AIDS Increase in Caribbean Alarms Experts

A dramatic increase in heterosexually transmitted AIDS in Haiti and other Caribbean islands has alarmed specialists and researchers, who say they fear that a lethal wave of infection--like the epidemic that has swept a number of African countries--will soon engulf this region.

“The potential exists for a massive epidemic propagated mostly by heterosexual transmission,” said Dr. Thomas C. Quinn of the National Institute of Allergy and Infectious Diseases at Bethesda, Md. Quinn is co-author of a new study describing the ominous trend in the Caribbean basin and parts of Latin America.

If the feared epidemic occurs, “the situation of AIDS in the Americas may rapidly parallel the situation in the African region,” the report says. Quinn’s associates in preparing it were Drs. Fernando Zacarias and Ronald St. John of the Pan American Health Organization in Washington.

In the United States and Europe, AIDS is largely a disease of homosexual men and intravenous drug users, infecting 11 males for every female victim, but in Africa the disease is spread mostly through heterosexual intercourse and strikes almost as many women as men, Quinn said in a recent interview at his Johns Hopkins University office in Baltimore.

The same trend is evident in new surveys in the Caribbean and parts of Latin America, where the disparity between the sexes has declined dramatically, he said.

Quinn, Zacarias and St. John reported ratios of 1.8 males to each female victim in the Bahamas, 1.5 to 1 in French Guiana, and 2.3 to 1 in the Dominican Republic and Haiti. The overall ratio throughout the Caribbean, they reported, is 2.4 to 1.

Since intravenous drug use is not widespread in the region, the researchers said, the surprising increase in the proportions of female victims points clearly to heterosexual transmission.

Before this study, Haiti was thought to be the only country in the Western Hemisphere where AIDS was developing on the African pattern as a heterosexual disease.

“A lot of people thought this was a problem unique to Haiti,” said Dr. Bernard Liautaud, a specialist in sexually transmitted diseases who has studied acquired immune deficiency syndrome in Haiti for most of this decade. “But when we looked at other islands, we saw the same pattern. The disease began with homosexuals and then moved much more quickly to heterosexuals than it has in the U.S.”

Infant Victims

A tragic consequence has been a steep increase in the number of infant victims born of infected mothers. The researchers said that 9% of the reported 3,971 cases of active AIDS in the Caribbean are children under 5 years of age.

The mother-to-child infection rate probably will grow much worse, according to Dr. Reginald Boulos, another leading AIDS specialist here. Boulos said he has found that 9% to 10% of all pregnant women tested in two clinics in Port-au-Prince and Gonaives, a large provincial capital, are infected with HIV-1 (AIDS virus).

Many of the young women who test positive for HIV-1 do not understand the gravity of the infection, Boulos said. He recalled a young pregnant woman who recently appeared at his hospital in a Port-au-Prince slum, carrying in her arms an emaciated child who appeared too small to be more than six months old.

“I asked how she had managed to get pregnant again so soon, and she said the child was 2 years old,” Boulos recalled. “It had developed AIDS, and there’s a good chance that her next child will develop it, too.”

Boulos and his father, the late Dr. Carlo Boulos, worked for a number of years to improve public health in Cite Soleil, the poorest slum in the poorest country in the Western Hemisphere. Until the AIDS epidemic struck, they felt that they had achieved a measure of success after a public health campaign that brought the infant mortality rate down from 236 per 1,000 to 89 per 1,000, Boulos said.

But now the number of dying infants is rising again, and Boulos is convinced it is because of the AIDS epidemic.

‘Wipe Out Progress’

“Unless something is done soon,” he said, “AIDS threatens to wipe out all the progress we have made in child survival during the last 10 years.”

Although the total number of AIDS cases reported in the Caribbean seems relatively small compared to the more than 88,000 in North America, Quinn and the other researchers said it is disproportionately large when viewed on a per capita basis in the small island countries. In the Bahamas, for example, the case rate per million is 379.7, compared to 71.7 in the United States.

And while the overall numbers appear relatively small, reported cases of fully developed AIDS are only the tip of a dangerous iceberg, according to the researchers, since there remains a reservoir, many times larger, of people infected with HIV-1 in whom the disease is still incubating.

A researcher from the University of Sussex in England recently projected the numbers of Haitians who at the current rate of infection will test positive for HIV-1 in the next 15 years. He said that the virus may infect as many as 1,073,324 by the year 2005 and that almost half a million Haitians could be dead of the disease by then.

“So many people are already infected that it will take at least five years before the really disastrous impact settles in,” said Dr. Michael White, a health specialist with the U.S. Agency for International Development in Haiti. “A horrible situation can’t be avoided, but I believe that inevitably people’s sex practices here will change just as they have in San Francisco and New York.”

General Population

Sexual promiscuity has been almost a way of life in Haiti, according to Liautaud and Boulos. They said that a major reason AIDS spread so rapidly to the general population after its probable introduction to Haiti by American homosexuals was the country’s unusually large number of bisexual men who passed the disease along to wives, girlfriends and prostitutes. Casual use of prostitutes by young men has been the norm rather than the exception for generations of Haitians.

“Many men have several partners at the same time,” Boulos said. He added that the average Haitian woman has children by three fathers, at least tripling her chances of acquiring a sexually transmitted disease.

But there are signs of change, the specialists said. Although Haiti and other poor countries in the Caribbean have spent little if any money on official AIDS prevention programs, enough information has been voluntarily spread by the local media to have some impact on sex practices, Boulos and Liautaud believe.

Over the past year, they said, they have witnessed what appears to be a sharp decline in new cases of sexually transmitted diseases such as syphilis and gonorrhea.

“For months I haven’t seen even one case of gonorrhea,” said Liautaud, the country’s leading specialist in sexually transmitted diseases. “In our general hospital there used to be daily cases of secondary syphilis, but now there is no more than one a week. I can’t document it yet, but I think that means there has been a change in Haitian sexual behavior.”