21 million for Guyana and $47 million for Haiti.
Some Members of Congress have wanted to expand the list of Caribbean
countries included as focus countries in PEPFAR. In the 108th Congress, both the
House-passed FY2004-FY2005 Foreign Relations Authorization Act, H.R. 1950
(Section 1818), and the Senate Foreign Relations Committee’s reported FY2005
Foreign Relations Authorization Act, S. 2144 (Section 2518), would have added 14
Caribbean countries to those targeted for increased HIV/AIDS assistance, but no final
action was taken on these measures. In the 109th Congress, S. 600, the Foreign
Affairs Authorization Act, FY2006 and FY2007, contains a provision (Section 2516)
that would add14 Caribbean countries to the list of focus countries targeted for
increased HIV/AIDS assistance.
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, FY2003-
FY2006, 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
Legislative Initiatives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
List of Tables
Table 1. HIV/AIDS in Latin America and the Caribbean, 2003 . . . . . . . . . . . . . . 2
Table 2. U.S. HIV/AIDS Assistance: CSH and GHAI Funding in
Central America and the Caribbean, FY2001-FY2006 . . . . . . . . . . . . . . . . . 9

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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, more than 2 million people were estimated
to be living with HIV/AIDS in the region in 2003, including 450,000 in the
Caribbean (including Belize, Guyana, and Suriname, which are considered Caribbean
nations because of their extensive linkages); 204,000 in Central America; 160,000
in Mexico; and 1.2 million in South America.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 11 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 and the Caribbean, 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 (ARV) 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.
At year end 2003, the Caribbean countries with the highest prevalence of
infection rates were Haiti, with a rate of 5.6%; Trinidad and Tobago, with a rate of
3.2%; the Bahamas, with a rate of 3%; Guyana, with a rate of 2.5%; and Belize, with
a rate of 2.4%. Four other countries — the Dominican Republic, Suriname,
Barbados, and Jamaica — had rates over 1%. Haiti and the Dominican Republic,
with a combined 368,000 adults and children living with HIV/AIDS, account for
about 82% 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,
while there are indications that the epidemic is stabilizing in Santo Domingo because
of effective prevention efforts, there are concerns that this trend is not occurring
1 Statistics are drawn from: Joint United Nations Program on HIV/AIDS (UNAIDS), 2004
Report on the Global AIDS Epidemic, June 2004. p. 202.
2 UNAIDS, Report on the Global HIV/AIDS Epidemic 2002, July 2002; Nevertheless, it
should be noted that prevalence rates vary in different parts of the country. In some cities,
infection levels above 60% have been reported among injecting drug users. See Joint United
Nations Program on HIV/AIDS (UNAIDS), 2004 Report on the Global AIDS Epidemic,
June 2004. p. 36.

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CRS-2
elsewhere in the country. Of particular concern is the Dominican Republic, where
sugar cane plantation workers have high HIV prevalence rates of 4.9%, HIV
prevalence among pregnant women is 2% higher than the national average, and
women under 24 years old are twice as likely to be HIV-infected than their male
peers.3
Table 1. HIV/AIDS in Latin America and the Caribbean, 2003
AIDS
Adults/Children
Deaths,
Area
Adult Prevalence (%)
Living with
(Adults/
HIV/AIDS
Children)
Caribbean
Haiti
5.6
280,000
24,000
Trinidad & Tobago
3.2
29,000
1,900
Bahamas
3.0
5,600
<200
Guyana
2.5
11,000
1,100
Belize
2.4
3,600
<200
Dominican Republic
1.7
88,000
7,900
Suriname
1.7
5,200
<500
Barbados
1.5
2,500
<200
Jamaica
1.2
22,000
900
Cuba
0.1
3,300
<200
Central America
Honduras
1.8
63,000
4,100
Guatemala
1.1
78,000
5,800
Panama
0.9
16,000
<500
El Salvador
0.7
29,000
2,200
Costa Rica
0.6
12,000
900
Nicaragua
0.2
6,400
<5,00
Mexico
0.3
160,000
5,000
South America
Argentina
0.7
130,000
1,500
Brazil
0.7
660,000
15,000
Colombia
0.7
190,000
3,600
Venezuela
0.7
110,000
4,100
Paraguay
0.5
15,000
600
Peru
0.5
82,000
4,200
Chile
0.3
26,000
1,400
Ecuador
0.3
21,000
1,700
Uruguay
0.3
6,000
<500
Bolivia
0.1
4,900
<500
Source: UNAIDS, 2004 Report on the Global HIV/AIDS Epidemic, June 2004.
3 UNAIDS, AIDS Epidemic Update, December 2004, pp. 32 and 34.

