Dittrich, Samantha (2012)

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The Caribbean has the world's second highest adult prevalence rate of HIV after sub-
Saharan Africa and AIDS-related mortality remains the leading cause of death among 25-44 year
olds in the region. Heterosexual sex is the main route of transmission throughout the Caribbean.
Women are particularly vulnerable to HIV infection as more than half of the people living with
HIV are women. Haiti and the Dominican Republic have one of the highest HIV-positive rates
in the Americas whereas the Cuban population has the lowest prevalence rate in the Americas
and one of the lowest rates of AIDS-mortality in the Caribbean.

The purpose of this project is to examine how and why AIDS mortality rates and
transmission patterns vary across three Caribbean countries: Cuba, the Dominican Republic, and
Haiti. Additionally, the goal of this project is to show how a small, low-income country like
Cuba has managed to have an extraordinary low prevalence rate of HIV/AIDS and how the
Cuban response to HIV/AIDS may provide useful strategies to the Dominican Republic and
Haiti such as awareness and prevention programs, educational campaigns, and HIV testing and
screening. In an effort to address these questions and offer an analysis on how culture and
religion, country specific infrastructure, and lack of public health policies and educational
resources have contributed to the HIV/AIDS crisis in the Caribbean, a comprehensive review of
relevant literature was conducted. The specific data reviewed/examined focused on incidence
and prevalence of HIV/AIDS, the origins of HIV/AIDS in the Caribbean, the history of Cuba, the
Dominican Republic, and Haiti, characteristics of the Cuban, Dominican, and Haitian
populations, as well as case studies and qualitative studies.

The main findings showed that the HIV/AIDS epidemic in the Caribbean is still largely
concentrated in most-at-risk populations and that new HIV infections now affects men and
women equally. As evident in Cuba, the Dominican Republic, and Haiti, many gaps exist in
access to prevention and care as well as in efforts to address the HIV/AIDS epidemic in the
Caribbean which has been compounded by the social, economic, and political realities of the

Table of Contents

Table of Contents Distribution Agreement i Approval ii Abstract Title Page iii Abstract iv Thesis Title Page v Acknowledgements vi Table of Contents viii List of Tables x List of Figures x List of Abbreviations xi Glossary of Terms xii Chapter I: Introduction 1 Introduction 1 Problem Statement 3 Purpose Statement 5 Research Questions 5 Chapter II: Methodology 7 Introduction 7 Data Collection & Analysis 7 Limitations & Delimitations 9 Chapter III: The Origins of HIV/AIDS in the Caribbean 11 Regional Overview 11 Epidemiological Patterns & Trends in the Caribbean 12 The Social Drivers of the Epidemic 15 The Regional Response to the Epidemic 17 Conclusion 19 Chapter IV: HIV/AIDS in Cuba 21 Background 21 The Cuban Response to HIV/AIDS 24 The Current Picture 27 Conclusion 29 Chapter V: HIV/AIDS in the Dominican Republic 30 Background 30 The Dominican Response to HIV/AIDS 33 The Current Picture 35 Conclusion 38 Chapter VI: HIV/AIDS in Haiti 39 Background 39 The Haitian Response to HIV/AIDS 44 The Current Picture 47 Conclusion 50 Chapter VII: Discussion 52 Introduction 52 Conclusion 53 Recommendations .55 References 59

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