Speeches & Op-Eds
Combating HIV/AIDS Stigma and Discrimination in The Bahamas
2007 Chiefs of Mission HIV/AIDS Conference
Kingston, Jamaica
October 4, 2007
Introduction
Yesterday and this afternoon we have heard truly harrowing stories about the challenges faced by those who have, or even those who are simply suspected of having, HIV/AIDS. Each day HIV/AIDS victims throughout the Caribbean deal with stigma and discrimination – all because many people are unwilling to see the face of people who have HIV and AIDS as no different than the face in the mirror.
In the Bahamas, Dr. Perry Gomez has spearheaded the country's successful HIV/AIDS work for nearly two decades. He told me when I visited his clinic last week that he believes providing care for those with HIV/AIDS must be at the heart of any program to combat stigma and discrimination. As he explained it, our first responsibility must be to guarantee affected individuals the ability to access healthcare. A person who is healthy and looks healthy while living with HIV/AIDS, he noted, is a living testament as to why there is no reason to stigmatize or discriminate against them. So as more people have access to care, the “face of AIDS” for the public will change from that of a sickly person in a mysterious hospital ward to that of a neighbor, a colleague, a friend.
All societies in the region face daunting challenges in overcoming deeply rooted prejudices and suspicions about HIV/AIDS. And The Bahamas is no different. But, I am pleased to say that The Bahamas has made significant strides in confronting the twin challenges of stigma and discrimination. I am also pleased that our Embassy in Nassau has been able to support the efforts of the Bahamian government and its outstanding NGO partners to this end. Through creative public outreach, government-NGO partnerships, and engagement from the private sector, some churches and many dedicated individuals, the barriers against people living with AIDS have been lowered and, in many cases, broken.
History & Progress
Given my focus on the linkage between care and treatment and stigma and discrimination, I would like first to offer a brief overview of the AIDS epidemic in the Bahamas and efforts to respond to it. As elsewhere in the region, the HIV/AIDS epidemic in Bahamas has been a generalized one, transmitted primarily through heterosexual contact. Widespread use of crack/cocaine in the 1980’s led many Bahamians to engage in high-risk behaviors, and a wave of sexually transmitted infections hastened the spread of HIV.
The Bahamas made one critical decision that proved instrumental to its subsequent success: health officials in Nassau early on categorized this disease as a health threat as opposed to a societal ill. This public health focus generated an early and aggressive public health campaign that led to a decrease in new infections beginning in 1994. Six years before that, the National AIDS Secretariat had already been formed, and, as early as 1995, the Government of the Bahamas was providing ARVs to pregnant women. Under Dr. Gomez's direction, the motto of the national program became: “no prevention without care.” HIV/AIDS clinics in Freeport and Nassau were established that served as cornerstones of a highly effective national monitoring system.
The Bahamas continued to fine tune its response in establishing a national coordinating body in 2000 and by developing a national HIV/AIDS program that charted clear national goals and methods to achieve them. This process brought together government officials, medical professionals, social workers, NGOs, and people living with HIV/AIDS to craft a realistic plan. Already in 2000, The Bahamas was well on the road to achieving the “three ones” necessary for a successful comprehensive HIV/AIDS strategy.
Building on this foundation, The Bahamas in 2002 decided on the ambitious goal of providing free treatment for all. But this goal quickly ran into the reality of high prices of generic drugs. Fortuitously, the just formed Clinton Foundation stepped in to support what would become its first national effort to reduce ARV drug costs, and assisted the government of the Bahamas in negotiating prices and access that made it possible to provide treatment to all people who required it.
This collaboration in turn helped make the “Bahamas Preventing Mother to Child Transmission Program” the biggest HIV/AIDS success story in the Bahamas. The program starts out in the local clinic. Nurses routinely ask every expectant mother who enters the clinic whether they would like to be tested. Assessments have consistently shown a high testing rate and a high compliance rate when women were offered free ARV treatment, home visits by the postnatal home service team, and a supply of artificial milk. The mother-to-child transmission rate dropped from 30 percent in 1997 to less than 3 percent in 2004 for those that accessed antenatal care. For the past two years there have been no transmissions to mothers who accessed antenatal care.
