The newly formed Caribbean Public Health Agency held it’s second partner’s meeting today at PAHO/WHO’s headquarters in Washington DC. According to a previous CARPHA press release, the meeting was
“to gain backing from the global community for this single, people-focused public health agency for the region.”
A Google News search found only one article with the search term “CARPHA”–about St. Kitts and Nevis officially signing documents to establish the agency, joining Antigua and Barbuda, Belize, Grenada and St. Lucia. So I’m hoping there will be more about this meeting in the coming days.
The meeting was attended by PAHO/WHO Director, Dr. Mirta Roses, and PAHO/WHO Deputy Director, Dr. Jon Andrus, Dr. Denzil Douglas, Prime Minister of St. Kitts and Nevis and CARICOM Lead Head of Government for Health and Human Resources, Ambassador Lolita AppleWhauite, Secretary General (acting) of Caribbean Community (CARICOM), and other regional authorities.
Caribbean American communities are incredibly diverse and have contributed greatly to the growth of this Nation. I learned from watching my mother, who worked as a nurse taking care of sugar cane plantation workers, not only the importance of hard work and dedication but also the importance of family and community. As a community, we face a significant challenge in tackling HIV. Even though Caribbean Americans comprise less than 10 percent of the total U.S. population, they are included in the disproportionately high rate of new HIV/AIDS diagnoses that occur in Black Americans. As a clinician and a professional in the field of public health, I have seen those challenges first hand.Yet as member of the community, I also know what we can accomplish if we work together. Caribbean American leaders can play an especially important role in the community to promote HIV awareness to address this public health issue. To help prevent HIV/AIDS, community leaders and care providers need to communicate about HIV in culturally relevant and linguistically appropriate ways.
As with other racial and ethnic minority communities, many Caribbean Americans have taboos against discussing sexual matters related to HIV risk. There is stigma associated with men having sex with men in some Caribbean American communities, and this challenge may influence some individuals to avoid getting tested for HIV. Delayed HIV testing and diagnosis among Caribbean Americans seriously endangers their health and the health of their sexual partners. We must be clear and open in discussing the risk factors associated with HIV and all work to reduce barriers to testing and treatment. With regular testing to identify new HIV infections, individuals who test positive can have the opportunity to receive appropriate care and treatment to prolong their lives and reduce the chances of infecting others.
Federal partners including HHS have been working with the White House Office of National AIDS Policy (ONAP) to develop a National HIV/AIDS Strategy using input from the public, to improve our response to the epidemic in the U.S. Active involvement by individuals and stakeholders including state, territorial, and local governments will be important in implementing the national strategy. The HHS Office of Minority Health will continue to partner with other agencies and organizations to support capacity building in hard-hit communities, improve care providers’ cultural competency, conduct outreach, and help people to get educated about HIV, get tested, and get treated. We are targeting those hardest hit by the epidemic – for example, our HIV/AIDS Health Improvement for Re-entering Ex-Offenders Initiative (HIRE) program bridges healthcare gaps that exist with the AIDS epidemic to improve the HIV/AIDS health outcomes of ex-offenders re-entering the mainstream population by supporting community-based efforts to ensure their successful transition from state or federal incarceration back to their communities.
Today, we recommit with others around the country to improve the lives of people living with HIV/AIDS. I learned a saying from my mother that not all silence is golden, and silence isn’t golden when it costs lives. On this Caribbean American HIV/AIDS Awareness Day, let’s raise our voices together to empower Caribbean American communities to challenge the stigma surrounding the disease in order to help reduce new infections and better serve people living with HIV. Let’s aim to reach our communities with a message focused on prevention and testing, understanding that if we work together we can continue to achieve great things, one of the greatest being an end to the HIV epidemic.
Garth Graham, M.D. is the Deputy Assistant Secretary for Minority Health at the U.S. Department of Health and Human Services.
An article in the UK’s Daily Mail is reporting on the alleged rape and attack of two British Charity workers on St. Lucia. This news also comes on the heels of investigations into reports of rapes and sexual assault from U.S. Peace Corps volunteers. When incidents such as these happen, countries are quick to protect their political and financial interest. Often, one of the first questions asked is ‘how will this affect tourism in the short term and in the long run?’
However, more questions needs to be asked of the culture in which women–whether nationals or foreigners–are victims of rape and sexual assault. And, we need to focus more on understanding why young men commit such crimes. Over the years, I’ve seen a rise in wanting to blame ‘society’ and ‘media’ without really knowing what implications these terms have on male socialization. Much have been written about hyper-sexualization of Caribbean men.
