Caribbean leaders are pushing Congress to expand President Bush's $15 billion AIDS relief plan to include more nations, saying broader help is needed to stop the spread of the epidemic. "Whatever happens in one specific corner of the region will have an impact in other places," said Rafael Mazin, acting chief of the HIV/AIDS unit at the Pan American Health Organization. "To be effective means [HIV]... needs to be prevented and contained in all places."

The current plan targets Haiti and Guyana, plus 12 African nations. A proposal to extend funding to 14 more countries could reach the US Senate as early as next week. "This is a regional crisis in our own hemisphere," said Sen. Christopher J. Dodd, (D- Conn.), who has championed the measure. "It deserves to be given the same serious attention that is being given to the HIV/AIDS epidemic in sub-Saharan Africa. If we're not careful, we are going to lose a generation of young people in the Caribbean."

As many as 500,000 people in this region of 38 million live with HIV. In some cities, more than one in eight people are infected; the disease has left more than 80,000 children orphaned. Haiti, where more than one in 17 people ages 15 to 49 are HIV-infected, and Guyana, a poor nation on the Caribbean coast of South America where the prevalence is 2.7 percent, are widely considered the region's worst-hit countries. But infection rates in nations as disparate as the Bahamas, Belize, Suriname and Trinidad and Tobago are all at least 2 percent and climbing.

"We realize that high prevalence rates can overwhelm our health care capacity, destabilize our economies, and increase migration flow - which could pose a real security risk for the US due to the proximity of the Caribbean," ambassadors from the Pan- Caribbean Partnership Against HIV/AIDS, a coalition of 16 nations, wrote in a recent letter to President Bush. "Without a regional approach to the Caribbean AIDS crisis, we fear that AIDS will lower life expectancy, increase the number of AIDS orphans, further threaten our already fragile economies, increase migration flow out of the region, and increase the threat to the U.S."

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