- Contributed
Members of the Peer Counselling Association performing a skit at a recent HIV sensitisation programme in Half-Way Tree, St. Andrew. In the skit, the man kneeling has just learnt that he is HIV-positive.
The article below was the winning entry in the print category of the JN/CARIMAC Media Awards.
Nakeisha Sewell, Contributor
"I DON'T think that enough is being done," says Synethia Ennis, a final-year student at the University of the West Indies (UWI).
"The media do a lot but I think the majority should be done in primary socialisation," adds Garfield Taylor, also a student at UWI.
These students are talking about the measures being used to combat the spread of Sexually Transmitted Infections (STIs), especially the Human Immunodeficiency Virus (HIV). The level of HIV infection seems to be rising unchecked in this country and while some STIs are actually decreasing in terms of the rate of infection, others are increasing.
In the AIDS Epidemic Update 2002, published by the Joint United Nations Programme on HIV (UNAIDS) and the World Health Organisation (WHO), the estimate of adults and children in the Caribbean living with HIV was placed at 1.9 million, 210,000 of which were said to have contracted the disease in one year alone (2002).
At-risk groups
Data obtained from the Ministry of Health shows that in any given year, while one parish is experiencing a decline in the reported cases of Acquired Immune Deficiency Syndrome (AIDS), other parishes are often experiencing an increase. The reported cases of AIDS in Kingston and St. Andrew declined by 33 persons in 2001 when compared to 2000, when there were 390 persons who were reported to have the disease. For the same period, there was an increase from nine persons in 2000 to 26 in 2001 in St. Elizabeth. The total for the period January to June 2002 stood at 511 new reported cases while in 2001, there were 939 reported cases for the entire year. These figures only refer to reported cases and there are infected individuals who either do not know that they have the disease, or suspect that they have the disease but refuse to get tested. A Pan American Health Organisation (PAHO) estimate puts the total number of infected persons in Jamaica at 18,000.
The age group that is most at risk, according to information obtained from the Ministry of Health, is the 15-49 age group, which is defined as a time when people are at their most productive and reproductive years. Having any of the other STIs places people at risk of contracting AIDS. This is because many sexually transmitted infections cause sores and blisters, which make HIV transmission from person to person easier.
In an effort to stem the rate of increase of HIV/STIs, a National Strategic Plan (NSP) has been developed for 2002-2006. The Ministry of Education, the Ministry of Health, and the Ministry of Tourism and Sports are all involved. The plan has several components, among these are a system of community-based response, long-term, sustained response, learning from experience and the provision of adequate resources.
The plan works on the premise that there are basic factors driving the spread of the epidemic. These are divided into three categories: behavioural, economic and social and cultural factors.
Behavioural
A prevalent behavioural factor is the practice of multiple-partnering. This is where one or both parties in the relationship carry on simultaneous relationships with other people. This, of course, increases the risk of transmission of STIs, which is why everyone involved in a relationship is advised to have only one faithful partner. As an extra precaution, people are advised to use a condom, the only proven method of protection against sexually transmitted infections if one is sexually active, of course.
False perception
Mavis Fuller, HIV/AIDS co-ordinator at the Ministry of Health, says it is sometimes difficult to convince people to use condoms. People who normally do not use condoms in their relationships are hesitant to introduce the topic. Asking that a condom be used can be perceived as a lack of trust. Married couples often have the problems with introducing this particular topic because fidelity is supposed to be a natural condition of marriage.
Another problem that crops up in the fight against STIs is what the National Strategic Plan refers to as a "lack of perception of actual risk". People do not normally believe that bad things will happen to them so this lulls them into a false sense of security where they do not use protection, get tested or practise responsible behaviour. AIDS has been perceived for a long time as a homosexual disease, so heterosexual people have always assumed that they cannot get it. Statistics show, however, that the primary means of transmission in Jamaica is through heterosexual sex.
Only seven per cent of HIV transmission is said to be through homosexual and bi-sexual encounters.
"Tourism and population movement," according to the NSP, is one of the factors that encourages the spread of the epidemic. As infected people migrate both within and into the country, they carry the disease with them and infect other people.
The 'sugar daddy phenomenon' is a social and cultural factor that encourages the spread of STIs. This is where a younger woman gets into a relationship with an older man who normally provides her with money and gifts.
Tackling AIDS
The NSP uses a multi-sectoral approach to tackle the problem of HIV and other STIs; this approach involves individuals from the public and private sector. The objective of the NSP is to "create the conditions for a more open, tolerant and supportive society regarding HIV/AIDS and people living with the disease".
The fear that persons who have the disease will infect the rest of society has divided society into two segments the healthy or the non-infected and the outcasts.
Additional plans outlined in the NSP see advocacy, which would result in the development of a "caring, protective and supportive environment".
"Equity will have to come from all angles," says Fuller, on this point.
The reduction of stigma and discrimination is also seen as a key component along with monitoring and evaluation and prevention through behaviour and belief modification. Though Fuller warns that "behaviour changes do not come easy".
Education, as always, plays an important role in the fight against this growing epidemic. The Ministry of Education, Youth and Culture is involved at all levels in the teaching of sexual and reproductive health. Students in school learn about sexual and reproductive health and attention is paid to STIs and the modes by which they can be contracted. Education not only takes place in schools but attempts are made to educate the public at large using inter-personal messages such as workshops, posters, commercials and pamphlets.
Synethia has a problem with the commercials she sees on television though. "They need to clarify what STIs are," she says. The change from the term STD, meaning Sexually Transmitted Disease, to that of STI, has taken some people by surprise. Reference to STIs periodically elicit the response, "What's that?"
Still, Synethia feels that sex education is necessary, especially considering the increased incidence of teenage pregnancy she has heard about over the past year.
