Review of HIV in the Caribbean: Significant progress and outstanding challenges

Current HIV/AIDS Reports

Volumn 11, Issue 2, 2014, Pages 158-167

  Figueroa, J Peter ^a  

^a UNIVERSITY OF THE WEST INDIES   (Jamaica)

Author keywords

Adolescent; AIDS; Barbados; Caribbean; Dominican Republic; Drug user; Gender; Global epidemic; Guyana; Haiti; HIV; HIV stigma; HIV AIDS; Jamaica; MSM; Prison; Research; Risk behavior; Risk factor; Sex worker; Sexual behavior; Social factors; Social vulnerability; STI; Violence; Youth

Indexed keywords

ADOLESCENT DISEASE; CENTRAL AMERICA; CULTURAL FACTOR; DRUG USE; HEALTH CARE ACCESS; HETEROSEXUAL MALE; HIGH RISK PATIENT; HOMOSEXUALITY; HUMAN; HUMAN IMMUNODEFICIENCY VIRUS INFECTION; HUMAN IMMUNODEFICIENCY VIRUS PREVALENCE; LEADERSHIP; MEDICAL LITERATURE; MEN WHO HAVE SEX WITH MEN; PRACTICE GUIDELINE; PRISONER; PROSTITUTION; PUBLIC HEALTH; REVIEW; SEX DIFFERENCE; VERTICAL TRANSMISSION; ADOLESCENT; ADULT; AGED; CARIBBEAN; CHILD; EPIDEMICS; EPIDEMIOLOGY; FEMALE; HEALTH; HEALTH SURVEY; HIV INFECTIONS; INCIDENCE; MALE; MALE HOMOSEXUALITY; MIDDLE AGED; PREVALENCE; RISK FACTOR; SOCIOECONOMICS; TRENDS; VERY ELDERLY; YOUNG ADULT;

ADOLESCENT; ADULT; AGED; AGED, 80 AND OVER; CARIBBEAN REGION; CHILD; EPIDEMICS; FEMALE; GLOBAL HEALTH; HIV INFECTIONS; HOMOSEXUALITY, MALE; HUMANS; INCIDENCE; MALE; MIDDLE AGED; POPULATION SURVEILLANCE; PREVALENCE; RISK FACTORS; SEX WORKERS; SOCIOECONOMIC FACTORS; YOUNG ADULT;

EID: 84903585297     PISSN: 15483568     EISSN: 15483576     Source Type: Journal    
DOI: 10.1007/s11904-014-0199-7     Document Type: Review

References (91)

