Today, World AIDS Day, we focus on one of the most pressing issues of concern in the Caribbean and the wider world: the increasing number of persons infected with the deadly virus HIV/AIDS. This year's theme of "Listen, Learn, and Live" calls on all of us to listen to children and young people, learn from one another about respect, participation, support and ways to prevent HIV infection and live in a world where the rights of young people are protected and where those living with HIV/AIDS are cared for and are not discriminated against.

At the end of 1998, nineteen of the twenty-one Member States served by the Caribbean Epidemiology Centre had reported an accumulated number of 12,686 cases of AIDS or 172 cases per 100,000 population. This means that in 1998 these states had the highest incidence of reported AIDS cases in the Americas and the fastest growing prevalence rate after sub-Saharan Africa.

Eighty-three per cent of those cases were in the age group 15-54 years, with 50 per cent being in the group 25-34 years. Since it may take as long as ten years to convert from HIV infection to AIDS this means that our young people are especially at risk.

Heterosexual transmission is the main mode of spread of this disease (63 per cent), indicating that women are increasingly involved in the epidemic. This has led to a rapidly growing problem of mother-to-child transmission (6-8 per cent). This worrying statistic is higher than North America or Europe.

Of major concern as well is the lack of information available on HIV infection. Few countries have any specific surveillance programmes in place and few individuals are willing to report if they are not ill.

Socio-economic Impact of the Epidemic

Sixty-three percent of the total accumulated cases have already died. In fact in the age group 25-44 years AIDS has become the leading cause of death in both males and females. Projections into the future at very modest growth rates indicate that by 2020 there will be a 8 per cent reduction in the total population.

Since a large number of deaths will occur among the working age population this will result, at the level of the family, in increasing poverty through loss of income and a growing number of orphans and other dependents on the State.

At the level of the Region, the epidemic was estimated to cost US$20 million in 1995 and is anticipated to rise to US$80 million by year 2020 which will represent 6 per cent of the GDP.

Since AIDS is a progressive debilitating condition it causes significant absence from work through sickness and then loss from the labour force through death. This combination impacts negatively on productive capacity and ultimately on the human resource development efforts.

A survey of people living with HIV/AIDS showed that most of them were unemployed. It was not clear how many had lost their jobs but they all expressed feelings of fear and abandonment related to workplace attitudes and some had voluntarily left their jobs.

It is evident, therefore, that the workplace is a critical focus for any meaningful programme to deal with the epidemic. Unfortunately much of the initial response has been limited to denial and severe discrimination. However, more recently, a survey conducted in seven Caribbean countries found some positive change in that situation.

The obvious policy imperatives that arise include the need to create a supportive environment at the workplace for those workers-at-risk as well as for those already infected with the HIV, and those already living with AIDS. Specifically, education programmes for all workers on the transmission, prevention and symptoms of HIV/AIDS, promotion of safe sex practices, inclusion of the rights of those workers with HIV/AIDS in the collective bargaining activities, and support for those workers to remain at the workplace for as long as they can, will go a far way to mitigate the unwanted effects of this epidemic. Survey information indicates that we have a far way to go as 76 per cent of the labour sector indicated that they have taken no specific steps to create the necessary supportive environment.

A Regional Strategic Plan

As we move into the 21^st Century , one of the major threats to our human development efforts is the HIV/AIDS epidemic. Following a review of the situation in the Caribbean in June 1998, a Task Force, under the chairmanship of the CARICOM Secretariat, has been established to chart a renewed effort through an expanded response to combat the rapidly growing epidemic. A Regional Strategic Plan is being developed by the Task Force to guide the review of national plans. The Labour sector has a critical role to play in this effort and is encouraged to develop holistic workplace health programmes with a specific thrust on the prevention and control of HIV/AIDS. It is also critical for the sector to participate in the main bodies dealing with the problem at the national and regional levels.

Let us shake off the slumber of denial and become advocates of safe sex practices. Let us end discrimination against those who are most at risk and adopt a more caring attitude to those members of our communities who are affected. Let us participate in the development of multi-sectoral plans and policies aimed at reducing the spread of this terrible disease. Let us LISTEN, LEARN and LIVE.