News from the Caribbean as of

COMMENTARY

HIV positive Caribbean women

Wednesday, August 16, 2006

by Dr Sonjia Kenya

HIV and AIDS are quickly becoming an epidemic in the Caribbean and women are the primary targets.

Dr Sonjia Kenya

In 2005, about 27,000 people contracted AIDS in the Caribbean, making it the leading cause of death among adults between 15 and 44 years old.

More than 330,000 people in the Caribbean are infected with HIV and women are contracting the disease at far greater rates than men. Most new cases of HIV result from heterosexual intercourse, indicating that women are having intimate relations with men who are infected but may not know their disease status.

Since medication for HIV and AIDS have improved, infected individuals can live a long, healthy life.

However, the Caribbean is known to stigmatise HIV positive people, causing many to ignore their disease status or refuse to seek treatment.

To avoid negative responses from their communities and access better medications, many Caribbean people with AIDS relocate to the United States or other countries.

To publicise the plight of Caribbean women living with AIDS as well as describe the quality of life for HIV positive Caribbean females who chose to leave their country, we have initiated an ongoing series of interviews with HIV positive females.

Our first featured woman is 34 years old, married, from Jamaica and diagnosed with HIV in 1993 who lives in the United States.

She said she contracted the virus through heterosexual contact and added that she did receive education about and information about HIV.

Explaining her family's reaction she said the majority of them know.

"At first my mom was disappointed but after the initial shock that was it."

She has three boys, none of whom have the virus and they know about their mom's condition.

"I told them because there can be an emergency situation in which they would need to know. They are a part of my life and it is very important for them to know. They are ages 19, 15, and 12 years old," she said.

Sadly our interviewee said that she did not believe she could live in the Caribbean being HIV positive.

"I went there on my job to deal with discrimination and isolation and it wasn't a pretty sight," she said.

"We did network with the black gay men, they also deal with positive people in the Caribbean and how they deal with their issue, the support there and the health care system. We did a summit in Jamaica where there were different Caribbean countries. We had Guyana, Trinidad, Barbados, the Greater Antilles, Virgin Islands and the Bahamas.

"It was different people coming from different places. It was last year.

"We traded information about how it's affecting the Caribbean populations. So when we went down there I got a chance to go into the field with nurses and give food packages and see first hand how people with HIV are treated." She explained that some mothers are put out of their communities and children are treated differently in the schools.

"It's Jazz (Jamaica AIDS support). I think they collaborate with Black Gay Mans Association but I know they get funding from the states and it's also funded by the Jamaican government" she said.

She also noted that the standard of care in the region fell far short of that in the US.

"Here you have access to medications. In Jamaica if you don't have the money you don't have access to care. In Jamaica, it's a financial issue not a healthcare issue. There is no Medicaid, ADAP or health plus or something like that," she said.

"In Jamaica it's if you have the money, you know what I mean. Most Jamaicans they network; like they get to travel and come up here and network with health care programs and navigate the system, like the programme that I was working with.

"They set it up where government funded programmes such as through GMHC, CAMBA, or places that funds undocumented people. Then the agency sets it up so that when they return home they can get the medication through the pharmacy back home. They don't have to live here all they have to be is positive and even visiting. Not many Jamaicans know about this.

The interviewee said that she lives as normal a family life as possible.

"I go to church and I don't think about it on a daily basis. I'm aware of it, it's there. I've been positive since 1993 so I mean 11 years past and I'm not on medications. So, it's not like I'm taking medication daily where I have to remember so it doesn't affect me in that negative sense. For instance, when I am intimate with my husband, then we take precautions so therefore you know that you are and you have do what you need to do," she explained.

Speaking about the prevalence and contraction of the disease she blamed the Caribbean culture.

"A lot of Jamaican men or Caribbean men don't believe in condoms.

Also, a lot of them truly don't believe in one partner either, they have wifey and sweetheart and so forth so they do their thing and a lot of times they think it's not going to happen to me. I think that's one of the biggest thing, the macho-ness of a man, he's not thinking about I am the one discharging inside of a woman and that a woman is more prone to getting disease. They are not thinking about that," she said.

"Caribbean women in relationship don't normally hmmm, how can I say this, they don't argue their health issue.  They are not going to say you man this is my body and you can't mistreat it.

"For the women, it's a financial thing, it's a one man thing, and they look at the idea of relationship.

Then there are the women here, liberated in America, doing her own thing and it's her own choice, she is not dependent on a man. Two different point's of view. It's not easy to get a job to support yourself in Jamaica.

"Here you can get a Macdonald's job or any kind of job to support yourself.  Not that you don't have educated women back home who can hold their own and is educated but at the same time the system is different. You more depend on a male back home because of the system and how far one income will stretch.

She noted that her own HIV diagnosis did not prevent her from reaching goals but said she was motivated even more to achieve what she wants.

"I take a step back and look at what I really want. It brings my life back into focus where as before it was like I have tomorrow, next week, next year. Time is the essence. I got to focus now and I got to get what I need done now because I don't know what tomorrow may bring," she said.

"Right now, I am not working but I want to go back into the field of social work, in the same line of work with HIV positive people in the system.

Speaking of the fear that is associated with the virus in the community at large she said she didn't like the word fear.

"I don't call them fears but more concerns. Fear is a powerful word, which is very crippling. I don't like the word fear. My concern is I wanted another child. After 11 years I am now working on that with my partner and it's like more of collaboration. It's not one sided where I wanted it one time and he didn't," she said.

"You still have to think about the reality of things. The what ifs. What if the child was to born positive?
Hmm...how we would deal with that?  What would be our preparation for that child?  How would the other children deal with it? Just regular people issues you know when it comes to children and the concerns of their future. Even with my children right now, what would happen to them? You know; every mothers fears."

She said too there were many challenges dealing with Caribbean women who are HIV-positive and living in medically underserved communities.

"They can overlook small issues. If the doctor can't give the care needed then that person is not going to go back," she said.

"Confidentiality is a major issue with women from the Caribbean. If you walk into the doctor's office and the doctor is someone I know, then I am not going to disclose nothing to you because now I have to think about who you know that I know.

"Also, if a family member knows you, you might disclose something unintentionally that family member I am not yet ready to disclose. e.g. Guess who I saw in my office today. In America, if you go to an American doctor and you disclose to your status to them, they are not looking down on you but, if you go to a Caribbean doctor it's like how you get this? or they pass judgment."

Offering advice to healthcare providers to improve health-seeking behaviors she spoke about a comfortable environment.

"One that is trustworthy, where you don't feel stigmatised. You don't want to be looked upon differently whether you are paying the same amount of money or not as the next person. You want to feel like a person or a human being," she said.

This interview was conducted by Lisa Matthews as part of a collaborative research study with Dr. Sonjia Kenya. Mrs. Matthews is a doctoral student at Columbia University in New York which is Dr. Kenya's alma mater. sonjiakenya@aol.com

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