Fernandes, who goes by the name “Isabella”, is also aware that despite efforts to decrease cases of people infected with HIV, the virus that causes the deadly acquired immunodeficiency syndrome AIDS, he belongs to the group men having sex with men MSM, considered in the Caribbean among the high risk groups capable of spreading the virus “I knew the road was not easy,” he told a regional gathering here, recalling his time in prison on a murder-related charge when “male sex workers were targeted for no reason at all” Marcus Day, who heads the St Lucia-based Caribbean Drug and Alcohol Research Institute, said the challenge for regional health authorities is to properly monitor male prisoners upon their release, since most of them become infected with the HIV virus while in custody “Mechanisms need to be put in place to cater to HIV inmates, especially those who are known to be homeless upon release,” he told the 2011 Caribbean HIV Conference that s here on Monday Day also suggested non-custodial sentences as a means of dealing with the spread of the virus Meanwhile, statistics from a new report by the UN AIDS agency UNAIDS released Monday concluded that 2011 saw unprecedented progress in the AIDS response, with 46 percent, or 66 million, of the estimated 142 million people eligible for treatment in low and middle-income countries accessing lifesaving antiretroviral therapy in 2010 The report shared that overall, fewer people are dying from AIDS and people with HIV are living longer In addition, new HIV infections have fallen to their lowest levels since the height of the epidemic In its 2009 global report, UNAIDS noted that 260,000 people in the Caribbean were living with HIV and that the rate of increase has varied little since the late 1990s It noted that one in five men who have sex with men in Trinidad and Tobago was living with HIV, while in Jamaica, an estimated 32 percent of MSM were living with the virus “I think the prevention programmes in many countries are not reaching the right people,” Michel de Groulards, regional programme adviser of the UNAIDS Caribbean Regional Support Team, told IPS One factor, De Groulards believed, may be that after 25 years of providing treatment, some countries have reached a plateau In other cases, people considered at risk, including MSMs, are not targeted Adult HIV prevalence in the Caribbean is about one percent higher than in any other region outside sub-Saharan Africa, according to UNAIDS figures, although new HIV infections there have declined slightly from 20,000 in 2001 to 17,000 in 2009 Still, the HIV burden varies considerably among and within Caribbean countries Cuba, for example, has a very low HIV prevalence of 01 percent while the Bahamas has an adult HIV prevalence of 31 percent, the highest in the region Overall, AIDS-related deaths in the Caribbean fell from an estimated 19,000 in 2001 to 12,000 in 2009 What has also changed in the region, De Groulards said, is that 48 percent of the people infected were now receiving antiretroviral drugs In some countries it is as high as 80 percent “That shows it is possible to get treatment,” he said He added, however, “it is clear that the decriminalisation of homosexuality will not get the rate down” by itself, noting that the stigma associated with the virus is still very much a factor in the Caribbean Only one Caribbean country, the Bahamas, has decriminalised homosexuality between consenting adults It is also the only regional state to sign the 1994 Paris Declaration, which set global standards for HIV and human rights “Still, significant stigma and sometimes discrimination persists This in turn creates a significant barrier to detection, care and treatment,” Prime Minister Hubert Ingraham told the conference Leading Caribbean HIV/AIDS researcher Peter Figueroa said that he was “most impressed” with the position adopted by the Bahamas and urged other Caribbean countries to follow “The Bahamas has had no adverse consequences and may well have had some positives in relation to their tourism and other relations,” he told IPS “The Bahamas has clearly shown that we can decriminalise men having sex with men” Figueroa, a professor of public health, epidemiology and HIV/AIDS at the University of the West Indies, said he was certain that other countries, despite their strong religious background, would not have objections to legislation dealing with the situation “So I think if we could frame the issue in terms of simple respect for one another and for an individual’s humanity, then we can take the initiative in terms of the human rights approach and decriminalise men who have sex with men,” he said “We are not talking about imposing a lifestyle on anybody else” “I think, quite honestly, our leaders are totally late on this question,” he added The non-government organisation Caribbean HIV&AIDS Alliance CHAA, which studied the vulnerabilities to HIV among gay men in Barbados, said that while MSM are considered a priority in the national HIV response, little is known about their social vulnerabilities and the kind of HIV prevention interventions that can be most effective As a result, authorities should capitalise on gay social networks and existing social activities to create opportunities for men to talk about HIV prevention as well as to “help create further awareness among gay men regarding their rights and how to better challenge or respond to stigma and discrimination” But even as Caribbean politicians, scientists, researchers, academics and other stakeholders continue to examine ways of dealing with the virus, 30 years after the first case was recorded in the region, there is growing recognition that cuts in overseas funding could seriously hamper future success However, Karl Theodore, head of the Centre for Health Economics at UWI, believes regional countries should step up and provide one percent of their gross domestic product to address non-communicable diseases in the Caribbean, which he said would need an estimated 180 million dollars annually to support such programmes Theodore told IPS that at least one country in the region, which he refused to name, spent 50 million dollars on health, which amounted to 05 percent of its 135 billion dollar income He called the amount “so close to zero, it is embarrassing”