USAID CBJ FY 2002: Caribbean Regional

Summary: AIDS is the leading cause of death among 15 to 44 year-olds in the English-speaking Caribbean. HIV seroprevalence in the region is second only to sub-Saharan Africa, and is particularly high in the Bahamas, Barbados, the Dominican Republic, Guyana and Haiti. In most of the remaining Caribbean countries, HIV/AIDS remains concentrated among population groups practicing high risk behaviors, but it has the potential to spread rapidly to the general population, a situation that this strategy seeks to address. By the end of 1999, the World Health Organization (WHO) and the Joint United Nations Program on HIV/AIDS estimated that region-wide, over 1.96% of adults (ages 15 to 49) were living with HIV/AIDS (about 360,000 persons). Given what is know about under-reporting, a more realistic estimate is 500,000 persons (about 2.72% of adults).

From 1991 to 1998, the annual number of new AIDS cases in the Eastern Caribbean had almost tripled from 854 to 2,279 cases. In some countries HIV/AIDS patients now occupy 25% of all medical ward beds. Late diagnosis is common and few people receive treatment, even for opportunistic infections, resulting in high case fatality rates. In terms of age-specific mortality, AIDS is the leading cause of death among 15 to 44 year-olds regardless of gender. In St. Vincent, for example, it is estimated that 40% of young men's deaths are linked to AIDS. The region also has an estimated 83,000 children under the age of 14 who are orphaned as a result of AIDS.

The primary mode of transmission is heterosexual. The region has one of the highest rates of new AIDS cases among women in the sub-regions of the Western Hemisphere where they now make up 35% of all HIV positive adults. Mother to child transmission of HIV is also higher in the Caribbean than in any other part of the Americas. The epidemic is shifting to younger populations and is reflected in the fact that half of all new HIV infections are among youth aged 10 to 25. Young girls, as in other parts of the world, are at higher risk of becoming infected by older HIV-infected men. Girls aged 10 to 19 are up to seven times more likely to be infected than boys aged 10 to 19 in some countries.

The overall purpose of USAID's response to HIV/AIDS in the Caribbean region is to strengthen and support regional and local institutions to better enable them to decrease the negative impact of HIV/AIDS in targeted Caribbean countries.

Key Results: The strategy for this new project was reviewed and approved by USAID's Latin America and Caribbean Bureau in March 2001. It will focus on two programmatic goals: 1) Increased capacity of non-governmental and community-based organizations to deliver HIV/AIDS prevention programs in target countries; and 2) Increased government capacity (in target countries) to implement an effective response to HIV/AIDS. Three indicators will track performance: 1) status of developing and implementing national AIDS strategic plans; 2) percent of health personnel providing quality management of people living with HIV/AIDS according to Caribbean Epidemiology Center (CAREC) guidelines; and 3) the number of non-governmental organizations (NGOs) which have reached a minimal performance standard.

Performance and Prospects: Program implementation will begin in the summer of 2001 with the award of contracts and grants. The strategic opportunity and rationale for USAID engagement lies in working collaboratively with regional partners under a common strategic framework to reduce the spread and impact of HIV/AIDS in the Caribbean. Therefore, prospects are excellent as numerous donors and organizations have pledged their support for this common strategic framework.

The bulwark of the strategy will be to introduce methodologies and approaches to reduce risk and vulnerability. Risk reduction interventions (i.e., reducing the probability that a person may acquire HIV infection) will be based on best practices and will target high-risk individuals and groups mainly through non-governmental organizations (NGOs) and other community-based groups as well as Peace Corps volunteers. Resources to CAREC will build the capacity of member countries to develop and implement an expanded response to the HIV/AIDS crisis.

In FY 2001, $500,000 will be used to strengthen national HIV/AIDS plans in target countries and approximately $997,000 will be used to support NGOs in the region that work in HIV/AIDS prevention. Activities to support and increase NGO and government capacity in the region will be expanded in FY 2002.

Other Donor Programs: Several bilateral and multilateral donors are also supporting HIV/AIDS programs in the region. These include the European Union, the development agencies of Canada, the United Kingdom, and Germany, the Inter-American Development Bank, and the World Bank.

Principal Contractors, Grantees, or Agencies: Implementing partners will include local and regional NGOs and the Caribbean Epidemiology Center (affiliated with the Pan American Health Organization). The Peace Corps is a U.S. implementing partner.

Caribbean Regional Program 538-008

U.S. Financing

(In thousands of dollars)

	Obligations		Expenditures		Unliquidated
Through September 30, 1999	0	DA	0	DA	0	DA
	0	CSD	0	CSD	0	CSD
	0	ESF	0	ESF	0	ESF
	0	SEED	0	SEED	0	SEED
	0	FSA	0	FSA	0	FSA
	0	DFA	0	DFA	0	DFA
Fiscal Year 2000	0	DA	0	DA
	0	CSD	0	CSD
	0	ESF	0	ESF
	0	SEED	0	SEED
	0	FSA	0	FSA
	0	DFA	0	DFA
Through September 30, 2000	0	DA	0	DA	0	DA
	0	CSD	0	CSD	0	CSD
	0	ESF	0	ESF	0	ESF
	0	SEED	0	SEED	0	SEED
	0	FSA	0	FSA	0	FSA
	0	DFA	0	DFA	0	DFA
Prior Year Unobligated Funds*	0	DA
	0	CSD
	0	ESF
	0	SEED
	0	FSA
	0	DFA
Planned Fiscal Year 2001 NOA	0	DA
	1,497	CSD
	0	ESF
	0	SEED
	0	FSA
	0	DFA
Total Planned Fiscal Year 2001	0	DA
	1,497	CSD
	0	ESF
	0	SEED
	0	FSA
	0	DFA
			Future Obligations		Est. Total Cost
Proposed Fiscal Year 2002 NOA	0	DA	0	DA	0	DA
	3,000	CSD	3,503	CSD	8,000	CSD
	2,000	ESF	2,000	ESF	4,000	ESF
	0	SEED	0	SEED	0	SEED
	0	FSA	0	FSA	0	FSA
	0	DFA	0	DFA	0	DFA

Caribbean Regional

Activity Data Sheet

Caribbean Regional Program 538-008

U.S. Financing