In terms of global HIV prevalence rates, the Caribbean region ranks second only to sub-Saharan Africa. Approximately 230,000 people are living with HIV and AIDS in the Caribbean. And in some places — like Haiti and the Bahamas — AIDS remains one of the leading causes of death.
Daljit Dhaliwal sits down with Julia Greenberg, the associate director of AIDS-Free World, a global advocacy group tackling HIV/AIDS. They place Jamaica’s AIDS epidemic within the context of the Caribbean region, address anti-sodomy laws in Jamaica and around the world and identify the successes and shortcomings Jamaica has experienced in containing the epidemic.
Daljit and Julia also look at the role women play in the epidemic. Women make up half of the adults living with the virus in the Caribbean, and are infected by “bridging populations” — bi-sexual men who are leading double lives. Julia raises the possibility of linking women’s rights with gay rights to tackle the spread of the epidemic.
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Daljit Dhaliwal: Hello, I’m Daljit Dhaliwal of Worldfocus, and joining me now is Julia Greenberg. She is the associate director of AIDS-Free World, a global advocacy group tackling HIV and AIDS, and she responsible for the Caribbean region. Julia, thank you very much for joining us.
Julia Greenberg: I’m delighted to be here.
Daljit Dhaliwal: So, give us some background on AIDS and HIV in the Caribbean, especially in Jamaica. Start off with that. What are the rates of infection and what are the trends that we are seeing?
Julia Greenberg: Sure. I think the most important thing to know is that in the general population the HIV prevalence rate is 1.6 percent. But if you look at the population of men having sex with men — the gay community — that prevalence rate soars to 31.1 percent.
Daljit Dhaliwal: And what is being done about trying to reach out to these groups and to try and educate them about HIV and AIDS, and to come up with preventative measures?
Julia Greenberg: Well, I think you have to step back when you look at the issue when it comes to men who have sex with men in Jamaica and look at the terrible culture of homophobia that is pervasive throughout the country. So there is a sodomy law — gay men’s lives are criminalized. So, in one of the segments thatWorldfocus aired earlier this week, in fact, there was a gay man who said, “AIDS is not killing us, people are killing us” referring to the very high murder rates of gay men in Jamaica.
Daljit Dhaliwal: Do you think it would make a difference if these laws around sodomy were decriminalized in Jamaica?
Julia Greenberg: I think it would be part of making a difference. I think we have to attack it several different ways. One is definitely getting rid of this sodomy law, which criminalizes sex between men. So if you’re going to do effective prevention for the population most affected by AIDS in Jamaica you would have to actually talk about the kind of sex that they engage in, and you can’t do that because that kind of sex is against the law.
Daljit Dhaliwal: And in terms of the big picture in Jamaica and in other parts of the Caribbean, do you think in the discussion of HIV and AIDS that we are moving away from treatment to prevention, or not?
Julia Greenberg: Well, I think the Caribbean is a perfect example of why we have to do both. So let’s look at treatment for a second. Jamaica has 43 percent coverage rates. So, 43 percent of the people who need AIDS treatment to extend their lives right now are getting it. Then, if you look at the prevention picture overall in the Caribbean, for every five (5) people put on treatment, 10 are newly infected. So we’re swimming against the tide. And it’s my opinion and I think the growing understanding in the AIDS movement that if you want to effectively deal with prevention, you have to deal with the concentrated epidemics among men who have sex with men, sex workers and in some regions drug users.
Daljit Dhaliwal: Right, and these trends that you’re talking about in Jamaica, do they also reflect a pattern in other parts of the Caribbean or is it too much to generalize? As far as you can generalize, what would you say is going on?
Julia Greenberg: They absolutely reflect a trend. If you look at Trinidad and Tobago, the prevalence rate is 1.5 in the general population and it’s 20 percent among men who have sex with men. In the Dominican Republic, for instance, where there isn’t a sodomy law, I believe the general prevalence rate is 1.1, and it is 11 percent in the gay population. So, it’s less than of a divide and maybe that speaks about the criminalization of gay men’s lives. But the trends are absolutely across the board similar.
Daljit Dhaliwal: In terms of Jamaica’s anti-sodomy laws, they would say, “Why is Jamaica always having the finger pointed as us? There are other countries around the world that also have anti-sodomy laws?” What would you say to them?
Julia Greenberg: I would say that’s true. I think there are about 80 countries around the world with sodomy laws or some kind of laws that criminalize relationships between men or relationships between women and women. And I think that’s really important. Look at the United States — it was only in 2003 that our Supreme Court ruling essentially nullified all state sodomy laws. So, that’s true. I would point to the recent Human Rights Watch report on the militia-sponsored attacks against gay men in Iraq. It would make your blood turn cold to read these reports. So, it’s a problem all over the world, absolutely. But the quality of the violence in Jamaica is quite stark. In fact, there are immigration lawyers here in the U.S. working with asylum seekers from Jamaica and they say that across the board, the quality of attacks is extreme, and, in fact, it makes it easier for them to win cases because of the nature of the violence perpetrated against the gay community there.
Daljit Dhaliwal: Is there some insight you can give us as to why this culture of homophobia is so pervasive in Jamaica, say, compared to other parts of the world? Are there cultural factors that make it that way?
