But one need not go half way around the globe to witness first-hand the devastating impact of AIDS. On the United States' `Third Border’ in the Caribbean, HIV/AIDS, left unchecked, poses a serious threat in human, economic, and social terms to the region as well as to the United States.

For much of the Caribbean, HIV/AIDS has become the leading cause of death in the 25-44 year age group. This region is the second most affected by AIDS in the world, after sub-Saharan Africa. UNAIDS estimates that in Haiti and Guyana, the two Caribbean countries most severely hurt by the disease, life expectancy is five years less than it would have been without the epidemic.

Because AIDS most often strikes the young and young adults, its social and economic impact can be devastating. In some Caribbean countries, HIV rates are five times higher in girls than boys aged 15 -16. A study conducted by the Health Economics Unit of the University of the West Indies predicts that AIDS could cause regional declines in gross domestic product as high as five per cent by 2005.

This is a crucial time in the fight against HIV/AIDS in the Caribbean basin. Concerted, intensive action can keep the epidemic from exploding. Recognising the role that U.S.-Caribbean tourism, migration, and commerce play in this shared epidemic, the United States government is working closely with the regional and global community in order to stop an HIV/AIDS catastrophe from occurring right on our doorstep.

Around the world, wherever the AIDS epidemic has levelled off or declined, proactive engagement by high-level leadership has helped dissolve the stigma surrounding the disease, reducing discrimination and encouraging preventative behaviour. In the Caribbean, the Prime Ministers of Barbados and St. Kitts and Nevis have championed the need to take decisive action against HIV/AIDS, while The Bahamas has taken the lead in addressing the problem of mother to child transmission of the disease.

Secretary of State Colin Powell has charged U.S. Ambassadors in the Caribbean, who recently came together in Port-au-Prince to coordinate strategies and heighten cooperation, to use their positions to engage proactively and visibly in the fight against HIV/AIDS. Secretary of Health and Human Services (HHS) Tommy Thompson led a U.S. Government team to Guyana for a day-long meeting with Caribbean health ministers last month where he signed the Pan Caribbean Partnership to Fight AIDS.

U.S. funding for HIV/AIDS programmes in the Caribbean for prevention, training, treatment, and research - through the U.S. Agency for International Development (USAID) and HHS - has doubled in the last year. The Department of Health and Human Services' Centers for Disease Control (CDC) Global AIDS Programme is providing staff in Guyana, Trinidad, and Haiti, and HHS programmes in Puerto Rico and the U.S. Virgin Islands help medical professionals share experiences and build upon best practices. CDC and the Caribbean Epidemiology Center are also tracking HIV/AIDS trends throughout the region.

Other U.S. Government programmes include engaging business and labour in the fight against the pandemic, funding workplace education programmes, and awarding grants for 20 participants from 10 Caribbean nations to attend a five-day HIV/AIDS leadership programme in Jamaica in June.

Multilateral support is also forthcoming from the Global Fund to Fight AIDS, Tuberculosis, and Malaria, to which the United States is the largest contributor with $500 million. The Fund's Board last month awarded a $10.2 million grant to an HIV/AIDS programme in Haiti. Other Caribbean countries whose proposals were sent back for revision and encouraged to be resubmitted or who will be applying for the next round of grants this fall are benefitting from U.S. technical assistance in preparing Global Fund proposals.

The HIV/AIDS epidemic in the Caribbean outstrips the region's capabilities to address the problem, creating a need for financial and technical support. However, funding is not the only ingredient needed to fight this epidemic. Equally important is strong leadership. Some Caribbean countries have demonstrated an impressive commitment to tackle this problem. We need to work with those regional leaders, and to encourage others.

Rising to the enormous challenge of defeating HIV/AIDS requires the Caribbean to be united and committed. There simply is no other option.