Outspoken artist Edison Liburd, in St. John's, Antigua. Credit: Desmond Brown/IPS

By Desmond Brown
ST. JOHN'S, Antigua, Feb 10 2015 (IPS)

At 49 years old, Edison Liburd has established himself as one of Antigua and Barbuda’s most recognisable artists. But Liburd was not always in the spotlight. In fact, you could say he was a man in hiding.

“I have been infected with the HIV virus for about 24 years. I got my first HIV test done in February of 1993 at the Allen Pavilion Hospital in Manhattan New York,” Liburd told IPS."Equity and social justice are very important as we respond to the HIV/AIDS epidemic. HIV is as much a social and developmental disease as a medical one." -- Eleanor Frederick

“I can remember that day vividly. I felt like the earth had been removed from beneath me when I was handed the results of the test.”

HIV/AIDS first emerged in the 1980s, and now, more than three decades later, stigma associated with the disease has persisted. Liburd pointed to that sigma as the main reason why he concealed his HIV status for as long as he did.

“I hid my status for years from family. I told a few friends, but most people who I knew did not know anything about my health condition. It was fear of being ostracised that kept me from disclosing my status,” he said.

“In Antigua, HIV infected individuals still have to face job insecurity – first to be fired and last to be hired. Stigma and discrimination is still high because many still think themselves superior to individuals who are infected.

“Somehow they think themselves better than, but I believe that it is when infected individuals become empowered by taking hold of their health and indispensable to nation building that this will take a huge bite out of discrimination. People will begin to see you differently,” Liburd said.

The Caribbean is one of the most heavily affected regions in the world, with adult HIV prevalence about one percent higher than in any other region outside sub-Saharan Africa.

The HIV pandemic in the Caribbean is fuelled by a range of social and economic inequalities and is sustained by high levels of stigma, discrimination against the most at-risk and marginalised populations and persistent gender inequality, violence and homophobia.

HIV in the Caribbean is mostly concentrated in and around networks of men who have sex with men. Social stigma, however, has kept the epidemic among men who have sex with men hidden and unacknowledged. There is also a notable burden of infection among injecting drug users, sex workers and the clients of sex workers.

The main mode of transmission in the Caribbean is unprotected heterosexual intercourse – paid or otherwise. Sex between men is also thought to be a significant factor in several countries, although due to social stigma, this is mainly denied.

The level of stigma and discrimination suffered by those infected and affected by the virus in the Caribbean helps drive the epidemic underground. This makes it difficult to reach many groups.

After facing the worst of his fears, being hospitalised and getting close to death’s door, Liburd has “resolved to fight back against the discrimination by increasing my capacity to help others in every way through my gift of art and my voice on and in the media, in church and otherwise.

“This has really been a powerhouse for me. I have become more confident and bold when faced with opposition. It has and is still more than ever being a source of inspiration and encouragement for many who hear my story, both infected and non-infected alike.”

Executive director of the Antigua and Barbuda HIV/AIDS Network (ABHAN), Eleanor Frederick, said individuals living with HIV face many challenges such as unemployment, homelessness, and in some cases, they are abandoned by their families.

She said there are also other issues that are faced by some individuals “such as stigma, discrimination, resource shortage and social marginalisation” depending on the community with which they identify such as sexuality, gender, commercial sex workers, men who have sex with men, drug users and prisoners.

“Many individuals are reluctant to start treatment because of the myths and stories about HIV and AIDS,” Frederick told IPS. “Healthcare providers, peers and treatment navigators can help individuals to understand, the barriers and how to overcome them.”

ABHAN has a Peer/Buddy HIV Treatment Adherence Programmme which recruits, monitors and retains patients into treatment and care and ensures that they adhere to their treatment regimen. It also delivers a comprehensive package of services, including case management, leading to decreased risky sexual behaviour, improved immune system functioning, and general health improvement.

“The programme provides direct support services by specially trained ABHAN and American University of Antigua Medical School (AUA) student volunteers, in the form of social interaction, emotional support, monitoring of medication adherence, and facilitation of health care concerns to persons living with HIV and AIDS, and to members of their families,” Frederick told IPS.

At the country level, she said while there is legislation which specifically addresses the treatment of employees living with HIV/AIDS, it is not always followed.

