The Heavy Co$T Of AIDS – With Global Funds To Dry Up, Jamaica In Peril

Prepared by Byron Buckley

CARIBBEAN AIDS prevention advocates fear that crucial funding to sustain hard-won gains over the last decade could dry up by year end. Financial support from the Geneva-based Global Fund could cease because Jamaica and other Caribbean states, having been classified as ‘middle-income’ countries, no longer qualify as recipients of funding.

Dr Edward Greene - File

In addition, a South-South agreement between the Organisation of Eastern Caribbean States (OECS) and Brazil, which facilitates universal access to antiretroviral drugs to treat HIV/AIDS, comes up for renegotiation later this year.

Faced with this spectre, Dr Edward Greene, United Nations special envoy for HIV in the Caribbean, says the world body will be working with Jamaica and other countries in the region to protest the ‘middle-income’ designation and secure its reversal.

Warns Greene: “With Jamaica experiencing its current level of financial constraints and renegotiating its debt with the International Monetary Fund, we are concerned about the possibility of the country being forced to suspend its social programmes. It would be catastrophic, in particular, for people living with HIV (PLHIV), if a withdrawal of support were to take place.”

The UN envoy flays the World Bank’s flawed study, based on income, which resulted in Jamaica’s reclassification. He notes: “Income does not tell you the burden of debt nor disease.”

It is the easing of the burden of HIV/AIDS on Caribbean societies that Greene and fellow advocates wish to sustain. A cessation of funding would threaten the fragile gains made in the Caribbean over the last decade. From 2001-2009:

The number of AIDS-related deaths declined by 9,000;
The number of new HIV infections decreased by 3,000;
The number of PLHIV in Haiti and Guyana declined;
The number of PLHIV in Jamaica remained the same;
Adult HIV prevalence rate declined in Jamaica, Haiti and Guyana;
Adult HIV prevalence remained stable in Suriname, the Dominican Republic, and The Bahamas.
In addition to these positive trends, Greene has high praise for Jamaica’s efforts to ramp up its HIV response. “It is obvious that Jamaica is on the path to the elimination of mother-to-child transmission by 2015, and that the Caribbean, as a whole, can aim to be the first region in the world to achieve this goal,” he says.

The OECS could eliminate mother-child HIV infection by 2015. Fifty per cent of people in the Caribbean have access to antiretroviral treatment (ART) drugs, 70 per cent in Guyana, and universal in Barbados.

Challenges remain

But challenges remain in the regional efforts to control the spread of HIV/AIDS. Overall, between 2001 and 2009, the number of PLHIV increased by four per cent, including in Cuba, Jamaica’s nearest neighbour. During the same period, the HIV adult prevalence rate increased in four Caribbean countries: Barbados, Belize, Trinidad and Tobago, and Cuba.

One area of grave concern in Jamaica is the 30 per cent HIV prevalence among gay men. This is among the highest in global terms, and is followed in the region by Trinidad and Tobago (20 per cent), Dominican Republic (11 per cent), and The Bahamas (10 per cent). Overall, the Caribbean, with an adult HIV prevalence rate of one per cent, is ranked second to Africa (five per cent). This makes the Caribbean anomalous in the Americas, where the adult/HIV prevalence is 0.5 per cent in both Central/South America and North America/Mexico.

Indeed, any reversal of the gains from the Caribbean’s HIV/AIDS prevention programme would give a black eye to the optimism that characterises the global outlook on the status of the epidemic. Over the last 10 years, there has been a decline in mortality rates for HIV/AIDS across the globe. The mortality rate is down because more people have access to medication.

Greene explains: “Having access to antiretroviral drugs is a lifesaver because it allows people to live a very active and normal life. In the Caribbean, we can almost safely say we can eliminate the disease. I think we are in a more optimistic position than we were 10 years ago.”

His optimism is also based on developments in medical science of formulas to eventually eliminate HIV/AIDS, just like what occurred with smallpox and polio in the 1980s. This upbeat posture, perhaps overblown, is also reflected in UNAIDS’s goals of getting to zero by 2015:

Zero AIDS infection
Zero AIDS-related deaths
Zero discrimination
Eliminating discrimination
Lifting the burden of the disease, importantly, involves the elimination of discrimination against PLHIV. Discrimination is considered an important driver of HIV infection rate, according to health advocates, because people refuse to be tested. Studies carried out in the OECS by the Caribbean HIV/AIDS Alliance found that even among medical practitioners, there was the perception of stigma. This often leads to some form of discrimination, – giving more legs to the disease because people don’t want to go to the clinic.

Commenting on the hot-button issue in Jamaica of repealing the buggery law, the UN envoy says it is secondary to addressing discrimination and promoting human rights in general.