1. UNAIDS Report on the Global AIDS Epidemic 2013. Accessed on 23 December 2013 at http://www.unaids.org/en/media/unaids/contentassets/documents/ epidemiology/2013/gr2013/UNAIDS-Global-Report-2013-en.pdf.
2. Figueroa JP. The HIV, epidemic in the Caribbean: meeting the challenges ofc achieving universal access to prevention, treatment and care. West Indian Med J. 2008;57(3):195-203.
3. UNAIDS Keeping Score III The Voice of the Caribbean People. UNAIDS 2011. Accessed on 23 December 2013 at http://observatoriovihycarceles.org/es/caribe. raw?task=download&fid=210.
4. UNAIDS Keeping Score II 2008. Accessed on 23 December 2013 at http://data.unaids.org/pub/Report/2008/20081206-keepingscoreii-en.pdf.
5. Ministry of Health, Barbados. The Barbados HIV/AIDS Surveillance Report 2010. Ministry of Health, Barbados 2012. Accessed on 23 December 2013 at http://www.colesxmedia.com/flipbooks/HIV/files/assets/basic-html/#toc.
6. Anderson T. HIV/AIDS in Cuba: Lessons and Challenges. Rev Panam Salud Publ. 2009;26(1):78-86.
7. .• Binns LA. An Unassuming Revelation: Cuba's Social Policy toward the AIDS Epidemic. West Indian Med J. 2013;62(4): 368-73. Cuba's success in controlling their HIV epidemic needs to be recognized and better understood.
8. Halperin DT, de Moya EA, Pérez-Then E, Pappas G, Calleja JMG. Understanding the HIV epidemic in the Dominican Republic: a prevention success story in the Caribbean? JAIDS. 2009;51:S52-9.
9. Gaillard EM, Boulos L-M, Cayemittes MPA, Eustache L, Van Onacker JD, Duval N, et al. Understanding the reasons for decline of HIV prevalence in Haiti. Sex Transm Infect. 2006;82 suppl 1:i14-20.
10. Figueroa JP, Duncan J, Byfield L, Harvey K, Gebre Y, Hylton-Kong T, et al. A comprehensive response to the HIV/AIDS epidemic in Jamaica: a review of the past 20 years. West Indian Med J. 2008;57(6):562-76.
11. .• Figueroa JP. The critical role of locally conducted research in guiding the response to the HIV epidemic in Jamaica. West Indian Med J. 2012;61(4):387-95. This paper reviews how locally conducted research contributed to controlling the HIV epidemic in Jamaica.
12. UNAIDS http://www.unaids.org/en/regionscountries/countries/ Accessed on 22 December 2013.
13. UNAIDS Fact Sheet. Accessed on 22 December 2013 at http://www.unaids.org/ en/resources/campaigns/globalreport2013/factsheet/.
14. UNAIDS Global Report 2012. Accessed on 22 December 2013 at http://www.unaids.org/en/resources/publications/2012/name, 76121,en.asp.
15. Mathers CD, Boerma T, Ma FD. Global and regional causes of death. Br Med Bull. 2009;92(1):7-32.
16. Duncan J, Beckford Jarrett S, Harvey K. Using estimation and projection package and Spectrum for Jamaica's national HIV estimates and targets. Sex Transm Infect. 2010;86(suppl II):ii43-7.
17. .• Rojas P, Malow R, Ruffin B, Rosenburg R. The HIV/AIDS Epidemic in the Dominican Republic Key Contributing Factors. J Int Assoc Providers AIDS Care (JIAPAC). 2011;10(5):306-15. This article reviews HIV/AIDS epidemiological data and recent research conducted in the Dominican Republic, with a focus on explaining the variability in estimated seroincidence and prevalence within the country.
18. .• UNAIDS, Jamaica National HIV/STI Program. Modes of HIV Transmission in Jamaica. Distribution of new HIV infections in Jamaica for 2012: Recommendations for efficient resource allocation and prevention strategies. 2013. This is the modes of transmission study for Jamaica 2012.
19. .•• Figueroa JP, Weir SS, Jones Cooper C, Byfield L, Hobbs M, Mcknight I, et al. High HIV Prevalence among MSM in Jamaica is associated with Social Vulnerability and other Sexually Transmitted Infections. West Indian Med J. 2013;62(4):286-91. This paper reports on a 2007 survey of 201 MSM in Jamaica in which HIV prevalence was 32%. Most of the men were of lower socio-economic status and many were socially vulnerable as well as sex workers. This illustrates the importance of social vulnerability among these MSM and helps to explain the high HIV prevalence reported for Jamaica.