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CRS-3
In the Caribbean, ongoing stigma and widespread homophobia (which drives
people away from HIV services), are significant factors in the spread of HIV.4 Sex
tourism also 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.5 In Jamaica, the resort town of Montego Bay has the highest
HIV infection rates in the country.6 In the Dominican Republic, AIDS activists are
concerned about child prostitution in resort areas and the spread of HIV.7
In Central America, Honduras has the highest prevalence rate of 1.8% (with
AIDS related diseases the second leading cause of death in the country), while
Guatemala has a rate over 1%.8 The epidemic in Central America is concentrated in
large urban areas, although some rural areas have been hard hit. 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 over 8% of the population
infected.9
While unprotected heterosexual sex has been the main mode of HIV
transmission in most countries in Central America and the Caribbean, sex between
men is a major factor in epidemics in both regions. In Costa Rica, for example, men
who have sex with men accounted for more than half of AIDS cases. In many cases,
men who have sex with men also report having female sexual partners. Bisexuality,
therefore, has been a significant bridge for HIV transmission into the wider
population in Central America.10 Other high-risk populations in Central America
include commercial sex workers, prisoners, and as noted above, the Garifuna
population in Honduras.11
4 UNAIDS, AIDS Epidemic Update, December 2004, pp. 31 and 35.
5 “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.
6 “Rising Rate of AIDS in the Caribbean,” All Things Considered, National Public Radio,
July 2, 2003.
7 “AIDS Activists Worried Over Child Prostitution in Dominican Republic,” Boston Haitian
Reporter, January 31, 2003.
8 UNAIDS, AIDS Epidemic Update, December 2004, p. 59.
9 Interview with Dr. Angel Coca, USAID Mission, Tegucigalpa, Honduras, November 27,
2001; UNAIDS, AIDS Epidemic Update, December 2004, p. 59.
10 UNAIDS, AIDS Epidemic Update, December 2004, pp. 57-60.
11 World Bank, “HIV/AIDS in Central America: An Overview of the Epidemic and Priorities
for Prevention,” October 2003.

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CRS-4
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 In the
Caribbean, which is the second most affected region in the world, AIDS has become
the leading cause of death among adults aged 15-44 years.13 Life expectancy and
infant mortality have already been affected in some countries. In Haiti, life
expectancy is 10 years lower and in Trinidad and Tobago it is 9 years lower than it
would be without the epidemic.14 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.
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.15 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.”16
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.17 In June 2002, Scott Evertz, then Director of the White House Office of
AIDS Policy, reportedly warned that AIDS problems abroad could jeopardize the
health of Americans, and described the Caribbean as “our third border.”18
12 Pan American Health Organization, “AIDS Threatens to Undo Health Gains,” September
7, 2001.
13 UNAIDS, AIDS Epidemic Update, December 2004, p. 31.
14 Ibid.
15 “Caribbean Leaders Call AIDS ‘Single Biggest Threat’ to Development, Announce Push
for Low-Cost Antiretrovirals”, Kaiser Daily HIV/AIDS Report, July 8, 2003
16 World Bank, HIV/AIDS in the Caribbean: Issues and Options, March 2001, p.xii.
17 Senate Foreign Relations Committee, Testimony by Paula Dobriansky, February 13,
2002, Federal Document Clearing House.
18 William Gibson, “AIDS Crisis Spurs U.S. Into Action; Disease Damaging World
(continued...)

