A Critical Appraisal of Education in the Caribbean and Its Evolution From Colonial Origins to Twenty-First Century Responses

The countries in the Caribbean Community (CARICOM) share a history of colonialism that has left an indelible mark on all their institutions and systems of socialization, including education. A dominating theme across these countries is the question of equitable access to quality education at all levels, an issue that increasingly finds resonance in the 21st century’s technological era. The region has generally made important strides in the areas of universal access to basic education and increasingly to secondary education. Tertiary education has also been prioritized under the new “knowledge economy,” with many countries exceeding the 15% of qualified cohort (those who are academically qualified to be enrolled) that was set as a regional target in 1997 by Caribbean governments. Yet, even with these strides, the education project is still incomplete, with new and continued challenges of affordability and quality. These concerns are now incorporated into the Caribbean’s deliberate attempts at regionalism through the Caribbean Single Market and Economy (CSME), which serves as CARICOM’s organizing mechanism to face the new opportunities and challenges of the 21st century’s knowledge economy. These regional and development plans are expressed in CARICOM’s Human Resource Development 2030 Strategy (HRD Strategy), a multiyear development plan that is predicated on educational advancement across the region. The Caribbean’s educational achievements, equity challenges, and development plans are best understood in a historical context that captures the social, political-economic, and cultural idiosyncrasies of the region.

Utility of a Short Neuropsychological Protocol for Detecting HIV-Associated Neurocognitive Disorders in Patients with Asymptomatic HIV-1 Infection

Human Immunodeficiency Virus type 1 (HIV-1) infection is a chronic disease that affects ~40 million people worldwide. HIV-associated neurocognitive disorders (HAND) are common in individuals with HIV-1 Infection, and represent a recent public health problem. Here we evaluate the performance of a recently proposed short protocol for detecting HAND by studying 60 individuals with HIV-1-Infection and 60 seronegative controls from a Caribbean community in Barranquilla, Colombia. The short evaluation protocol used significant neuropsychological tests from a previous study of asymptomatic HIV-1 infected patients and a group of seronegative controls. Brief screening instruments, i.e., the Mini-mental State Examination (MMSE) and the International HIV Dementia Scale (IHDS), were also applied. Using machine-learning techniques, we derived predictive models of HAND status, and evaluated their performance with the ROC curves. The proposed short protocol performs exceptionally well yielding sensitivity, specificity, and overall prediction values >90%, and better predictive capacity than that of the MMSE and IHDS. Community-specific cut-off values for HAND diagnosis, based on the MMSE and IHDS, make this protocol suitable for HAND screening in individuals from this Caribbean community. This study shows the effectivity of a recently proposed short protocol to detect HAND in individuals with asymptomatic HIV-1-Infection. The application of community-specific cut-off values for HAND diagnosis in the clinical setting may improve HAND screening accuracy and facilitate patients’ treatment and follow-up. Further studies are needed to assess the performance of this protocol in other Latin American populations.