Caribbean - Regional Overview

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 remains rare in much of the region, with the exception of Puerto Rico. 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’.

The harm reduction response remains limited, with needle and syringe exchange and opioid substitution therapy only available in Puerto Rico. The predominant response in the rest of the region is characterised by abstinence-based, high-threshold services for people who use drugs. The use of illicit drugs is highly criminalised, with harsh sentencing resulting in large numbers of people who use drugs in Caribbean prisons. Despite evidence that drug use is playing a role in HIV epidemics in the region, national drug and HIV policies remain largely unlinked. However, in the past two years, there have been indications that the need for a harm reduction approach to drugs is increasingly being recognised on some Caribbean islands.

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