Much of what
I learned about sex as a teenager I either learned from my peers, or
I figured out by myself. Like many of those around me I entered
into sexual relationships early and, by the age of fifteen, I was already
making my way through the concerns that come with being sexually active:
the threat of pregnancy; pap smears; and negotiating condom use.
Sadly, for many teenagers, the sexual landscape is still very uncertain and unsure terrain and many of their concerns and questions still go unanswered. Even in the age of information the issue of sexual activity and interest amongst adolescents is still a taboo one. When I was a teenager the biggest concern amongst my peer group was pregnancy; but for teenagers these days, a lack of information and avenues for safe discussion is potentially far more dangerous.
With this past month's commemoration of World AIDS Day, the uncertainty of this sexual terrain was sharply brought into focus with news reports pointing to notable increases in HIV/AIDS infection amongst the 15-24 age group. With data released by the Jamaican Ministry of Health and the Environment indicating that AIDS is the second leading cause of death for youths in this age group, the risks associated with inadequate information, access and unsafe sexual practices have been highlighted as key areas for concern.
Against this backdrop, the focus for December 2008's commemoration of World AIDS Day has been placed on youth; with leaders in the political, education and health arenas calling on young Jamaicans to adopt a proactive and leadership role in stemming the spread of the disease, and in increasing tolerance for those affected. Calling on young people in the 15 - 24 age group to become advocates and agents of change, one official from the Ministry of Health's National HIV/STI Control Programme reaffirmed the unit's commitment to equip "young people with the necessary information, skills and attitude to stay HIV-free".
Interestingly however, the official position taken by another arm of the government, the Ministry of Education, has remained steadfast in its resistance to the distribution of condoms in Jamaican schools. The ministry has instead reaffirmed that its' focus will be on its' health and family life education program, which is designed to provide students with access to information that would empower them to make healthy lifestyle decisions.
While acknowledging the "cultural context" in which many students live, which may lead to early initiation of sexual activity, Minister of Education Andrew Holness has refused to supply students with condoms in the schools. This principle is in direct conflict with that of the Ministry of Health, whose policy allows for the provision of condoms to adolescents through its' local health centers. Access through these centers has however been reportedly undermined by adolescents' unwillingness to go into the clinics to receive condoms, because of the condescending attitudes of the health care workers.
Therefore, despite an official approach which supports the empowerment of adolescents, the Ministry of Education is still undermining the right of these teenagers to protect themselves.
Students themselves
have issued
a call for access
to condoms through schools. Noting their unwillingness to make use of
other avenues such as the health centers, students themselves have noted
that condoms should be made accessible through schools' guidance counselors.
It seems hypocritical
to me to make a statement regarding the empowerment of adolescents while steadfastly denying them access to a range of choices. This
continues to rely heavily on a moralistic approach based
on the idea that students themselves do not know how to manage their
behavior and by extension their sexual lives.
The series of articles, "The Reality of HIV/AIDS - Diary of an HIV-Positive, Pregnant Girl" gives us a glimpse into a largely hidden world, highlighting some of the challenges faced by pregnant teenagers, in particular those that are also HIV-positive. Now five months pregnant, Gabrielle's stories underline issues such as discrimination and inadequate health care, pointing to how they have shaped her experiences of pregnancy.
One of the issues highlighted is the sexual vulnerability of many HIV-infected persons who, displaced from their homes, may end up in housing arrangements that put them at particular risk. Gabrielle, who at the time was living with a relative of her late boyfriend, had to endure the (sometimes violent) advances of a man who felt entitled to sleep with her by virtue of the fact that he was providing her with a place to stay.
Discrimination against those living with HIV/AIDS often takes the form of them being ejected from their households upon discovery of the disease, and subsequently having to live in unsafe domestic situations. Factors such as inadequate job skills;,insufficient education and subsequently, limited job opportunities disproportionately affect women in poorer socio-economic settings. For those with limited income earning abilities, homelessness is not an easily solved challenge. Many people, and women in particular, are forced to endure living arrangements in which they may be subjected to unwanted sexual advances, and further, sexual abuse such as rape.
The teenager's story highlights another impact of discrimination against those living with HIV/AIDS: inadequate service from health care providers. Many teenagers who become pregnant relate the negative ways in which they are treated by health care providers, who judge them for having sex at their young age, and further for becoming pregnant. In the case of a pregnant teenager who is also HIV-positive, there is a potential double burden, increasing the likelihood that they will receive inadequate service, as a result of the ways in which they are perceived.
Gabrielle's recollection of interacting with a nurse who persistently scolds her for becoming pregnant knowing she is HIV-positive, is coloued by the obvious discomfort felt by the teenager, a discomfort which has made her fearful and reluctant to go to the health care centre. Noting that the nurse makes her "feel like she is standing on a stool looking down at (her) and judging (her)", Gabrielle brings to the forefront the ways in which health care services for those living with HIV/AIDS is often compromised when intersected with value systems that negatively judge infected persons and their presumed lifestyle.
