Substance Users

While most international focus on the HIV epidemic and risk among substance users has focused on intravenous drug use (IDU), by far the greater threat in the Caribbean is from addiction to cocaine, especially crack cocaine. A sub-population of great concern for CVC is crack addicts who live on the city streets or in crack houses across the Caribbean. Studies in Jamaica, St. Lucia, and Trinidad have shown that crack-addicted women are more vulnerable than their male counterparts to infection with HIV.

The trailblazer in research in substance use and HIV has been the St. Lucia-based Caribbean Drug Abuse Research Institute (CDARI), founded by Marcus Day, Ph.D, a member of the Board of Governors of CVC. When few in the Region were aware of the severe hardships and vulnerabilities of substance users and crack addicts in the region, CDARI systematically collected data to clearly establish the link between addiction and vulnerability to HIV. In Jamaica, Coalition member Winston de la Haye has done an important study based on the CDARI's work that clearly showed a 3:1 ratio of women to men treating for crack addiction and also testing positive for HIV. This is in a context where, as in other parts of the world, access to ARVs for addicts is highly controversial. Some government officials believe that addiction disqualifies persons from accessing ARVs; activists in the region are divided on the issue. Where there is consensus, however, is on the vital need to provide shelter for homeless substance users, and to expand treatment facilities for those in recovery. There is also need for more funded programmes for street level interventions.

While research has clearly established the need, prevention work with substance users in the Caribbean remains underrecognised and underfunded. Many civil society agencies such as the Ionie Whorms Inner City Counselling Centre have been operating without an agency budget and have been surviving on limited funds pulled together by their principals. CVC believes this is a short-sighted approach to substance use in the region. The coalition is committed to advocating for the inclusion in both HIV prevention and treatment programmes for substance users.