Over the past three weeks I've visited three different Caribbean territories, and have been taking the opportunity while there, to meet with local HIV/AIDS officials to begin to gauge what HIV/AIDS looks like in the respective islands. I spent the past two weeks in the British Virgin Islands (BVI)—a UK overseas territory which consists of some 60 islands, rocks and cays and is home to a population of approximately 27, 000.

As I made my way around Tortola (the main island), two things became apparent to me: firstly, the island's economic success and secondly, that a large segment of the BVI population seemed to consist of non-nationals. Indeed the BVI is a symbol of economic growth, with the economy having grown by 11 percent in 2006, and an estimated Gross Domestic Product (GDP) of U.S. $992 million. One of the characteristics of this economy—which is fuelled mainly by tourism and financial service—is the presence of a significant number of non-nationals, who collectively form a significant percentage of the territory's workforce, with an estimated 49.9 percent of the population having been born outside of the territory.

Since the first AIDS case was reported to the Ministry of Health in 1985, there have been 84 reported cases, 57 of whom are still living with the illness. According to the Caribbean Epidemiological Centre (CAREC), this represents a prevalence rate of infection of 1.5, and based on the population size could mean that approximately 400 people are infected.

With the BVI's socio-economic status and its cultural nuances, come certain challenges for the management of, and response to HIV/AIDS. On the basis of its financial success, as well as its status as a UK overseas territory, the BVI has not had access to much of the financial aid that has been made available to many of its Caribbean neighbours for research and programming. Given the accelerated rate of growth enjoyed by the BVI, it cannot qualify for funds that are earmarked for "developing" countries. In answer to this challenge, the BVI, along with other European overseas territories such as St. Maarten, have collaboratively successfully submitted a funding proposal to the European Union.

One of the troublesome outcomes of this lack of international funding for the BVI has been the associated limitations on technical and human resources. Despite the Government's financial and moral support, the strength of the BVI's tourism and financial sectors relies on the funnelling of the majority of resources into those more financially lucrative sectors.

One of the main challenges that arises from this lack of human, technical and financial resources has been the inability to focus efforts on research, and the majority of energy is therefore spent on prevention measures. This focus has led to significant public awareness programmes, which have drawn on the assistance of local bodies such as churches and community organisations. It has not, however, been able to produce a comprehensive profile of HIV/AIDS in the BVI.

Another challenging characteristic of the local HIV profile has been the tendency for residents to travel outside of the BVI for testing and care. Research shows that as of 2003, some 32 patients who are BVI residents and/or nationals were registered in the neighbouring U.S. Virgin Island of St. Thomas (PDF). This pattern of behaviour challenges the strength of the national surveillance system, as it does not give an accurate estimation of the HIV situation within the territory. This pattern is heightened by the transient nature of the BVI's labour force and population, which also affects the human resources and therefore the continuity of care for patients, and for programming efforts.

As with any community, issues of care for HIV infected persons are always major concerns in programming efforts. CAREC's report (PDF), in light of a high fatality rate for infected persons (as of 2002), called for an improvement in the quality of care and treatment—including the provision of antiretrovirals (ARVs). The current picture of treatment in the BVI marks a significant improvement, with the 29 AIDS patients receiving ARVs and the 28 HIV infected persons receiving monthly monitoring.

There have been significant improvements in the level of care and treatment for the BVI's infected population, as well as noteworthy attempts at prevention through public education. A clear need however exists for increased research efforts, as well as for the strengthening of ties with neighbouring territories, such as St. Thomas, so as to provide a more accurate picture of the HIV climate in the BVI. It is hoped that with the expected injection of funds into HIV/AIDS programming, this Caribbean territory will be able to expand its human and technical resources to better meet the needs of its diverse population.