Poignantly, Gabrielle also highlights the fear that she feels for her child, noting that there is a deep concern amongst HIV-infected mothers-to-be that their children will contract the disease. In her emotional tale, the often-ignored nuanced emotional needs of young women such as Gabrielle are brought to the fore, underlining another key shortfall in many of the health care policies on HIV/AIDS - the psychological impact of the disease, particularly in the case, the needs of HIV-positive, pregnant women. Beyond the concerns for self that will typically confront infected persons, there is the further sense of responsibility for the health of one's unborn child.
The experiences of this young woman have touched the hearts of many who may not have otherwise heard her story. While the articles do highlight many of the daily challenges faced by the young woman, my one concern is that it also adopts a common approach to reporting on HIV/AIDS: the heavy focus on the tragedy of the situation. This technique plays heavily on the emotional side of the story, and while it is useful in promoting the humanity of those living the disease, it tends to cast them in somewhat of a victim role. An integrated approach to reporting in contrast, highlights not only the challenges faced, but also the way forward as people find new ways to manage their disease and their lives -- that there is hope for redemption.
That said, the groundbreaking series of articles does take a step towards clearing the air to allow for deeper and more progressive interactions on the issue of HIV/AIDS and the numerous and specific ways in which it affects the lives of those who live with it.
*Names have been changed.
]]>As should be expected, the image of the girl has been met by some degree of public outrage. Interestingly enough, the moderate level of outrage seems to me to be in sharp contrast with the wide-scale public reaction, some months ago, to the proposed introduction of a school textbook that made passing mention of homosexual families. At that time, the collective national sentiment towards the text, which in defining family types made mention of those with same-sex parents, can be summed up as "Not in Jamaica!" The thinking and feeling seems to have been that condoning, even if implicitly, the normalcy of homosexuality would be a very un-Jamaican thing to do. Yet, this same level of nationalism does not surface when we see the body of a young girl being portrayed in such a manner.
The lack of
collective outrage is an indictment on our society.
Against a wider
backdrop of sexual violence being committed against, and perpetrated
by, children and adolescents, the sexualization of an under-aged teenager
is extremely problematic and potentially dangerous.
We live in a sexualized world. Companies use sex to sell the most random of products, from jump drives to cars. Rapid advancements in the media have made images and information accessible to almost everyone, easily bringing music and home videos, photos and advertisements directly into our homes, our phones, and our computers. The music we listen to; the movies we watch; the advertisements which inundate us; and the newspapers that we read are typically filled with references to, or explicit mention of sex.
Sex is not a bad thing; but by fostering societies in which it is encouraged to become a driving force, almost an entity of its own, we are engaging in a dangerous game of Russian roulette. We are paving the way for misplaced desire, in which desire becomes the be-all and end-all, and humanity in general, and the protection of our children in particular become secondary issues.
Calls have been
made for local
authorities to band together to tackle the growing wave of sexual violence
that is threatening the lives of our children. While it cannot
be stated that images such as that of the 13-year old model automatically
trigger sexual violence against children, with burgeoning evidence of
such abuse, it just seems like a risk we can no longer afford to take.
As the saying goes, if we are not choosing to be a part of the solution,
we must therefore be a part of the problem.
Any move, subtle or otherwise, which not only encourages us to look at under-aged girls as sexual objects; but by extension creates misplaced ideas amongst young girls of what it means to be sexy, is dangerous, and ultimately, our children are paying the price.
]]>It is leading me to ask, now what? This is a question (and in many ways a challenge) that I actually want to throw out there. I want to hear real suggestions and real comments. I'm feeling a little jaded. Although I unquestioningly believe in the value of education, particularly as it relates to providing information as a means of challenging the status quo, I really do want to know how to move beyond the rhetoric.
These questions
arose after I read an article in the Jamaican newspaper, outlining
plans by the current government to implement a policy that will protect
the rights of HIV/AIDS infected and affected persons within the workplace.
In light of statistics that indicate that a large majority of the HIV/AIDS
infected population fall within the 20 - 60 age group, or the working
class, such a policy would appear to be long overdue.
Amidst a cultural
climate in which there still remain too many strong - and sometimes
shocking - examples of stigma
and discrimination,
such a move could symbolize a major step in the ways we treat with this
key issue. What it could do is move the discussions
around HIV/AIDS away from a strictly health-centered or moralistic approaches,
to one that recognizes that HIV/AIDS affects far more than health and behavior, but affects
development at all levels - from the workplace, to the economy, to
the social advancement of our respective countries.
Importantly, the proposed policy also appears to address the gendered nature of HIV/AIDS, an acknowledgment that will hopefully take account of the significantly different ways in which women and men understand, manage and react to their sexual lives, and by extension, the sexual health choices that they make. Such analyses will hopefully take what has worked from disciplines such as feminism, by fully incorporating key concepts such as "power" into their analysis.
