With the second-highest H.I.V. infection rate in the world, after sub-Saharan Africa, many Caribbean nations have been working hard to improve their public health and AIDS education efforts. Jamaica, however, needs to work harder.

A disturbing new report from Human Rights Watch suggests that Jamaica cannot win the battle against AIDS until it confronts the virulent forms of anti-gay bigotry that run through the country's popular culture, its police force and much of its medical system. The report, grimly titled "Hated to Death," alleges that a pervasive anti-gay bias is driving the epidemic by forcing people at risk to avoid hospitals, and by making it difficult for them to acquire condoms and other things that would help them remain free of the infection.

Not surprisingly, "Hated to Death" has drawn fiery condemnations from some in the Jamaican government. But it will take more than angry denials to sweep away the distressing testimony in this report, which recounts the experiences of gay Jamaicans forced to flee their homes under threats of violence and death. One of the bedrock problems is the government's timidity in the face of a primitive set of laws that criminalize gay sex among consenting adults. The police appear to extend their harassment to outreach workers, who are sometimes persecuted for passing out condoms.

The medical system is improving, but still problematic. It sometimes abuses gay patients and sometimes turns them away. The report coincides with disturbing data suggesting that the AIDS epidemic may be deepening in Jamaica and that unprotected sex is far more common than it should be.

The Jamaican government has already embarked on an effort to provide AIDS sufferers with broader access to important medicines. But these efforts cannot become fully effective until the government can summon the courage to attack the virulent anti-gay prejudices that are driving this epidemic by making people at risk fearful of seeking treatment.