Order Code RL32001
CRS Report for Congress
Received through the CRS Web
AIDS in the Caribbean
and Central America
Updated January 18, 2006
Mark P. Sullivan
Specialist in Latin American Affairs
Foreign Affairs, Defense, and Trade Division
Congressional Research Service ˜ The Library of Congress

---

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 3%; the Bahamas, Guyana, and Trinidad and Tobago, with rates over 2%;
and Barbados, Belize, the Dominican Republic, Jamaica, and Suriname, with 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 an estimated $76 million in FY2005. The FY2006 request
was for almost $91 million, with $21 million for Guyana and $47 million for Haiti.
In the first session of the 109th Congress, Congress approved H.R. 1409 (P.L.
109-95), which authorizes assistance for orphans and other vulnerable children in
developing countries, including in the Caribbean. Pending legislative initiatives in
the second session include S. 600, the Foreign Affairs Authorization Act, FY2006
and FY2007, which contains a provision (Section 2516) that would add14 Caribbean
countries to the list of focus countries targeted for increased HIV/AIDS assistance;
H.R. 164, which would provide for the establishment of pediatric centers in
developing countries, including Guyana, to provide treatment and care for children
with HIV/AIDS; and S. 350 and H.R. 945, which would provide assistance to combat
infectious diseases in Haiti, including HIV/AIDS. As in past years, FY2007
appropriations for HIV/AIDS assistance in the Caribbean and Central America will
be funded through the Foreign Operations appropriations bill.
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.

---

Contents
Characteristics of the Epidemic in the Region . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Consequences of the Epidemic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Response to the Epidemic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
U.S. Policy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
Legislative Initiatives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
List of Tables
Table 1. U.S. HIV/AIDS Assistance: CSH and GHAI Funding in
Central America and the Caribbean, FY2001-FY2006 . . . . . . . . . . . . . . . . . 8

---

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, some 2.1 million people were estimated to be
living with HIV/AIDS in the region in 2005, including 300,000 in the Caribbean and
1.8 million in Latin 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.
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 unprotected heterosexual contact, which makes
it difficult to contain the epidemic because it affects the general population.
In 2005, the overall adult infection rate in the Caribbean was 1.6%, with the
epidemic claiming 24,000 lives. AIDS was the leading cause of death among adults
in the Caribbean aged 15-44 years. The Caribbean countries with the highest
prevalence or infection rates are Haiti, with a rate over 3%; the Bahamas, Guyana,
and Trinidad and Tobago, with rates over 2%; and Barbados, Belize, the Dominican
Republic, Jamaica, and Suriname, with rates over 1%.
Haiti and the Dominican Republic account for the majority of the region’s
infected population. The U.S. Agency for International Development (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 both
countries, however, there are indications that the epidemic could be reaching a
turning point because of prevention efforts. In Haiti, the decline in HIV infections
appears to be associated with some behavioral change, although AIDS mortality is
1 Statistics are drawn from: Joint United Nations Program on HIV/AIDS (UNAIDS), AIDS
Epidemic Update, December 2005.
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.

---

CRS-2
reported to be a contributing factor. In the Dominican Republic, workers on sugar
cane plantations (bateyes) continue to have high prevalence rates.3
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.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, 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%.7 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.8
Although 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 factor in epidemics in both regions. In Costa Rica, men who have sex with
men accounted for more than two-thirds of all reported 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.9 Other high-risk populations in Central America
include commercial sex workers, prisoners, and as noted above, the Garifuna
population in Honduras.10
3 UNAIDS, AIDS Epidemic Update, December 2005. pp. 53-55.
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, AIDS Epidemic Update, December 2004, p. 59.
8 Interview with Dr. Angel Coca, USAID Mission, Tegucigalpa, Honduras, November 27,
2001; UNAIDS, AIDS Epidemic Update, December 2004, p. 59.
9 UNAIDS, AIDS Epidemic Update, December 2004, pp. 57-60.
10 World Bank, “HIV/AIDS in Central America: An Overview of the Epidemic and Priorities
(continued...)

