No local HIV hotspot, but officials eye rise in Clarendon, Westmoreland
Relationship power imbalance driving up rates
While there is no HIV hotspot in the country as the sexually transmitted infection is present in communities across the island, the heath ministry has said that, because of the population density in town centres, new cases are most likely to pop up...
While there is no HIV hotspot in the country as the sexually transmitted infection is present in communities across the island, the heath ministry has said that, because of the population density in town centres, new cases are most likely to pop up in Kingston and St Andrew as well as St Catherine.
In the tourism belt, St Ann and St James stand out, but Westmoreland and Clarendon in particular are now emerging as new places where HIV cases are on the increase, according to Dr Alisha Robb-Allen, senior director (acting) of the HIV/STI Unit in the health ministry.
All parishes are on the ministry’s radar and using its data-driven programme to track and record these changes in real time. The HIV/STI Unit responds by channelling resources to those areas to lessen the spread.
The response to a rural parish such as St Elizabeth would be different than in an urban setting, Robb-Allen further explained.
“So our teams on the ground develop their plans, their activities to fit the population they are serving. So we know St Elizabeth is a farming parish and the team in the southern region has tailored some of their responses to meet the farmers where they are at, so we can have a greater uptake in terms of our outreach services and our prevention services,” she told a recent Gleaner Editors’ Forum ahead of the December 1 observance of World AIDS Day.
HIGH RISK FOR SPOUSES
Among the persons most at risk of getting infected across the island – not because of their own lifestyles but that of their promiscuous partners – are married women and common-law wives in established relationships.
Robb-Allen said that this was supported by their prevalence studies done in 2017/2018, which also showed the highest prevalence of HIV transmission among the transgender population and men who have sex with men.
“In 2018, we did also have a pop-up group of women, who we termed them low-risk women because they weren’t female sex workers or women who had multiple partners, but were obviously partners of somebody who was positive based on the risk profile of their partner,” said Robb-Allen.
Jamaica AIDS Support for Life Executive Director Kandasi Levermore said that the risk for these women is deep-rooted and grounded in the hypocrisy of Jamaica’s patriarchal society, which prevents them from insisting on the use of condoms when they have intercourse with their stable – and usually only – sexual partner.
“We are talking about issues around economic independence, family and children. Whether I am going to get one or two box (slap to the face). You have to be realistic [because] that’s the country that we are living in, where there is no equity in relationships. So these things will always come back on the table around equality, gender equality: how are we addressing issues around gender-based violence? Who is the powerful person in the relationship? Who is making the money? Who run round them house and who run them house?” she told the forum.
Robb-Allen believes the problem lies in the education and empowerment of people in Jamaica, pointing out that some married women may not think they are at risk because their current sexual partner has been their only one since – or even before – marriage.
“If there isn’t the empowerment of a woman to say that there is the possibility that my partner may not be who I think my partner is, then I will never bring up the argument of a condom. I will never discuss condom use because I may be low risk, but my partner may be high risk because of his behaviour. Those are the conversations that partners need to have, and people need to be empowered to have those conversations so they can better know how to navigate their sexual practices,” she said.
The power dynamic at work here is cross-cutting along the lines of gender, gender equality and gender-based violence as it relates to HIV and AIDS, according to Levermore.
“In a lot of instances, women are not necessarily as empowered as they could be to make those kinds of demands on our men to say, ‘I am not doing it if you don’t use a condom’,” she told the forum.
Meanwhile, with a 2020 survey showing that more than 16,000 persons are getting their antiretroviral medication on a regular basis, some 9,000 are still yet to get on treatment, a worrying situation for the health ministry.
“It is a cause for worry; hence, the reason why we need persons to come into care, for them to understand that there is more to a diagnosis of HIV – a life after diagnosis in which there is treatment available and (they) can continue to live in a better setting with HIV,” said Levermore.
“So it is a cause for concern and that’s why stigma and discrimination have to be addressed. That’s why we have to have the education out there and we have to have the persons out there who are spreading the correct message around HIV,” she said.