- PHOTO BY BARBARA ELLINGTON
In Bhuddist Thailand, largest incidence of extra-marital sex is between businessmen, tourists and sex workers.Laurie-Ann Jackson, Contributor
THE ISSUE of HIV/AIDS in Jamaica is not a problem we can pass off onto our prostitutes. Legalisation of the trade or the promotion of 100 per cent condom use would only just begin to address Jamaica's desperate battle with HIV/AIDS as sex with prostitutes accounts for only 25 per cent of the infection rate.
On the other hand, 46.6 per cent of all HIV infections in Jamaica is linked to multiple sexual partners or contact, and a history of STDs.
This statistic does not include our prostitutes. It does include our young girls in secondary school. It includes our heterosexual young men and embodies our bus conductors, accountants, sales clerks, politicians, UWI/UTech students, fathers and mothers. It is both rural and urban. We are all at risk.
The article 'Focus on HIV/AIDS - Prevention is much cheaper than cure' in The Sunday Gleaner of May 14 echoes much of the misconception about the spread of HIV/AIDS in Jamaica. This article is evidence that there still exists a dangerous disconnect between the sexual culture of this nation and the direction we are choosing to take in fighting it.
100 PER CENT CONDOM USE
After having seen the remarkable success story of Thailand, we have begun to flirt with the idea of 100 per cent condom use as the primary means of curtailing the rising HIV infection rate. This approach not only addresses one of the smallest at-risk groups, but it does nothing radically to change the sexual attitudes and behaviour of our people.
With the majority of new HIV cases in Jamaica being women between the ages of 13-29 and persons who have histories of STDs and multiple sex partners or contact, the promotion of condom usage alone will prove to be insignificant in decreasing the infection rate. Unlike Thailand, the majority of women and men who contract HIV in Jamaica are not involved in the commercial sex trade. (Ministry of Health [MoH] HIV/STD Prevention and Control Programme 2005). Jamaicans are dying of HIV/AIDS because of their attitudes towards sex.
While the numbers quoted in the aforementioned article in terms of the reduction of the incidence of HIV are impressive, Thailand achieved this remarkable feat solely through the promotion of 100 per cent condom use among its sex workers. In a Buddhist society, where the largest incidence of extra-marital sex is between business men or tourists and sex workers, it makes clear sense that this be the target of intervention.
Those excited by the success story of Thailand do not understand that unlike Jamaica, the spread of AIDS in Thailand was primarily through its commercial sex trade.
Prostitution functions as a significant part of the country's tourism industry and is an accepted pastime for the business class. The Government recognised that there was a direct connection with prostitution and the spread of AIDS and so carefully propagated a 100 per cent condom use campaign. It was mandated that condoms be used every time and all the time in Thailand's brothels. As prostitution became an organised and controlled industry, the HIV infection rate began to decline and Thailand began to regain control of its suffering economy. This story would be more relevant to us if we had the same underlying problem. Prostitution is not the primary contributor to our rising infection rate. Those most at risk of being infected are our youth and productive workforce.
REGULATION
The power of the Thai model lies in the regulation of condom use in the brothel and, therefore, the prostitutes' ability to negotiate safe sex. In Jamaica, this same approach falters because of our attitudes towards the negotiation of sexual encounters. Ministry of Health statistics indicate that the majority of persons living with AIDS are heterosexual men between the ages of 29-35. Since the group with the fastest rate of new infection is women between the ages of 13-29, we may infer that there may be power inequalities in sexual relationships which seriously limit the negotiation of safe sex by women.
Generally, Jamaican women seem to have a difficulty insisting on condom use or safe sex practices, how much more so when they are 14 and 15 years old in their first sexual encounters. The risk of infection for urban women was twice that of rural women in the 20-24 age group. (MOH HIV/STD Prevention and Control Programme 2005)
This may be attributable to the trend of multiple sex partners among women in that age group and could be why our university students and more young women than we would like to believe are contracting HIV. When we add to that, the 'nuff gyal an gyal inna bungle' message that has been ingrained into our local sexual culture, we may begin to see the underlying issues driving the rapid rise of the HIV infection rate in Jamaica.