---

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.11
Although the share of HIV infections in the Caribbean attributed to sex between men
is about 12%, homophobia and stigma could hide a higher percentage.12 In recent
years, human rights organizations have criticized Jamaica for pervasive homophobia
and targeted violence against gay men that has also carried over to violence against
people living with AIDS and organizations providing HIV/AIDS education and
services.13 In June 2004, Jamaica’s leading gay rights activist, Brian Williamson,
was murdered, while on November 30, 2005, Steve Harvey, a noted Jamaican AIDS
activist, was murdered in what some news reports have characterized as a hate crime.
UNAIDS condemned the murder and called on the Jamaican government to bring his
killers to justice and address homophobia and other causes of stigma and
discrimination that are fueling the spread of AIDS.14
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.15 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.16 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.17 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,
10 (...continued)
for Prevention,” October 2003.
11 UNAIDS, AIDS Epidemic Update, December 2004, pp. 31 and 35.
12 UNAIDS, “Caribbean Fact Sheet,” November 21, 2005.
13 Hated to Death: Homophobia, Violence, and Jamaica’s HIV/AIDS Epidemic, Human
Rights Watch, 2004.
14 “UNAIDS Condemns Killing of AIDS Activist in Jamaica,” Press Statement, UNAIDS,
Dec. 7, 2005.
15 Pan American Health Organization, “AIDS Threatens to Undo Health Gains,” September
7, 2001.
16 UNAIDS, AIDS Epidemic Update, December 2004, p. 31.
17 Ibid.

---

CRS-4
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.18 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.”19
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.20 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.”21
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.22
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
18 “Caribbean Leaders Call AIDS ‘Single Biggest Threat’ to Development, Announce Push
for Low-Cost Antiretrovirals”, Kaiser Daily HIV/AIDS Report, July 8, 2003
19 World Bank, HIV/AIDS in the Caribbean: Issues and Options, March 2001, p.xii.
20 Senate Foreign Relations Committee, Testimony by Paula Dobriansky, February 13,
2002, Federal Document Clearing House.
21 William Gibson, “AIDS Crisis Spurs U.S. Into Action; Disease Damaging World
Economies, Leaders Determine.” Sun-Sentinel, June 23, 2002.
22 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.

---

CRS-5
(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 $226 million, or
almost 12% of disbursed funding, going to this region as of early January 2006.
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 multi-country programs for
CARICOM, the Caribbean Regional Network of People Living with HIV/AIDS
(CRN+), 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
region vary because of unequal socioeconomic development and high population
mobility.23
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.24 Some observers caution that treatment is concentrated
23 UNAIDS and WHO, AIDS Epidemic Update, December 2002, pp. 19-21.
24 UNAIDS and WHO, Progress on Global Access to HIV Antiretroviral Therapy, June
2005, p. 13.

---

CRS-6
in the larger countries of the region, but that in many smaller poorer countries, the
percentage of people receiving ARV treatment is much less.25
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.26 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.27 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 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. 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
25 International Antiviral Therapy Evaluation Center (IATEC), “Antiretroviral Access
Panorama Continues to be Grim for Much of Latin America,” IATEC Update, June 2005.
26 World Health Organization, “Haiti: Summary Country Profile for HIV/AIDS Treatment
Scale-up,” June 2005.
27 See the Partners in Health website at [http://www.pih.org/wherewework/haiti/index.html]

---

CRS-7
behavior, and an expansion of therapy to those in greatest need.28 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.29
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.)
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 1.)
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
28 Pan American Health Organization, HIV and AIDS in the Americas: An Epidemic with
Many Faces, 2001, p. 45.
29 World Bank, HIV/AIDS in the Caribbean: Issues and Options, pp . xiv, xvii, and 35-38.

---

CRS-8
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.
Table 1. 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.
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

---

CRS-9
promote widespread societal participation in HIV prevention.30 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.
USAID has also focused on fighting stigma and discrimination against people living
with AIDS in Jamaica. 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.
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.
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.31
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
30 U.S. Agency for International Development, Santo Domingo, Program Summary, May
2005.
31 See the CDC’s website at [http://www.cdc.gov/nchstp/od/gap/].

---

CRS-10
scientists. In the Caribbean and Central America, NIH has funded research studies
and/or training programs for most countries in the region.32
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.33 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.34 Other Members note that
the legislation does not preclude the President from designating additional Caribbean
countries.
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.
Other legislation and legislative initiatives in the 109th Congress include the
following: P.L. 109-95 (H.R. 1409, Lee), approved by both houses in October 2005
and signed into law November 8, 2005, amends the Foreign Assistance Act of 1961
to authorize assistance for orphans and other vulnerable children in developing
countries, including 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; and S. 350 (Lugar) and
32 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.
33 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.
34 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.

---

CRS-11
H.R. 945 (Lee), both introduced in February 2005, would provide assistance to
combat infectious diseases in Haiti, including HIV/AIDS, and to establish a
comprehensive health infrastructure.
Appropriations for HIV/AIDS assistance to the Caribbean and Central America
are funded largely through Foreign Operations appropriations measure. For further
information, see CRS Report RS21181, HIV/AIDS International Programs:
Appropriations, FY2003-FY2006, by Tiaji Salaam-Blyther.

---