HEALTH:
AIDS Stigma, a Major Hurdle in the Caribbean
Dalia Acosta

HAVANA,  (IPS) - The discrimination that people living with HIV face on a day-to-day level in the Caribbean results in frequent violations of their basic rights and is a major hurdle to the implementation of anti-AIDS programmes, say U.N. officials.

"Prejudice based on religious, social or other reasons are exacerbated when HIV is thrown into the mix. This is one of the big obstacles to the fight against AIDS in the Caribbean and the rest of the world," Miriam Maluwa, representative of UNAIDS for Jamaica, Cuba and the Bahamas, told IPS.

In the region, there are women who have free access to the antiretroviral drugs that slow or inhibit the reproduction of HIV, the AIDS virus, but who do not show up for treatment in order to avoid the stigma of being identified as seropositive, she said.

People living with HIV/AIDS fear losing their jobs and their homes, not to mention the effects of the stigma on their young children, said the UNAIDS (Joint United Nations Programme on HIV/AIDS) delegate.

Another hurdle to fighting the epidemic, she said, is the "limited social commitment."

"People are afraid to work with people living with HIV because they don't want to be lumped in together with them," added Maluwa, who has a long history of involvement in human rights issues.

She noted that Cuba "has the smallest number of people living with HIV and the smallest number of people who die" as a result of AIDS. But she also pointed out that last year there was a slight rise in the number of cases detected, arguing that prevention efforts among society at large and among the highest risk groups should be stepped up.

Although those living with HIV in Cuba report that they feel stigmatised, all HIV/AIDS patients have free access to antiretroviral drugs, and their jobs are guaranteed, unless they present a risk to the patient's health.

Maluwa talked to IPS during a four-day visit to Cuba in late February, where she met with authorities, people living with HIV and U.N. representatives.

Some 24,000 people died of AIDS in the Caribbean last year, and 300,000 are living with HIV, according to the UNAIDS/WHO AIDS Epidemic Update, published in December 2005.

In the Caribbean, the region hardest hit in the world by HIV/AIDS after sub-Saharan Africa, AIDS has become the primary cause of death among the 15-44 age group, and the disease is mainly spread through heterosexual sex and prostitution, with poverty and sexual inequality playing a strong role.

The situation varies considerably from country to country, according to UNAIDS and WHO (World Health Organisation) statistics.

Average HIV prevalence stands at around one percent of the adult population in Barbados, the Dominican Republic, Jamaica and Suriname, around two percent in the Bahamas, Guyana and Trinidad and Tobago, and three percent in Haiti. In Cuba, meanwhile, prevalence is under 0.2 percent.

Although the Caribbean was the only area in the world where the AIDS rate did not grow last year, a comprehensive approach is needed, that includes prevention, treatment, care and support, said Fritz Lherisson, director of the regional UNAIDS office based in Trinidad and Tobago.

At a press conference in the office of the resident coordinator of the U.N. system in Havana, Lherisson said the epidemic can be prevented, and underlined that "we know how to do it." But, he added, what is needed is a "change of attitude."

The need to foment cultural, social and legal changes and to modify people's way of thinking is especially urgent given the fact that there are Caribbean island nations, like Jamaica, that still have laws on the book which prohibit homosexual relations and even provide for penalties.

"Many men who have sex with men live a double life," said Maluwa on her first official visit to Havana. "They have a home, a wife, children. They live, pretending to be what they are not, for fear of stigma and discrimination as a result of their sexual behavior."

Although she acknowledged that the problem is not so pronounced in Cuba, she said the AIDS prevention programme aimed at men who have sex with men must be "consolidated and expanded."

Gay men account for around 12 percent of HIV/AIDS cases reported in the Caribbean overall, although the real number could be much higher.

But in Cuba, 80.4 percent of the 6,827 cases reported between 1986 and 2005 involved men, most of whom had sex with other men.

By contrast with other countries in the region, "there is a good working relationship with people living with HIV," Raúl Regueiro, national coordinator of work with homosexuals in the National Center for the Prevention of STDs/HIV/AIDS, told IPS.

Regueiro stressed the need to expand prevention efforts geared towards bisexual men, based on activities already being carried out in provinces in eastern Cuba.

The project that works with gay men in Cuba forms part of a much broader programme put into effect by the Cuban government with support from the Global Fund to Fight AIDS, Tuberculosis and Malaria (26 million dollars for the 2003-2008 period) and from the office of the U.N. system in Cuba.

UNAIDS can support the monitoring and evaluation of efforts by the Cuban government, to see how they can be further expanded and "document what has been done in the country, to share it with other countries both within and outside of the Caribbean region," Maluwa told reporters.