Introduction

• Author: Christine Barrow, Marjan de Bruin, Robert Carr
• Pages: 17-32

xvii

INTRODUCTION

This book looks at risk, sexuality, rights, power, culture and

vulnerability in the context of the epidemic of HIV in the Caribbean.

It examines how power, gender, sexuality and other cultural determinants

promote risk taking in sexual behaviour, sustain vulnerabilities and

undermine resilience in dealing with the pandemic. The discussion is also

set within questions of citizenship and human rights.

As such, this volume represents an attempt at a different kind of

conversation about HIV, meant to take our understanding of the epidemic

substantively further. It brings together a diverse group of academics and

activist scholars –– lawyers, anthropologists, economists, communication

specialists, frontline service providers, specialists in education –– who

were asked to analyse the Caribbean response to the epidemics of HIV

and AIDS and to delve, from their discipline and perspective, into what

‘vulnerability’ means and what constructs it.

This volume explores the dynamics of marginalisation and the realities

of the excluded, peeling back layers of silences to see what we might learn

about how vulnerabilities are constructed. The book, thus, examines some

of the most virulently outcast yet impacted groups facing infection rates

several times higher than the general population around them –– drug

users, sex workers, gay men and other men who have sex with men ––

and those whose exclusion is more obscured, complex and normalised,

particularly women, especially young women, and girls.

Introduction

Sexualities, Social Exclusion and

Human Rights: Vulnerabilities in

the Caribbean Context of HIV

Christine Barrow, Marjan de Bruin and Robert Carr

xviii

SEXUALITY, SOCIAL EXCLUSION AND HUMAN RIGHTS

For some time, discussions of ‘risk’ in relation to HIV have been the

frame through which responses to HIV have been developed. ‘Risk’ here

has come to be equated with individual behavioural risks, such as

inconsistent condom use or multiple partners. The physical act of

unprotected sex initially became the major focus for intervention aimed

at behaviour modification. HIV prevention was seen, predominantly, as

a (public) health issue, focusing on an individualised view of sexuality.

The assumption was that ‘high-risk’ sexual behaviour could be changed

into safer sexual behaviour by encouraging desired behaviours through

the provision of knowledge. This approach, based on the medical model

with its epistemological certainties, turned to psychology for insights

into effective prevention strategies and focused on individual behaviour

change, understood as rational and volitional responses to risk, amenable

to change through information and education. Models of programmes

for prevention have been based on the assumption of a rational subject,

motivated by self-protection and enjoying the freedom to choose exactly

when, how and with whom to engage in sex. This often does not hold

up under scrutiny however, as desire proves deeply irrational.

At the national and regional planning levels, while situational analyses

have incorporated some recognition of vulnerability as a result of complex

economic, social and cultural drivers of the epidemic, the national strategic

plans themselves have been limited in their response by presenting a

similarly narrow understanding of risk and, therefore, of risk reduction.

For instance, in examining gender, while many national strategic plans

state that power inequities between men and women play a substantial

role in increasing women’s risk, there is little or no programming designed

to address this in the national response. Most focus on promoting condom

use, faithfulness or partner reduction, or else abstinence. But this is exactly

where the link between risk reduction and vulnerability reduction needs

to be made: the imperative to consider what it actually means for women

to abstain, be faithful or use a condom. None of these options takes

place in a vacuum; each of them exists and is lived in specific socio-

cultural, economic and political contexts which predispose, enable and/

or reinforce behaviour and constrain free choice. In many instances, the