20. UNAIDS, Consejo Presidencial del SIDA, Direccion General de Infecciones de Transmission Sexual y SIDA. HIV Modes of Transmission Model: Analysis of the distribution of new HIV infections in the Domican Republic for prevention 2010.
21. Figueroa JP, Jones Cooper C, Edwards J, Byfield L, Eastman S, Hobbs M, Weir SS. Understanding the High Prevalence of HIV and other Sexually Transmitted Infections among Socio-economically Vulnerable Men who have Sex with Men in Jamaica. Submitted.
22. Beyrer C, Baral SD, van Griensven F, Goodreau SM, Chariyalertsak S, Wirtz AL, et al. Global epidemiology of HIV infection inmen who have sex with men. Lancet July 2012 special issue on HIV in men who have sex with men 19-29.
23. Allen CF, Edwards M, Williamson L, Kitson-Piggott W, Wagner HU, Camara B, et al. Sexually Transmitted infection Service Use and Risk Factors for HIV Infection among Female Sex Workers in Georgetown, Guyana. JAIDS. 2006;43:96-101. (Pubitemid 44306495)
24. Dechamps MM, Zorrilla CD, Morgan CA, Donastorg Y, Metch B, Madenwald T, et al. Recruitment of female commercial sex workers at high risk of HIV infection. Rev Panam Salud Publ. 2013;34(2):92-8.
25. Duncan J, Gebre Y, Grant Y, Wedderburn M, Byfield L, Bourne D, et al. HIV Prevalence and Related Behaviours among Sex Workers in Jamaica. Sex Transm Dis. 2010;37(5):306-10.
26. Duncan J, Weir SS, Byfield L, Jones-Cooper C, Jarrett S, Figueroa JP. STI prevalence and Risk Behaviours among Club-based and Street-based Sex Workers in Jamaica. Submitted.
27. Jamaica National HIV/STI Program. HIV Epidemic Update Facts and Figures 2011. Accessed 28 December 2013 at http://www.nhpjamaica.org/hiv-epidemic- update-facts-and-figures-2011.
28. Puerto Rico Department of Health. Puerto Rico Statewide Coordinated Statement of Need 2012 and HIV Treatment Comprehensive Plan 2012 - 2015. Accessed on 2 February 2014 at http://www.salud.gov.pr/Programas/ ryanwhiteparteb/Documents/ StateWide%20Coordinated%20Statement%20of%20Need%202012%20and%20Puerto%20Rico% 20HIV%20Comprehensive%20Plan%202012-15.pdf.
29. Gomez MP, Kimball AM, Orlander H, Bain RM, Fisher LD, Holmes KK. Epidemic crack cocaine use linked with epidemics of genital ulcer disease and heterosexual HIV infection in the Bahamas: Evidence of impact of prevention and control measures. Sex Transm Dis. 2002;29:259-64. (Pubitemid 34477913)
30. Andrinopoulos K, Kerrigan D, Figueroa JP, Reese R, Gaydos C, Bennett L, et al. Establishment of an HIV/sexually transmitted disease programme and prevalence of infection among incarcerated men in Jamaica. Int J STD AIDS. 2010;21:114-9.
31. Gough E, Edwards P. HIV seroprevalence and associated risk factors among male inmates at the Belize Central Prison. Rev Panam Salud Publ. 2009;25(4):292-9.
32. Rodríguez-Díaz CE, Reece M, Rivera-Alonso B, Laureano-Landrón I, Dodge B, Malow RM. Behind the Bars of Paradise: HIV and Substance Use among Incarcerated Populations in Puerto Rico. JIAPAC Publ Online. 2011. doi:10.1177/1545109711398664.
33. Boisson EV, Trotman C. HIV Seroprevalence Among Male Prison Inmates in the Six Countries of the Organization of Eastern Caribbean States in the Caribbean (OECS). West Indian Med J. 2009;58(2):106.
34. Andrinopoulos K, Figueroa JP, Kerrigan D, Ellen JM. Homophobia, stigma and HIV in Jamaican prisons. Cult Health Sex. 2011;13(2):187-200. doi:10.1080/13691058.2010.521575.
35. Andrinopoulos K, Kerrigan D, Figueroa JP, Reese R, Ellen JM. HIV coping self efficacy: a key to understanding stigma and HIV test acceptance among incarcerated men in Jamaica. AIDS Care. 2010;22(3):339-47.
36. Anastario MP, Tavarez MI, Chun H. Sexual risk behavior among military personel stationed at border-crossing zones in the Dominican Republic. Rev Panam Salud Publ. 2010;28(5):361-7.
37. Allen CF, Edwards P, Grennari F, Caffe S, Boisson E, Jones S, et al. Evidence on Delay in Sexual Initiation, Multiple Partnerships and Condom Use among Young People: Review of Caribbean HIV Behavioural Studies. West Indian Med J. 2013;62(4):292-8.
38. Devieux JG, Rosenburg R, Saint-Jean G, Bryant VE, Malow RM. The Continuing Challenge of Reducing HIV Risk among Haitian Youth: The Need for Intervention. J Int Assoc Providers AIDS Care. 2013. doi:10.1177/ 2325957411418119.
