The Caribbean region, which has the second highest HIV/AIDS prevalence rate in the world, faces various common problems which necessitate the need to address HIV/AIDS collectively via a common front. The fact that resources are limited, coupled with rampant poverty, has served to derail efforts to curb the spread of HIV/AIDS. Although various international organizations, such as Pan Caribbean Partnership against HIV/AIDS (PANCAP), have been established, various hurdles are still evident which have largely slowed down the achievement of any tangible progress. This literature review analyses various important studies carried out in the Caribbean region about stigma and discrimination against persons living with HIV/AIDS (PLWHAs). In addition, it adds to the burgeoning literature about PLWHAs in the Caribbean region, which serves to highlight their plight and the need for immediate action.
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Stigma and discrimination have since time immemorial been subjected more on a particular group rather than equally among persons living with, or affected by HIV/AIDS. Rutledge et al. (2009) have summarized stigma and discrimination faced by PLWHAs in Eastern Caribbean, which comprises of countries such as Trinidad & Tobago and Grenada. The study, aimed at evaluating how PLWHAs were discriminated against in the medical services and healthcare sectors, was carried out on ‘eight focus groups’ with a total of 51 respondents living with HIV/AIDS, affected families and healthcare providers. It was found out that PLWHAs were branded as ‘physically contagious and socially deviant,’ which led to discrimination and maltreatment by healthcare providers and medical personnel. Practices that propagated stigma and discrimination were more so pronounced if such persons were regarded as ‘gay or bisexual.’ Hospital employees were reluctant to attend to such persons and privacy and confidentiality as to their status was disregarded.
The Caribbean region, which consists of multiple islands, is culturally diverse and encompasses various religions. Over 40 million persons, mainly of African and Indian ancestry live in approximately 1000 islands. In the recent past, a number of devastating epidemics, such as HIV/AIDS, have occurred. The large populations and poor infrastructure have undermined any tangible efforts to survey and control such epidemics. Notably, religion, which promotes ‘social conservatism,’ has greatly impeded efforts to salvage the situation. Although heterosexual sex has resulted in the highest cases of transmission, there are a large number of cases whereby persons have been infected via ways considered as ‘socially unacceptable,’ such as men who have sex with men (MSM) and bisexuals. Such groups have been completely neglected and discriminated against. ‘Widespread homophobia, anti-gay violence and criminalization of homosexuality’ are common discriminatory practices in the region.
Similar sentiments have been echoed by Arregui (2007), who observes that stigma and discrimination does not affect various groups equally, rather, there are existing prejudices against certain groups. This study was conducted in the Dominican Republic and found out that PLWHAs ‘do not receive adequate health services and the protection of their right to employment.’ Those interviewed in every community included persons living with HIV/AIDS, or were affected either in their families or work environment. So as to avoid bias, a cross-cultural approach was adopted, such that those interviewed were from different work contexts and backgrounds.
There were various indispensable findings derived from this study. First, it was observed that stigma and discrimination were meted out to different groups in different measures. There are ‘existing prejudices and rejection’ associated with different groups. ‘Threatening people,’ such as Haitians, gay persons and prostitutes, were identified and classified as social transgressors. Therefore, these groups were most stigmatized and discriminated against. On the other hand, heterosexuals and children were less stigmatized although they were not totally exempt from discrimination and maltreatment. ‘Racism and xenophobia’ was at the heart of Haitian immigrants’ stigmatization in the Dominican Republic. The anti-Haitian prejudices and homophobia mainly stem from the fact that HIV was first associated with gay persons from Haiti. Children are least stigmatized since they are known to have been vertically infected unlike women who are perceived to have been infected due to their own promiscuity.
Secondly, cultural contexts and traditions have served to perpetuate stigma and discrimination among couples living in the Dominican Republic. The existing power differences between men and women, and the cultural perception of love, whereby the man is viewed as dominant in a relationship and should be pleased at all costs, have served to discriminate against women in heterosexual couples. Women are treated as inferior to men. In some instances, women were unable to approach their husbands so as to persuade them to visit a testing centre, even after being advised by a medical practitioner. In such cases, they opted to save their marriages instead of saving their lives. In other cases, women chose to re-marry without informing their new partners, even after knowing that they were infected. Arregui attributes this to the fact that they have to face ‘accusations of being prostitutes, unfaithful, and other things that our chauvinistic society permits to men.’
Religion and societal norms have weighed heavily against gay persons in comparison to any other group. White & Carr (2007), in their study among homosexuals in Jamaica, found out that stigma and discrimination are more harshly meted out to gay persons, unlike any other group living with HIV/AIDS. By use of focus groups, interviewees and ethnography, data was gathered on 33 adults who included healthcare providers, those living with HIV/AIDS and persons with same sex partners. The study found a close co-relation between homophobia and PLWHAs, though this varied with ‘class, gender and race.’ Therefore, among those groups considered as sexually defiant, such as homosexuals, sex workers and intravenous drug users, homosexuals were most stigmatized and discriminated against. The study clearly showed the need to address homophobia and its relation to HIV/AIDS in addition to educating health professionals and service providers.
Stigma and discrimination have also cut across education and professionalism. Despite having a host of information and data at their disposal, the elite have held on to stigmatizing and discriminatory practices, which are more pronounced towards those groups that are seen as negating the social norms. A study by Norman & Carr (2005) among university students in Jamaica showed that that little sympathy and tolerance was extended to those living or affected by HIV/AIDS. In this survey, data was collected from 1252 students through questionnaires so as to analyze their attitudes, knowledge and behavior towards PLWHAs in school and workplaces.
There were two major observations. First, ‘sympathetic attitudes’ and tolerance were least extended to gay persons (41% of the respondents) and female prostitutes (44%). On the other hand, majority of the students were sympathetic towards the plight of heterosexual males (67%) and ‘non-prostitute females’ (81%). Secondly, the study showed that PLWHAs are treated differently in different professions. Majority of the students stated that PLWHAs ‘should be allowed to teach’ (80%) and in the case of children, be allowed to attend school (62%). However, few students felt that nurses living with HIV/AIDS should be allowed to work (36%).
This reinforces the fact that ‘sexual stigma’ is widely practiced in Jamaica, and more so in the Caribbean region, which has been attributed to the strong religious and cultural values. Those seen to have been infected due to ‘immorality’ or ‘improper behavior’ have been less embraced by the society. Children are least discriminated against, since they are perceived as ‘sexually innocent.’
Therefore, there is a need to approach stigma and discrimination against persons living with HIV/AIDS not only through education but also from a cultural approach. As this literature review has shown, culture influences people’s perceptions and attitudes towards a particular situation. It forms the baseline that leads to the origin of myths and their consequent acceptance. Although different societies have different views as to various issues, there is a common view as to what is considered morally right or wrong. For instance, homosexuals, female prostitutes and intravenous drug users are frowned upon in any given society. If campaigns against stigma and discrimination are to be successful, people’s attitudes and perceptions towards HIV/AIDS need to be addressed.