ST JOHN’S, Antigua – How do men who have sex with men (MSM) fare in Antigua & Barbuda? A new online survey conducted by UNAIDS seeks to find out.
CARIMIS, the Caribbean Men’s Internet Survey, is underway now in the English, French, Spanish and Dutch-speaking Caribbean. The anonymous study will shed light on issues that are often hidden. What are MSM’s behavioural risks? Do they get HIV prevention education that’s tailored to them? And are there barriers to accessing testing, treatment and care? Different people have different takes on these matters.
“Antigua is different than the typical Caribbean island,” ventures AIDS Programme Manager Delcora Williams. “We have MSM that are very public people. We grow up with them. We don’t go after them. They are your friends. We don’t really persecute them or arrest them.”
Williams says that the community has access to the full spectrum of HIV prevention and treatment services and identifies only one area in which the national response leaves something to be desired.
“Sometimes the care they receive when they are hospitalised isn’t up to standard,” she admitted. “We’re still working on that.”
A 25-year-old gay Antiguan disagrees on some points, noting, for example, that information on HIV is predominantly targeted toward general audiences with almost no communication specifically directed to the community. And he agreed that some MSM have problems when seeking care in the public health system.
“It is horrible,” he says. “While in some cases we are tolerant to MSM in our society when it comes to accessing healthcare the frontline workers like receptionists, secretaries, cleaners, messengers and junior staff are not trained in the areas of stigma and discrimination, respect and confidentially. They are the ones who run not only MSM, but also sex workers and other members of key populations, underground.
“Even nurses and doctors have issues with MSM at times, especially if they are HIV positive. There is verbal abuse and the things being said about them are horrible. So when we are talking about accessing care, yes, it is there and it is free. But because of the treatment associated with it some people would be reluctant to either come or continue,” the gay man said.
Karen Brotherson is the executive director and programme manager for the Health, Hope & HIV network (3H Network), an organisation for people living with and affected by HIV.
She recounted that discussions with MSM and sex workers revealed that healthcare workers and police officers were the two main service delivery personnel who discriminate against them the most. This revelation led to a 10-week-stigma and discrimination project with funding from USAID, through the Caribbean HIV/AIDS Alliance.
As part of the project activities, Brotherson facilitated human rights and anti-stigma and discrimination workshops for two batches of police officers as well as a group of student nurses. By the participants’ own admissions, there are issues.
“The method has been working because the process brings them to a place to reveal their authentic self and admit to their thoughts, omissions and commissions,” Brotherson says.
“One officer said that if a gay person came to the station to make a complaint, he may have turned him away and not given assistance readily. Another said that if an MSM called out to him on Market Street, he would have turned in the opposite direction. They continued by saying that the training has opened their eyes and they pledged to create safe spaces for at-risk populations,” Brotherson said.
The student nurses were equally cathartic. Participants were given the opportunity to share acts of discrimination they have witnessed. They also heard one man’s story of discrimination within the healthcare setting.
“There is a level of discrimination that exists within the system, resulting in a small group of persons who would say ‘I am not going there because they will discriminate against me’,” Brotherson explains.
“Stigma is a social practice of branding an individual or group as disgraceful and it devalues them because of some actual or perceived characteristic. It is a powerful force that negatively influences the way an individual or group is not only seen or perceived by others, but also by themselves. Self-stigma – the internalisation of the negative responses and reactions of others resulting in feelings of worthlessness combined with feelings of being isolated from society – can lead to depression, and self-imposed withdrawal, causing people to become ineffective in relation to the management of their own care.”
Article 29 of the 2011 Political Declaration on HIV/AIDS notes that many national HIV prevention strategies inadequately focus on populations that evidence shows are at higher risk.
In June, governments committed to identifying the specific populations that are key to their epidemic and response, “based on the epidemiological and national context.”
CARIMIS will contribute to this goal by offering new insight into the realities of Caribbean MSM communities at country-level.
Among the health and development priorities listed in the 2008–2010 National Business Plan for Health are consistent programmes with MSM, increased support for people living with HIV (PLHIV) and a reduction in stigma and discrimination. Williams looks forward to the CARIMIS results for her country, saying that it would inform the way forward on these mandates.
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