39. Lashley J, Yearwood J. Drug Use and Risky Sexual Behaviour in Tertiary Institutions in Barbados: Personal and 'Liberal Campus' Effects. J East Caribb Stud. 2011;36(4):60-90.
40. Andrews B. Sociodemographic and Behavioural Characteristics of Youth Reporting HIV Testing in Three Caribbean Countries. West Indian Med J. 2011;60(3):276-83.
41. Figueroa JP. The Challenge of Sexually Active School Children in the Caribbean in the era of HIV/AIDS. Chapter in Challenging HIV & AIDS: A new role for Caribbean Education, pages 167-173. Ed M Morrissey, M Bernard, D Bundy. Ian Randle Publishers, UNESCO 2010.
42. Morrissey M. Response of the Education System in the Commonwealth Caribbean to the HIV/AIDS Epidemic: A Preliminary Overview. Chapter in Challenging HIV & AIDS: A new role for Caribbean Education, pages 1-13. Ed M Morrissey, M Bernard, D Bundy. Ian Randle Publishers, UNESCO 2010.
43. The CARICOM Secretariat. HIV and AIDS Education Through HFLE for 10-14 year olds. Chapter in Challenging HIV & AIDS: A new role for Caribbean Education, pages 289-303. Ed M Morrissey, M Bernard, D Bundy. Ian Randle Publishers, UNESCO 2010.
44. Barrow C. Sexual Identity, HIVand Adolescent Girls in Barbados. Soc Econ Stud. 2008;57(2):7-26.
45. Plummer D. HIV in Caribbean Schools: The Role of Education in the Second Most Severely Affected Region in the World. Chapter in Challenging HIV & AIDS: A new role for Caribbean Education, pages 14-25. Ed M Morrissey, M Bernard, D Bundy. Ian Randle Publishers, UNESCO 2010.
46. .• Challenging HIV & AIDS: A new role for Caribbean Education. Ed M Morrissey, M Bernard, D Bundy. Ian Randle Publishers, UNESCO 2010. This is an important collection of papers exploring the implications of HIV for the education sector in the Caribbean.
47. Hutchinson MK, Kahwa E, Waldron N, Hepburn Brown C, Hamilton PI, Hewitt HH, et al. Jamaican Mothers' Influences of Adolescent Girls' Sexual Beliefs and Behaviors. J Nurs Scholarsh. 2012;44(1):27-35. doi:10.1111/j.1547-5069.2011. 01431.
48. Kempadoo K, Taitt A. Gender, Sexuality and Implications for HIV/AIDS in the Caribbean: A Review of Literature and Programmes. UNIFEM and IDRC 2006.
49. Bombereau G, Allen C. Social and Cultural factors driving the HIV epidemic in the Caribbean: a literature review. Caribbean Health Research Council 2008.
50. Figueroa JP. Understanding Sexual Behaviour in Jamaica. In: Horace L, editor. "The African-Caribbean Worldview and the Making of Caribbean Society". Kingston: University of the West Indies Press; 2009.
51. Anderson P.Measuring Masculinity in an Afro-Caribbean Context. Soc Econ Studies Nov 2011.
52. Lefranc E, Wyatt GE, Chambers C, Eldemire D, Bain B, Ricketts H. Working Women's Sexual Risk Taking in Jamaica. Soc Sci Med. 1996;42(10):1411-7.
53. Padilla MB, Guilamo-Ramos V, Bouris A, Reyes AM. HIV/AIDS and tourism in the Caribbean: an ecological systems perspective. Am J Public Health. 2010;100(1):70-7.
54. Padilla MB, Guilamo-Ramos V, Godbole R. A Syndemic Analysis of Alcohol Use and Sexual Risk Behavior Among Tourism Employees in Sosúa. Dominican Repub Qual Health Res. 2012;22(1):89-102.
55. Boxill I, at al. Tourism & HIV/AIDS in Jamaica & The Bahamas. Arawak Publications 2005.
56. Allen C. Intersections between HIV/AIDS and Violence Against Women: Research to Develop Pilot Projects in Barbados and Dominica. J East Carib Stud. 2011;36(4):39-59.
57. Le Franc E, Samms-Vaughan M, Hambleton I, Fox K, Brown D. Interpersonal violence in three Caribbean countries: Barbados, Jamaica, and Trinidad and Tobago. Rev Panam Salud Publ. 2008;24(6):409-21.
58. Casado W, Skewes R. Domestic violence in San Jose De Ocoa, Dominican Republic 2008-2011. Inj Prev. 2012;18:A180. doi:10. 1136/injuryprev-2012- 040590q.
59. Forbes MA. Music, Media & Adolescent Sexuality in Jamaica. Arawak Publications 2010.
60. Rowe Y. Vitamin S: Messages, Music and Video - An Analysis of the sexual Content and Perceptions of Sexuality Communicated in Popular Music Videos. Soc Econ Stud. 2013;62(1):227-47.