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CRS-5
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.19
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. Under this program, the Bank has approved loans
to Barbados (2001), the Dominican Republic (2001), Jamaica (2002), Grenada
(2002), St. Kitts & Nevis (2003), Trinidad & Tobago (2003), the Caribbean
Community’s (CARICOM) Pan Caribbean Partnership Against HIV/AIDS
(PANCAP) (2004), Guyana (2004), St. Lucia (2004), and St. Vincent (2004). In
March 2005, the World Bank approved an $8 million Central America regional
project to manage and control the epidemic.
The Inter-American Development Bank has supported HIV/AIDS activities in
such countries as Haiti, Honduras, the Bahamas, Jamaica, Guatemala, Nicaragua, and
a regional program through CARICOM. Moreover, its assistance to support health
infrastructure in the region has been important for HIV/AIDS treatment and care
programs.
The Global Fund to Fight AIDS, Tuberculosis, and Malaria has begun funding
programs throughout Latin America and the Caribbean, with about $159 million, or
12% of disbursed funding, going to this region as of mid-July 2005. Beneficiaries
in Central America and the Caribbean include Belize, Costa Rica, Cuba, the
Dominican Republic, El Salvador, Guatemala, Guyana, Haiti, Honduras, Jamaica,
Nicaragua, Panama, and Suriname as well as regional programs for CARICOM and
the Organization of Eastern Caribbean States (OECS). (See the Global Fund’s
website at [http://www.theglobalfund.org/en/]. 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
18 (...continued)
Economies, Leaders Determine.” Sun-Sentinel, June 23, 2002.
19 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.

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CRS-6
region vary because of unequal socioeconomic development and high population
mobility.20
Access to ARV drugs has improved significantly in a number of countries,
although in poorer resource-limited countries, universal access to treatment could
take years to achieve. Brazil has been a model in the developing world in terms of
offering antiretroviral treatment to all people living with HIV, and the survival rate
of AIDS patients in the country has risen significantly because of this. AIDS
mortality has also declined in other countries providing universal coverage for ARV
treatment, including Argentina, Barbados, Costa Rica, El Salvador, and Panama.
Other countries like Honduras, Guyana, and Peru have been scaling up access to
ARV treatment, while other countries like Guatemala, Nicaragua, Bolivia, and
Ecuador have lagged behind in providing ARV treatment to people living with AIDS.
According to the World Health Organization, out of a total of 465,000 people
needing ARV treatment in Latin America and the Caribbean, an estimated 290,000,
or 62%, were receiving it.21 Some observers caution that treatment is concentrated
in the larger countries of the region, but that in many smaller poorer countries, the
percentage of people receiving ARV treatment is much less.22
In Haiti, an estimated 42,500 people needed ARV treatment in 2004, while as
of March 2005, only about 4,000 people, or 9%, were receiving it.23 Funding from
the Global Fund will reportedly allow Haiti to expand programs for ARV treatment
to 30% of those in need by 2007. Partners in Health, a non-profit organization
affiliated with the Harvard Medical School, has provided HIV screening and
counseling since 1988, and is now providing ARV treatment to patients in several
impoverished rural villages in the Central Plateau region of the country.24 The
project demonstrates that even in severely impoverished countries with little health
infrastructure, there can be sustained treatment for people with AIDS.
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 (PANCAP), a new coalition
established to involve government, business, and the international community in
20 UNAIDS and WHO, AIDS Epidemic Update, December 2002, pp. 19-21.
21 UNAIDS and WHO, Progress on Global Access to HIV Antiretroviral Therapy, June
2005, p. 13.
22 International Antiviral Therapy Evaluation Center (IATEC), “Antiretroviral Access
Panorama Continues to be Grim for Much of Latin America,” IATEC Update, June 2005.
23 World Health Organization, “Haiti: Summary Country Profile for HIV/AIDS Treatment
Scale-up,” June 2005.
24 See the Partners in Health website at [http://www.pih.org/wherewework/haiti/index.html]