UGANDA'S CASE
A 2002 USAID study on the rise and control of HIV/AIDS in Uganda, found that a type of 'social vaccine' was the reason for the dramatic decline in the country's HIV infection rate. Uganda faced a much more staggering rate of infection than Thailand. A reported 50 per cent of the population in the late 1980s early 1990s had been directly impacted by the disease. The majority of new cases contributing to that figure was, as is the case in Jamaica, women between the ages of 13-19. Uganda's 'one in two' statistic became popular and was widely known across the globe.
For Ugandans, however, it was a severe and very real threat to each person's life chances. The president, seeing the potential economic disaster, decided to radically alter the way the public saw the disease and its general attitude towards sex. President Yoweri Museveni chose to unify and order the nation's stance on the battle with HIV. He adopted a full-fledged 'ABC' programme, the method recommended by the WHO. The method entails the combined or targeted use of:
Abstinence/delay of sexual debut.Being faithful to a single partner.Condom use.He, however, established that the priority of the message should be delaying of sexual debut, then abstinence to the youth, fidelity in the marital context, and lastly, condom use in the case of multiple partners. Uganda's comprehensive programme was aimed at changing the way the public viewed not just the disease but the sexual attitudes and practices that were contributing to the country's grave infection rate. This 'social vaccine' was injected into the society as an ordered holistic intervention. Thus, every person who received the message about HIV/AIDS received it in the 'ABC' order.
SEXUAL ATTITUDES
The USAID report points out that social marketing of condoms was significant but not the major contributor to the decrease in rate of HIV incidence. The numbers show an increase in the use of condoms by both men and women, however, nearly all the decline of HIV had already occurred by the time condoms became widely available in 1995. Additionally, consistent and exceedingly high levels of condom usage across all sectors of society would have been necessary to achieve the kind of epidemic level decrease in infection rates that Uganda experienced which was not the case.
The study found that there was an undeniable correlation between changes in sexual attitudes and behaviour and significant decreases in incidence of HIV. In 1994, 60 per cent of youth (ages 13-16) had reported being engaged in some form of sexual activity. By 2001, that number fell to an astonishing five per cent, leading to a phenomenal decrease in the rate of infection and transmission.
The research shows that the most significant factors in the reduction of HIV incidence appeared to be delay in sexual debut, abstinence, a decrease in multiple sex partners (particularly if never married), and limiting sex to the marital context. The percentage of people in Uganda living with HIV fell from 15 per cent in the mid 1990s to five per cent in 2001, and to 4.1 per cent at the end of 2003. (http://www.avert.org/aidsuganda.htm)
Another 2002 USAID study compared HIV/AIDS programmes of several countries including Uganda and Thailand. The report emphasised that there is a clear need for a balance of abstinence, fidelity and condom-use interventions. It also emphasised that approaches should be combined as appropriate based on the local cultural context, as well as the state of the AIDS epidemic in the region.
APPROPRIATE MIX REQUIRED
In many African countries, the epidemic is more generalised and thus requires an appropriate mix of abstinence, fidelity and condom-use approaches. Our story is Uganda's story.
Let us create a message that will communicate to our young girls and teens the real power of abstinence and marital fidelity. Let us give them back the power to protect their own future, to stay alive and to have a life. Let us begin to show how dramatically sexual responsibility can impact the quality of life of our labour force, economy and nation.
The significant commonality in the stories of Thailand and Uganda is that their leaders took a firm position on the issue and fervently chartered the course best suited for their own nation. As HIV/AIDS increasingly becomes a disease that mostly afflicts women, let us urge our new Prime Minister to take a stand.
Laurie-Ann Jackson is a recent graduate of Williams College, Massachusetts, United States, where she majored in political science and international studies.