Julia Greenberg: The story that is important to understand and tell, but is really difficult to face in Jamaica is that the prevalence is so high in the gay community and stigma is so strong, that gay men are getting married or having female partners and they’re acting as a bridging population to the heterosexual community, and specifically women. And that’s not something that’s discussed. It’s a very difficult issue to discuss again because of the culture of homophobia, but also because it feeds into homophobia. So then, the homophobic elements in the culture can say, “See these gay men are infecting our innocent women.” And, obviously, that’s not the picture.
Daljit Dhaliwal: And what role is Jamaica’s government playing? Could it be doing more? Is it doing what it can do with the money and resources it has available within its widerhealth care budget?
Julia Greenberg: Well I’ll break it down again between the government and the Ministry of Health. So the government has said some terrible things about how they’ll never repeal the sodomy law, the prime minister has said he’ll never have a gay man in his cabinet. So there is a lot being done at the highest levels of government to fuel homophobia. And when homophobia is fueled, you’re not going to, again, contain the AIDS crisis. The Ministry of Health is another story. They’ve recognized that they’re not going to get their job done unless they deal with the epidemic among men who have sex with men.
Again, if I might refer again to one of the Worldfocus segments, the former head of the national AIDS control program said, “It would be good if we could repeal the sodomy, and that the entire government and Ministry of Health needs to understand that they’ve failed when it comes to prevention.”
Daljit Dhaliwal: Is it a political issue for the Jamaican government that they don’t want to decriminalize or repeal the sodomy law, or is it more to do with this culture of homophobia, which you’ve been describing?
Julia Greenberg: I think it’s really integrated and complex. I think it’s a political issue because it really is ingrained in the culture and the society and there would not be popular support for such a move.
Daljit Dhaliwal: Give us a sense of what Jamaica has done — the kind of progress that it has made. And give us some context about the antiretroviral drugs, which have been provided by Jamaica, which are free, whether they are accessed or not accessed by individuals.
Julia Greenberg: There’s been an increase in the uptake of antriretroviral drugs in Jamaica. And it’s fantastic that they’re given for free. They are now achieving 43 percent coverage of people who need the treatment. But it’s important to state that the global community — the heads of state, the U.N. — have all said that universal access must be achieved by 2010. We’re about a third of the way there, and Jamaica is only a little ahead of the curve.
Daljit Dhaliwal: Is Jamaica unique in using community liaison groups and individuals like Ida, the woman that we saw in our film, in terms of educating communities and trying to reduce the stigma around HIV and AIDS?
Julia Greenberg: I wouldn’t say they’re unique. I think it’s been generally understood because of activism in the global AIDS advocacy community, that communities have to be involved in every aspect of AIDS prevention and support. So, governments are actually required to have communities involved in all of their programs. It seems to me that the Jamaica program is quite strong. The parish AIDS communities seem to be doing really great work. And you see communities adhering to their drug regimens and really absorbing prevention messages when they’re working with community leaders such as Ida.
Daljit Dhaliwal: Give us some examples of the kind of grassroots campaigns that these activists are involved in. And can you share some of the strategies that they are using, which perhaps have or haven’t worked, or you feel you can make better?
Julia Greenberg: To say grassroots campaigns is to overstate it because the lesbian, gay, transgender community in Jamaica has to basically exist underground. Again, as one of the excellent segments you aired shows, if you so much as embrace in public you’re at risk of being attacked by a mob. So, the kind of work the gay community is doing is underground, it involves speaking out when the government or the church says something egregious about the lives of homosexuals and how they should be criminalized, how they’re an abomination in the eyes of the lord.
Daljit Dhaliwal: So what is the best way of tackling that?
Julia Greenberg: Tackling that? I think one of the most important ways is finding leaders within the culture, in the church, in the communities — where you can find an opening. Where they’re willing at least to say that it is not OK to beat or kill gay people. And start working with them to see if they can begin to take a leadership role in making changes.
Daljit Dhaliwal: Let’s talk a little bit about how women are being infected by these “bridging” populations and the way in which they access treatment. Does it happen along gender lines that they have difficulty accessing treatment? Or, are they more stigmatized as a group if they become infected? What is the role of women in HIV and AIDS in Jamaica?
Julia Greenberg: Again, it’s another complex picture. When I was there last February I had the opportunity to meet with a group of HIV positive women at the office of an excellent organization called Jamaica AIDS Support. And these women, I have to say, after spending 10 years working in sub-Saharan Africa in some of the poorest communities in the world, there was no difference between the lives of these women and lives of the women that I met in my work and my travels in Africa. The stigma is intense. The poverty is intense. They’re not able to stay on their drugs for lack of food. They’re not able to get to the clinics for lack of transportation.
Daljit Dhaliwal: Right, and what kind of role can these women play in helping to lessen the epidemic?
Julia Greenberg: I’ve talked to a lot of activists about this — how can we get the gay community and the women’s rights community together talking about this issue. And it’s not happening yet. It really needs to happen. There needs to be an understanding that both communities are affected and they’re in it together.
Daljit Dhaliwal: There is also a culture of blame, as well.
Julia Greenberg: There is a culture of blame.
Daljit Dhaliwal: How do you get beyond those very, very emotional issues when a women becomes infected by a man she thought was straight, and it turns out he’s bisexual or he’s gay? How do you have those conversations?
Julia Greenberg: I don’t think those conversations as far as I understand — they may very well be happening at a personal level, but they’re not happening at a national level or even an organizational level, among the organizations that are working on this issue. It’s really, really tough.
Daljit Dhaliwal: Alright, Julia Greenberg, thank you for talking to us and giving your insights.
Julia Greenberg: A pleasure to be here, thank you.
Lisa Biagiotti produced this interview.
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