September 27, 2013
I just spent a few days in the Eastern Caribbean conducting a site visit with our colleagues at the Dominica Chapter of the Caribbean HIV/AIDS Partnership (DomCHAP). My visit coincided with two events: A meeting to form a coalition promoting LGBT rights as a public health strategy and a training to launch the GMT Initiative-supported Dominica Healthy Men Project. amfAR receives generous support from the Elton John AIDS Foundation (EJAF) for this program and for all of its grants in the Caribbean.
Currently, throughout the Caribbean, progress in the fight for LGBT rights is being challenged by reactive conservative forces -- especially in places like Belize and Jamaica where violence and protests have erupted in recent months. However, in Dominica, there is a new movement to proactively promote human rights for LGBT and prevent this kind of violent conservative backlash by framing the issue as a public health strategy that can reduce HIV rates nationwide. I'm happy amfAR is a part of that effort.
In Dominica, same-sex sexual activity is illegal and punishable by up to 10 years in prison, but many organizations and the government seem receptive to change. At the coalition meeting, representatives from the Ministry of Health and individuals from various NGOs -- including Dominica Planned Parenthood Association, Child Fund, and Caribbean HIV/AIDS Alliance, among others -- discussed LGBT rights in Dominica. All were in agreement that the issue was a vital one, but that it would be a lengthy process, and must be framed in a public health context. They also all agreed that any movement must be led by Dominicans themselves, a strategy that aligns well with amfAR's model of supporting GMT community-led efforts.
The Dominica Healthy Men Project will train peer educators to use the newest science of HIV prevention and promote healthy living among GMT. The rest of my visit was spent assisting with training 12 gay and bisexual young men for the program. They were each very earnest about helping their community, and most arrived on time at 9 a.m. for all three days of the training -- even on Sunday morning! We spent a lot of time discussing issues about being healthy vital to their own lives and circumstances. For example, we had lengthy discussions about healthy romantic relationships, during which most of the guys described their dreams of the day they will be in a long-term romantic relationship, complete with a house, white picket fence, nice car, children, and a dog.
They were also very excited about biomedical approaches to reducing HIV. During the training, I introduced the concept of "community viral load." This concept is based on new science indicating that if people living with HIV are enrolled in HIV care and adhere to antiretroviral (ARV) medication, they will be virally suppressed and less likely to transmit HIV to others. Thus, reducing "community viral load" is a strategy to encourage HIV testing and treatment within the entire GMT community. The guys really liked the concept, as it fit well with their earnestness about helping their community. Unfortunately, HIV-related stigma is rife among GMT in Dominica, deterring many people from getting tested. We therefore spent a lot of time discussing the causes and effects of HIV-related stigma among GMT -- such as inadequate knowledge about how HIV is spread and the isolation associated with an HIV positive diagnosis -- and strategies to overcome that stigma. In the end, work plans were developed for program implementation, but more importantly, these guys are now more empowered to make a difference in their community. I look forward to receiving their reports of impact on the epidemic among GMT in beautiful, tropical Dominica.