The equality challenge

One in every hundred Caribbean adults is living with HIV. But for some groups the odds of being infected are far higher. Prevalence among men who have sex with men (MSM) is an estimated five percent in parts of the Dominican Republic, eight percent in Cuba,  19 percent in Guyana, 20 percent in Trinidad and Tobago and 32 percent in Jamaica. For female sex workers, rates range from 4.8 percent in the Dominican Republic and five percent in Haiti and Jamaica to 17 percent in Guyana and 24 percent in Suriname. We asked advocates to weigh in on how best to reach these groups.

Miriam Edwards, Chairperson, Caribbean Sex Worker Coalition

There are multiple issues facing Caribbean sex workers. These include stigma and discrimination in the health care system and from law enforcement personnel (both police and customs) accompanied with violence and abuse, including sexual violence. The criminalisation of sex work is an important challenge because it leaves sex workers without any protection in legal terms. One other area for concern is the lack of meaningful involvement of sex workers in the development and implementation of programmes targeting them. Caribbean leadership should advocate for the decriminalisation of sex work in the region, the empowerment of sex workers and the reduction of stigma and discrimination towards sex workers by health care and law enforcement professionals. Special attention should be paid to the provision of care and support to AIDS-affected children and economic opportunities should be made available to sex workers to get them out of the streets.

Maurice Tomlinson, Attorney and advocate, AIDS-Free World

I think we need to appreciate that the response would never be effective if we keep denying the rights of lesbian, gay, bisexual and transgender (LGBT) people. The fact is that LGBTs, especially men who have sex with men (MSM), are some of the most vulnerable poulations. We are courting a disaster by trying to do these middle-of-the-road responses and not being dramatic enough in terms of addressing the core issues. We continue to see a spiral in the rates. The politicians have come to a place where they are understanding the financial implications of the loss of Global Fund financing. They need to be more strategic and bold in the steps that they take. One challenge is making sure that all the vulnerable populations are brought out of the shadows. Anything we do while these (anti-gay) laws are in place will have to be done clandestinely and that automatically undermines effectiveness. The persons who may need services may not know about their availabllty or may not feel free to access them.

Louise Tillotson, Technical and Policy Coordinator, Caribbean Vulnerable Communities and El Centro de Orientación e Investigación Integral (CVC/COIN)

Homophobia, whorephobia, xenophobia, gender inequality and institutionalised discrimination reinforced by laws that criminalise sex work and homosexuality and across the board drug use are drivers of the Caribbean HIV epidemic. Human rights must be at the centre of the global HIV effort. Decriminalisation of same-sex relationships needs to happen across the region for an improved response to HIV and AIDS.  Studies have shown clearly that criminalisation limits access to sexual reproductive healthcare and services.  For example, Caribbean countries which prohibit same sex relationships all have higher HIV prevalence among men who have sex with men.  In response to this, CVC has been supporting the constitutional challenge in Belize and partnering with other national organisations pushing for recognition of sexual orientation and gender identity rights.  These are exciting times, but there is still much work needed to realise an enabling environment for HIV prevention in the Caribbean.