Wednesday, April 16, 2014

Continued oversight or deliberate overlooking of Jamaican SGL Women in HIV Prevention?

Given what we now know of the recently concluded ‘Justice for All” campaign that is supposedly designed to address HIV/AIDS issues, dignity for persons living with the disease, addressing stigma and discrimination and the all important vulnerable populations, although we know that that means MSM for the most part and one is aware of the thirty year history of the epidemic which started in the gay community in the US predominantly but after seeing the expansion of the problem into heterosexual populations and women in particular why hasn’t the prevention strategies both nationally or at the none state actor level improve to include same gender loving women? Why has the regimes over the years seem to have fostered and maintained a culture of almost with normalcy ignore SGL women as if they do not exist in the scheme of things? 


Bisexual, Lesbian and some trans-invisibility still is present.

Knowing that bisexuality is a bridge for the disease especially owing to our multiple partnering culture steeped in misogynistic imperatives.

The recently hyped lesbian transmission story in the United States brought the matter back to some mainstream prominence, I remember my days in the national system where a few voices were asking similar questions as posed above but were met with a deafening silence and as for the NGO community they were not interested in moving on it as the general feeling is that their concentration was and is more on MSM getting testing up, condom distribution with very little psycho social/sexual supportive interventions. Local studies as early as 2003 from memory have suggested that there is a problem in continuing to ignore this group when they also are a main part of the bridge although mother to child transmission work is exemplary the specific identification and targeted work of same gender loving women to include polyamorous practices that do exist locally is yet to be strengthened; yet I am left thinking it seems to be a cat and mouse game that is at work where professionals are more about keeping their jobs with the holy grail of Global Fund money more so than anything else. The concluded Justice for All conference here in Jamaica and the platitudinous announcements of increased funding for HIV prevention and the Prime Minister with a flowery speech on protecting marginalized groups albeit the smoke has not settled from her dodgery yet again on a suggested conscience vote on buggery how is anyone to take her word on such groups even also as homeless LGBTQ population numbers increase with all kinds of challenges with arrests yet again of two only last week.

Dr Karen Carpenter in a 2000/1 study published a set of phenomenology papers in the Social & Economic Studies Journal ISSN 0037-7657 Vol. 60 #1 March 2011 Sexualities in the Caribbean a study sub titled “Love on a Continuum” that took a look at MSM and WSW (women who have sex with women) and HIV. The publication also had as subject matters:

Christopher A, D. Charles: Representations of Homosexuality in Jamaica

Noel M. Cowell: Public Disclosure and Popular Attitudes towards Homosexuality in Jamaica

Annecka Marshall: Reclaiming the Power of Black Women

In 2003 the Ministry of Health had commissioned the study on MSM/WSW populations for to find mapping of the risks in those groups, it found that a continuum of descriptions among male homosexuals however hence it was reasonable to also assume that a similar diversity was at hand in the same gender loving female group as well then in 2006 another study was conducted specific to the women who have sex with women grouping and Mckenzie conducted a further MSM study replicating the phenomenological approach of Carpenter’s WSW research. The data was collected through audio recordings of 24 in depth interviews via email, face to face, phone and internet messaging. Previous studies only looked at MSM, there were no known efforts prior in the Caribbean overall as WSW have been overlooked and indeed ignored for some time so no consideration was taken into account in as far as HIV prevention or mapping was concerned.

The constructs of sexual identity are still larger defined by behaviour and sexual practice on all sides (anti gay groups included hence the HIV is a gay disease construct in their public advocacy) without taking into account psychological and internal desires of the individual as we also see this gap in the lack of response to the homeless issues for e.g. the haste in the premature closure of the 2009 Safe House Pilot project by Jamaica AIDS Support’s then board citing “bad behaviour” as the reason yet no psychological courses that were written in the project rationale’s were executed to see their effectiveness or lack thereof. Much of the theoretical underpinnings of tend to encourage a view of sexuality as a dichotomy and this is largely restricted in many instances to a notion of exclusive homosexuality and heterosexuality. This narrowed focus therefore works on the premise that MSM or WSW do not have sex with opposite sex partners and that women who have sex with men do not see themselves as lesbians or MSM do not see themselves as gay if they engage women sexually. The Center for Disease Control, CDC in the US reported “ ....... Through December 2004 a total of 246,461 women were reported as HIV infected, of these some 3,461 were reported to have se with women .......” (Center for disease Control 2006, 2),

This raises other issues as well in terms of unprotected sex involving WSW who actually self identify as lesbian, then the biphobic nature of the exclusively gay individuals towards, bisexuals, pan polyandrous, polyamorous or polygamists for that matter as they are considered confused and disease carries hence the untrustworthiness quotients and deep mistrust that surfaces every now and again. Gay men for example who do not endorse the notion of bisexuality as an identity believe that over time a collection of experiences strengthens this preference towards what may be considered a more solid homosexual identity although some have had past experiences with women as response to societal demands and not an expression of identities. This belief is at the heart of the negative sentiments to the idea of bisexuality as a solid identity. It is at this cross over juncture in a bid to meet those societal demands proof of manhood via offspring is crucial hence higher HIV risk is eminent.

