Inter Press Service - October 10, 2001
Zadie Neufville

Estimates of the total population infected with the human immunodeficiency virus (HIV) range between 15,000 and 25,000 people in this northern Caribbean island nation.

Some 40 percent of them are women and those aged 20-39 years are at particular risk, experts say, because of a decline in condom use and the growing prevalence of multiple partners.

According to the health ministry's Lovelette Byfield, condom use among women has fallen from 96 percent in 1996 to 67 percent in the first half of this year and condom use among regular partners has fallen to 38 percent, from 41 percent.

"Many women feel they have steeled down and discontinue use of the condoms because they feel that the condom indicates mistrust,'' she says.

According to Byfield, it is quite common that even while suspecting there is another partner, some women are willing to do without the condom "as long as the man is using one with his 'outside' partners".

The head of the Caribbean Epidemiology Centre (CAREC), C. James Hospidales, says the increase in infections among women also has led to an increase in the numbers of children with the disease. Comprehensive testing of pregnant women is an effective way of tracing the source of infection and preventing transmission, he says, but warns against compulsory testing, which would be a breach of human rights.

"Experience shows that when women understand that if they have the disease they can prevent their children getting it, they are always willing to do the test,'' Hospidales says.

Between 15 and 20 of every 1,000 pregnant women tested here are HIV positive and every week three children die of AIDS. According to epidemology reports since the start of the year, 90 children under the age of 15 have lost either a mother or both parents to the disease.

The north coast and West Kingston section of the capital are of particular concern as infections here continue to increase. Hospidales says poverty, ignorance, and poor socialisation have robbed women of the ability to negotiate condom use. These, he notes, are the same reasons for rising crime. AIDS is the second cause of death among the young here, he adds.

There is growing concern for adolescent females, who in the last three years have become the fastest growing group of new infections. Data from the health ministry show that females aged 10-14 and 15-19 have twice and sometimes three times the rate of infection as boys of the same age groups. A report the joint U.N. programme UNAIDS states that at one surveillance centre for pregnant women, girls in their late teens had almost twice the prevalence rate of older women.

Part of the problem, Byfield says, is unplanned sex and sex between older men and young girls. The health official notes that social factors that include the belief that having sex with a virgin will cure sexually transmitted disease as well as a "breakdown in the moral values" that causes many to exchange sex for material gain is fuelling infections.

Last year, a UNAIDS report recommended the examination of the young girl/older man relationship particularly because "in many countries of the Caribbean the hidden story is rape, incest, domestic violence and 'sugar daddies'." The last term is a reference to older men on whom younger women come to rely for material needs, often basic, and who extract sex in return for financial support.

The National AIDS Committee's Verity Rushton says research on women and HIV/AIDS is needed to determine the trends and their root causes. ''It is a growing trend that more young females are being infected by older men but there is no research on why they are having relationships with these men," she says.

The Caribbean Group for Cooperation in Economic Development, in a recent report, noted, "women are economically and emotionally dependent and are expected to defer to the male demands and decision-making." This, Rushton says, means women often can't refuse unwanted sex or insist that their partner use a condom.

Hospadales insists, "We have to tell them to abstain and if they can't then they should use a condom.'' He admits, however, that this message - sustained since the health ministry first reported the disease in 1982 - has run up against "resistant sections of the population".

He also warns that employers who subject job seekers to mandatory HIV tests are pushing the problem underground, as are homophobia and discrimination. Preventing transmission here will save 500 to 700 lives a year, Hospadales says. Given the region's and Jamaica's success in eliminating measles, polio, and other common childhood diseases, he says there is ample experience and ability to bring AIDS under control.

According to the U.N. Fund for Women (UNIFEM), last year 1.3 million women worldwide died of AIDS and 16.4 million were living with the virus.

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