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HIV/AIDS related discrimination: A blot on Jamaica ’s record

By Andrea Downer

Jamaica ’s success in controlling HIV/AIDS and meeting the commitments made at the United Nations General Assembly Special Session on HIV/AIDS in 2001 is being marred by persistent stigma and discrimination which abounds in all sectors including health.

“Because of fear of being labelled, and of the negative repercussions if their HIV positive status becomes known, people are not getting tested and they are not seeking treatment,” Lilieth*, a member of the Jamaica Network of Seropositives stated.

Lilieth was diagnosed HIV positive 12 years ago and cites stigma and discrimination as the greatest inhibiting factor to the successful implementation of the UNGASS commitments.

“This denial by the PLWHA drives the epidemic underground and means that the programmes by the Ministry of Health and other agencies that are geared towards PLWHAs are not reaching the targeted population,” she explained.

Lilieth said that sometimes, even people who know their status are in denial and will even refuse to disclose their status to health care providers when they go to seek treatment for opportunistic infections. She said this withholding of information stems from the fear that disclosure of their HIV status will impact on the level of treatment that they receive.

“The fear is valid,” she said, as she has witnessed instances at the one urban hospital where health care workers refused to, or took hours to treat a PLWHA who was critically ill, after the PLWHA disclosed her status.

She said the young woman had undergone a minor surgery and had been sent home, when a complication developed.

“She began bleeding profusely and we rushed her to the hospital. They were in the process of attending to her when she informed them that she was HIV positive. She was told to wait a little until a doctor was located. It was several hours before she was attended to.”

Lilieth recounted another instance in which an HIV positive man was admitted for 17 days at the same public hospital, and health care personnel refused to attend to him for the duration of his stay. He was eventually sent home without even receiving medication.

In a third case at the same hospital, a woman who was HIV positive and too ill to leave her bed, was not given assistance to procure medication from the hospital’s pharmacy, which was on a different floor of the hospital. She was not able to enlist the help of her family members, as she had not told them of her HIV status, out of fear that they would reject her. The PLWHA was only able to get the medication after several days when another PLWHA came to her assistance.

All three incidents occurred within a three-month period, during the first quarter of 2006.

Miriam Maluwa, UNAIDS representative in Jamaica , said stigma and discrimination, which is part of a wider societal problem, is the greatest threat to the achievement of the UNGASS goals.

“As long as stigma and discrimination exist, we will never achieve universal access,” Ms. Maluwa said with strong conviction.

Her views are shared by former Health Minister John Junor, who cited stigma and discrimination as Jamaica ’s greatest challenge in fulfilling the UNGASS commitments and said homophobia is a major part of the problem.

DISCRIMINATION AT WORK

Outside of the health sector, another area of concern is the workplace.

President of the Jamaica Network of Sero-positives (JN+), Marcus* explained that the high level of stigma and discrimination in the general society exists in the work place and that influences how people at work react to co-workers who are HIV positive.

“I think the problem still exists within workplaces, because even though a lot of workplaces may have a policy, they are mostly sleeping policies and until they are tested you will not know how effective they are,” he stated.

Dr. Kevin Harvey, Coordinator of Treatment, Care and Support for PLWHA at the Ministry of Health, says discrimination in the workplace against PLWHA has declined.

“I do not think that happens to a large extent anymore, particularly in the government services. This is mainly due to increased interventions over the past five years in workplace policy especially with the Ministry of Labour and various private sector companies who have developed workplace policies outlining that persons should not be discriminated against for employment because of their HIV status,” Dr. Harvey stated.

However, Director of Targeted Interventions, at the Jamaica AIDS Support for Life, Ian Cruickshank, says he has found that discrimination against PLWHA still exists in the workplace. He said whenever such complaints are brought to the attention of the agency, they would write to companies against whom the complaints are levelled or refer the PLWHA to the Public Defender’s Office for them to access legal assistance.

