Critical Population Spotlight: HIV and the Garífuna of Honduras—Comment on Gandhi et al. “Migration, Multiple Sexual Partnerships, and Sexual Concurrency in the Garífuna Population of Honduras”

In most regions of the world HIV epidemics have stabilized or even declined in recent years. These broad stroke general population statistics hold true in Latin America where national HIV prevalence is less than 1 % [1]. However, as is often the case with national HIV surveillance, stable infection rates in Latin America mask alarming increases in HIV incidence within localized sub-epidemics. For example, in Honduras national HIV surveillance shows declining incidence, prevalence, and HIV-related deaths rates for the past decade. Honduras hosts approximately 17 % of the population of Central America, and yet Honduras has 44 % of Central America’s reported AIDS cases [2]. There are an estimated 24,000 people living with HIV in Honduras and more than one in three are women [1]. However, these general population statistics obscure significant increases in Honduran subpopulations. Of particular importance in the Honduran HIV epidemic are the Garifuna, a disenfranchised and marginalized ethnic minority group. The Garifuna HIV epidemic occurs primarily within heterosexuals with increasing cases among men who have sex with men. HIV infection rates within this subpopulation are inverted relative to those of the general population [3]. Furthermore, within the Garifuna subpopulation, women are at particularly high-risk for HIV infection relative to their nonminority Honduran counterparts. The highest national HIV prevalence rates are observed among female sex workers (10 %), men who have sex with men (MSM, 8 %), and the Garifuna (8 %). HIV incidence is highest in MSM and the Garifuna, both of which are higher than female sex workers [4]. Garifuna youth, ages 16-20, are more than three times at risk for HIV compared to their non-Garifuna majority population counterparts. Co-occurring sexually transmitted infections (STI) are likely driving HIV transmission, with HSV prevalence as high as 50 % [5]. The racial and ethnic heritage of the Garifuna is key to understanding the current HIV crisis in this subpopulation. Much of the population in Latin America has mixed racial heritages due largely to the lack of European women available to the Conquistadores when they settled the ‘New World’. Streams of migration further resulted in ethnic, racial, as well as cultural mixing. The heritage of the Garifuna is traced to shipwrecked Nigerian slaves who made it ashore and settled with the indigenous population [2, 6]. Ancestors of contemporary Garifuna appeared in Honduras around the 1830 s during a widespread Cholera outbreak, killing masses of the Black-Caribbean population. The Garifuna stem form the surviving population that settled along the coasts of Honduras, Nicaragua and Guatemala. Thus, the Garifuna have been marginalized throughout their history. Racial discrimination against the Garifuna has contributed to transnational migration, particularly among men in search of labor opportunities. Transnational migration of men is also important in the context of gender roles, where women carry traditional roles with limited decision power even when men are absent. Long-standing histories of social discrimination, poverty, isolation, unequal educational opportunity, and poor access to health care contribute to the Garifuna HIV epidemic. The Garifuna population experiences lower wages (for both genders) & Hannah F. Kalichman hannahkalichman93@gmail.com