“For me, that (repealing the buggery law) is not the main problem. The main problem we are dealing with is the human rights, generally speaking,” he reasons. “People are entitled to access care, because if they don’t, that could affect society on a whole.”

Greene believes the State has an obligation to protect citizens on a whole to ensure that people with communicable diseases have access to care and treatment.

He reasons: “If I put the accent on reducing stigma and discrimination and human rights, I am ensuring that there is no overt discrimination for PLHIV in the workplace and in the school. This is because I don’t want to exclude one per cent of the population, or 30 per cent of men who have sex with men (MSM), from having access to those things that other people have. Just like how I would not exclude people from certain services because of their race, gender or where they live – as happens to job applicants living in inner-city communities.”

According to the UN envoy, it is important that PLHIV have certain responsibilities – to go and get tested, to adhere to their regime of treatment, to ensure that they educate their family and friends.

“So homosexuals have the right to health care,” Greene argues, “but they also have to behave in particular ways to conform to the norms of the communities. If they expect to be treated a certain way, they can’t behave in ways that are subversive to the community.” For example, he notes, members of the homosexual community should not “prey on young, vulnerable boys”. They must act responsibly, thus balancing the human rights structure.

Faith-based organisations

The goals of zero infection, deaths and discrimination require the involvement of the faith-based community. Greene is hopeful that after recent consultations with local church leaders, they will be able to adopt a message of abstinence, faithfulness to one’s partner and condom use. He points to the role played by faith-based organisations in East Asian societies in producing the lowest HIV/AIDS prevalence rate of 0.1 per cent per population.

“Notwithstanding its religious tenets, East Asia promoted safe sex as a practice for a fairly long time. It has not allowed its religious precepts to get into the way of practical sexuality.

“This is one reason we are seeing the very low prevalence rate, overall,” Greene observes.

The situation in East Asia contrasts with what obtains in the Caribbean where family life is breaking down; sexual promiscuity is rampant; and communities foster a culture of fear that leaves young girls vulnerable to sexual predators.

Of course, per capita income is quite high in East Asia, and the level of poverty there does not compare with prevalence rates in India and South/Southeast Asia.

Greene points out: “We have to see AIDS also as a development issue. Enhancing development could impact positively on AIDS outcome.”

He was in Jamaica to discuss a number of issues with governmental and non-governmental organisations, particularly surrounding human rights and HIV, as well as the financial sustainability of HIV programmes. As a result of these discussions, it has been agreed that Jamaica will hold a national consultation on human rights and the reduction of stigma and discrimination on World AIDS Day, December 1, 2012.

Byron Buckley is associate editor at The Gleaner. Email feedback to columns@gleanerjm.com and byron.buckley@gleanerjm.com.
Low HIV prevalence in East Asia linked to:

Religious and family patterns;
Historical cultural mores, spiritualism;
Less multiple partners in sex;
Greater degree of abstinence before marriage;
Higher degree of faithfulness to partners

Living a lie – MSM use women to cover up their sexuality

by Eve for Life info@eveforlife.org

He is a 42-year-old bisexual man. He lives at home with his wife, the mother of his two children. She does not know he is also having sex with men.

During his 14-year-old relationship with his wife, he has had two different ‘steady’ relationships with males that lasted three and five years respectively. In the latter case, he went to his partner’s house. In the other they would have to find other places … car, brothel, and gay friends’ houses.

He has never used condoms with his wife — that is the way they have negotiated their relationship over the years.

“I would feel a bit cute to introduce condoms at this stage in our relationship,” he said.

In the early days with men he said he periodically used condoms, but with the advent of HIV, he has started to use condoms with his male partners.

“It is not always easy. Sometimes I do not have condoms because I cannot carry condoms home in my pocket or wallet or bag. My children always search my bag for sweets and money.

“I recall one time my male partner and I started to have sex without a condom but stopped. After that, I went to do a test. I tested negative and have not gone to another man without a condom,” he said.

He said he has no fear about his wife having sex with another man and giving HIV to him. Fatalistic as it is, if he is to get HIV, he would prefer to get it from her than from a man.

He said he wished he could tell his wife about the other side of his life but is fearful that she will be devastated. He loves her. He does not want others to know. He loves his children and does not want to lose them. All his male partners know about his wife and have had to respect that. He would also like to live with a man but cannot decide how he could live with both a man and woman.

“Sometimes my mind is overloaded and weighed down hard, but I take it one day at a time. I never made myself this way. If I did, I would change it. It’s not easy,” he said.

John Ward, a successful business owner, said he knew he was attracted to men from his early preteens, but got married for legal sex as he grew up in the Pentecostal church.

