The effects of social stigma and legislative discrimination on the allocation of resources for HIV prevention in the Caribbean
AIDS prevention in the Caribbean has predominantly focused on risk reduction in the general population; however significant numbers of HIV infections occur in stigmatized groups, including men who have sex with men (MSM), commercial sex workers (CSW) and migrants. Although funding for HIV prevention has increased in the region, the allocation of resources directed towards these vulnerable groups is undetermined. This study summarizes existing prevention programmes in Caribbean countries and examines the role that social stigma and laws criminalizing homosexuality and commercial sex work may have on the distribution of funds and/or prioritization of resources.
National AIDS Program coordinators of all Caribbean Community (CARICOM) member countries, Aruba, and the Netherlands Antilles were invited to participate in the study. A 22-item questionnaire was applied detailing national priorities of HIV prevention programs, target groups, sources of funding, distribution of funds, legislation concerning homosexuality and commercial sex work, and their perceived impact on priority setting or initiation of programs.
95% of countries participated. Although all had services directed at youth, voluntary counseling and testing, condom social marketing and mother-to-child transmission, fewer than 30% had programs for HIV prevention in vulnerable groups, including MSM, CSW and migrants. Where programs existed, they were predominantly organized by the non-governmental sector. The majority of respondents (72%) agreed that political or legal constraints, such as laws prohibiting sodomy or prostitution, hindered prevention campaigns targeting vulnerable populations
HIV prevention programs in the Caribbean do not adequately address risk reduction in stigmatized populations, resulting in few or no programs in many countries. Both social stigma and legislative discrimination may be partly responsible for the non-inclusion of high impact HIV/AIDS interventions in national strategic plans. Changes in societal attitudes and laws may be necessary before full access to preventive strategies is achieved by high risk groups.