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CRS-7
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. 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. 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 an expansion of therapy to those in greatest need.25 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.26
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,
the Department of State, 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. 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. (For more, see CRS Report RS21181, HIV/AIDS
International Programs: Appropriations, FY2003-FY2006.)
25 Pan American Health Organization, HIV and AIDS in the Americas: An Epidemic with
Many Faces, 2001, p. 45.
26 World Bank, HIV/AIDS in the Caribbean: Issues and Options, pp . xiv, xvii, and 35-38.

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CRS-8
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 $33.8 million in FY2003. Because of
the inclusion of Guyana and Haiti in the President’s Emergency Plan for AIDS Relief
(PEPFAR), largely funded through the Global HIV/AIDS Initiative (GHAI) foreign
assistance account, assistance to the region for HIV/AIDS increased to an estimated
$47 million in FY2004 and an estimated $76 million in FY2005. For FY2006, the
Administration requested almost $91 million in HIV/AIDS assistance for Central
America and the Caribbean, with $21.4 million for Guyana and $47 million for Haiti
funded through the GHAI account. The balance of the request is from the Child
Survival and Health (CSH) foreign assistance funding account. (See Table 2.)
In the Caribbean, USAID provides HIV/AIDS assistance through both bilateral
and regional programs, and is an active member of the Pan Caribbean Partnership
Against HIV/AIDS. As part of its Caribbean regional program, USAID has initiated
a program focusing on Caribbean countries that do not have a permanent USAID
presence: Trinidad and Tobago, Suriname, St. Kitts and Nevis, St. Lucia, St. Vincent
and Grenadines, Grenada, Antigua and Barbuda, Dominica, and Barbados. 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.
USAID Missions in the Dominican Republic, Jamaica, Guyana, and Haiti
provide bilateral HIV/AIDS assistance. In the Dominican Republic, USAID funds
NGOs that provide prevention information to vulnerable groups, support people with
HIV, and work in the policy arena to reduce stigma and discrimination. The Mission
also provides assistance for mother-to-child transmission prevention, voluntary
counseling and testing, and prepackaged therapy programs. It also collaborates with
the Dominican Republic’s Presidential HIV/AIDS Council and other donors to
promote widespread societal participation in HIV prevention.27 In Jamaica, USAID
provides assistance to the Ministry of Health in support of a strategic plan to combat
the epidemic, including support to target Jamaica’s high-risk adolescent population.
In Guyana, USAID supports prevention, treatment, and care activities, including
support for voluntary counseling and prevention of mother-to-child transmission.
Prevention activities will be scaled up as a result of increased assistance under
PEPFAR. In 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. As a result of
increased assistance under PEPFAR, assistance for prevention, treatment, and care
activities, including ARV treatment, will be scaled up.
27 U.S. Agency for International Development, Santo Domingo, Program Summary, May
2005.