The policy also speaks to the issue of education, calling on employers - in conjunction with their employees - to develop "culturally appropriate" and "gender-sensitive" education programs that will collectively work to shift the ways in which we speak of, understand, and deal with HIV/AIDS and those affected by it.
Undeniably, this is a necessary move, as the lack of accurate information has proven to be one of the major forces that retards progressive change -- but is it enough? When placed in a cultural environment in which some people still believe that contracting the disease is a punishment for immoral behavior (particularly as it relates to the issue of homosexuality), how will such policies fare?
Admittedly, research has shown that there have been positive changes in local attitudes towards persons living with HIV/AIDS. Access to information does play a vital role in shaping our cultural belief systems. It does go a far way towards debunking harmful myths such as "sleeping with a virgin cures AIDS," and "white rum and marijuana kills AIDS." However, when information is not contextualized, and provided alongside concerted participatory efforts to reshape our old, troublesome values, it can only go so far. Which brings me back to my initial question: where do we go from here?
]]>
For many people, prostitution
still maintains that almost-mythical status, a practice that many see
as the ultimate representation of the under-bellies of our societies.
Despite the pervasive nature of commercial sex work , which is
commonly referred to as "the oldest profession in the world," the
pracitce typically remains hidden. As with most hidden acts, in particular
those of a sexual nature, attempts to bring them to light are met with vehement opposition from moralists, who fear the impact that
such exposures will have on already "decaying" societies.
We saw this dynamic play out recently in Jamaica, following the assertion by Dr. Keith Harvey, a senior public health official, in the Government that prostitution should be decriminalized, and further, that commercial sex workers should be taxed as a means of generating income to promote sexual health care.
As expected, the suggestion
that the taxation of sex workers could provide much-needed funds to support
education and rehabilitation programs to improve the sexual health
of vulnerable groups, such as sex workers themselves, has been met with strong opposition.
Responding to the proposal, leader of the Opposition
Party, the People's National Party (PNP) Portia Simpson-Miller forcefully stated that sex workers need more skills training opportunities, calling on the government
to invest its energy in this area rather than in the decriminalization
and regulation of sex work.
Similarly, the Jamaican
Prime Minister, Bruce Golding, has openly condemned the statement made
by Dr. Harvey, assuring the public that his government
has no such intentions. Golding also went a step further to warn
that in the future, public officials can face
serious sanctions if they
make public statements that run "counter to Government policy."
The suggested decriminalization of commercial sex work was proposed as a viable form of regulating the now-unofficial industry, potentially bringing in approximately up to JMD 3 billion (approximately USD 428 million) annually. These much needed resources could then be used to educate sex workers about effective condom use, and also towards the facilitation of a safer, regulated sex work environment, thereby reducing the transmission of HIV and other STIs within this vulnerable group.
This comes against the backdrop of a political and policy environment in which there has typically been "little support...for messages of intervention dealing with risk reduction and increased access to treatment and care targeted at certain at risk groups, among them sexually active minors, men who have sex with men, incarcerated men, commercial sex workers and those in places where other forms of transactional sex are practiced."
The absence of an enabling environment has translated into inefficient support to make substantial changes in protecting the rights and lives of those who fall within these groups.
Admittedly, Jamaica, with
its strong presence of a vocal fundamentalist Christian society, is
not a country in which I can see the legalization of sex work happening without a fight. However, with research showing that (i) one in every four HIV-positive
poersons reported having had sex with a sex worker at some point, and (ii)
that the rate of infection in the sex industry is three times that of
the general population; it would be remiss of us as a society to ignore
the urgent health care challenges that the lack of regulation presents.
The irony for me lies in the socio-cultural position that I now occupy as "Mother." On one hand, as a mother, I am now seen as a "real" woman. The once dubious nature of my womanhood has now been cemented, with my mini-me daughter providing evidence of my fertility. On the other hand, the perceived "naturalness" of the woman equals mother designation also serves to hide the value of the work (yes, I said it, work) that we do as mothers.
Because we live in societies that take it for granted that women will willingly and happily give birth no matter what, we by extension live in societies that also take us, as mothers, for granted, while penalizing those women who fail to fulfill this maternal obligation. From the world of policymakers to physicians, we exist within climates which fail to provide large numbers of women with adequate support systems, simply because of the notion of "motherhood" as natural; an organism operating independent of intervention. This endemic failure to see motherhood as an institution - complete with guidelines, values and norms - often translates into policies and practices that overlook the complex and diverse needs of women as mothers.