While this success has been noteworthy, the country faces continuing challenges to provide the healthcare foundation necessary to combat broader stigma and discrimination. For example, many Bahamians have trouble traveling to the centers in Nassau and Freeport on a regular basis for routine care. The Bahamas government has therefore identified decentralization as one of their priority goals. Such decentralization of care would allow the health care system to reach people presently underserved, while allowing them to maintain the normal work schedules they need in order to be able to support their families and avoid the stigma associated with going to centralized HIV/clinics. Again, the goal as Dr. Gomez outlined, is to provide care that will allow people to lead normal, productive lives and change the stereotypes that exist about people living with HIV/AIDS.
The Bahamas also faces the challenge of treating and caring for its largely Haitian immigrant community. Health professionals have long been concerned that their messages were not reaching the Haitian community, which accounts for 25 percent of all cases in the Bahamas. Building on an Embassy grant and corporate sponsorship, the HIV/AIDS Center was recently able to translate their popular “Know Your Status” campaign into Creole and have it played on Creole radio programs. A working group was set up with priests in Haitian churches to help distribute the information. This expanded outreach will remain vital in reaching communities wary of government.
Despite the free availability of ARV treatments, clinic staff finds that not everyone who is eligible consents to consistent treatment. One of the main reasons for this lack of participation is fear of discrimination when they, as an otherwise healthy looking person, walk into the clinic labeled HIV/AIDS for routine care, or, when because of problems in confidentiality, word of their conditions spreads around the small society where everybody knows everybody else’s business and loves to talk about it. And that brings us right back to the issue of stigma and discrimination.
Combating Stigma and Discrimination
Two weeks ago, we visited the HIV/AIDS clinic in Nassau at the invitation of Dr. Gomez. The clinic has grown so much that it takes over three corridors of the hospital once a week. Visitors to the clinic are confused and think they are there on the wrong day because they find it hard to believe that there are so many “healthy looking” people in the waiting room (pic: HIV/AIDS clinic). The concept of people living with HIV/AIDS, not AIDS “victims”, has proven crucial to humanizing those who have the virus and, in turn, overcoming the stigma associated with it.
That is why the Bahamas Strategic Plan for 2006-2010 has as its first goal the reduction of societal stigma and discrimination. While a high standard of treatment and accessibility of services is key to being able to show that people can live with HIV/AIDS, this standard of treatment must be linked with the additional step of making sure we communicate that message to society. Governments, medical professionals, and civil society leaders need to be active in highlighting the progress made in battling this disease and shaping a climate of acceptance within the society as a whole. This is also where Embassies can play a role in communicating and reinforcing this message.
Clearly the first step in spreading this message of societal compassion is education, whether of children or adults. And here, too, The Bahamas is hard at work – often with the support of the Embassy.
In 2006, the Embassy partnered with the Bahamas Network for Positive Living -- a support network of people, mainly HIV-infected, who provide a public face of AIDS in the Bahamas – to involve young people nationwide in an effort to combat stigma and discrimination. The project brought two hundred students together from the various islands of the Bahamas to create an HIV/AIDS ceramic quilt. Beyond the message of prevention, the quilt focused on caring for and respecting people with HIV/AIDS. The tiles carry messages such as: "Stop the Epidemic," "Use Protection At All Times," "I Love You," and "Be Careful." Several of the children were able to come to Nassau to attend the event hosted by the Ambassador at the National Art Gallery and after the debut, the quilt toured several other locations in the Bahamas.
For even younger children, Bahamian NGOs have focused on projects that taught awareness about HIV/AIDS and the importance of respecting people who have the disease. The New Providence Community Center, a local church with a large following, brought together dozens of children from different schools. With the assistance of a local artist and an Embassy grant, they designed murals depicting what they had learned about HIV/AIDS. The project has now been repeated and the murals adorn the inside and outside of the church.