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Table 2. U.S. HIV/AIDS Assistance: CSH and GHAI Funding in
Central America and the Caribbean, FY2001-FY2006
(U.S. $ millions)
FY2005
FY2006
Country
FY2001
FY2002
FY2003
FY2004*
(est.)*
(req.)*
Dom. Rep.
3.3
4.0
5.3
5.3
5.3
5.3
El Salvador
0.5
0.5
0.5
0.5
0.5
0.5
Guatemala
0.5
0.5
0.5
0.5
0.5
0.5
Guyana
0.8
1.0
4.2
6.8*
13.2*
21.4*
Haiti
4.4
4.0
7.7
18.3*
39.4*
47.0*
Honduras
2.6
3.5
4.2
4.2
5.2
4.2
Jamaica
1.3
1.3
1.3
1.3
1.3
1.3
Nicaragua
0.5
0.5
0.5
0.5
0.5
0.5
Central
America
3.7
4.0
4.7
5.0
5.4
5.5
Program
Caribbean
1.5
5.5
4.9
4.7*
4.7
4.7
Regional
Program
Total
19.1
24.8
33.8
47.0
76.0
90.9
* For F2004, Guyana, received $5.1 million in Global HIV/AIDS Initiative (GHAI) funding and Haiti
received $13 million in GHAI funding. For FY2005 and FY2006, all assistance for Guyana and Haiti
was GHAI funding. The remainder of assistance for all countries and years came largely from the
Child Survival and Health (CSH) funding account, with the exception of $1 million in Economic
Support Funds for the Caribbean Regional Program in FY2004.
Sources: U.S. Agency for International Development, website at [http://www.usaid.gov/our_work/
global_health/aids/Funding/FactSheets/lac.html]; U.S. Department of State, FY2006 Congressional
Budget Justification for Foreign Operations, February 2005.
In Central America, USAID funds HIV activities in Honduras, Guatemala, El
Salvador, Nicaragua, Belize, and Panama. In Honduras, which has the largest
program, USAID supports both the public and private sector, including support to
local NGOs working with populations that have high rates of HIV prevalence and
support for the promotion and marketing of condoms. 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.
Among its prevention activities, USAID has funded a condom social marketing and
behavioral change program focusing on high-risk populations.

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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
the Caribbean Epidemiology Center (CAREC) based in Trinidad and Tobago. 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 $4.8 million, with $1.4 million
for Guyana, $1.6 million for Haiti, and $1.8 million for the Caribbean regional
program.28
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.29
The Department of Labor has funded HIV/AIDS workplace education and
prevention projects in Belize, the Dominican Republic, Guyana, Haiti, Jamaica, and
Trinidad and Tobago.
Legislative Initiatives. Some Members of Congress have wanted to expand
the Caribbean countries that would benefit from increased assistance under PEPFAR
beyond Haiti and Guyana, arguing that high mobility in the region necessitates a
regional approach in combating the epidemic.30 Members and Caribbean leaders
have expressed concerned 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.31 Other Members note that
the legislation does not preclude the President from designating additional Caribbean
countries.
28 See the CDC’s website at [http://www.cdc.gov/nchstp/od/gap/].
29 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.
30 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.
31 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-11
In the 109th Congress, a provision in S. 600 (Section 2516), the Foreign Affairs
Authorization Act, FY2006 and FY2007, would add 14 Caribbean countries to those
countries targeted for increased HIV/AIDS assistance under PEPFAR. 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.
In the 108th Congress, similar provisions were included in both the House-passed
FY2004-FY2005 Foreign Relations Authorization Act, H.R. 1950 (Section 1818),
and the Senate Foreign Relations Committee’s reported FY2005 Foreign Relations
Authorization Act, S. 2144 (Section 2518), but no final action was taken on these
measures.
Several other legislative initiatives in the 109th Congress have been introduced
dealing with AIDS in the Caribbean. H.R. 164 (Millender-McDonald), introduced
January 4, 2005, would amend the Foreign Assistance Act of 1961 to provide for the
establishment of pediatric centers in certain developing countries, including Guyana,
to provide treatment and care for children with HIV/AIDS. S. 350 (Lugar),
introduced February 10, 2005, and H.R. 1409 (Lee), introduced March 17, 2005,
would amend the Foreign Assistance Act of 1961 to provide assistance for orphans
and other vulnerable children in developing countries, including in the Caribbean.
H.R. 945 (Lee), introduced February 17, 2005, would provide assistance to combat
infectious diseases in Haiti, including HIV/AIDS, and to establish a comprehensive
health infrastructure.

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