Ten Essentials for Combating HIV/AIDS in the Caribbean
Ever since the first cases of HIV/AIDS were identified more than thirty years ago, the epidemic continues to ravage countries causing untold death and intense human suffering. More than 60 million people worldwide have contracted the virus, more than 25 million have died and daily more than 7,000 people (including 1,000 children) contract the virus. These are the alarming statistics as international HIV assistance continues to decline.
The majority of persons in low and middle income countries living with HIV/AIDS are not receiving any form of treatment or are receiving inadequate treatment. For every one person starting treatment two are newly infected. The growth of the HIV/AIDS epidemic continues to outpace the response. The trajectory of costs associated with responding to HIV/AIDS is unsustainable. It is essential that we prevent new infections.
In light of the above, CARIFAM suggests ten essentials for a successful HIV/AIDS programme in the Caribbean:-
1. Tailor response to nature of epidemic. This is critical. Successful interventions in concentrated epidemics have not worked in generalised epidemics.
Epidemics are different in nature and require tailored solutions. The HIV/AIDS epidemic has been characterised by the World Health Organisation (WHO) as being either generalised or concentrated. Concentrated if mainly among vulnerable groups, generalised if mainly outside vulnerable groups and within the general population. Most Caribbean islands have a concentrated epidemic. In the Caribbean, the main drivers of the epidemic are (i) multiple sexual partners (ii) purchasing of sex i.e. prostitution (called “sex work”) and homosexual activity “men who have sex with men”. Crack cocaine use is also noted as an emerging driver of the epidemic.
All of the above are high risk behaviours. The evidence clearly shows that whereas widespread distribution of condoms has been successful in reducing HIV transmission in concentrated epidemics amongst high risk groups such as prostitutes, widespread distribution of condoms has not been successful in reducing HIV transmission in generalised epidemics – and in fact, has had the opposite effective of causing transmission rates to increase because the false sense of security which comes with using condoms encourages more promiscuity and irresponsible sexual behaviour. Even within high risks groups where the use of condoms is more effective in reducing transmission, it has not been as effective as partner reduction. Programmes should place more emphasis on promoting and encouraging behaviour change both among high risk groups and within the general population.
2. Aim to eliminate not merely reduce risk of contracting HIV/AIDS. Pursue and prioritise risk/harm avoidance not risk/harm reduction.
A successfully athlete always goes for gold! A successful student goes for an A (even an A+). Our main goal should be to eliminate the risk altogether, and not merely to reduce it. Risk or harm reduction strategies focus on reducing the harm and treat symptoms. They defend people’s rights to engage in inherently destructive behaviours giving the false assurance that there is a safe way to engage in high risk behaviour. Homosexuals are 44 to 86 times more likely to contract HIV/AIDS than men who do not have sex with men according to the US Centers for Disease Control. According to the Caribbean Regional HIV/AIDS Partnership Framework (2010-2014) prevalence within the “MSM” population in Jamaica is as high as 33 percent. In Guyana prevalence among the “sex worker” population is 31 percent and in Suriname 21 percent.
Harm reduction strategies are an excuse for continuing and even justifying high risk behaviour. They ignore the many other risks posed to individuals by these lifestyles. They promote an overreliance on condom use as opposed to abstinence and faithfulness thus ignoring at that there is a false sense security associated with condom use which encourages the taking of further risks. They send the unfortunate message that society has given up on the drug addict, the “sex worker”, the homosexual, the unfaithful spouse/partner’s ability to change his lifestyle.
3. Provide a holistic and person-centred response – which is effective, and goes further than merely treating symptoms.
This kind of approach involves the person in decisions relating to him/her, assesses all of his needs for prevention, care, treatment and support, provides interventions which have maximum effectiveness and respects his dignity as a person. For example, in addition to providing essential anti- retroviral drugs, care and other forms of social support, Governments as well as civil society should provide additional care and support to high risk groups such as:-
Providing the drug addict with resources and support to overcome his drug addiction
Providing the “sex worker” with real opportunities for meaningful employment, as well as tightening and enforcing laws against prostitution,
Providing effective, confidential and professional therapy for men with unwanted same sex attractions
Encouraging/challenging persons who have multiple sex partners to form stable relationships and to be faithful, and providing them professional counselling services where needed.
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All of the above interventions are respectful of human dignity and recognise the capacity of people to make responsible choices. They focus on changing the underlying behaviour which puts the person in a position of harm. These services should be provided to the highest professional standards in a sensitive, welcoming, confidential and person-friendly environment. There are best practise models which should be studied and implemented with appropriate modifications for the Caribbean context.
4. Provide young people with a clear, consistent, unambiguous message, about what causes the spread of HIV/AIDS and how to avoid spreading or contracting the virus.
Establish well structured and Health and Family Life Education (HFLE)Programmes in all schools which deliver a well developed and taught HFLE curriculum which includes the following characteristics:-
Teaches respect for the inherent dignity of all persons.