Sex as identity is restricted to a definition based on a biological concept (as anti gay group JCHS repeatedly does in their sometimes belligerent advocacy) which highlights the anatomical distinctions between males and females thus sexual relationship’s social underpinnings is grounded in genitalia (Cesso & Shirley 1984) ways however in which persons define themselves is also important. 


Power and control also play a key role in HIV risk I feel especially owing to the personality dynamics involved or assumed hetero-normative gender roles with sexual positions as a major factor. Material gain is crucial as well linked to power differentials understood in social labels for, e.g. butch, fems, lipstick lesbian, jeans lesbians, stud (most problematic of the group in terms of rejection and stigmatization from within the WSW community); it determines the “how” of sex, roles, when and has implications for abuse leading to HIV risk, another example of high risk is tribadism practised by exclusively lesbian women or women who get into gay sex for money or the sex industry (porn, strip clubs, massage parlours by request of male clients, or substitutional sex in same sex environments such as prisons, places of safety etc.) the actual meeting of both vaginas to create friction while pleasurable is highly risky as passing of infections such as yeasts, dermatophites as tinea curis is critical one can therefore assume that if the labia minora or lips of the vagina has been compromised and blood is exposed then transmission is possible even if the other party does not have broken skin but simply as the vagina is a receptive organ the opening allows for the orifice acting as a gateway.

Dr Carpenter also spoke to “Sexual Health Issues in Women who Have Sex with Women” at the Ena Thomas Memorial public lecture & Symposium on the 24th November 2013 where the matter of overlooking the WSW population came up for mention she referenced the 2003 study where she went further into the findings outlining some seminal data though dated but it appears not much has changed, for e.g Kingsley report says that vaginal penetration with sex toys serving as substitutes for the penis had been quite rare in WSW history that is of course exclusive lesbian women, another overlay that we need to also grapple with is pornography as hinted to above; while porn is meant to be a fantasy WSW scenes is a glamorised view catering to a man’s ideal concept of a lesbian not a lesbians’ lesbian as men think they will have more fun with more women hence the massage parlour phenomenon and lesbian entertainment on stage in strip clubs with all kinds of risky behaviour to include penetration with toys, drink bottles (Heineken or other typed pouring of beer in a dancer’s vagina to create the volcano effect) and fingering (orgasms on stage at times) and anal play. During her attempts to collect the data the “what about dildos and transmission?” question came up and it was clear that the response had not been taking into account these issues on a large scale. For those who do use toys however there is a concern I have had for years about simultaneous use of toys in a single sexual episode without a condom, an issue from memory that was discussed at the now defunct Couture Elements weekly forum at the Oasis bar and as far back as 2000 when Women for Women had Friday night lymes with guest speakers. The rapid passing of the toys is the issue as persons either do not wait for a time before use in fear of losing the “high” of the moment nor do they do not cleanse the device/object prior to use nor employ any barriers as it is assumed once the vagina is not offensive looking or smelling then all is well.

She also went into a polyamory forum (persons with more than one consenting partner who are aware of each other) that she conducted out of which came the continuum hence the Love on a Continuum caption. Some of the agencies seem to be guilty of not getting more background information on women who come in for HIV testing (apart from refusal to disclose) as the culture seems to suggest they do not want to hear about lesbians testing for HIV, one main NGO was named as having this misnomer as evidenced in their customer experience, the nurses when questioned by Dr Carpenter they had two formally registered cases of lesbians who tested yet the cohort when interviewed had been tested for the most part, so it is safe to say that it is assumed that if you’re female then you must be having sex with a man and you couldn’t be having sex with a woman and coming in for testing.

Sadly also some in the cohort do not disclose to their lesbian partners that they are having sex with men now we see how infection can occur as here is another bridge for the virus’ transmission.

There must be a concerted effort by the powers that be to include and not only include for a short time but onwards for specific populations with tailored interventions, we have had conference after conference after conference yet they seem to be nothing more than a meeting place for polite society than actually formulating and enacting better and specific responses to so called marginalized groups. It is interesting the ease at which the call letters LGBTQI are used at these conferences, human rights meetings by “experts” to sound good and have an inclusive image in the name of public advocacy but take a look at understanding the specific needs on the ground especially and you’re left thinking something else. One wonders if the slow march to dealing with these challenges with the cop out excuse that funding is not available is deliberate, is it that there must be a reservoir of victims all the time so agencies and bureaucratic systems can be around forever, was it ever about addressing the issues as they become apparent, why does the older agencies especially have to wait until issues get out of hand before they act, where is the needed pro-activity?

Hmph

Peace and tolerance

H

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