“A pilot programme was undertaken in 2012. The intention was to encourage the implementation and observance of the standards set out in the International Labour Organisation (ILO) code of practice on HIV/AIDS and the world of work, the ILO Recommendation No. 200 as well as the National Tripartite Workplace Policy on HIV and AIDS in Antigua and Barbuda; based on the universal human rights standards applicable to HIV and the world of work,” Frederick explained.

“Individuals have lost their jobs because of their HIV status and others have been asked to take an HIV test when it was suspected that they were possibly infected.”

The ABHAN executive director said HIV should be everyone’s concern, because “HIV does not discriminate, and knows no borders.”

She added that “equity and social justice are very important as we respond to the HIV/AIDS epidemic. HIV is as much a social and developmental disease as a medical one.

“Therefore, I would like to encourage everyone to help improve the quality of life for people with HIV and AIDS and increase compassion for them and their loved ones by providing vital human services for those in need of it based on a philosophy of non-judgmental support as practiced by ABHAN.”

Edited by Kitty Stapp

Zimbabwe has criminalised gay relationships, striking fear into the hearts of many gays like these two walking side by side in the country’s capital, because they are being left out in strategies to combat HIV/AIDS. Credit: Jeffrey Moyo

By Jeffrey Moyo
HARARE, Dec 18 2014 (IPS)

Despite a mandate to eradicate HIV/AIDS under the U.N. Millennium Development Goals (MDGs), Zimbabwe has done little or nothing to reduce the rate of infection among vulnerable gays and lesbians, say activists here.

The MDGs are eight goals agreed to by all U.N. member states and all leading international development institutions to be achieved by the target date of 2015. These goals range from halving extreme poverty to halting the spread of HIV/AIDS and providing universal primary education.

Gays and lesbians activists here say more needs to be done because population groups such as men who have sex with men and transgender people remain at the periphery of the country’s intervention strategies.

“In as far as combatting HIV/AIDS is concerned, there are no national programmes targeted for minority groups or interventions that can easily be accessible by the LGBTI (lesbian, gay, bisexual, transgender and intersex) community on prevention and care within the public healthcare system,”Samuel Matsikure, Programme Manager of Gays and Lesbians of Zimbabwe (GALZ), told IPS.“Whether the Zimbabwean government likes it or not, it has to face the reality that gays and lesbians exist and should therefore cater for their HIV/AIDS needs in emerging with strategies to combat HIV/AIDS just like it does for all other citizens, for how do we end the scourge if we ignore another group of people who will certainly spread the disease” – civil society activist Trust Mhindo

“There are knowledge gaps of healthcare workers on the needs and best methods on prevention, treatment and care for the HIV-positive LGBTI individuals,” adds Matsikure.

GALZ is a voluntary association founded in 1990 to serve the needs and interests of LGBTI persons in Zimbabwe, pushing for social tolerance of sexual minorities.

But 24 years after GALZ was founded, Zimbabwe’s Sexual Offences Act still criminalises homosexuality. According to Section 4.78 of Zimbabwe’s new constitution, persons of the same sex are prohibited from consensual sex or marrying each other.

Civil society activists say the Zimbabwean government has to accept the reality that gays and lesbians exist.

“Whether the Zimbabwean government likes it or not, it has to face the reality that gays and lesbians exist and should therefore cater for their HIV/AIDS needs in emerging with strategies to combat HIV/AIDS just like it does for all other citizens, for how do we end the scourge if we ignore another group of people who will certainly spread the disease,” Trust Mhindo, a civil society activist, told IPS.

HIV/AIDS activists here rather want the legislation on gays and lesbians changed. “We need to fight for a change of laws so that gays and lesbians are given recognition, without which fighting HIV/AIDS among LGBTI will remain futile,” Benjamin Mazhindu, Chairperson of the Zimbabwe National Network for People Living with HIV (ZNPP+), told IPS.

Globally halting the spread of HIV/AIDS by 2015 is part of the U.N. MDGs, but with members of the LGBTI sidelined in fighting the disease in Zimbabwe, the battle may be far from over.

“Most healthcare facilities in Zimbabwe are not friendly to LGBTI persons, hindering disclosures of ailments like anal STIs [sexually transmitted infections]while sexual and reproductive health information for the LGBTI community is non-existent, creating a vacuum with healthcare facilities for minorities,” GALZ director Chester Samba told IPS.