Teaches girls and boys to develop the essential character attributes of respect for self and for others, self control, and future mindedness; how to make responsible healthy choices including to delay sexual debut, practice abstinence before marriage, and fidelity within marriage.
Is science-based and, at age appropriate levels, highlights the scientific, biological and social disadvantages of engaging in early sexual behaviour for girls and boys ( in particular highlight the particular vulnerability of girls – their susceptibility to STD’s due to the immature cervix as well as risks of pregnancy and infertility)
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Highlights the health risks of engaging in anal sex and of multiple sexual partnerships and other high risk behaviours and encourages youth to avoid these behaviours
Promotes support, and, where needed, facilitates the establishment of school and community based clubs and organisations which encourage healthy lifestyles among youth such as “drug free” and “ sex- free” clubs
Provides specialised counselling and therapy for youth who may require these services in particular for those at risk.
Encourages youth to build strong and healthy relationships as a foundation for building strong, healthy families
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5. Responses must be home-grown, led, and driven by the local community in order to be effective and must respect cultures and traditions.
The most successful HIV/AIDS programmes have been community driven. Uganda’s very successful efforts during the 1990’s involved the entire nation from the President to the individual man and woman. The message of behaviour change and faithfulness (“zero-grazing”) was echoed by political leaders, church and community leaders. It was the responsibility of each and every individual (in words and actions) to ensure efforts were successful. This programme was not handed by a foreign government, and tied to development aid. The message was in harmony with people’s perception of good, healthy, and responsible living (which their lives literally depended on). They embraced the call to action as it affirmed not undermined, traditional, cultural and family values. The success of the programme proved beyond the shadow of a doubt that African men (read Caribbean men) can be faithful to their spouses and partners.
6. Caribbean governments must resist pressure from developing countries who tie development aid to foreign solutions which undermine our social cultural and traditional values.
On a daily basis, locally, and in regional and international fora. Caribbean governments are pressured into accepting foreign ideas and solutions which are not effective, exacerbate rather than address our social problems, and disregard our cultures and traditions.
During the 2011 United Nations High Level Meeting on HIV/AIDS Caribbean governments were threatened with losing all development aid for HIV/AIDS programmes unless they also agreed to accept controversial terms such as those relating to “men who have sex with men” and “sex work” although the focus on these high risk groups in the document did not address the inherent dangers of their high risk activities in a manner which prioritised or even encouraged behaviour change. We must seriously consider rejecting foreign aid if it means we must also accept foreign solutions which will not work.
7. Focus on reducing HIV/AIDS and improving overall health not on ideology and political correctness.
In the last decade (more so in the last five years) the campaign for unlimited sexual rights (in the name of “fundamental human rights”) and the right to engage in the most irresponsible sexual behaviours has overtaken the MDG 6 goal of combating HIV AIDS. As more and more people contract HIV/AIDS worldwide and suffering and death increases, so does the call for legalising buggery (and other harmful sexual orientations) and prostitution (“sex work”) the very behaviours which have been identified as significant drivers of the epidemic. The HIV AIDS epidemic has been hijacked by gay rights activists bent on advancing a radical sexual agenda and efforts are no longer primarily focused on combating HIV/AIDS by addressing the root causes of the virus, but rather on advancing ideology and in the name of rights and political correctness.
The HIV/AIDS agenda should re focus on saving lives and alleviating human suffering!
8. Strengthen the Natural Family as the fundamental cell unit of society.
If efforts were focused on building strong, healthy families, we would solve not just the problem of HIV/AIDS aids, but of crime, poverty and the majority of our social problems. The problem of HIV/AIDS itself stems largely from the breakdown of the family, from ignoring the primary purpose of sex as procreative, within a stable union between man and woman, to a merely pleasure seeking activity which can be bought and sold as a commodity on the market.
The sexual rights agenda is a campaign to destroy the natural family, based on marriage between one man and one woman. The natural family is recognised in the Universal Declaration of Human Rights (UDHR) “the natural and fundamental cell unit of society …entitled to protection by society and the state” (Art 16(3).
Caribbean governments should place the family at the heart of their development agenda.
9. Strengthen the Health and Social Services network
In most of our countries our health systems are weak and our social service agencies are bursting at the seams. We almost do not want to know the true nature of the epidemic in our countries because we fear that we do not have the capacity to deal with the findings. Effective programmes should at the very least provide:-
Essential antiretroviral treatment as early as possible for persons who need it
Community based care for the sick and dying
Care for orphans and children living with HIV and Aids
Education and awareness programmes which combat stigma and discrimination, which dispel myths about the virus and encourage persons to be tested
Prevention of Mother to Child transmission
10. Role of the Media
The media should continue to be fully on board in promoting awareness of HIV/AIDS. As well, the media should promote the key essentials above by refusing to glamorise irresponsible sexual behaviour and, instead, promote family friendly programmes which encourage healthy relationships, and respect for women.
(NB the above is not intended to be an exhaustive list, but points us in the right direction. We recognise that resource constraints may limit the implementation of all of the above but this where our efforts should be heading).