Editorial =
A Symptom of Being Marginalized
Can the marginalization of groups such as men who have sex with men (MSM) serve as a causative factor to being most at-risk of or vulnerable to HIV infection? And if so, which types of HIV prevention strategies and activities are best for these populations, where legislature and national polices condemn and exclude the needs and rights of same sex / gender populations?
At a recent consultation meeting held in Barbados in June 2008, the Caribbean Vulnerable Communities Coalition (CVCC) proposed the question of HIV being a symptom of being marginalized, to a number of regional stakeholders possibly able to best reach men who have sex with men (MSM) in the Eastern Caribbean States OECS), Guyana and Trinidad.
Some identified key issues faced by regional MSM are: Confidentiality breeches at HIV Testing facilities; accessing HIV Treatment; discriminatory attitudes and behaviours of health care providers; legislature and national policy; messages promoted by the media and religious institutions; homophobic violence in lyrics of some Dancehall music; lack of community-specific support projects; and diversity amongst MSM. For many MSM living in the Caribbean, HIV is still considered a death sentence.
The CVCC appealed to the groups to consider strategies and activities to address these issues, other than ‘just giving out condoms and lubricants’, and take into consideration the issues of personal and physical safety, access to health care, attitude of the media and attitude of religious institutions.
Whilst efforts in scaling-up prevention, treatment and care projects throughout the region to include and reach groups marginalized, for many there is more talk than implementation occurring in the field and on the ground. Prevention resources are not proportionally allocated to reach these affected populations. To date there are only a few or limited number of funded projects. This gap results in significant numbers of persons and populations not being reached or excluded for various reasons.
“Men who have sex with men are at the heart of the HIV epidemic throughout the world, yet they remain invisible. It is because of denial, stigma, and violence that permeate societies and their governments on every continent”, reports Bob Roehr of the Windy City Times covering the conference on MSM and HIV in Mexico City, prior to the XVII International AIDS Conference.
"What we are seeing today in Asia, in every single major city that we have looked at, are epidemics of HIV of men who have sex with men that remind me of what we saw in the US, and Western Europe, and Australia in the 1980s," said Peter Piot, executive director of UNAIDS. Modelling suggests that by 2020, half of all new infections in Asia will be among MSM. But the response with targeted prevention "is not there at all." Piot pointed to "homophobia in all its forms" as "one of the top five obstacles to really stopping this epidemic."
The message to the Caribbean in the UNAIDS 2007 report stated,” Even more significant than the new infections and reality of people dying in large numbers is the inability of Caribbean societies to counter high prevalence rates amongst populations at high risk for contracting the virus: Men who have sex with men, Sex Workers, Young Females and groups such as prisoners and those living in conditions of abject poverty.”
Acting Director of UNAIDS in the Caribbean, Dr Michel de Groulard, noted that the prevalence rate amongst these groups is 20 times as high as in the rest of the population.
This is not to say that efforts have not been or are being made by MSM in our region, but it has been problematic and a great uphill struggle. In 1997 a group of regional individuals called CFLAG came together to address the need to manage in-community initiatives for and by MSM. Organisations such as JFLAG and JAS in Jamaica, UGLAAB in Barbados and the M4M Chatroom project in Trinidad (now referred to as the Friends for Life community support group) existed a number of years prior to what we at FRee FORUM call the big MSM bang.
The MSM big bang refers to a big push to synergise a second wave of projects targeting MSM in the Caribbean in 2003. Unfortunately, this regional initiative was short lived with relative funding to these groups lasting for 2 - 3 years, and thwarted by the agency’s governing institutional polices and controls, limited human resource management and cultural and environmental understanding of the needs of its partner stakeholders.
This is not to say that there weren’t varying issues with some of the partner groups. One of the significant lessons to be learnt from this is the importance to have a greater understanding of needs and limitations of those marginalized, expected to work amongst the marginalized.
Despite efforts, there was a significant deficit of technical assistance and mentoring support to these ‘specialised’ groups and or individuals. Overlooked was the understanding that as there is the need for different strategies and approaches outside of the box to reach the marginalized, equally so are the technical needs and capacity building requirements for those who can best reach them.
Another critical issue was the availability to commit to managing projects. Many of the interested already possessed jobs and mobilizing in-country groups to design, manage and conduct after-hours projects proved as challenging as implementing their projects. For many in the smaller islands especially in the OECS, engaging in such activities posed a threat to their personal safety, well being and job security.
Additionally, there was a need to provide on-going technical assistance and training for new candidates and build on establishing resource pools, as there seems and continues to be a rapid turnover or fall-out of in-country stakeholders.
To date there are less than a handful of groups that have survived or been able to sustain their projects. Sadly for the majority, the experience was viewed as dysfunctional, leaving behind a wake of confusion, animosity and anger.
With an understanding that most if not all national HIV campaigns do not affect or reach groups who exist on the fringes of civil society, understanding that each territory may require a unique or specialized project, and stakeholder groups may require specialised support or mentoring - the CVCC’s intention is to re-energise interests amongst these groups, build on the successes and challenges of the recent past, and introduce new grassroots intervention projects amongst regional MSM populations, by the end of 2008. It intends to do so through the support of amfAR with the provision of a number of small grants.
The CVCC is a coalition of organisations and individuals working in rights-based HIV prevention, care, treatment and support in the Creole, Dutch, English, French and Spanish speaking Caribbean, from Belize in the northwest to Suriname in the southeast. It was formed at a meeting of civil society groups from around the region held in Jamaica in December, 2004. The organisation’s formation arose from the need to fill a gap in the regional response to the HIV epidemic. That gap relates to diminishing the susceptibility of certain populations to HIV as well as to the inclusion of persons living with HIV and AIDS from those populations into culturally appropriate and accessible care, treatment and support programmes.
These populations include sex workers, substance users, inmates, men who have sex with men, mobile populations, youth in difficult circumstances, orphans and other children placed at increased social risk by HIV and AIDS.
For more on the CVCC go to: http://www.cvccoalition.org