What does it mean when we report that a recent Jamaican government study found that nearly one-third of gay men in Jamaica are HIV positive?

Jamaica, to me, is a land of deep contradictions.

On one hand, it's a lovely, lush tropical country, blessed with sandy beaches, fantastic flowering shrubs, ripe mango and coconut trees, and inhabited by a strong, proud people who clearly share a basic sense of personal dignity and a deep-seated hospitality towards strangers. I found this to be true regardless of whom I was speaking with, be they rich or poor, educated or illiterate, straight or gay.

It takes just 15 minutes to set up an underground church.

Two boxes and a white sheet make up the pulpit. The altar is a card table. Folding chairs constitute the pews. Then Rev. Robert Griffin, a solidly built gay American minister in his mid-40s, unpacks a battered cardboard box; inside is a wooden chalice, two candle holders, a communion plate and a dog-eared copy of the King James Bible. Add a pianist warming up on an electric keyboard and suddenly an empty meeting room is transformed into the Kingston branch of the Sunshine Cathedral, Jamaica's only gay church.

We may be accustomed to thinking of AIDS as most rampant in distant parts of the world like Africa, India, and South Asia. But these days the epidemic is flaring up a bit closer to home, in the Caribbean. Indeed, AIDS is now the leading cause of death among adults there, and the Caribbean's rate of new infections is the second highest in the world, following just behind Sub-Saharan Africa.

Stigma and discrimination prevent people around the world from accessing the HIV prevention, care and treatment services they need. This is particularly true in areas of the Caribbean, such as Jamaica, where anti-sodomy laws and concerns about violence put vulnerable populations at extreme risk.