By Dr Ernest Massiah
Recently, the discussion on HIV has been a mix of the selective review of scientific evidence, comments on an administrative procedure at the regional university, and perceptions on the existence of agendas that seek either to change or hold back Caribbean societies. Lost in this debate is a Caribbean reality.
Dr Ernest Massiah is UNAIDS Caribbean Regional Support Team Director
At the end of 2012, UNAIDS estimated that there were 260,000 people living with HIV in the region. In many countries, approximately one in three new cases is among men who have sex with men. How do we deal with this as we work to end the epidemic in the Caribbean?
First we must recognise that HIV is a virus, not a crime. Laws that criminalise being HIV positive, sexual behaviours such as anal sex or sexual orientation, make it difficult to mount an effective HIV response. Persons who know their sexual behaviour or orientations are illegal are less likely either to go to health services or to speak openly about their sexual behaviour while there, thus limiting their treatment options and prevention efforts.
A soon to be released UNAIDS internet survey of more than 3,500 men who have sex with men across the Caribbean, the CARIMIS study, shows that about two in three men who got a negative HIV test result from the private or public health sector, did not talk to their doctors about their sex with men. Our laws should help create an environment in which there is no impediment to delivering targeted prevention and treatment services to a population particularly affected by HIV.
There is consensus around this among leaders of the region’s HIV response. Over the last ten years, under the umbrella of the Pan Caribbean Partnership against AIDS (PANCAP), civil society, national AIDS responses and international partners have supported the goal of removing laws that criminalise sexual orientations and behaviours. The 2008 – 2012 Caribbean Regional Strategic Framework reinforced this target. This is a regional goal and a global one. It is one of the key steps that must be taken to end AIDS.
Second, we must remember that stigma and discrimination still exist. It is not only the law that complicates people’s lives; it is the prejudice that the law codifies and reinforces. The UNAIDS CARIMIS study shows that within the month before responding to the survey, almost a quarter of the men were verbally abused because of their same sex attraction.
Recent surveys of doctors and nurses in two Caribbean countries show that approximately 25 percent reported seeing HIV positive persons receiving low quality medical treatment and about ten percent would rather not provide services to men who have sex with men. These workers had been trained. They had the clinical knowledge. What they did not have was the ability to overcome their prejudices. Until we overcome prejudice, people will not seek services and we will see a steady rise in new cases.
Sexual behaviour and sexual orientation exist in a social context in which prejudice, stigma and the fear of violence influence the behaviour of both those who seek health services and the medical professionals who offer those services. That’s why removing criminal laws against consensual same sex sexual conduct cannot be a stand-alone strategy.
UNAIDS urges all governments to implement laws to protect men who have sex with men, lesbians, bisexuals and transgender people from violence and discrimination; to address homophobia and transphobia through public education campaigns; and to ensure that adequate health services are provided to address their needs. UNAIDS stands for all those living with or vulnerable to HIV, regardless of their social or legal status.
Finally, we must ensure the rights of all Caribbean citizens. Caribbean history is one of a struggle to ensure the inclusion of all citizens, against a backdrop of exclusions based on race, class, ethnicity and colour. The individuals who stood for the rights that we now enjoy were called names, jailed, beaten and killed.
Today, those who stand up for the rights of gay, lesbian bisexual and transgendered citizens are labelled as supporting a “gay agenda”. There is no gay agenda. There is a human rights agenda, which seeks to ensure that all Caribbean citizens are treated with respect and dignity. Every individual should benefit from HIV prevention, treatment, care and support and all people should have the same human rights everywhere.
All rights are coupled with responsibility. Freedom of expression carries the burden of responsibility for the consequences of one’s speech. In Belize, Mr Caleb Orozco, the young man who asked the court to determine whether the sodomy law violated his constitutional rights, faced verbal abuse, physical violence and death threats. The recent media coverage has led to increased threats against him.
The voices speaking for the removal of punitive and discriminatory laws are women, adolescents, gay men, public health professionals, human rights supporters, researchers, leaders in the regional HIV response, priests, pundits, and imams. These are people from different walks of life, with differing backgrounds and beliefs, united against prejudice.
This is what standing up for justice and freedom should be about. This is what will be required if we are to end AIDS and leave no Caribbean citizen behind.