In 2004 approximately 53,000 people acquired the HIV virus, bringing the total number of infected persons in the region to more than 440, 000. The estimated adult prevalence rate is said to be 2.3%, with prevalence exceeding 2% in the Bahamas, Belize, Guyana, Haiti and Trinidad. The HIV epidemic is mainly driven through heterosexual transmission accounting for almost two thirds of infection. Transmission through blood transfusion and intravenous drug use is still rare, and with the exception of Bermuda where drugs accounts for 43% of cases. Homosexual or bisexual transmission is 11% of reported cases but is probably higher since many of the males classified in the unknown category (17% of all reported cases) may be bisexual. The Hispaniola Island (Haiti and Dominican Republic) makes up 80% of the total number of cases. Haiti alone, at the end of 2003, had over 280, 000 persons living with the disease. However, this is by no mean explains the severity of the epidemic prevalence-wise. Using the prevalence criteria will demonstrate that some small islands territories are among the most affected territories. In 2003, there were between 26,000 and 140,000 new HIV infections and from 23,000 to 59,000 AIDS-related deaths in the region. Among young people 15-24 years of age, 2.9% of women and 1.2% of men were living with HIV by the end of 2003.

There have been many studies examining the impact of the disease on the development of these small islands. Of major concern, however, is the impact on poverty, particularly within households. In the Caribbean, this disease is now the leading cause of death in adults in the age group 15-44, the most economically active group of the population. At the end of 2000, the highest prevalence rate was at 35.3% for persons age 25-34. Being the most economically active often translates into being the 'breadwinners' for individual households and sometimes the extended family. In the event that the breadwinner is not infected, the additional expense of caring for the infected person will still be of economic concern. Loss of earnings and increased expenditure due to both illness and death will have adverse effects on any household, regardless of initial financial status. Many studies however, reveal that not only is the incidence of poverty higher for households affected by HIV/AIDS, but that the situation is less likely to improve even after a person's death.

It also important to note that with over 20 million visitors each year, the main economic activity in the majority of Caribbean nations is tourism related, accounting for up to more than half of the GDP in some countries. (Bahamas 59%, Barbados 51%, Antigua and Barbuda 55% and Saint Lucia 69%).  Furthermore, countries and territories dependent on tourism rank amongst most highly affected by HIV/AIDS. In islands such as the Dominican Republic and Jamaica, it is often observed that the highest incidences of HIV/AIDS are concentrated in the areas most popular for tourists or in the resort areas of the island. In 2003 the highest prevalence rates in Jamaica were in Montego Bay in the parish of St. James and the parish of Kingston and St. Andrew, where the prevalence rates were 2.47% and 2.09% respectively. Other parishes ranged between 0.85% and 1.67%. The emergence and continuing growth of sex tourism has also increased the rate of transmission in the already vulnerable and high-risk group of Commercial Sex Workers (CSWs).