One of the areas in which much work remains to be done in order to meet the needs of mothers is that of maternal health care. The Caribbean, with maternal mortality rates ranging from 60-170/100,000 live births (and Jamaica with an annual rate of 45 maternal deaths for every 50,000 live births), has indeed come a far way in the provision of safer maternal health care as mandated by the UN Millennium Development Goals. However, much remains to be done to not only reduce the existing numbers, but further to improve the quality and scope of care received by pregnant women and new mothers. What is maternal health? How do we define a healthy birth? Is it one in which both mother and child survive the birth experience, or does it extend to a wider, more holistic approach to women, mothering and childbirth? Can maternal mortality rates in themselves capture the nuances of birth? Or does maternal health - in its truest sense - refer to an environment in which mothers are valued not only for the content of their wombs, but also as feeling, thinking human beings with valid and individual concerns and conditions?
Such a conceptual shift in the perception of motherhood would go beyond the current approach which focuses on the quantitative deliverables of maternal health (eg. infant and mortality rates) to include the provision of care and services that meet the needs of mothers, as defined by mothers themselves. In all areas of development we speak to the need for a bottom up approach; yet in maternal health, an area that cuts across all communities, women have not been actively engaged in the shaping of programmes or policies.
Despite this, there seems there could be a light at the end of the tunnel. According to Jamaican health care officials, initiatives are underway that could re-shape the ways in which we as a society perceive and manage safe motherhood. Incorporating a multi-pronged approach which will include media advocacy (PSAs, informational videos etc), there may be a recognition of the need to engage the key stakeholders in maternal health, with women and their partners being included in that number. As noted by Dr. Karen Lewis-Bell, Director of Family Health Services in the Jamaican Ministry of Health, the achievement of safe motherhood will necessitate a collaborative approach, one that goes beyond the inclusion of hospitals and UN agencies to include families. I am urging us all to press for a re-conceptualization of the way we see motherhood in general, and mothers in particular. It seems to me that maternal health, in its truest sense, cannot be achieved without an integrative approach that is based on the needs of mothers, fathers and their unborn children.
]]>Additional information on maternal health care in Jamaica can be found here and here.
This is a feeling I have heard expressed by a number of other women. We often avoid certain places and situations, not only because of a general fear of crime, but in many cases, because of a specific fear of rape. Rape affects both men and women, as sexual violence can be directed at anyone, regardless of their sex. Despite this, however, women are disproportionately the victims of rape. In this way, rape becomes an undeniably gendered issue, in which concepts such as ‘masculinity,' ‘femininity' and ‘power' often come together to endanger female bodies.
That the threat of rape so greatly shapes the experiences of so many women, both those who have survived it, as well as many who have not been personally affected by it, speaks to the pandemic nature of sexual violence against women.
In a report entitled "Against Her Will," released in 2006 by PANOS Caribbean, which undertook a situational analysis of rape in Jamaica, links are drawn between high levels of violence in poverty-stricken inner city communities, and the use of rape as a weapon in war.
It can be argued that the high levels of violent crimes cannot in and of itself qualify Jamaica as a war-torn country. However, in a number of select communities, gunplay between warring factions has become commonplace, with young, black males featuring as the main victims and perpetrators of this violence. However, among those who have been directly affected by the violence is a growing number of females, with sexual violence being used as a weapon of war.
Despite assertions by local police officials that "reprisal rapes" are infrequent, gender specialists and activists have challenged that view, noting the persistence of strong links between community-based violence and rape. In the drive to instill fear into communities the bodies of females are sometimes caught in the middle, and "gang rape and rape-as-terrorism... is used on women and young girls in these troubled communities as a form of revenge and also to render the occupants powerless. It sends a message to the people in the community about ‘who run things'. In one such case, two teen-aged sisters were repeatedly and brutally gang-raped by a group of eleven men (who originated from a community other than theirs), who threatened them that they would die because of the area in which they lived.
What emerges is an ugly side to the increasing crime situation in Jamaica, one that disproportionately affects the lives of many working-class, black women in war-torn communities. The need to examine the gendered impact of crime in these communities is succinctly expressed by Jamaican gender specialist Dr. Glenda Simms, who notes: "As long as there are Jamaican communities which are militarized, the figure for rape and other sexual offences will continue to increase. Women pay the price for war."
]]>Amidst evidence of rising rates of domestic violence in Jamaica, there is absolutely no place for "humor" of this sort. It is, however, very useful in highlighting the ways in which we speak of, and don't speak of, domestic violence as a society. It speaks to a cultural environment of complicit acceptance of gender-based violence (GBV); with women accounting for the vast majority of reported cases.
According to recent reports, there has been an upward turn in the rates of domestic violence in Jamaica, with domestic-related murders jumping 20 per cent between 2005 and 2006. The statistics, released by the Jamaica Constabulary Statistics Department, point to steadily increasing reports of domestic wounding and assault, with 49 of the 1,674 murders in 2005 being domestic-related. According to police reports, 17 per cent of all murders in the island between 2001 and 2006 were committed within the home, and the victims of these crimes were predominantly female. It goes without saying that, while these figures highlight increases in acute cases of GBV - resulting in death - they do not paint a thorough picture of the issue, as most cases will still undeniably go unreported.