61. .•• Barrow C, Aggleton P. Good face, Bad Mind? HIV Stigma and Tolerance Rhetoric in Barbados. Soc Econ Stud. 2013;62(1):29-52. The authors analyse the limits of tolerance as an antidote to stigma and discrimination and call for fundamental "reform of discriminatory laws, along with county-specific mechanisms for stigma elimination, sanctions and redress for discrimination".
62. Plummer D, McLean A. The Price of Prejudice: The Corrosive Effect of HIV-Related Stigma on Individuals and Society. Chapter in Challenging HIV & AIDS: A new role for Caribbean Education, pages 232-239. Ed M Morrissey, M Bernard, D Bundy. Ian Randle Publishers, UNESCO 2010.
63. Clarke TR, Gibson R, Barrow G, James S, Abel WD, Barton EN. Disclosure of HIV status among HIV clinic attendees in Jamaica. West Indian Med J. 2010;59(4):445-9.
64. Padilla MB, Reyes AM, Connolly M, Natsui S, Puello A, Chapman H. Examining the policy climate for HIV prevention in the Caribbean tourism sector: a qualitative study of policy makers. Dominican Repub Health Policy Plan. 2012;27(3):245-55.
65. St John A, Mascoll K, Waterman I, Chrichlow S. Ruther Reduction in Mother-To-Child Transmission of HIV in Barbados following intervention with HAART. J East Carib Stud. 2011;36(4):28-38.
66. Christie CDC, Pierre R. Eliminating Vertically-transmitted HIV/AIDS while Improving Acess to Treatment and Care for Women, Children and Adolescents in Jamaica. West Indian Med J. 2012;61(4):396.
67. Morgan ND, Ferguson TS, Younger NOM, Tulloch-Reid MK, Francis DK, McFarlane SR, et al. Prevalence of High-risk Sexual Behaviour in Jamaican Adults and its Relationship to Sociodemographic and Religious Factors: Findings from the Jamaica Health and Lifestyle Survey 2007-2008. West Indian Med J. 2012;61(9):873-80.
68. White L, Byfield L, Sutherland S, Reid R. "Pinch, Leave an Inch and Roll" Applying the Communication-for-Behavioural-Impact (COMBI) Approach to the Promotion of Proper Male Condom Use in Jamaica. Caribb Q. 2012;58:43-66.
69. Weir SS, Figueroa JP, Byfield L, Hall A, Cummings S. Suchindran. Randomized controlled trial to investigate the impact of site-based safer sex programmes in Kingston, Jamaica: trial design, methods and baseline findings. Trop Med Int Health. 2008;13(6):801-13. (Pubitemid 351678629)
70. .•• Figueroa JP, Weir SS, Byfield L, Hall A, Cummings S, Suckindron C. The Challenge of promoting safe sex at sites where persons go to meet new sex partners in Jamaica: results of the Kingston PLACE randomized controlled trial. Trop Med Int Health. 2010;15(8):945-54. In the Kingston PLACE randomized controlled trial, 147 sites where persons go to meet new sex partners were grouped into 50 geographic clusters and randomized to receive or not receive a multilevel PLACE intervention during 2006. There was no significant difference between the intervention and control groups in the proportion of men and women who reported new or multiple relationships in the past year and inconsistent condom use. Reasons given for the failure to show an intervention effect included difficulty in implementation, patron mixing among sites, intensity of national education campaigns, delay in conducting the post-intervention survey and evidence of other interventions at some control sites.
71. Anderson C, Gallo MF, Hylton-Kong T, Steiner MJ, Hobbs MM, Macaluso M, et al. Randomized controlled trial on the effectiveness of counseling messages for avoiding unprotected sexual intercourse during STI and reproductive tract infection treatment among female STI clinic patients. Sex Transm Dis. 2013;40(2):105-10.
72. Chin-Quee DS, Wedderburn M, Otterness C, Janowitz B, Chen-Mok M. Bridging emergency contraceptive pill users to regular contraception: results from a randomized trial in Jamaica. Contraception. 2010;81(2):133-9.
73. Figueroa JP, Jones-Cooper C. Attitudes towards male circumcision among attendees of a sexually transmitted infection clinic in Kingston, Jamaica. West Indian Med J. 2010;59(4):351-5.
74. Walcott MM, Jolly PE, Ehiri JE, Funkhouser E, Kempf MC, Hickman D, et al. Factors associated with the acceptability of male circumcision among men in Jamaica. PLoS One. 2013;8(9):e75074. doi:10.1371/journal.pone.0075074.
