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.
* Please refer to the table below for ranges, where these are available. The maps display midpoint averages only.
|Country/territory with reported injecting drug usea||People who inject drugsb||Adult HIV prevalence amongst people who inject drugs||Hepatitis C antibody (anti-HCV) prevalence among people who inject drugsc||Hepatitis B surface antigen (anti-HBsAg) prevalence among people who inject drugs||Harm reduction responsed|
a In 2008 the UN Reference Group found no reports of injecting drug use for Antigua and Barbuda, Barbados, Belize, Dominica, Grenada, St Kitts and Nevis, St Lucia or St Vincent and the Grenadines.
b Unless otherwise stated, data are sourced from Mathers B et al. for the Reference Group to the UN on HIV and Injecting Drug Use (2008) Global epidemiology of injecting drug use and HIV among people who inject drugs: a systematic review, Lancet, 372(9651):1733–1745.
c Nelson PK et al. (2011) Global epidemiology of hepatitis B and hepatitis C in people who inject drugs: results of systematic reviews, Lancet, 378(9791): 571–583.
d Unless otherwise stated, data on NSP and OST coverage are sourced from Mathers B et al. for the Reference Group to the United Nations on HIV and Injecting Drug Use (2010) HIV prevention, treatment and care for people who inject drugs: A systematic review of global, regional and country level coverage, Lancet 375(9719):1014–28.
e The number in brackets represents the number of operational NSP sites, including fixed sites, vending machines and mobile NSPs operating from a vehicle or through outreach workers. (P) = needles and syringes reported to be available for purchase from pharmacies or other outlets, and (NP) = needles and syringes not available for purchase.
f The number in brackets represents the number of operational OST programmes, including publicly and privately funded clinics and pharmacy dispensing programmes. (M) = methadone, (B) = buprenorphine, (O) = any other form (including morphine and codeine).
g Estimate from 1998–2001.
h This figure is sub-national and relates to San Juan only.