Domestic violence is typically enforced by a cultural code of silence, which masks the true nature of inter-personal relationships between and amongst women and men. These statistics paint a troublesome picture of violent crimes against women, pointing to the violation of women's human rights generally, and their sexual and reproductive health in particular. The presence of violence - be it emotional, physical or sexual - diminishes the ability of healthy individuals to demand and enforce healthy sexual relationships, and by extension a healthy sense of self.
]]>In typical fashion, the key issue that has arisen in the debate is one regarding the rights of the woman versus the rights of the unborn foetus; with religious and moralistic values heavily influencing the cited reasons why the act of abortion should remain illegal. Ultimately the debate raises the issue of women's control over their bodies and their sexual and reproductive health; a debate that raises key sexual health concerns and nuances.
The act of abortion, as with many gendered acts that shape women's lives, typically remains clouded in a veil of secrecy. The clandestine environment in which abortion is situated is reflected in the legal and policy approaches to the issue. While abortions are legally governed by a 150-year old body of legislation which criminalizes the procedure, common law has allowed for the procedure to be done in specific circumstances. As such, common law allows for the termination of pregnancy in cases of: (i) significant fetal abnormality; (ii) where pregnancy would represent a threat to the welfare or health of the mother and (iii) in cases where pregnancy is an outcome of rape or incest.
This approach to the termination of pregnancy brings with it some major health care challenges.
One of the more evident flaws in the common law which governs the actions of local medical practitioners is its' subjectivity. In instances that are not as clear cut as fetal abnormality or pregnancy as a result of rape, the physician becomes the main holder of power, determining whether or not women who fall outside of these predetermined categories can in fact terminate their pregnancies. What then, happens to those women whose conceptions may not meet the criteria for "rape"; but whose relationships may in actuality be fraught with power imbalances such as the perceived inability to enforce protected sexual intercourse?
An associated health care challenge also arises regarding the ambiguity in the existing legislation and the common law itself. Common law, which develops over an extended period of time on the basis of widespread practices is seen to sharply contrast with the laws on the books in Jamaica. As such, despite the mentioned criteria which allows for abortions in the specified circumstances, the fact remains that legislation takes priority over common law. This places not only the affected women in jeopardy of prosecution, but also the participating physicians themselves. Such an approach potentially impacts women's sexual health, as it could discourage trained specialists from performing the procedure, thereby reducing women's options for safe health care.
The effects of curtailing women's choices for safe reproductive health care are potentially fatal. According to the World Health Organisation (WHO), some 22, 000 abortions are performed in Jamaica each year, collectively representing a significant section of the Jamaican population. This number is cause for concern when taken in tandem with evidence suggesting that complications from unsafe abortions are among the ten leading causes of maternal mortality in Jamaica, particularly amongst pregnant teenagers.
What this means is that for a large number of women, unsafe abortions performed by untrained and/or unspecialized physicians and practitioners are amongst the most accessible options for the termination of pregnancies. This fact is particularly dangerous for those women who may not be able to afford the high cost of having their pregnancies terminated by private and well-trained physicians.
This undeniably places working class women at particular risk. The cost of an abortion by a private physician can fall within the range of JMD 40, 000 (approximately USD 570.00), a cost which is inaccessible for the vast majority of working class Jamaican women. These women, without the alternative option of accessing the procedure within the public health care system - unless they meet the specified guidelines governing abortion - are often forced to access cheaper and potentially far more dangerous options.
The existing policies on abortion therefore privilege women of financial means, and in contrast, work to unfairly curtail the health care rights of working class Jamaican women.
Jamaica, as a signatory to the UN Millenium Development Goals, has undertaken to reduce maternal mortality by 2015, a goal that cannot be achieved if women are denied access to safe and legal abortion services.
While moral values and the right of the foetus are important considerations in the abortion debate, they should not supersede the right of the woman to determine how and when and if she will give birth.
State emphasis must therefore be placed on providing women with the information and support needed to make wise sexual health decisions, one of which could include the decision about whether or not to terminate their pregnancies.
]]>In response to the report, a variety of possible explanations for the practice have been given by advocates and practitioners in the field, including: a lack of father figures; peer pressure; low self esteem and marriage as a means of economic survival. There is indeed merit in all of these contributing factors, and there are undeniably strong links that can be made between the incidence of poverty and the entry of adolescent girls into relationships with older men who are able to assist them and their families financially.
Importantly, one key discussion that also comes to the fore is the persistence of cultural values that often offer covert protection to both the young girls and the older men in such relationships; thereby obscuring the potential danger for the under-aged females in the unions. Responding to the report, child advocate Mary Clarke, pointed to the cultural silence that surrounds such illegal unions, stressing that the wide-scale failure to report such unions is a cause for concern.
The cultural silence surrounding this issue is indicative of wider patterns of silence with regard to sexual and reproductive health issues. Although ideas regarding men's right to ownership over ‘their' women in intimate relationships can be found across communities, the practice of cohabitation between under-aged females and older men is predominantly found in communities marked by poverty. In many instances, young girls become bargaining tools for economic improvement, placing them in relationships in which the power imbalances often affect them negatively.
