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Caribbean - Regional Overview
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After Sub-Saharan Africa, the Caribbean is the region of the world most affected by HIV and AIDS. Here, the virus is predominantly sexually transmitted and injecting drug use is rare in much of the region. However, research has highlighted a link between non-injecting drug use and sexual HIV transmission in several Caribbean countries, with HIV prevalence estimates among crack cocaine smoking populations reaching those found among injecting populations elsewhere. Crack cocaine is widely available on most islands, due to drug transhipment routes, and its use is reported to be ‘extensive’. Only in Puerto Rico, where the majority of new HIV cases are associated with injecting drug use, are both needle and syringe programmes (NSP) and opioid substitution therapy (OST) available. Elsewhere in the region, abstinence-based, high-threshold services are the predominant response. Despite the evidence that drug use is playing a role in HIV epidemics in the Caribbean, national drug and HIV policies remain largely unlinked.
Drug use is highly criminalised here and large numbers of people are incarcerated for drug-related offences. As a result, Caribbean prisons are amongst some of the most crowded in the world. Although HIV prevalence is elevated within prison populations, prisoners have limited access to HIV prevention, treatment and care.
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Injecting Drug Use, HIV and Hepatitis C
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The following maps and table outline the current available data on injecting drug use, as well as the prevalence of HIV and hepatitis C among injecting populations in the Caribbean.
The map below illustrates HIV prevalence among injecting drug users in countries of the region.
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The map below illustrates hepatitis C prevalence among injecting drug users in countries and territories of the region.
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The following table provides the latest estimates of HIV and hepatitis C prevalence within injecting populations, as well as the estimated total number of injecting drug users in countries and territories of the region.
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Countries/territory with reported injecting drug use
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| | Adult HIV prevalence amongst people who inject drugs**
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| Adult HCV prevalence amongst people who inject drugs***
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*Mathers, B. et al. Reference Group to the United Nations on HIV and injecting drug use (2008)
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The global epidemiology of injecting drug use and HIV among people who inject drugs: a systematic review. The Lancet 2008, Volume 372.
**Mathers, B. et al. Reference Group to the United Nations on HIV and injecting drug use (2008) The global epidemiology of injecting drug use and HIV among people who inject drugs: a systematic review. The Lancet 2008, Volume 372.
***Cook, C & Kanaef, N (2008) The Global State of Harm Reduction: Mapping the global response to drug-related HIV and hepatitis C epidemics. International Harm Reduction Association, UK
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Harm Reduction Policies
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No countries or territories in the Caribbean currently include harm reduction in their national policies on HIV or drugs.
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| Explicit reference to harm reduction policies in official documents*
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| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | Saint Vincent & Grenadines
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*International Harm Reduction Association (March 2009) Harm Reduction Policy and Practice Worldwide: An overview of national support for harm reduction in policy and practice [PDF:2.59KB]
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Harm Reduction Programmes
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Key harm reduction interventions (including needle and syringe exchange and opioid substitution therapy) are not available across the majority of countries and territories in the Caribbean, as illustrated in the maps and table below. The response to drugs in this region is overwhelmingly abstinence-focused.
Drug use is highly criminalised here and large numbers of people are incarcerated for drug-related offences. As a result, Caribbean prisons are amongst some of the most crowded in the world. Harm reduction in Caribbean prisons is limited to a pilot opioid substitution therapy programme in Puerto Rico. Although HIV prevalence is elevated within prison populations, prisoners have limited access to HIV prevention, treatment and care.
The following table indicates which countries have a) one or more needle and syringe exchange sites operational both in and outside prisons, b) prescription of opioid substitution therapy for maintenance in and outside of prisons c) one or more drug consumption rooms in countries of the region.
A tick in this table does not indicate the scope, quality or coverage of services. Also it should be noted that in some countries, harm reduction services, NSP in particular, are NGO-driven and may be operating without governmental support.
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| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | Saint Vincent & Grenadines
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*International Harm Reduction Association (March 2009) Harm Reduction Policy and Practice Worldwide: An overview of national support for harm reduction in policy and practice [PDF:2.59KB]
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The map below shows which countries have operational needle and syringe programmes and opioid substitution therapy programmes.
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The map below shows which countries have prison-based needle and syringe exchange programmes and opioid substitution therapy prescription.
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