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Commentary: Risky behaviours driving HIV epidemic in the Caribbean
Published on June 9, 2014 Email To Friend    Print Version

By Dr Lazarus Castang

In recent times, I have paid close attention to a letter and four articles: “The costs of homophobia in CARICOM” by Sean Macleish, “UWI terminates professor’s contract following testimony in gay sex case” by a Caribbean News Now contributor, “Pressure mounts on UWI as Bar Association criticizes firing of Professor” on Jamaica Observer, “HIV in the Caribbean: Science, rights and justice” by Dr Ernest Massiah, “Let’s work together to end Aids” by Dr Edward Greene, and “Stigma and discrimination driving HIV epidemic in the Caribbean,” an anonymous article on behalf of PANCAP.

Dr Lazarus Castang is a licensed psychotherapist and an ordained SDA Minister of Religion. He holds a PhD in Old Testament, a Masters in Psychotherapy, and has completed studies in basic medical science. He has ministered to several communities in St Lucia, Barbados and the US and has provided therapy to individuals, couples and groups. He is a graduate of University of Southern Caribbean in Trinidad and Andrews University in Michigan. He has written two theological books and several articles on social relations. (
Except for the article on Jamaican Bar Association (Jambar), all other articles rotate on the axis of the removal of buggery laws and/or social stigma and discrimination against men having sex with men (MSM) to end AIDS and/or give room to healthcare treatment of MSM, or the economics of homosexuality.

Having myself read the contents of Mr Bain’s expert testimony, it is clear that his contract was terminated because of his expert testimony in a court case which indirectly supported the retention of Belize 1861 law that criminalises MSM.

Bain’s individual professional opinion that physical health and financial costs to individuals, families and governments are reasonable considerations in any public approval to the risky behaviours of MSM was represented as a conflict of interest (between group of churches and Caribbean HIV/AIDS Regional Training (CHART) network), and as not only support of continued criminalization, but also of stigmatisation of MSM.

Consequently, it is said that Professor Bain lost “the confidence and support of a significant sector of the community which the CHART programme is expected to reach... thereby undermining the ability of this programme to effectively deliver on its mandate.”

Except for the Jambar article, what is conspicuously absent from Dr Massiah’s article and the rest is the risky sexual behaviours of MSM. Though there are other ways HIV can be contracted, the reason for the HIV epidemic among Caribbean MSM is not discrimination, not buggery laws, not social stigma or prejudice, but the Caribbean men having risky unsafe sex with men period.

For educated, well-positioned men to write in such unbalanced, irresponsible ways demonstrate a certain moral mindset in which: (1) intellectual honesty is not the best policy, (2) their discrimination is moral because it discriminates against another’s moral discrimination which for them is immoral, (3) they desire to crush diversity of moral opinions for uniformity on their shared opinion, (4) they assume that money will secure zero discrimination and stigma for MSM, and with zero stigma, discrimination, prejudice and buggery laws, AIDS will end among MSM, and (5) they hide behind the goals of funding agencies to conceal their intolerance of tolerance, to stigmatise and marginalise in the AIDS programme one they perceive/classify as stigmatising and marginalising MSM.

The deep-seated need to move MSM from “endangered species” (victims) to “social untouchables” (zero opponents/opposition) by rightfully highlighting public violence, verbal abuse, visual intimidation, discrimination and prejudice against them, but tragically soft-pedaling their risky sexual behaviours for fear of gay-bashing accusation, or of appearing to add moral salt to their social/public wounds, is unjustifiably unsound. In addition to public victimization of MSM because of sexual preference, MSM are self-victimizers with the contraction of HIV period.

Dr Massiah alleges that the removal of laws that criminalises sexual orientations and sexual behaviors is “one of the key steps that must be taken to end AIDS.” This I perceive as puerile, myopic reasoning from the perspectives of prevention and treatment. In terms of prevention of HIV, even Dr Massiah should know that it is risky homosexual behaviours that cause them to contract and spread the disease. After the contraction of HIV, the disease may be controlled, and only ended for the individual in death, if it is not perpetuated in others by promiscuity and unsafe sex practices.

From a treatment perspective, since AIDS is presently an incurable, communicable disease, the removal of buggery laws and social prejudice will not end AIDS. To suggest that social prejudice and buggery laws prevent the education of MSM on how AIDS can be contracted is to pass the buck and blame shift, and not allow MSM to take responsibility for the protection of the health of their bodies, thereby worsening the epidemic. Even the idea of treatment as prevention, that the antiretroviral drugs reduce the risks of infecting others, does not eliminate the possibility of infection or negate the need to practice safe sex.

Furthermore, it would not be reasonable to suggest that Caribbean healthcare providers withhold information from MSM in terms of how to protect themselves from contracting STDs including HIV. The general protocols of safe sex to avoid HIV apply to heterosexuals as well as to homosexuals. Prejudice among some healthcare providers cannot be the alibi for the prevalence of homosexual risky behaviours.

Nonetheless, I must add that Caribbean healthcare providers are never justified in treating MSM patients with disdain or disgust. However, poor treatment by healthcare providers, stigma, prejudice and discrimination in the Caribbean do not give HIV to MSM, though veritably this poisonous atmosphere can prevent or complicate caring treatment of MSM and hold them back from seeking education before and treatment after HIV contraction or from giving information for the purposes of health assessment and treatment.

