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In the global AIDS pandemic, the Caribbean is the second-most affected region in the world. Among adults aged 15–44, AIDS has become the leading cause of death. The adult prevalence rate is between 1.1% and 2.7%. HIV transmission occurs largely through heterosexual intercourse, with two thirds of AIDS cases in this region attributed to this route. Sex between men is also a significant route of transmission, even though it is heavily stigmatised and illegal in many areas. HIV transmission through injecting drug use remains rare, except in Bermuda and Puerto Rico.