He noted though, like Dr. Harvey, that the level of discrimination in the workplace has decreased. However, he said while a number of organizations have bought into the workplace policies, it does not always translate into how staff, such as line managers, relate to a PLWHA.

“While persons might not be fired or asked to resign because of their HIV status, sometimes there are still ways in which subtle pressure is exerted to achieve the same result,” he explained.

Chief, Epidemiology & AIDS in the Ministry of Health, and head of the National HIV/AIDS/STI Control Program Dr. Peter Figueroa, said that more effective policies and programs to reduce stigma and discrimination associated with AIDS must be developed.

At present, there is no national legal framework, which specifically protects the rights of the PLWHA or marginalized groups from discrimination. An anti-discriminatory act for PLWHA is in the draft phase and could become law within the next three years. However, no such legal framework has been undertaken for other vulnerable groups.

Dr. Harvey said while specific anti-discriminatory legislation does not exist, there are laws, which can serve to protect the rights of PLWHA until specific legislation is enacted.

“Though we recognize the need to have specific legislation passed in the near future, the national HIV policy, which was recently approved by Parliament, provides a guiding framework for the treatment of persons with HIV. There are several laws, which, protects the general populace from acts of discrimination and victimization, which can be applied to HIV infected individuals.”

John Junor, former, Minister of Health and Parliamentarian does not believe that anti-discriminatory legislation for PLWHAs is the answer to HIV/AIDS related stigma and discrimination.

“I think the route to go is to guarantee rights under your ( Jamaica ’s) constitution. Specific anti-discriminatory legislation for HIV/AIDS would serve to reinforce the stigma and discrimination that we are trying to avoid,” he stated.

Mr. Junor suggests that general legislation on health grounds is what is needed, as, at present there is no legislation that prevents discrimination against persons suffering from other lifestyle diseases such diabetes and hypertension. He said Jamaica ’s Charter of Rights has an anti-discriminatory provision, which he thinks is wide enough to cover the needs of PLWHA.

Archaic laws in Jamaica serve to perpetuate stigma and discrimination to the point where it has put PLWHAs and marginalised groups at serious risk. The Offences Against the Persons Act of 1864, while not technically making homosexuality illegal, outlaws “the abominable act of buggery” and “acts of gross indecency.” Other existing legislation makes transactional sex illegal. Various public figures, including Parliamentary committees, have called for the repeal of buggery laws and the regularisation of commercial sex work. However, these appeals have been countered by strong opposition from a variety of civil society groups. This has helped to ensure that the laws remain firmly in place along with the stigma and discrimination, which they engender.

Experts claim that this and Jamaica’s deeply entrenched homophobic culture affects intervention programmes geared towards men who have sex with men and provides a challenge for agencies such as Jamaica AIDS Support for Life in their attempts to distribute condoms and conduct public safer sex awareness talks publicly with MSM.

Failure to address these issues means that the country has not met the UNGASS commitments in paragraphs 48 and 64 of the DoC which stipulates that “prevention targets that address factors that spread the epidemic and reduce the incidence of HIV among groups with high rates of infection or a high risk of infection, be established by 2003.” 

Other challenges to the success of Jamaica ’s national response, as seen by Dr. Figueroa are:

• The need for GOJ to establish posts for HIV staff in health and other sectors in order to sustain the National Program.

• The need for a strategic plan in the Education Sector to ensure that young people are adequately prepared with life-skills including safe sex education and skills.

• The need to establish one unified authority for AIDS with more autonomy and resources

• Procurement procedures need to be simplified and streamlined and the various financial thresholds increased. A number of measures agreed on in November 2005 have not been implemented.

• Considerable additional resources need to be mobilized to sustain and expand the HIV/AIDS prevention, treatment and social support as well as address significant gaps currently in the program.

 The article above is part of a five country series on the Caribbean ’s HIV/AIDS response since individual governments signed the United Nations General Assembly Special Session on HIV/AIDS Declaration of Commitment in 2001. It is now five years since those promises were made and time to assess the progress made. This is a collaborative effort between Panos Caribbean and The Gleaner Newspaper.