SAN JUAN, Puerto Rico | Caribbean leaders are pushing Congress to expand President Bush's $15 billion AIDS-relief plan to include more nations in the island chain, saying broader help is needed to stop the spread of the epidemic.
While they welcome the aid, which targets Haiti and Guyana alongside 12 African nations, they liken the approach in the Caribbean to treating only two organs in a body quickly being ravaged by cancer.
''Whatever happens in one specific corner of the region will have an impact in other places,'' said Rafael Mazín, acting chief if the HIV/AIDS unit at the Pan American Health Organization. ''To be effective means needs to be prevented and contained in all places.''
The Caribbean has the highest infection rates for HIV outside of sub-Saharan Africa.
As the virus spreads from island to island, infecting mobile populations that share a tradition of traveling to seek out the best medical treatment, officials here are pressing Washington to back a region-wide attack on the epidemic.
''Any resources coming for HIV action is a step in the right direction,'' said Dr. Yitades Gebre, chairman of the Alliance of Caribbean National HIV/AIDS Programme Coordinators. ''We appreciate and applaud the effort. But we have to be as inclusive as possible.''
A proposal to extend funding to 14 more countries could reach the U.S. Senate as early as this week.
''This is a regional crisis in our own hemisphere,'' said Sen. Chris Dodd, D-Conn., who has championed the measure. ''It deserves to be given the same serious attention that is being given to the HIV/AIDS epidemic in sub-Saharan Africa. If we're not careful, we are going to lose a generation of young people in the Caribbean.''
The five-year plan signed by Bush last week authorizes up to $2 billion annually for direct aid to 14 target countries in Africa and the Caribbean and up to $1 billion annually for the Global Fund To Fight AIDS. Congress, which must approve funding year by year, is expected to act soon on the first installment, to begin in October.
If funded at the envisioned levels, the plan would nearly triple the U.S. commitment to fighting AIDS worldwide. While details have not been determined, the Office of National AIDS Policy says the plan will provide life-extending anti-retroviral drugs to 2 million HIV patients, offer care to 10 million HIV patients and AIDS orphans, and prevent 7 million new infections.
''In the face of preventable death and suffering, we have a moral duty to act, and we are acting,'' Bush said in signing the bill last week.
Officials in the Caribbean, a region largely overlooked by international donors, say the inclusion of Haiti and Guyana alongside 12 African nations to share $10 billion over five years signals a new level of recognition of the epidemic here.
As many as 500,000 people in this region of 38 million live with HIV. In some cities, more than one in eight people are infected; the disease has left more than 80,000 children orphaned.
''To couple the Caribbean with Africa is crucial,'' said Caroline Ansteyo, country director for the region at the World Bank. ''We're seeing roll back the development gains we've seen in the last two generations.''
Haiti, where more than one in 17 adults aged 15 to 49 carry the virus, and Guyana, a poor nation on the Caribbean coast of South America where the prevalence is 2.7 percent, are widely considered the countries in the region that have been hit the hardest by the epidemic.
But infection rates in nations as disparate as the Bahamas, Belize, the Dominican Republic, Suriname and Trinidad and Tobago are all at least 2 percent and climbing.
''It's very difficult to de-link the different countries,'' said Edward Green, assistant secretary-general of the Caribbean Community for human and social development. ''You have migration from Haiti to the Dominican Republic, Haiti to the Bahamas, Guyana to the rest of the Caribbean. Although we can target countries, it might be more effective to look at the region as a whole.''
Green chairs the Pan-Caribbean Partnership To Fight AIDS, a coalition of 16 nations formed with the blessing of the United States to develop a regional response. The group, which includes the 15 members of the Caribbean Community plus the Dominican Republic, has appealed to U.S. officials on security grounds.
''We realize that high prevalence rates can overwhelm our health care capacity, destabilize our economies and increase migration flow which could pose a real security risk for the U.S. due to the proximity of the Caribbean,'' ambassadors from the group wrote in a recent letter to Bush. ''Without a regional approach to the Caribbean AIDS crisis, we fear that AIDS will lower life expectancy, increase the number of AIDS orphans, further threaten our already fragile economies, increase migration flow out of the region, and increase the threat to the U.S.''
Nations not included among the target countries still may apply for grants though the Global Fund To Fight AIDS, to which the United States is the largest donor. The Geneva-based fund, established two years ago by the United Nations and paid for by the world's industrialized nations, has approved more than $50 million in grants to Cuba, the Dominican Republic and Haiti.
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