Risking Education: Placing Young MSM in the HIV Prevention Equation

• Author: R. Anthony Lewis
• Pages: 259-276

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RISKING EDUCATION

Risking education

R. Anthony Lewis

Chapter 13

SETTING UP

Among the groups especially vulnerable to HIV in Jamaica are men

who have sex with men (MSM). Estimates suggest that infection

rates in this group are higher than those in the general population (WHO/

PAHO/UNAIDS 2006; Ministry of Health 2005, 2006 and 2008). In

response to the situation, Jamaican government policy recommends that

‘MSM should have the right of access to prevention knowledge, skills

and services and to treatment, care and support within a non-threatening

environment’ (Ministry of Health 2005, 24). As noble as this goal is,

much remains to be done for its achievement, as many gay, bisexual and

other MSM, because of the socioeconomic conditions within which they

exist, often find themselves outside of the HIV-education loop (Royes

1999). Further compounding their situation is the extreme homophobia

of the Jamaican culture, which drives them underground and makes them

an invisible population (Human Rights Watch 2004). This invisibility

often carries over into HIV-prevention programmes, making it difficult

for these men to be reached (Royes 1999). Against this background, it is

important to explore how men who have sex with men, particularly the

more difficult to reach subgroup of young men who have sex with men

(cf. Gunter 2007), might be better integrated into HIV-prevention

programming.1

Data from the Ministry of Health indicate that at the end of 2006,

among reported AIDS cases for whom information on mode of infection

was available, more than 90 per cent reported engaging in heterosexual

Placing Young Gay, Bisexual and Other MSM in the HIV

Prevention Equation

260

SEXUALITY, SOCIAL EXCLUSION AND HUMAN RIGHTS

sexual practices. On the other hand, among the reported male AIDS

cases for whom information was available, homosexual or bisexual

practices were reported by 14 per cent. Cumulatively, the data also reveal

that from 1980 to 2006, 71.5 per cent of reported cases have been

heterosexual, with 2 per cent homosexual male and 2.8 per cent bisexual

male (Ministry of Health 2006). The data point to the fact that HIV

infection in Jamaica, as elsewhere in the Caribbean (CAREC 2003), is

overwhelmingly the result of unprotected heterosexual sex. This fact,

Royes notes, came to light at the turn of the 1990s, when the Ministry

of Health observed that there was ‘a growing number of AIDS cases

among women and children’ (1999, 6).

Muturi (2008), citing Bertrand (2004), Melkote, Muppidi and

Goswami (2000) and Parker (2004), points out that over the last several

years, in response to the growing HIV and AIDS crisis, many organizations

have pumped millions of dollars into prevention programmes, focusing

mainly on changing patterns of sexual and drug use behaviour. While

some of these programmes have been geared towards marginalized groups

(cf. Human Rights Watch 2004), interventions have mainly focused on

demographics that reflected the changing nature of the Jamaican and

wider Caribbean epidemic, viz. the heterosexual population. Thus, while

MSM, the group most affected by the epidemic in the early years, have

benefited from targeted HIV services (Royes 1999), responses to the

disease have largely centred on the heterosexual community (cf. Ministry

of Health 2006 and 2008).

ASKING A FEW QUESTIONS

The primary question that arises in this chapter is whether the heavy

emphasis in policy and programming on addressing the heterosexual mode

of HIV transmission has contributed to the reinforcement of conditions

that fuel the spread of the virus among young gay, bisexual and other

MSM. The backdrop to this issue is the view echoed by Muturi (2008),

Royes (1999), Human Rights Watch (2004) and WHO/PAHO/

UNAIDS (2006), that Jamaican (and Caribbean) AIDS statistics mask