Factors such as age, economic dependence and a lack of decision-making power often come together to place the young girls in these unions at particular risk for domestic abuse, unwanted pregnancies, and HIV and other STDs. Based on the lack of power that these girls are often able to tap into, there is also evidence that they are particularly likely to suffer emotionally and mentally, resulting in low self esteem which further compromises their ability to demand and protect their sexual health rights.
Amidst calls for increased vigilance in reporting and penalizing the men involved in these unions, we must also be mindful that based on the economic reality of many of the affected girls and their families, such unions may in fact seem like the best available option. Inadequate education opportunities, cultural norms and values and limited support systems (both emotional and financial) inevitably play a role in shaping the environment in which these practices exist.
Any attempts to address, and ultimately eradicate this practice must be grounded on an understanding of this dynamic, or they may in fact put in place systems that do little to actually improve the girls' lives. An exploration of the complex nature of these relationships must lie at the center of these efforts so as to provide these girls and their families with viable options for their survival needs. Failure to do so will inevitably leave in place values and practices that will inevitably undermine any anticipated change for the better.
]]>In a number of communities across the Caribbean, we have come to place an extremely high value on youth, moving away from traditions that elevated our elders to a place of respect, and in essence obscuring their faces, silencing their voices and by extension, increasing their vulnerability. Given the dimension of gender, which often places women at a disadvantage in the allocation of, and access to power, the vulnerability of aged communities becomes an even more pressing issue for numbers of elderly women. Even within most organizations and education programs whose work is dedicated to social advancement, issues related to the elderly often go unaddressed.
In the 2001 text, Health Issues in the Caribbean, mention is made of the growing life expectancy across the English-speaking Caribbean, with a current life expectancy rate of approximately 75 years. This means that, thanks to social advances such as increased access to health care, larger numbers of our population are living longer. What then are we doing to protect the lives and interests of this section of our societies?
The vulnerability of elderly women recently came sharply into focus in Jamaica with charges being made by female residents of an ‘old age home' in a financially depressed community that they are often verbally, and in one case sexually assaulted by members of the surrounding community. One of the most shocking elements of the newspaper article was not, however, the allegations of abuse, but rather the dismissive manner in which authorities responded to the allegations. The elderly women were charged with unnecessarily seeking to stir up trouble, with a key authority stating that the charges were untrue because she would have known about these violations if they were indeed taking place.
Such a response does not take into account one of the key characteristics of abuse: it usually goes unseen, and by extension, unreported. The hidden nature of abuse is exacerbated in cases where factors such as age, poverty, and inadequate social support systems are at play. Many elderly persons virtually live in obscurity, put aside by their families and communities. The invisibility of this group puts them at particular risk.
While a number of goodwill organizations typically intervene in providing assistance and company for the elderly, we as a society are yet to fully integrate the issue of the abuse of the elderly into discussions of sexual and reproductive health. Our inability to view the elderly as sexual beings therefore has the spill-over effect of blinding us to many cases in which their sexuality is being violated.
Any truly successful society is one in which all members are valued, irregardless of their age, gender or social status. Issues such as the sexual health of the elderly must necessarily be integrated into discussions of HIV/AIDS as well as broader sexual health discussions if we are to truly meet the goals of development.
]]>In the global fight to manage and eventually eradicate HIV/AIDS, emphasis has continually been placed on the role of public education in general, and more specifically, on changing sexual and social behaviour that may place individuals at risk for contracting HIV.
By emphasizing the social dynamics that often contribute to the transmission of HIV, policy planners and practitioners are better able to zero in their efforts on issues that may not automatically be seen to be related to HIV. As such, issues such as poverty, gender dynamics (for example, the different understandings of masculinity and femininity), access to education, and community development must be included if we are to create and sustain balanced, effective and sustainable programs and projects. This allows us to broaden our focus on HIV beyond seeing it solely as a health issue, but rather as a social and development issue.
Despite the undeniable need for this broader approach to HIV management, public officials often fail to make the connection between the transmission of HIV and social and cultural behavior.
In celebration of World Aids Day on December 1, Jamaican Prime Minister Bruce Golding publicly announced that the Global Fund grant - a program which covers the cost of HIV/AIDS programs, including antiretroviral drugs for persons living with the virus - will be sustained over the next five years. The grant, which takes effect in 2008, will provide US$44 million (J$3.1 billion) to carry out HIV prevention, treatment and care programmes.
The Prime Minister also expressed concern about the island's need for an additional US$200 million (J$14.2 billion) to deal with HIV initiatives and programs over the next five years; noting that the government would only be able to provide one-third of that amount. He further stated that despite the importance of the fight against HIV/AIDS, the government must also tend to other national priorities such as crime and education. To this end, the Prime Minister has called on the private sector to step up their role in contributing to HIV causes.
