Size matters! HIV prevention in small island states
30 June 2006
What is life like for community groups in very small countries? We visited St Vincent and the Grenadines, St Kitts, and Antigua in the East Caribbean, countries with small populations spread over a number of islands, where eleven community animators have recently been recruited as part of a USAID-funded Alliance project to carry out peer-to-peer prevention activities with hard-to-reach populations.
Sarah works mainly with sex workers and Jon 1 with gay and bisexual men. They tell us more about their work and the challenges and successes so far.
Sarah
“Sex work is very hidden here. There are no brothels – the town is too small for that. Sometimes two or three of the girls share an apartment, but most work on their own. Once I got started, it wasn’t too difficult to reach the girls. I spoke to one girl and we talked about safe sex. She then gave me phone numbers of friends, and that way I am getting to know more and more.
“You have to respect them; no one has an easy life. One woman I spoke to has two children. Her husband left her last year. She said to me, ‘I have no choice now but to have two or three men’. She sells sex to put her son through primary school and pay the bus fare for her daughter to get to her secondary school. She said to me ‘I don’t know if what I’m doing is right, but I have no choice’.
“This work really opens your eyes. In some colleges, a teacher has said to the parents – send your daughter to me for private lessons and extra homework. But it’s not homework she gets. A neighbourhood finds out and the girl’s reputation is ruined.
“I tell the girls about testing. There are two places in the country where you can get an HIV test – the central hospital or a private doctor. No one trusts the confidentiality at the hospital – the anonymous code is your initials and date of birth. In a country as small as this, it identifies you right out. Well-established people will fly to Miami for a test, that’s the only way to guarantee confidentiality.”
Jon
“I work with bisexual men. There’s no out gay community here. You can be beaten up or killed in the Caribbean if a crowd thinks you’re gay. Growing up in a community like this, image is everything. Even if you want to live a certain lifestyle you daren’t, so there’s lots of men ‘on the down-low’ – bisexual or men who have sex with men (MSM).
“Lots of teenagers are pressured to have sex with older men. They’re uncertain but have no one they can talk to. That’s where we come in. These lads can’t tell their parents about their sexuality. If they did, their parents would beat them, hoping this will eradicate their thoughts on homosexual acts.
“Billboards and adverts have little effect here. The TV spots are on the local channel but everyone who can watches cable TV from the USA. Most people get their information by word of mouth. So myths are passed on. It’s our job to make sure the information passed around is accurate. A billboard doesn’t change people’s behaviour. For example most men know about condoms now, but they open the packet with their teeth in the heat of the moment. Then of course the condom breaks, and they tell their friends. We distribute condoms, and work closely with PSI animators, to make sure people not only get condoms but know how to use them.
“The Ministry of Health has an HIV programme, but most of the staff are married women. Married Christian women too. They don’t know much about the MSM guys. You have to be on their level, use the slang, the jargon they use. Mainstream health talks don’t have much effect, they’re boring. You have to be innovative.
“I was outside a barbershop last week chatting to some guys. That’s where they go to lime (hang out) before a night of action. The owner of the shop brought the staff out to listen to the conversation. He wanted them to listen and understand issues and concerns about HIV and AIDS. In fact, shopkeepers are pretty good. That’s how information circulates, around the streets – we have to make sure the information is correct.”
Sarah
“We have two other animators who are living positive. Sometimes we go into colleges to speak to students. I was talking to some women about HIV at a bus stop and suddenly these girls from the school started joining in. It was great; they practically took over the conversation. They knew all about it and were explaining it to the older women. I wasn’t needed. That made me feel really good.”
1 Not their real names