75. Carter M, Gallo M, Anderson C, Snead MC, Wiener J, Costenbader E, et al. Intraviginal Cleansing among Women Attending a Sexually Transmitted Infection Clinic in Kingston, Jamaica. West Indian Med J. 2013;62(1):56-61.
76. Foster TM, Lee MG, McGaw CD, Frankson MA. Prevalence of Needlestick Injuries and other High Risk Exposures among Healthcare Workers in Jamaica. West Indian Med J. 2010;59(2):153-8.
77. World Health Organization.WHO Consolidated Guidelines on The use of ARV drugs for treating and preventing HIV infection: Recommendations for a public health approach. Geneva: WHO, June 2013: http://apps.who.int/iris/bitstream/ 10665/85321/1/9789241505727-eng.pdf, accessed 28 January 2104.
78. Duncan J, Grant Y, Clarke TR, Harvey KM, Gibson RC, Barrow G, et al. Sociodemographics and clinical presentation of HIV in Jamaica over 20 years. A comparative analysis of surveillance data. West Indian Med J. 2010;59(4):409-17.
79. .•• Koenig SP, Rodriguez LA, Bartholomew C, Edwards A, Carmichael TE, Barrow G, et al. Long-term antiretroviral treatment outcomes in seven countries in the Caribbean. J Acquir Immune Defic Syndr. 2012;59(4):e60-71. doi:10.1097/QAI.0b013e318245d3c1. HIV treatment outcomes for 8,203 patients starting ART from 1998 to 2008 were studied in 7 Caribbean countries. Mortality was 13% overall with 75% of patients alive and in-care at the end of the study period.
80. Halpern M, Lachmansingh B, Minior T, Hasbrouck LM, Persaud N, Foo A. Implementation of a standardized HIV patient monitoring system in Guyana. Rev Panam Salud Publ. 2010;28(2):107-13.
81. .•• Landis RC, Branch-Beckles SL, Crichlow S, Hambleton IR, Best A. Ten Year Trends in Community Viral Load n Barbados: Implications for Treatment as Prevention. PLoS One. 2013;8(3):e58590. Analysis of viral load trends in Barbados showed a significant improvement in viral load suppression in the past decade; from 33.6% of clients achieving the 200 copies/ml threshold in 2002 to 70.3% in 2011 (p<0.001) (80). This translated into an estimated 26.2% viral load suppression at a population level at the end of 2010, which is similar to reports in developed countries that used similar methods.
82. Allen CF, Simon Y, Edwards J, Simeon DT. Adherence to Antiretroviral Therapy by People Accessing Services from Non-governmental HIV Support Organisations in Three Caribbean countries. West Indian Med J. 2011;60(3):269-75.
83. Harvey K, Carrington D, Duncan D, Figueroa J, Hirshorn L, Manning D. Evaluation of adherence to highly active antiretroviral therapy in adults in Jamaica. West Indian Med J. 2008;57:293-7.
84. Ravas G, Jack N, Alonso Gonzalez M, Sued O, Perez-Rosales, Gomez B, et al. Progress of implementation of the World Health Organisation strategy for HIV drug resistance control in Latin America and the Caribbean. Rev Panam Salud Publ. 2011;30(6):657-62.
85. Duke N, Aboh S, Bosivert N. Analysis of Resistance Testing in Trinidad. West Indian Med J. 2010;59:400-2.
86. Barrow G, Hylton-Kong T, Rodriguez N, Yamamura Y, Figueroa JP. HIV-1 Drug Resistance Testing in Treatment Naïve, Chronically Infected Patients in Jamaica. Antivir Ther. 2013. doi:10.3851/IMP2869.
87. Machado LY, Dubed M, Díaz H, Ruiz N, Romay D, Váldes N, et al. AIDS Res Hum Retrovir. 2013;29(2):411-4.
88. Hamilton CL, Eyzaguirre LM, Amarakoon II, Figueroa P, Duncan J, Carr JK, et al. Analysis of protease and reverse transcriptase genes of HIV for antiretroviral drug resistance in Jamaican adults. AIDS Res Hum Retrovir. 2012;28(8):923-7.
89. Collins-Fairclough AM, Charurat M, Nadai Y, Pando M, Avila MM, Blattner WA, et al. Significantly longer envelope V2 loops are characteristic of heterosexually transmitted subtype B HIV-1 in Trinidad. PLoS One. 2011;6(6):e19995.
90. .• Barrow C, Barrow G. HIV Treatment as Prevention in Jamaica and Barbados: Magic Bullet or Sustainable Response? JIAPAC 2013. J Int Assoc Provid AIDS Care 2013 Dec 30. [Epub ahead of print]. This paper discusses the potential and challenges of ARV treatment as prevention in the context of Jamaica and Barbados.
91. Figueroa JP. Turning the Tide toward an AIDS Free Generation: Is It Within Our Reach? West Indian Med J. 2013;62(4):279-81.