By Floyd French
(Basseterre, St. Kitts) – Like other forms of information, statistics may be distorted for a sensational or bias effect.
A recent media report suggests that one in every 160 persons in St. Kitts-Nevis is infected with HIV/AIDS – and that is not correct, according to a top Federation health official.
The 288 cases that represent the one in 160 person ratio of the entire population of the Federation is the cumulative figure of HIV/AIDS cases from 1984 to 2007, said National HIV/AIDS Coordinator Mrs. Gardenia Destang-Richardson.
That means that some of 288 persons living with HIV/AIDS would have already passed away either from diseases brought on by an AIDS-compromised immune system or other possible forms of demise.
Based on the records of the National HIV/AIDS Secretariat, 80 persons are listed as having died from AIDS. But Mrs. Richardson cautioned that prior to a few years ago, AIDS would not have been listed as a cause of death on death certificates, so other illnesses would have been recorded as the cause of death.
“Additionally, there are people who might have been HIV positive on our books but might have died of something else, car accident or something else and that would be the cause of death,” said Mrs. Richardson.
She pointed out that sometimes sensationalism might create the sort of response in society that makes people aware of the situation. Although Mrs. Richardson felt that the title of a SKNvibes article on AIDS might have been misleading, she lauded the media house for the comment section. She said the comments revealed that the public recognised the problem of HIV/AIDS and made positive suggestions.
For Mrs. Richardson, sensationalism can be an eye-opener because the cumulative figure from 1984-2007 does include 18 new cases for 2007 alone. She stressed that these figures represent only reported cases and there might be many undiagnosed cases out there.
The National HIV/AIDS Secretariat has now started rural testing clinics after tremendous success in Basseterre. The free testing clinic in St. Pauls in March was hailed a success and it is anticipated that the clinic for Cayon on May 13, will also be successful. The aim is to get more people tested and know their status.
“Driving the epidemic underground”
Fear over the wilful spread of the HIV virus is a concern that hinders anti-discrimination strategies. Some people would like to see the names of persons living with HIV/AIDS be made public. Such a move would cause people not to get tested and “drive the epidemic underground” said Mrs. Richardson.
“Honestly, stigma and discrimination are still big issues. As a matter of fact, we believe they are great obstacles to overcome. I think that when we get to the point where people stop normalising HIV and AIDS, we would have accomplished much.
“Even if there are people going around deliberately trying to give other persons HIV and AIDS, they can only do that to you if you are raped. Your sexual responsibility is that of your own,” she said.
She stressed that protection is the responsibility of the individual sexual partners.
The “Your Condom or My Condom” campaign tries to make the public aware of their individual right and responsibility in healthy sexual relationships.
Mrs. Richardson and her staff are currently working on an anti-discrimination strategy for the Federation. The strategy would take into account what is stigma and discrimination; areas of life where discrimination occurs; who is affected; and what target interventions are needed to address stigma and discrimination.
“A life-long commitment to care”
Care for people living with the disease is a crucial aspect of any overall successful HIV/AIDS strategy. Currently, care is provided for 48 persons living with the disease, and 16 of number are on the antiretroviral treatment.
The cost of antiretroviral treatment is expensive and Mrs. Richardson said it is important for those on the medication to follow the regiment.
“This is a life-long commitment we are looking at … we have to make sure you are ready to accept medication, meaning that you understand the whole issue of taking your medication on time and everyday for the rest of your life, you cannot afford to fail,” she said.
Failure has implications for everyone, persons living with HIV/AIDS and those who are not infected. For the person living with HIV/AIDS, failure means that the virus in that person becomes resistant to the drug and other drugs are needed. “In St. Kitts we are only giving first line medication free, we are working on negotiating to get second line,” said Mrs. Richardson
There are three lines of defence or treatment, explained the Coordinator. The lines are based on potency of the drugs and regiment, how much of the drug and the intervals between taking the drugs.
The lack of resources makes it difficult for the Ministry of Health to provide free treatment for those who fail the first line, she said.
She also warned that failure to stick to the regiment would result in the person’s body developing resistance to the current drug, which could lead to resistant strain of the virus.
“We cannot afford to have resistant strains of the virus in St. Kitts, in the Caribbean for that matte,” she said.
Fortunately, the 16 in the Federation who are taking antiretroviral are following their regiment.
The Federation’s response to HIV/AIDS has been one of the better ones in the region. This augurs well, as Mrs. Richardson pointed out that future international funding is dependent on implementation of preventive strategies.
The successes were accomplished with the help of social partners many of which are local companies and government departments or agencies, she said.
HIV/AIDS was once thought to be a disease affecting homosexuals and those thought to be engaged in other sexual behaviours such as prostitution. While HIV/AIDS is still mostly transmitted through sexual contact, the images of the participants of those sexual transactions are changing.
“For homosexuals we usually say, if you are referring to men, we say men who have sex with men (MSM), because there are men who are having sex with men who don’t identify with homosexuals. Homosexual refers to a man who have sex with only men, but you have (MSM) who have sex with men and women,” Mrs. Richardson said in distinguishing the nuisances of sexual identity.
“There is also a difference between commercial sex workers and sex workers. Commercial sex means those who actually have sex for the exchange of money. Then you have sex workers those who engage in sexual activities for the exchange of other items, cell phones, top-ups, hair-do, house rent, child payment. This is what we call transactional sex,” she said.
These characteristics of the vulnerable groups are so endemic in our society that there is not much self- awareness by members of the vulnerable groups. Mrs. Richardson pointed out that in the case of MSM, the Ministry of Health does not work directly with that group.
“What we have been doing is working with Caribbean Alliance, and they have been working using what they call community animators, people somehow either they are involved with them or are people they trust to go in and work with them.”
Mrs. Richardson said biases and prejudices create a relationship of mistrust even of health and government officials, so the effort of the Caribbean Alliance community animators is appreciated.
The local Caribbean Alliance chapter works with a support group on men who have sex with men issues. This partnership, according to Mr. Richardson, deals with HIV/AIDS education and preventive strategies.
For Mrs. Richardson and her staff the taboos of sex in general are the major hurdle to understand and appreciate the fight against HIV/AIDS.