Men having consensual (anal/oral) sex with men in private do not want laws or other people to regulate their behaviours. Therefore, the greater onus is on them to avail themselves of accessible tips on self-protective sex and follow through with them. Sex education increases risks awareness but does not guarantee behaviour modification in the moment.

However, programmes that treat humans as humans in a welcoming environment can be of huge benefit in terms of a re-emphasis on the importance of self-protective sex. Heterosexuals and Christians with moral objections to MSM safe-sex programmes would do well to consider that HIV is also among heterosexuals and/Christians, and the increase of HIV in the Caribbean among any sector risks increase in all other sectors.

Now since there are buggery laws in the CARICOM nations, are they not to be obeyed until the time they are changed or modified? Should these laws be publicly flouted if they are seen as unfair, discriminatory and oppressive to a minority?

If these laws are not even enforced at present in some quarters, should they still be seen as primary reinforcements of social prejudice and stigma against MSM instead of MSM unsafe practices or promiscuous behaviours? It seems to me that Caribbean people are reacting against MSM more from social, cultural and religious norms, than from mere criminalisation of homosexual behaviours.

These questions are not to undermine the vital importance of working assiduously to prevent public violence, verbal abuse, visual intimidation, discrimination and prejudice against MSM. MSM are human beings of value and gifts and citizens with rights. They are part of the human family to be respected and cared for especially when in need of health services. But buggery laws, stigma and prejudice should not appear as the red herring for the cause, or prevention, or prevalence of HIV/AIDS among MSM.

Buggery laws intended to prevent homosexual acts which predispose MSM to the contraction of HIV in the first case, are portrayed as a key factor sending MSM underground to contract HIV and not report it or seek treatment. The presenting issue here then is HIV/AIDS as an important public health matter to be addressed. But the core issue is for MSM to achieve the status of public morality like heterosexuality in Caribbean societies. This has been variously called social inclusion, or equality, or human rights, or justice.

The movement appears to be toward a moral and legal nondiscrimination of MSM that removes buggery laws which are alleged to reinforce stigma and discrimination against MSM and then outlaw opposition to MSM as hate crimes to take care of the social, cultural and may be the religious norms. So, ironically MSM is to be decriminalised to clear the way for reverse criminalisation of as many forms of public opposition to MSM as possible, because public opposition, not risky sexual behaviours at all, feeds social stigma and moral discrimination.

I would like to propose three underground factors that drove the Bain controversy and the skewed way some chose to write about MSM.

1.) There is an attempt to use funding for prevention and treatment of HIV/AIDS to reshape public morality on the issue of MSM in the Caribbean. “He who pays the piper calls the tune.” However, not funding, but conflict of interest, incompatibility with PANCAP leadership position and the loss of confidence and support from a large sector which CHART serves, are being used as the smokescreen for the sacking Dr Bain.

The approach of a money-based/-controlled public morality is not strange to the Caribbean because it is the same line of reasoning used to accommodate casinos for gambling and commercial sex workers (so-called victimless crimes) in the Caribbean.

2.) Homosexual victimization necessitates and justifies reverse discrimination. In this context, a redefinition of homophobia as a kind of morbid fear of homosexual reprisal in terms of loss of job, loss of international and/or gay funding, loss of freedom of speech even in a court case on homosexual issues for homosexual agenda promotion, is appropriate.

Dr Massiah cannot be more right when he asserts, “All rights are coupled with responsibility. Freedom of expression carries the burden of responsibility for the consequences of one’s speech” (and I will add “and action”). The problem with Dr Massiah’s argument of chosen imposed consequence is that he applies it only to Dr Bain in context of the goals PANCAP, but not to MSM in the context of Caribbean legal, social, cultural and religious norms. With clear intellectual bias and reverse discrimination, they levy consequences on Dr Bain, but work to unlevy or forestall consequences on MSM.

3.) Homosexuality can thrive best in a culture of silence or of moral acceptance. Instead of trying to respect the diversity of moral opinions in the Caribbean and work with it for the healthcare of MSM, they have chosen to derail this professional difference in frustration by stigmatising and discriminating against one in their opinion who supports stigmatisation and discrimination against MSM.

Plus, to Caribbean chagrin and in blatant contradiction, it is asserted that “PANCAP views this current situation as an opportunity for the region to engage in a dispassionate, thoughtful and holistic discussion that accommodates differing views and promotes understanding and inclusion.” On this note, PANCAP’s attempt at objectivity is only relevant to MSM, but not Bain’s expert testimony.

Furthermore, the success of any programme to reduce the prevalence of HIV in the Caribbean will never achieve its full potential if it is stuck at reverse penalization and injudicious fighting to create a culture of silence on or moral acceptance of the risky or promiscuous behaviours of MSM or even of heterosexuals for that matter.

Finally, if this discussion surrounding the Bain controversy can drive some MSM and heterosexuals to protect their lives and health, it would enrich and protect Caribbean societies, and achieve an effect of infinite value because every human life is precious in God’s sight, whether we agree or disagree with the way it is lived.
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