“If you today walk into any government healthcare centre, be sure not to find any information or literature on gays and lesbians in as far as HIV/AIDS is concerned,” he added.

And for many Zimbabwean gays like 23-year-old Hillary Tembo, living with HIV/AIDS amounts to a death sentence because he fears accessing medical help from government healthcare centres.

“I’m HIV-positive and ridden with STI-related sores in my anus and truly I’m afraid to show this to health workers, fearing victimisation owing to my sexuality,” Tembo told IPS.

But Zimbabwean Health Minister David Parirenyatwa told IPS: “When a person visits a healthcare centre, nothing is asked about one’s sexual orientation.”

According to Samba, although there are no reported cases of HIV-positive LGBTI people being denied antiretroviral treatment on account of their sexual orientation, “there is need for a national HIV/AIDS response to address the barriers preventing members of the LGBTI community from accessing services that address their HIV/AIDS health care needs, including access to information that is relevant to them.”

However, faced with a constitution forbidding gay relations, government here finds it an uphill task to consider a group of people that it constitutionally does not recognise in combatting HIV/AIDS.

“We can’t arm-twist our supreme law which does not condone homosexuality to fit in to the needs of a small group of people who are disobeying the law,” a top government official, speaking on the condition of anonymity, told IPS.

And for gays and lesbians in this Southern African nation, whether the U.N. MDGs matter or not, to them suffering may continue as long as they remain a forgotten lot in fighting HIV/AIDS.

“As homosexuality is illegal in Zimbabwe, it is difficult for prevention programmes to reach men who have sex with men (MSM) and all MSMs living with HIV/AIDS are often unable to access HIV treatment, care and support,” Samba told IPS.

Asked how many HIV-positive LGBTI persons there were in Zimbabwe, the GALZ director said that he could not give figures because “there are no mechanisms at national level to capture data based on one’s sexual orientation.”

However, in its yet-to-be published 2014 research on the impact of HIV/AIDS on LGBTI persons, GALZ says that of the 393 MSMs tested for HIV/AIDS this year, 23.5 percent were found positive while of the 179 women having sex with women (WSWs) tested for HIV/AIDS, 32.6 percent were found positive in Zimbabwe.

According to the National Aids Council in Zimbabwe (NAC),1.24 million people in the country are living with HIV/AIDS, which is approximately 15 percent of the country’s over 13 million people. LGBTI persons are part of this percentage.

Statistics from the Zimbabwe National Statistics Agency this year show that LGBTI persons in Zimbabwe contribute about four percent of the people living with HIV/AIDS.

With a membership of 6,000 gays and lesbians, GALZ says 15 percent of these are living with HIV/AIDS, with five of its members having succumbed to HIV/AIDS since January. The organisation claims that it normally loses 5 to 10 people each year. “Statistics we have so far are of GALZ-affiliated members, not representative of the national statistics,” said the GALZ director.

For many HIV-positive Zimbabwean gays like Tembo, as the world rushes towards the deadline for attainment of the U.N. MDGs, without clearly defined strategies to fight HIV/AIDS within the LGBTI community, the war against the scourge may be far from over.

“How can we triumph over HIV/AIDS when among the LGBTI community we are without strategies from government to combat the disease?” Tembo asked rhetorically.

(Edited by Lisa Vives/Phil Harris)

Unlike the flattening or even declining rates of HIV infection among nearly all other communities, the epidemic among gay men globally is rapidly expanding.

But according to new research, the reason for this fast expansion is biological, not behavioural, thus countering some of the core priorities of traditional AIDS funding.

“The trajectory of HIV epidemics among MSM” – men who have sex with men – “is expanding virtually everywhere we look, in low-, middle- and high-income countries, and across all regions,” Chris Beyrer, a professor of international health, told a panel discussion here on Thursday.

“Much of this comes down to a fundamental biological reality: it’s not about gender but about the gut.”

Beyrer, who contributed to a recent groundbreaking special issue of The Lancet, the British medical journal, on HIV in MSM, says that researchers have found that the HIV virus is far more efficiently transmitted through the gut, hence leading to a far higher transmission probability in anal sex, for either a man or a woman – around 18 times more likely than through vaginal transmission.