In the artistic community, Antonius Roberts, a well-known local sculptor, created a series of silhouettes of people living with HIV/AIDS. His well-received exhibition showed Bahamians of all ages and backgrounds who are HIV positive (pic; focus on hope – from NPCC). Many of those depicted in the silhouettes were hesitant to be “outed” because they are leading normal lives in all other regards, working or attending school – they are HIV positive yet live with their sero-status a secret from most of those around them. This gave people an opportunity to step forward while also showing that the face of AIDS is not always who many think it is.
The 2006 Ambassador’s Fund also supported The Bahamas Network for Positive Living (BNN+) in staging a Concert for Positive Living that brought into the public spotlight the number of people with HIV/AIDS who are enjoying fulfilling lives as active members of the community, as activists, as friends, and as family members.
Beyond the important stimulus provided by the Ambassador’s Fund and other donor programs, the everyday support from Embassy leadership and staff members has also helped boost local efforts to combat stigma and discrimination. One of the most powerful news stories from last year’s World AIDS Day was that of our then Ambassador, John Rood, being publicly tested for HIV/AIDS. This was something that had never been done before in The Bahamas and it made the headlines in local media as a symbol of U.S. solidarity with people living with HIV/AIDS. Coinciding with the testing, the Embassy published a series of op-eds in local media about the importance of HIV/AIDS awareness and of reducing the stigma attached to the people who have the disease. Reflecting on this personal outreach on testing recently, a member of a local NGO told us it was one of the most notable things that had happened over the year to combat stigma because it got people talking.
Our Embassy's involvement does not stop at the Front Office. Staff members from all sections in the Embassy participate in HIV/AIDS awareness activities during the year. On World AIDS Day, a large Embassy contingent helped form a human red ribbon in the main square of downtown Nassau. In addition, a group of early risers, including the former Ambassador, joined an AIDS walk along the main thoroughfare on the island. Our Economic Officer also serves as an active member of the HIV/AIDS Resource Committee which brings together actors from government, police, the medical field and local NGOs to coordinate policy, programs and action.
Happily, the many Bahamian and U.S. outreach efforts on HIV/AIDS do appear to be having an impact on public policy. The Bahamas is currently advancing legislative reforms to make discrimination against people living with HIV/AIDS illegal in the workplace and in schools. The Bahamas Employment Act of 2001 explicitly forbade discrimination in the workplace on the basis of HIV/AIDS status. The Bahamas Ministry of Education also established an HIV School Committee in 2004 that has just completed work on a comprehensive new school policy regarding HIV. The policy specifies that there should be no discrimination and that each child should be afforded the opportunity for education. After consultations with teachers and the Attorney General’s office, the policy will be reviewed and approved by the cabinet. Extensive efforts are also being made to educate teachers and students to support the policy’s implementation. Our Ambassador’s Fund grants have been used to support the expansion of these programs to 15 schools including in the Family Islands.
Conclusion
As everyone here knows from your own experiences, making progress in fighting HIV/AIDS discrimination, educating the public, and developing programs with results can be difficult and frustrating. However, I believe the case of the Bahamas makes clear that the instinctive fear and prejudice can be overcomem, and that the best way to combat stigma and discrimination is, in fact, to keep people healthy. Raising the level of care for people living with HIV/AIDS is the best way to ensure that old stereotypes of AIDS victims don't apply. That, in turn, will create a more fertile ground for efforts by governments and people – supported by our Embassies – to educate and challenge the assumptions that give rise to stigma and discrimination. And as stigma and discrimination fade, we will enjoy even greater success in preventing and treating HIV/AIDS throughout the Caribbean.
As everyone here knows from your own experiences, making progress in fighting HIV/AIDS discrimination, educating the public, and developing programs with results can be difficult and frustrating. However, I believe the case of the Bahamas makes clear that the instinctive fear and prejudice can be overcomem, and that the best way to combat stigma and discrimination is, in fact, to keep people healthy. Raising the level of care for people living with HIV/AIDS is the best way to ensure that old stereotypes of AIDS victims don't apply. That, in turn, will create a more fertile ground for efforts by governments and people – supported by our Embassies – to educate and challenge the assumptions that give rise to stigma and discrimination. And as stigma and discrimination fade, we will enjoy even greater success in preventing and treating HIV/AIDS throughout the Caribbean.
Thank you.