Patricia Watson, Senior Staff Reporter
"THE BIGGEST challenge we face with the young people has to do with abstinence. It is very difficult to abstain when you live in a marginalised community. I am not saying it is impossible, but it is difficult based on how the communities are set up."
In an environment where poverty and myths surrounding sex are high, where culture demands that young women start having sex as soon as "dem bus' breast", many in Jamaica's poor communities are at high risk of sexually transmitted infections (STIs) and HIV. According to experts, due to the social, cultural and economic factors embedded in these communities, young women are driven into having unprotected sex, putting them in danger of early deaths. So serious is the situation in these communities that they are among the Ministry of Health's targeted groups, based on their vulnerability.
"From a very young age, children are exposed to a lot of sexual overtones and as a result, our messages of abstinence is sometimes irrelevant for them. We are criticised very often because we offer the option of condom use, but the reality is that they are sexually active and they live in a situation where it is very difficult to abstain. Many of them have very little control, the exposure to incest and rape is very high," Michelle Witter, a behaviour change expert told Outlook.
According to her, the stacks are piled high against young women in these communities as in many instances, they have no control over the decision to have sex.
"You have the situation where the community don can send to a mother and say I need so and so. Female adolescents are therefore targeted, once, as they say, 'she bus' breast', they become targets," Miss Witter explained.
Another behaviour change specialist, Millicent Reid, who has lived and worked in marginalised communities, also noted that dons do force young girls into relationships, but in many instances this is not necessary.
"To a large extent it is a privilege to sleep with the don, and from you sleep with him 'yu deh wid' him basically. People look up to you, so the young girls throw themselves at these men, they will go out of their way to attract them and once they are with the don, they know, no other men will bother them."
The Behaviour Change and Communication Task Force (BCCTF) Report (2001), also notes that the need for love is a strong driving force for young girls to become sexually active. Quoted in the same report, Althea Bailey explains that "the issue of gender socialisation and how young girls are parented in the brutal and isolated environment of the Jamaican inner-city in particular also shapes these girls' sense of the world, of how to cope with inner and interpersonal conflict and what it means to be a sexual being." Miss Bailey is currently the Health Promotions Officer at the South East Regional Health Authority.
But outside of that, young adults are pressured into having sex in order to prove they are not homosexuals or 'mules'. Although this happens in other areas, it is even more pronounced in marginalised areas. "For the young boy there is the pressure not only to have sex but also to produce a 'youth', to show their manhood. There is the feeling among men in general, not only in the inner-city, that the condom is not ideal to be used in relationships. They might use it with women who they feel are promiscuous, or 'sketels', but if they feel that you are a nice clean girl, then they won't use a condom."
Poverty and deprivation
Research has shown that when people live in poverty and are deprived of certain basic necessities, they are driven into risky sexual alliances, which under normal circumstances they might not have done. Population Reports (Fall 2001) found that in Kenya, young women from poor unstable family environments were more likely than women from better family environments to have had sex. In Ecuador, it also noted that sexual risk taking by young women was more common among low-income families, with one breadwinner. As in other marginalised communities across the globe, young women in Jamaica, lacking opportunities seek support from older men (Sugar Daddy syndrome) in exchange for sex, putting themselves at risk of contracting HIV. "She may be getting money for food, he may be paying her school fees or she may be getting other sorts of payment from the man. This makes her vulnerable. How do you demand that such a man use a condom? She can't," Miss Witter stated.
Althea Bailey, Health Promotion Officer at the South East Regional Health Authority, confirmed that such behaviour is possible. "I've had situations where mothers force their girls to find men to supplement their income. One girl said her mother told her at 15-year-old that 'when me reach your age, me have man a support me, so is time yu go get a man fi support yu'," Miss Bailey said.
She explained that when she spoke to the mother, the mother told her she was alone and was having difficulty taking care of all the children. "A lot of people don't understand the dilemma these girls go through, instead they judge them. I know that almost as much as 80 per cent of the teenagers who are sexually active were pressured by someone they know," she said.
