The understandings of the epidemic have also changed from the initial period where AIDS was related (narrowly) causally to infection by the HIV virus and could be dealt with as one deals with, for instance, an infection by an influenza virus: that is, with minimal reference to its social economic and cultural context and with measures which take into consideration the relatively short timeframe of a ‘flu epidemic. As the HIV/AIDS epidemic unfolds we are beginning to appreciate the unprecedented nature of this epidemic and why to date we are still at a loss to curtail its spread. Physically, it is transmitted, mainly, through sexual intercourse, a fundamental life function, and in the body, it destroys the immune system: another fundamental life function. Compounding this, and very specific to AIDS, is the time factor. Just as it is predictable that HIV infection in an individual will lead to AIDS after a more or less long time period, so too, are we understanding that direct individual infections lead to discrete epidemic clustering to generalized and eventually to indirect social and economic impacts far removed in time from the silent period of a few individual infections. Unfortunately, just as individuals are unaware, or are unwilling to learn, of the gradual breakdown of their defense systems, with the consequences of ultimate illness and likely death, so too countries are unaware or unwilling to take cognizance of the gradual subtle erosion of household, community then national investments and savings until micro and macro level impacts force themselves on national and political attention.

Recognition that, worldwide, the Caribbean is second in severity of the epidemic, from a per capita point of view, should logically encourage us to examine carefully the epidemic in those countries/regions which have or are experiencing a more advanced state of the epidemic. This would instruct us on lessons learned, above all, stimulate us to examine analytically and urgently our own contexts in order to appreciate the threats, opportunities and the options for action to prevent, predict, respond to the next epidemic wave, that is, the social, cultural impact compounding the individual tragedies we now live with daily.

This workshop is an innovative and effective way of taking us through this larger understanding of the epidemic to subjective and objective analyses and, ultimately, to planning strategically to preempt the predicted and gathering storm.

The workshop provides a guide to adapt the present response to the evolving realities of the epidemic and its requirements for the involvement of more sectors and partners than hitherto. In a series of logically-linked sessions and using a very user-friendly manual, facilitators took participants through a lively interactive four-day program. Having experienced the workshop both as a facilitator and as a participant, I recognize the potential of this participatory approach to divest the bare AIDS statistics of their anonymity and give the epidemic its human face of suffering, injustice and also its opportunities for personal commitment and effective action. However, there are major difficult issues that Caribbean policy makers must face squarely. First and foremost is sustained political will at the highest level. This means personal and political commitment to advocate, to make policies and allocate sufficient and necessary resources to effectively respond to the epidemic. Another difficulty is discrimination and stigmatization of persons living with HIV/AIDS and those affected. In the region, both these issues have effectively driven the epidemic "underground" and it is now surfacing but with widening impact. This is ubiquitous. Unprotected sex, multiple sexual partners, the fluidity of sexual relations and dominant dysfunctional gender discourses are driving forces behind the epidemic. Yet taboos and misunderstandings surrounding sexuality would interdict appropriate responses. We must admit, where religion and culture can’t. Now, more than ever the need persists for responses to the epidemic which are both realistic and effective. For example with regard to the sexual transmission of HIV, the well-known slogan says it all: "Culture and religion can’t, condoms can"

I must admit that I felt quite honoured being chosen as a resource person for the first UNDP, HIV and development workshop in the Caribbean. I had arrived in Barbados and by the end of the first session familiar thoughts began to run through my mind, my patience running thin. I donned the demeanor of a disbelieving Thomas and voiced my sentiments. I had participated in numerous workshops on HIV/AIDS during my thirteen year stint in "The AIDS business" and I was weary. I voiced my opinion across the room. "What makes you all think that this was going to make a difference?" At that point I had not yet read the manual but felt motivated enough to be the devil’s advocate. I think the floor went silent for a minute. Not because the facilitator was unsure about the content of the workshop, but because he was strategically anticipating the response from the other participants.

I say strategically for as the days went on I came to the realization that the entire process was so intricately woven that there was going to be no room for the slightest doubt with regards to the merit of the workshop.

That night I began reading through the manual and managed to lose myself in it’s approach. Further to which the workshop got on the way and from one process to another I began to realize a new light with regards to my knowledge and understanding of this phenomenon we call HIV/AIDS. I was reborn into a new world of information and response that fueled me much to the point of propulsion and I envisaged how powerful it would be if these words, thoughts, actions, feelings, revelations could be spread throughout our region what a wealth of knowledge and power we would have gained and how easy it would become to us a Caribbean people to put an end to the madness and mayhem that pervades around HIV/AIDS collectively marching forward in battle against this life-threatening disease.