It is often pointed out that the groups most vulnerable to HIV infection are men who have sex with men, sex workers and injecting drug users and that, as the epidemic spreads, females are more vulnerable than males. It is less often pointed out that large proportions of people in all of those categories are young and that more than half of the people newly infected with HIV each year are under the age of 25 (UNAIDS, 2006a; UNAIDS Inter-agency Task Team on Young People, 2006). This publication looks at initiatives sup - ported by the German Technical Cooperation Agency (GTZ) and German Development Bank (KfW), beginning in 1995 and 2005, aimed at HIV prevention among youth and the social marketing of condoms and behaviour change communications. It differs from other publi - cations in this Collection in that it describes the context of such initiatives in considerable detail. This is so because the Caribbean is a region of extraordinary diversity and complexity with unique characteristics that call for unique responses; and because the Caribbean has a com - plex set of national and regional mechanisms for coordinating its responses to the AIDS epidemic. The publication is divided into four parts.
The first part looks at the region and its epi - demic in context. It points out that the region’s epidemic emerged among men who have sex with men in a social and cultural environ - ment that is deeply hostile to homosexuality. That hostility has contributed to delays and distortions in mounting practical and effective responses to AIDS. Sex work and transactional sex, related only in part to the tourism industry, are common throughout the region and the predominantly young women and men who engage in such sex are at high risk of being infected by HIV and transmitting their infec - tion to others. In addition, the Caribbean is a region famous for the macho attitudes and behaviour of its men and these contribute to the sexual exploitation and abuse of women and of both female and male adolescents and children, putting them all at high risk of HIV infection.
The second part looks at regional mecha - nisms, policies and programmes for respond - ing to AIDS. It makes a distinction between those serving the CARICOM sub-region, now home to 37.5% of the region’s population, and those serving all 29 countries of the re - gion, home to more than 40 million people. The third part describes the promising practices through which GTZ supported the three com - ponents of capacity development for an effective youth-initiated, youth- centred response to AIDS_ • Strengthening local youth-run services • Establishing and supporting national and regional youth networks and • Ensuring youth participation in the develop - ment and implementation of national and regional policies and programmes countering HIV among youth.
The third part also looks at the results of these projects, including achievements, identified challenges and lessons learnt. The fourth part looks at a regional pro - gramme, supported by KfW, called Caribbean Social Marketing to Prevent HIV and AIDS (CARISMA). Since 2005 the programme has been implemented in Belize, the Dominican Republic, Haiti and Jamaica. The beneficiaries range from the general population (Jamaica) to young girls and boys (Dominican Republic, Hai - ti), migrants (Belize, Dominican Republic) and men who have sex with men and sex workers (several countries). It looks at achievements and limitations, and draws lessons from this region - ally oriented approach. (Note that this part has not yet been through the peer review process).