Further, because gay men can switch sexual roles in a way that is impossible among heterosexual couples – acting as both the acquisition and transmission partner – the efficiency of transmission among MSM networks appears to be far higher than previously understood.

In a hypothetical MSM group in which men did not alternate their sexual roles, Beyrer reports that HIV incidence could be reduced by up to 55 percent.

“The network-level effects are really trumping the individual level,” he says. “So, people who have modest individual-level risks but who are having sex in high-risk networks and communities have very high lifetime acquisition risks.”

Taken together, the ramifications of these two findings are startling. These two factors, the new research suggests, account for a full 98 percent of the difference between HIV epidemics among MSM and heterosexual populations.

“What this means is that all the things that we had been focusing on – multiple partners, behaviours, etc. – only explain about two percent” of new infections, Beyrer says. “We have got to have programmes that are more responsive to the actual realities of transmission – focusing on the tail of the problem is unlikely to have the impacts we’d like to see.”

Rethinking donor priorities

The policy implications of these new findings are both clear and significant, for both Western and developing countries. In 2011, after all, the developing world for the first time spent more on AIDS – 8.6 billion dollars – than did rich donors.

At the 19th International AIDS Conference, held in July here in Washington, the U.S. government, backed by numerous organisations, set a formal goal of an “AIDS-free generation”. Yet according to this new data, such a goal will be impossible without a significantly larger focus on new and existing interventions tailored specifically for those communities experiencing this continued expansion of HIV infections.

While the administration of President Barack Obama, which provides the single largest tranche of AIDS funding in the world, is generally lauded for bringing about an increased focus on MSM-related issues, those who contributed to the Lancet research papers are calling on the international community to increase MSM-related HIV funding five- to tenfold.

The researchers note that, worldwide, just 10 to 20 percent of this community have access to any targeted HIV prevention.

“This biological reality is fundamental to how we need to be thinking about doing prevention, suggesting that just behavioural strategies are not going to be sufficient to curb HIV epidemic among MSM,” says Patrick S. Sullivan, a professor of epidemiology.

“But we also can’t say that we need more research before acting. Using a package of the tools we have today, we estimate that we could avert about a quarter of new HIV infections among MSM in the next 10 years.”

One lesson for national governments and donors is that funding for fighting HIV “needs to be following the epidemic”, says Chris Collins, the director of public policy at the Foundation for AIDS Research here in Washington. “There is clear evidence from around the world that there is a real mismatch between funding for HIV among gay people and their piece of the pie in the overall epidemic.”

Two issues that many advocates have highlighted as having received insufficient international focus have been, first, the sensitisation of public-health practitioners and, second, LGBT (lesbian, gay, bisexual, trangender) rights more generally. Both of these issues, researchers say, are central to the hope of continuing to make progress against the AIDS epidemic.

“Around the world, health-care professionals are not sufficiently equipped to provide support for individuals who are not heterosexual,” says Kenneth Mayer, a visiting professor of medicine with the Harvard Medical School. “This is a substantial structural problem and is really impeding an effective response to the AIDS epidemic – health-care providers are a big missing piece of the puzzle.”

Health and rights

Ultimately, the single most important structural issue in this regard is almost certainly the continued social and legal hurdles faced by gay people around the world.

This includes outright criminalisation in 30 African and 10 Caribbean countries, a factor that frequently leads governments to justify a lack of investment in prevention while further exacerbating the lack of self-agency experienced by many LGBT people around the world.

Some advocates are increasingly suggesting that this and the broader issue of ensuring an enabling environment be viewed not just as a human right but also as a critical issue of public health.

Chris Beyrer suggests that, to a certain extent, this understanding is being undermined by an international funding priority that feeds billions of dollars into AIDS research but a relatively miniscule amount into strengthening global LGBT rights.

Still, he points out, the issue of HIV overall has largely fallen to the side for the single most important constituency in the anti-AIDS movement – the LGBT community itself.

“If you look at the data, I think our failure right now is with young MSM, those under 18 and those 18 to 26 years old,” Beyrer warns.

“We need a community reinvigoration. People today have strong mobilisation around marriage equality and the issues that really matter to the community, but right now HIV is insufficiently on the short list – and we have to get it back.”