Background The Turks and Caicos Islands (TCI) is a UK overseas territory in the Caribbean, with an estimated population of 35,000. In 2003/2004, the National AIDS Programme became fully operational, offering voluntary counselling and treatment, in addition to other efforts to prevent the spread of HIV/AIDS. In 2010, the European Union commissioned this study to assess current knowledge, attitudes and risk practises for HIV in the Turks and Caicos Islands, after the Programme’s decade of operation.

Methods A KABP questionnaire was administered to a random sample of 837 persons representative of the territory’s 15–49 year old population and the data generated was manipulated and analysed using SPSS.

Results 92.1% of respondents were sexually active and overwhelmingly heterosexual (97.7%). Of these, more than half (54.1%) did not use condoms, with percentage non-use increasing with age. Factors significantly associated with condom non-use were number of partners, living arrangements, age and sex while under the influence of alcohol or drugs.

62.8% of those not using condoms, gave “trust my partner” as their reason, yet 65% of trusting partners tested within the past year. Further, 58% of all respondents were unsure of their partner’s reaction to using a condom, feared that their partner would be upset and/or were embarrassed at the use of a condom.

Conclusion These data speak to a dire need for condom negotiating skills among older persons, reputedly in committed relationships, especially given that one in nine had multiple partners. The challenge is to employ a strategy that is appropriate to and acceptable by such a population. One possibility is to promote condom use as a sign of respect and care for one’s partner.