Ministry of Health statistics show that girls 15 to 19 years old had twice and three times higher risk of HIV infection respectively than boys the same age group. This, they theorise, is as a result of social factors whereby young girls are having sexual relations with infected older men. Data also show that the number of AIDS cases in the over-50 age group has doubled in the last three years. Of the 939 new cases of HIV reported in 2001, 69 or 7.7 per cent were young people aged 15 to 24 years old.
A source at one clinic in a marginalised community told Outlook that based on the
stigma attached to HIV/AIDS in Jamaica she could not give the number of cases seen there. However, she stated that "the number of persons coming in for treatment of STIs under 19 is very high. Definitely it is high and they are not having sex with boys their own age, but with older men who can buy the clothes they want to wear, give them the lunch money, the bus fare..."
She further explained that in conversation with some of the men who visit the clinic, the men prefer the young girls because they are felt to be clean, that is, infection-free. This is not necessarily the case though as the girl may be involved with two or more other sugar daddies.
"The young girl is usually in this relationship based on what she can get, but she still has her young boyfriend on the side. In some cases the girls will tell you that it's the older man who usually tells her if something is wrong down there. As an adult he is able to identify when there is an infection," the source said.
Socio-cultural factors
Although we are all Jamaicans, it is believed that persons living in marginalised communities live by completely different rules. The culture is also different. Secrecy is almost non-existent, based on the set up of the communities. Thus for instance, children living in one bedroom establishments may be exposed to sex very early and if this is not explained to them early, may feel they are to become involved as well.
The BCCTF Report (2001) notes those young girls in marginalised communities show very early sexual initiation with most starting between 11 and 13 years old. By the time they are 15, they are seasoned in the art. The Report further states that the large number of women 20 - 29 years old who have AIDS "reflects the infections were contracted in the first formative years of the girls sexual identities.
That their mothers were also teenagers when they became pregnant, and now compete with these girls for attention and support from the same pool of men compounds the problem in complex ways."
Miss Witter further explained the culture in certain communities as it pertains to relationships.
"In the inner-city, there are networks of people who have sex with each other. For instance one male may have four baby mothers, they know about each other and because of this, when one person in that chain becomes infected, it automatically puts all the others at risk. That is why you find that the rate of STIs is so high, because it is the same people ... it is like a pool and they spread the infection in that pool, because everybody is having sex with each other. Thus multiple partnership and the fact that condom use is not seen as ideal contribute to the spread of HIV," Miss Witter stated.
Miss Reid also explained that there exists in these communities, numerous myths about sex and sexuality, which tended to change the perception of the risk they face.
"Knowledge of HIV is high in the communities - people can tell what it is, how you get and how to prevent it. They can tell you all of that; the problem comes in the behaviour. The man might not want to use the condom and the woman does not bring up the argument. They are not looking at the fact that they have more than one woman," Miss Reid said. "Adolescent girls in the inner city tend to have more partners than the boys. The boys will tell you that the girls don't want them; they prefer to be with older men who can give them things."
Is there hope?
Horace Levy and the World Bank based on their studies done in the inner-city, says there are "are critical issues that drive the sexual practices of young women and must e taken into consideration when designing a behaviour change intervention aimed at saving their lives" (BCCTF, 2001). The Ministry of Health is aware of the factors behind the sexual behaviour of young women in the communities and are hopeful they can effect significant changes in the community fast to stem the rate of infection.
"The culture in these communities is such that confidentiality and secrecy is absent. Once anything happens in these communities, everybody knows. So we have been working with communities to educate them about HIV and these have been quite successful," Miss Bailey told Outlook.
She explained that she along with others in the Ministry of Health have been telling the young people in the inner-city about alternatives to sex, but that there is very little else to do. "It takes money for instance to become involved in certain activities. It is not everyone who will be able to play football or cricket and there are not many clubs in these communities."