In theory, the Prime Minister is right. With a steadily growing crime rate and particular challenges in the area of education, these are key priorities for national development. However, what is missing from his analysis are the linkages between and amongst these areas. Issues such as education cannot be dealt with in isolation from HIV/AIDS, as over time, the links in these areas will become increasingly apparent. The same can be said for most development issues, yet in public forums, public officials often fail to recognize or underline the interconnectedness between these areas.
Another major oversight made by the Prime Minister is his sole focus on the need for increased private sector involvement, with no specific mention being made of the role of civil society organizations in managing HIV. The empowerment of civil society groups must be a core component of any national policies designed to tackle HIV/AIDS-related issues. Failure to recognise, and beyond that to publicly support the work being done by these organisations leaves many stones unturned. These are the people who are actively working to uncover the linkages between social and cultural development issues and HIV, often with little financial or public support.
A key component of any well thought out policy or program must necessarily be the inclusion of civil society organisations. The focus on public education and meeting the needs of those infected with HIV can take us only so far towards managing it. In order to manage HIV, we must first contextualize it. As necessary as funding and private sector support are, they will only take us so far without the input of key players on the field.
]]>In Jamaica, as of January 2007, 5,125 children under the age of 15 were estimated to have been orphaned by AIDS. In 2006, 73 children aged zero to nine years old were diagnosed with HIV.
In the Rapid Assessment of the Situation of Orphans and Other Children living in Households Affected by HIV/AIDS in Jamaica (2002), the unique circumstances of this group of children was outlined. Issues such as access to poverty, effective public health care, stigmatization, insufficient psycho-social support and inadequate network systems all come together to negatively impact the lives of children affected by HIV. Negative cultural attitudes towards the illness negatively impact the level of support - both emotional and financial - that many children receive from their families and immediate support groups following the death of their parents or caregivers. This is further complicated in smaller communities, thereby increasing the stigmatization that is endured during an already troublesome period of their lives.
In recognition of these dynamics, there have been ongoing efforts to centralize the experiences of these children. In 2006, twenty-five young persons that are either infected with, or affected by HIV came together, with the guidance of Panos Caribbean to produce a series of public service announcements entitled "Our Own Voices: Youth Fighting HIV." Providing the young participants with basic journalistic training, as well as training on basic sexual and reproductive health issues and child rights, the program has not only sought to create an avenue for this group to cope with the realities of their lives by giving voice to their concerns, but also to use their experiences as vehicles for change.
In the last week, another powerful initiative has been launched by affected and infected youths, Panos and a local media house, the Gleaner Company. In an initiative entitled "Special Delivery," children living with, and/or affected by HIV will deliver a number of letters to influential persons in the society, advocating positive change on issues that they have identified as being key to their lives. What is of special significance is that the issues that are addressed are those that the children and adolescents themselves have identified, based on the belief that they themselves are most intimately aware of their needs and concerns. In this manner, there are two key outcomes: one, the development of a people-centered approach which can better inform policy and, two, a shift in the lives of the children themselves, whereby, through advocacy they are better able to play active roles in their own lives.
The letters, which are published in the Jamaica Gleaner, have thus far addressed issues such as the need for parenting seminars and the inclusion of parenting components to HIV projects, which would better enable their parents and caregivers to cope not only with their own status, but with the impact on their children.
The two mentioned initiatives illustrate not only the powerful potential of the media for affecting change, but also the importance of privileging the experiences of affected groups, in this case children infected with, and affected by HIV. In so doing, we are able to affect change on two key levels: individual empowerment and social consciousness.
By highlighting the stories of children, as told by children themselves, the "Special Delivery" initiative clearly takes a step towards challenging cultural attitudes towards HIV and those infected with it.
]]>As a non-Jamaican, albeit one who has lived here for years, this has been a grey area for me, because the issues of sexuality in general, and homosexuality in Jamaica in particular, are very complex ones. In Jamaica, attitudes towards homosexuality seem to more visibly relate to relationships between men, and are typically placed in opposition to cultural ideas about masculinity and what it means "to be a man." Even in reference to same-sex relationships between women, the term "sodomite" is often used, again drawing the parallel between "aberration" and male homosexuality.
This strong adherence to gendered ideas about appropriate behaviors and relationships between women and men is further deepened by the overt and covert presence of a strong fundamentalist Christian base, which has resulted in cultural attitudes that call for fire and brimstone to be brought down on those who challenge - through their sexuality and sexual practices - these ideas of appropriateness.
What has clearly emerged is an environment marked by an unwillingness to change, despite the obvious impact that Western (in particular American) society has had on Jamaica. Coming out of this has been a strong sense of "Jamaican-ness,"
i.e. what it means to be Jamaican and "of Jamaica." Homosexuality is positioned in direct opposition to this "Jamaican-ness," and is taken to be a result of external influences on the island.
