HIV has always told a tale about gender, moving over the last three decades from a virus that overwhelmingly infected men who have sex with men (MSM) to one with increased impact on women and girls.
We’ve been hearing for quite some time that the Caribbean has the highest HIV prevalence rate (0.9 percent) outside sub-Saharan Africa. Now UNAIDS reports that aside from sub-Saharan Africa, ours is the only region where the proportion of women and girls living with HIV (53%) is higher than that of men and boys. (Note that this situation is skewed by data from Haiti and the Dominican Republic where 68% of people living with the virus are women. There are also more women than men living with HIV in the Bahamas and Belize.) Still not convinced that there’s a gender dimension to HIV? According to UNICEF HIV rates are five times higher in girls than in boys aged 15-19 in Trinidad and Tobago. At one surveillance center for pregnant women in Jamaica, girls in their late teens had almost twice the prevalence of older women.
While reiterating that there are variations in national rates and the gender burden of the virus within the region, Project Coordinator of the Caribbean Coalition on Women Girls and AIDS (CCWA), Marina Hilaire-Bartlett, explained that the increased impact on females is a universal trend.
“The Global Coalition on Women and AIDS (GCWA) began in 2004 in response to the worldwide epidemic becoming more feminised. We need to specifically look at the issues of women and girls. When you look at the evidence women are differently affected by HIV than men,” she said.
Why are women vulnerable? Hilaire-Bartlett pointed to a cocktail of cultural factors.
“There is still a great deal of violence against women in the Caribbean—both domestic violence and violence in general. You can’t negotiate safe sex when you have a forced encounter. We have issues surrounding MSM also having female partners and not having protected sex. For young women in the Caribbean there is a discrepancy between the age of consent and the point at which they can access sexual and reproductive services. There’s also a prevalent culture of having multiple partners and an early age of first intercourse. There are a number of reasons for this and some of it has to do with child sexual abuse which is very common… far more so than we care to admit,” she listed.
And the scope of the challenge isn’t confined only to issues of transmission and treatment. The Global Coalition has pointed out that “in the context of HIV, women carry a significant burden of care – a labor that tends to go both unrecognised and unpaid.” As care-givers, survivors and an at-risk population, the female face of HIV presents a myriad of challenges.
So how can the CCWA can make a difference in the lives of Caribbean women? Their mandate is to advocate for comprehensive HIV and AIDS prevention, treatment, care and support as well as the human and sexual and reproductive rights from the specific point of view women and girls. Hilaire-Bartlett outlined an approach that has drawn lessons from our successes and failures over the course of the HIV narrative. The CCWA is a varied group. From creators to researchers, politicians to people living with HIV (PLWHAs), the motley crew isn’t your typical HIV organisation.
“We were trying to bring persons that have influence in the Caribbean but who may not traditionally fall within the HIV arena. They have a variety of backgrounds since we were going for a multi-sectoral, multi-disciplinary partnership,” she said. The idea is to have people operate within their spheres of influence—whether civil society or the legislature,” she noted. There was an explicit mandate to include young people as well as PLWHAs. Along with the advocates other organisations and UN agencies comprise the Coalition.
They plan to pair a focus on empirical evidence with empathy. It’s an important shift away from the anecdotal and condescending.
“As people who think we know better we often go into communities and tell people what they need and that what they are doing is wrong. Instead we need to meet people where they are, genuinely listen and understand why they hold certain positions and values,” she said.
Of course all this comes at the time when global funding streams are drying fast. Hilaire-Bartlett says that reality forces the CCWA to stakeholders “to become much more creative in how we utilise the resources and how we can garner other resources.”