“As a teenager, I tried to conform, but it was very confusing and painful, not only for me but for the girls I dated. I wasn’t seen as macho enough — it was fine being friends with them but not anything else,” he explained.

Ward, who is now divorced, explained that he was attracted to and still finds his ex-wife very attractive, but the marriage didn’t work as he found he still wanted to have sex with men. Their sexual relationship was very good and she knew before they got married that he had interest in men.

“When I discussed it with her, she said I should choose. I found that I was even attracted to men who were her friends and spoke to her about it, but she kept saying I needed to choose,” he said.

“I remember at one point she told me to make sure I used condoms when I am with my male partners. I think at that point she had started to accept. We still maintain a relationship. We are still friends,” he explained.

Ward noted that the challenge was that his ex-wife couldn’t understand why she was not enough and “that was unhelpful”.

As it relates to condoms, he explained that he never planned to be unfaithful to his wife and so was not prepared for the times he did.

“I did use condoms a few times, but never really found them enjoyable with my wife and definitely with the outside partners I never planned these encounters. I just yielded to temptation and then swore it would never happen again,” Ward said.

Currently, Ward is not in a steady relationship and so far he continues to test negative for HIV.

Tribadism and safer sex

Tribadism (pronounced /ˈtrɪ bæd ɪzm/) or tribbing, also known by the slang term scissoring, is a form of non-penetrative sex in which a woman rubs her vulva against her partner’s body for sexual stimulation. This may involve female-to-female genital contact or a female rubbing her vulva against her partner’s thigh, arm or stomach; it can also refer to a masturbation technique in which a woman rubs her vulva against an inanimate object such as a bolster, in an effort to achieve orgasm.

The term is most often used in the context of lesbian sex, but is not exclusive to lesbians.

History
In the sexuality of the ancient Romans, a tribas was a woman who wanted to be an active partner or “top” in intercourse. The Romans did not classify according to homosexuality and heterosexuality. They instead had words for who was the active partner and who was the “bottom”.

Until the 20th century, the term was used to refer to lesbian sexual practices in general. Therefore, lesbians were occasionally called tribades.

This position is not exclusive to humans. Females of the bonobo species, found in the Democratic Republic of the Congo, also engage in female-female genital sex, usually known as GG rubbing (genito-genital).

Safe sex issues
As with any exchange of bodily fluids during sexual activities, tribadism has the potential to transfer sexually transmitted diseases (STDs) if those are present in one or more of the partners. Participants have the option of safe sex practices.

Tribadism in popular culture
The glam pop band Scissor Sisters derived their name from the scissoring position.
Bands named after tribadism include Scissorfight and the lesbian punk band Tribe
Genital-genital tribadism was depicted three times during the “D-Yikes!” episode of the cartoon South Park, referred to in that episode as “scissoring”.
Australian band Rocksteady pay homage to tribadism with their song “Scissoring”.

SEE: Bonobo Sex and Society
The behavior of a close relative challenges assumptions about male supremacy in human evolution

Remember HIV OK:
It infects CD4 cells and uses them to make new copies of HIV, which go on to infect more cells. The lower a person’s CD4 count, the weaker their immune system will be.

Very low risk but NOT No risk
HIV is transmitted when blood, vaginal fluids (including menstrual blood), breast milk or semen from an HIV+ person enters your bloodstream.

It is true that instances of female-to-female HIV transmissions that have been documented are far less than the other modes of transmission mainly unprotected heterosexual and homosexual penetrative sex. The route possibly being sex toys, used vigorously enough to cause exchange of blood-tinged body fluids.

Lesbians are fortunate enough to be in the lowest risk and it’s very rare for women to transmit HIV to each other sexually.

Each woman must assess the risks for herself and decide how she’s going to conduct her sex life. Many of us consider monogamy to offer all the ‘safety’ we need sexually. Although it can’t protect against HIV if someone already carries the virus.

Sexual identity does not necessarily predict behaviour. Just stay aware and enjoy what and who you do!

Safety first
Safer sex for women who have sex with women is a personal choice. If you are concerned you may want to follow the following tips:

Use protection during oral sex. Dental dams, cut up condoms, or cling film can be used to minimise contact with fluids during oral sex
Don’t share sex toys, or if you chose to, make sure you use a new condom every time it enters a new hole!
Cuts on hands create risk during vaginal masturbation/ fisting so you may want to use latex gloves
Rough sex is safe if there is no blood involved
If you are piercing each other then disinfect the needle and body areas
If shaving the vaginal area, do not share razors.

Frottage (rubbing bodies together) is better and recommended by most experts in HIV as the risks as outlined briefly above can pass HIV and other STIs if the action is rigid and there is contact with blood and other bodily fluids to blood.

Peace and tolerance

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