Our region has among the highest rates of sexual assault in the region. I’m sure any reported number is lower than actual happenings simply because many of these incidents go unreported. According to a Kaieteur News Online article on a UNIFEM report released last year,
“Sexual violence against women is high across the Caribbean, with all CARICOM countries showing higher than the global average per capita rates. This is according to United Nation Development Fund for Women (UNIFEM).”UNIFEM disclosed that crisis centres report significant under-reporting of all forms of sexual violence as victims lack confidence in the administration of justice. “Women victims did not expect police sympathy and would only report with great reluctance.””
What is the best way to go about gathering data on the determinants on rape and sexual assault across the region? Considering that many cases are not reported, what can be done to inform and educate women-and men-about the impact of such abuses on the individual, family and community lives as well as on the population level? What types of interventions (structural?) might be implemented to decrease the prevalence and incidence of sexual assault and rape in our society?
An article published today in the New York Times reports that getting HIV infected individuals to treatment immediately after diagnoses, instead of waiting for a low CD4 count, greatly reduces the risk of transmission.
The study, lead by Dr. Myron Cohen at the University of North Carolina at Chapel Hill followed more than 1700 couple, and the early results from the study led an independent review panel to conclude that all participants should be given treatment.
This is definitely good news for those working to end the HIV epidemic. In the past few years, several campaigns have focused on testing and treating individuals as early as possible, including UNAIDS Test and Treat; the Know Your Status campaign targeting Black Americans and the various community-level interventions.
The article brought up a good point-about the doctor patient communication-regarding access to treatment. It reminded that despite the promise of the study, it is still up to doctors to decide with their patients when to begin treatment. Also mentioned were the various barriers to access to care. In the Caribbean region, like most of the world, those who need treatment are not always able to get it because of cost or other issues.
In what ways can health communication be used to advance the research presented in this study? How might one design an intervention targeted at doctors treating newly infected HIV patients? What type of health education intervention would you design to let people know that early treatment is an option after getting tested?
Is having simultaneous multiple sex partners a mental illness? One Jamaican psychiatrist certainly thinks so. Dr. Frederick Hickling, speaking at a mental health campaign launch at the Caribbean Institute of Media and Communication (CARIMAC), called this behavior a “pathology.” He continues saying, “I think that in this culture we are enticed by transgression and we condone transgressive behaviour. We more condone transgression than we condone normality. When somebody comes to you and asks for a ‘bly’ they are really saying ‘allow me to do something that is wrong instead of doing something for myself’. I think that is absolutely wrong and I think it is abnormal and I think it is a form of psychological denial about things that we know we ought not to be doing”.
Dr. Frederick also took to task the often-cited links between polygamy in Africa and Jamaican (and by extension Caribbean) men’s multiple sexual partnerships, noting that the African links are used as an excuse for transgressive behavior.
As evidence for his mental illness theory, Dr. Frederick also cited the numerous musical examples glorifying such behavior. Among the ones mentioned was Beenie Man’s “Nuff Gyal” below.
Reflecting on the music and on men having simultaneous multiple sex partners, Dr. Frederick also said this “reflects the kind of attitude we have in the Caribbean towards transgression. That’s a very male, chauvinistic position where the man believes he can do what he wants, and when he wants. This is neither a pandemic, nor is it soft. It is an epidemic and it is hard”. To be sure, he also said this behavior is not a male only phenomenon, but it is male dominated.
So, is this a mental illness? I need much more evidence before coming a solid conclusion as such. And considering that these statements were made at the launching of a mental health awareness campaign, Dr. Frederick made every attempt to include cultural, sociological and psychosocial explanations for considering this a mental illness. Nevertheless, before we call it a metal illness or jump to how such behavior is (re)presented in music, we should look at how males are socialized across the Caribbean region. From young, men are often asked to prove their maleness by being with women. We make it very difficult for a young man to choose to abstain from sex or to choose to be with one person. Oftentimes, our parents or other adults nearest and dearest to us were engaged in this behavior and although we are not told to ‘do this’, we are also often not told the opposite.
Although I am not convinced this is a mental illness, it is a societal ill. It is reflected in the many single-parent or grand-parent headed households across the region. It is reflected in the rising HIV and other STI cases, particularly among Caribbean women. It is reflected in rising violent crime committed by young men. It is reflected by the number teen pregnancies.
This is actually an important conversation to have. We should be talking more about mental health across the region. We should also be talking more about the impact of simultaneous multiple sex partners not only from a mental health standpoint, but also from a public health and sociological standpoint. I’m just not sure if the two belong in the same conversation in then vein of Dr. Frederick.
The full article is available at the Jamaica Observer website here.
The newly formed Caribbean Public Health Agency held it’s second partner’s meeting today at PAHO/WHO’s headquarters in Washington DC. According to a previous CARPHA press release, the meeting was
Caribbean Health Communication Blog 