This "Jamaican-ness" came sharply into focus for me in the past week. A textbook that was allegedly proposed by the Ministry of Education for inclusion in the home economics school curriculum came under fire due to its mention of same-sex unions and families. The home economics textbook in question includes a section stating, "When two women or two men live together in a relationship as lesbians or gays, they may be considered as a family. They may adopt children or have them through artificial insemination."
In response to the public outcry about the proposed inclusion of the text, Minister of Education, Andrew Holness, made reference to the "offensive clause" in the text, denying that it had ever been ministry-recommended, and further stating: "We want to make it absolutely clear that the Ministry of Education does not endorse or support the teaching of homosexual relationships as the accepted standard of family. We don't teach it and we don't recommend it."
This position has been supported by the Jamaica Teacher's Association (JTA), whose president Ena Barclay stated: "It [homosexual relationships] is not something that we embrace in Jamaica, and we can't ask our teachers to teach such a matter to students."
To put such a text in a public forum specifically for the use of children has been taken as an assault on the way things are done in Jamaica, resulting in a response that has unified many Jamaicans, rich and poor, who have been able to transcend social boundaries to condemn the text in unison.
Crime and murder rates in Jamaica are persistently high. Domestic and child abuse have continuously been cited as serious issues compromising the rights and lives of large numbers of women and children. There are serious social issues that warrant attention in this island, and it just seems to me that the collective energy that was brought to bear in the past week could be so much better used by focussing on issues such as those just mentioned.
In the meantime, "Jamaican-ness" reigns supreme, resulting in a climate in which an issue such as homosexuality are so taboo that it only seems to warrant wide-scale discussion when there is a collective move to clamp down on it, and ultimately, to eradicate it. This past week held the potential for serious discussions about the rights of human beings, regardless of their sexual orientation. There was the opportunity for us to really begin to talk openly and honestly about the lives and realities of members of this society.
Instead, Jamaican-ness has prevailed...and the gay textbook is out.
]]>I want to share some stories. They are the stories of teenaged girls that I know. These girls are not estimates. They are not samples of the population. They are just three teenaged girls that I know.
The reason I am sharing these stories is because a young friend of mine recently lost her virginity. Thinking about her...her innocence; the purity of her Spirit; the way she smiles and looks like ten again...thinking about her made me mourn for the loss of a certain part of her life, and pray that she will make the right decisions to protect her life. Thinking of her made me think of other young girls that I know who are just like her: struggling to define and come to terms with their sexuality. As much as we speak about the politics behind sexuality, my friend made me remember that at the center of policy lie young women and men with real stories.
This is a decision that this teenager has been contemplating for a while now. She has a teenaged boyfriend whom she loves. She has the love and friendship of a mother with whom she is able to share her thoughts and feelings about sex. Her mother has made her aware of, and they have discussed the variety of choices open to her: (preferably) to abstain; to protect herself; to not "go all the way." She has chosen to become sexually active.
The second girl that I know is fifteen years old. A couple of weeks ago she believed that she was pregnant. She was scared about this possibility. She is in a relationship with a man many years her senior. They live together. She left her mother's house to avoid being sexually abused by her step-father. This older man has taken her in and provides for her financially. She wants to find a way out, but she really feels like she nowhere to go for assistance. She feels that she no choice but to be sexually active.
At fourteen years of age and five months pregnant, the third girl is well aware of her choices to prevent her from "repeat pregnancies." She attends a Jamaican organization that allows teenaged mothers to complete their education and to receive developmental counselling, with one of the core areas of concern being "delaying unwanted pregnancies." Despite this, she tells me that she doubts she would use a condom with her partner. She tells me he won't use them and that she wouldn't push him to, because he might think she has another "man." She says that she suspects he is sexually active with other people.
These girls are real people. They are real young women who are grappling with the feelings and consequences of their entry into sexual relationships. They have all of the fears, strengths, insecurities, and challenges that make up many of our lives. They each have had a different experience with sex, and they each deserve a health care system that is responsive to their needs and challenges.
Statistics have highlighted the particular risks for sexually active female adolescents, particularly those involved in relationships with older men. In response to these and other red flags that define the sexual lives of many teenagers, the Government of Jamaica has implemented programs such as JA-STYLE aimed at helping adolescents to make wise sexual decisions. All of these are wise and necessary efforts, but I want more.
I want these stories to be heard. I want the young women and men who these policies seek to help to become the ‘experts' on adolescent sexuality who are informing us about it, instead of us informing them. I want an interactive approach that does not berate teenagers for feelings the ways they do. I want my young friend and the other young girls who may be like her, or vastly different to have options, and to have a platform on which they can speak about their fears, concerns and challenges. In which they can make wise decisions and have a number of options that show them how to protect their lives.
The stakes are high. We need to protect our children. No matter how we feel about adolescent sexuality, the fact remains: real girls and boys are choosing to, or being forced to, enter into sexual relationships every day. The stories are numerous. We need to listen. Lives depend on it.
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