In just over a week’s time leaders in the field of health and HIV/AIDS policy will be gathered in the Austrian capital of Vienna for the 18th International AIDS Conference. Coming on the heels of the FIFA World Cup in South Africa, this conference comes as a somber reminder of the challenges facing that country and the world. The official conference communiqué describes the event as: the premier gathering for those working in the field of HIV, as well as policy makers, persons living with HIV and other individuals committed to ending the pandemic. It is a chance to assess where we are, evaluate recent scientific developments and lessons learnt, and collectively chart a course forward.
It is true that here in the Caribbean, in spite of reasonably high per capita incomes, smaller land masses and populations (when compared to countries in Central America and Africa) significant challenges remain as it regards access to health care services in general and HIV treatment and prevention services in particular. However, beyond the issue of access to personnel and physical hospital infrastructure there is the issue of access to pertinent information especially for the Lesbian, Gay, Bi-sexual and Transgendered (LGBT) community. Indeed, it must be assessed that the time has come for serious questions to be asked at the regional, local/national and community level about the design of HIV prevention strategies and existing policy support programmes.
The Issue of Homophobia
One of the major questions that must be asked is whether both at the level of policy and implementation if too much time and other resources are being expended on avoiding stigmatizing the disease as a GAY DISEASE. In fact the stigmatization concern at the design level may very well be occurring at the expense of developing meaningful LGBT centered intervention strategies in the region.
An astute observer would note that regional policy makers are constrained in their ability to target the LGBT community because of the presence of restrictive local laws (In the case of Jamaica these restrictions are noted in Sections 76-79 of the Offences Against the Person Act). Further, the global statistics show that even in countries that do not have restrictive laws on homosexual activity, the prevalence rates in their LGBT communities approach epidemic proportions. However, it is that same astute observation that allows us to calculate the cost of maintaining homophobic legislation on the books.
In Table I below: Jamaica, Guyana and Trinidad and Tobago maintain anti-buggery legislation on their books and have the highest MSM HIV prevalence rates in the Caribbean. The other four sample countries, namely: the Dominican Republic, the Bahamas, Suriname and Cuba have significantly lower prevalence rates. Notably even if one were to control the sample for cultural differences and thus eliminate Cuba, Suriname, and the Dominican Republic- the cost of maintaining homophobic legislation in the English Speaking Caribbean ranges from 8% to 24% in the case of Jamaica.
Therefore the programmatic cost of maintaining homophobic legislation is “Tenement Yard” HIV/AIDS strategies that provide less than adequate support to anyone. This, however, does not equate to the human and social cost of broken families and loss of economic productivity.
Yet whilst boardroom level discussions are important, good and instructive, these cannot negate the importance of conversations in the bedroom, back alley, Back Road or where-ever because ultimately that is where the overwhelming majority of new and repeat HIV infections occur. Whilst it is recognized that hardcore questions must be asked of programmers and policy makers, persons in the LGBT community must begin to speak openly, empower themselves, use condoms properly and use water based lubricants.
On the matter of anti-buggery legislation, maybe J-FLAG and aligned groups should get a heterosexual married couple to launch a constitutional challenge to Sections 76-79. In fact wouldn’t it be ironic if the Pro-buggery campaign became linked to the defense of Marriage. Remember Hebrews 13 vs 4: Marriage is honourable in all, and the bed undefiled