Dr R Oswald Thomas
Wednesday, 13 January 2010 08:54
By Dr. Oswald R. Thomas
Antigua and Barbuda, like most countries around the world, commemorated World AIDS Day just over a month ago. In contrast to other countries, which appear to be winning the war against HIV/AIDS by reporting a significant decrease in the number of new cases, Antigua and Barbuda and the Caribbean, apparently, are losing the war against HIV/AIDS.
In Antigua and Barbuda and the Caribbean, the trend shows that the region is reporting new incidences of infection at an alarming rate comparative to our small populations.
The AIDS Secretariat and the country’s AIDS Clinical Coordinator Dr Sir Prince Ramsey and many other Caribbean professionals in the field are reporting an increase in infection rate. In the United States, HIV/AIDS continues to decline overall, however when compared by race, age, and religion, HIV/AIDS infection has increased among Blacks, Hispanics, youths between the age of 14-24, and senior citizens 64-80. However, the same cannot be said for the White population. One way to slow the disease is through education, backed by public health sensitive legislation.
In Antigua and Barbuda, to win the war against HIV/AIDS, the government, the churches and other social groups must conscientiously address the need for relevant education of our youths.
HIV/AIDS cannot and should not be discussed without exploring related issues such as sexual orientation, sexual identity, culture, religion and sexual behaviours. Sexual orientation refers to the emotional, romantic, and/or sexual attractions to men, women, both genders, neither gender, nor another gender. Sexual orientation also includes a psychological component, such as the direction of an individual’s erotic desire, or a behavioural component which focuses on the sex of the individual’s sexual partner(s).
Sexual identity and sexual behaviour are related to sexual orientation. However, they are distinguished, with identity referring to individual’s conception of themselves, behaviour referring to actual sexual acts performed by the individual, and orientation referring to “fantasies, attachments and longings”. An important observation in the educative process is this: persons may or may not express their sexual orientation in their behaviours, people who have a homosexual sexual orientation that does not align with their sexual identify are called closeted.
Research conducted by the Center for DeaeseControl (CDC) indicates that there are two driving force behind the raise in HIV among the Black and Hispanic communities. They posited that for Hispanics, religion is the main cause, due to the fact that many Hispanics are members of the Catholic Church and adhere to Catholic teaching, the sex is only for procreation – hence the use of protective barriers such as condoms and jellies to stop the spread of HIV are not used.
While that is true for Hispanics, the same cannot be said for Blacks, as the increase in HIV in the Black population is levelled at the feet of one’s culture. For cultural reasons, many Black men will not admit to being homosexual or bi-sexual, and under the cover of darkness or discretion will engage in such sexual behaviours while maintaining a sexual relationship with a woman or women well known to the public. What is a fact for both Hispanics and Blacks is, men who engage in anal sex with other men where he is the top (meaning the man) he nor society will consider him homosexual. The same can also be said to men in person, return to a waiting women. The man who is the bottom (meaning the woman) is often considered to be a homosexual.
All these educational concepts have practical implications. If HIV/AIDS is to be controlled through preventative and corrective interventions, it is vital that our school system teach not just biology, but human sexuality as well. Another important element in the educative process is the importance of groups’ formation along gender lines to discuss sex and sexual behaviours, and issues related to living with and preventing the spread of HIVS/AIDS requires, an ethics of care couched within an open and non-judgmental environment.
It is also important for the government to seek to pass laws to require pre and post test counseling for individuals seeking to be tested for HIV/AIDS. In first world counties, counseling in HIV and AIDS is a core element of a holistic approach to health care, where psychological issues and concerns are an integral part of patient management. HIV/AIDS counseling is critical to the prevention of HIV transmission and the wraparound support for those affected directly and indirectly by HIV.
HIV/AIDS counseling has been proven to facilitate changes in behaviours, as persons are shown positive coping and prevention behaviours. For example, one-on-one counseling enables open and frank discussion of sensitive areas of a person’s life that other settings may not readily produce. With respect to confidentiality or anxiety about a judgmental response, persons are likely to be less than forthcoming in open forums.
When people know that they have HIV infection or disease, they can suffer great psychosocial and psychological stresses through fear of rejection, social stigma, disease progression, and uncertainties. Some choose to die by refusing to take medication or eat, while others become bitter and seek satisfaction in knowing that they will not die alone. This sense of not wanting to die alone compels them to give it to as many men or women they could be sexually involved with. And still, there are others who believe that another person should not have to suffer as they have, and adopt a more positive approach. They try to warn others about how not to behave in ways that are more likely to expose them to HIV/AIDS.
The government should also make it mandatory that all newborns in Antigua and Barbuda are tested for HIV, and all women giving birth will be told of the infants’ HIV test results, which will indicate if the mother is HIV infected and the baby was exposed. The mother should know that if she does not consent to be tested prenatally, she will be tested post partum through her infant.
As a public health response, a person knowing their HIV status early gives them the advantages of effective treatment and prevents opportunistic infections. This process of education backed by legal enforcement is likely to slow the disease progression and reduces the risk of infection to others. While condoms and other methods have proven to help prevent the disease, the most effective method still remains the most daunting -- abstinence.
Dr. Oswald R. Thomas Dr. Oswald R. Thomas is a Certified and Registered Clinical Hypnotherapist/Psychotherapist with the American Board of Hypnotherapy, the International Association of Counselors and Therapists, and the International Board of Medical and Dental Association. He is founder of the Thomas Center Human Development, Inc. and serves on Bronx Mental Health Committee, served on Community Board #5 in the Bronx, and the Bronx Neighborhood Planning Committee as Chair of the Youth Committee. With a Ph.D. in Psychology, a Master’s in Public Administration, and a Bachelor’s of Professional Studies in Human Services, Dr. Thomas is a counseling therapist/Behaviorist, and Professor at Metropolitan College of New York. Email: