Access to HIV Services for Mobile and Migrant Populations in Antigua

APRIL 2012
A Mapping Study on
Access to HIV Services for Mobile and Migrant
Populations in Antigua
Submitted to:
EPOS Health Management GmbH
Hindenburgring 18
61348 Bad Homburg
Germany
0
KN CONSULTING

This research was made possible through the sponsorship of GIZ and
EPOS and under the guidance of PANCAP. The author’s viewpoints do
not necessarily reflect the views of the sponsoring agencies.
Submitted by:
KN Consulting
P.O. Box 2788
Phone: 268-764-5574
Email: korenkardia@hotmail.com
Author:
Koren A. Norton
Research Assistant:
Tritia S. George
Date of Publication:
April 2012
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FACTS ABOUT ANTIGUA
• Capital - St. John’s
• Size - 108 Sq. miles
• Approximate population - 85-88,000
• Primary language – English
• Secondary language – Spanish
• Currency – Eastern Caribbean Dollars and US Dollar
• HIV/AIDS treatment is free to all persons living in Antigua and Barbuda
MIGRANT INFORMATION
• Approximate migrant population – between 30-33%
• Most migrants from – Guyana, Jamaica, Dominica, Dominican Republic, Britain
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TABLE OF CONTENT
Table of Tables…………………………………………………………........................... 07
Table of Figures…………………………………………………………………………..10
Acknowledgements……………………………………………………………………… 12
List of Acronyms………………………………………………………………………… 13
Executive Summary……………………………………………………………………... 15
1. Background……………………………………………………………………….. 15
2. Method……………………………………………………………………………. 15
3. Results…………………………………………………………………………….. 16
4. Limitations………………………………………………………………………... 17
5. Recommendations………………………………………………………………… 17
Introduction……………………………………………………………………………… 19
1. Background……………………………………………………………………….. 19
2. Antigua Data……………………………………………………………………… 20
3. Relevance of Study………………………………………………………………..23
4. Outline……………………………………………………………………………. 24
Literature Review……………………………………………………………………….. 26
1. Introduction………………………………………………………………………. 26
2. History of Migration…………………………………………………………….... 27
3. Current Migration Patterns……………………………………………………….. 29
4. Migrants in the Sex Industry……………………………………………………… 31
5. Migrants and Stigma and Discrimination………………………………………… 32
6. Xenophobia and Violence Against or Among Migrants…………………………. 33
7. Legal Aspects Related to Sex Work in Antigua………………………………….. 33
8. Migrant MSM Population………………………………………………………… 34
9. HIV/AIDS Care………………………………………………………………….. 35
10. HIV and Behaviour in Antigua…………………………………………………… 37
11. Data and Statistics on HIV/AIDS in Antigua…………………………………….. 37
12. Current Concentrated Epidemic………………………………………………….. 38
13. Mortality………………………………………………………………………….. 40
14. HIV/AIDS Services and Organizations Available in Antigua…………………… 41
15. Migrant Access to Healthcare in Antigua………………………………………… 44
Mapping Methodology………………………………………………………………….. 45
1. Population………………………………………………………………………… 45
2. Sample Size………………………………………………………………………. 45
3. Justification for Sample Size…………………………………………………....... 46
4. Map of Hotspots and Hot Zones…………………………………………………. 47
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5. Design of Survey Tools……………………………………………………………48
6. Data Analysis…………………………………………………………………….. 48
7. Personnel………………………………………………………………………….. 48
8. Ethical Consideration…………………………………………………………….. 49
9. Limitations of Study……………………………………………………………… 49
Stakeholders Reports……………………………………………………………………. 51
1. Governmental Stakeholders…………………………………………………………... 51
1.1.Dr. Prince Ramsey – Former Clinical Care Coordinator…………………………. 52
1.2.Ministry of Health………………………………………………………………… 52
1.3.AIDS Secretariat/NAP Office……………………………………………………. 53
1.4.Mount St. John Medical Center………………………………………………….. 55
1.5.Ministry of Labour……………………………………………………………….. 56
1.6.Immigration Department………………………………………………………….. 57
1.7.Gender Affairs Division………………………………………………………….. 58
2. Non-Governmental Stakeholders…………………………………………………….. 61
2.1.Health, Hope and HIV (HHH)……………………………………………………. 61
2.2.Caribbean HIV and AIDS Alliance (CHAA)…………………………………….. 63
2.3.Antigua and Barbuda HIV/AIDS Network (ABHAN)…………………………… 64
2.4.Antigua Planned Parenthood Association (APPA)………………………………. 65
2.5.Women Against Rape (WAR)……………………………………………………. 65
3. Faith-Based Organizations……………………………………………………………. 67
3.1.Pentecostal Church……………………………………………………………….. 67
3.2.Catholic Church……………………………………………………………………68
3.3.Seventh-day Adventist Church…………………………………………………… 68
4. Private Medical Practitioner………………………………………………………….. 69
4.1.Dr. Dane Abbott – Women’s Clinic……………………………………………… 69
4.2.Dr. Nagabis Sanchez……………………………………………………………… 70
5. Other………………………………………………………………………………….. 71
5.1.Guyana Consulate………………………………………………………………… 71
5.2.GAAP Support Group…………………………………………………………….. 72
6. Conclusion of Stakeholder Interview………………………………………………….72
7. Recommendations Based on Stakeholder Interview…………………………………. 74
Key Findings and Recommendations…………………………………………………... 76
1.1.Non-Governmental Organizations Focus Group Report…………………………. 76
1.2.Non-Governmental Organizations Focus Group Discussions and Conclusion…... 80
1.3.Non-Governmental Organizations Focus Group Recommendations…………….. 80
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2. MSM Reports…………………………………………………………………………. 81
2.1.MSM Survey and Focus Group Reports………………………………………….. 81
2.1.1.MSMs in Antigua…………………………………………………………… 82
2.1.2.MSM Hotspot Mapping Exercise…………………………………………... 83
2.1.3.Condom Use…………………………………………………………………82
2.1.4.HIV Information……………………………………………………………. 83
2.1.5.HIV Testing………………………………………………………………… 84
2.1.6.Access to Healthcare Services……………………………………………… 86
2.1.7.Discrimination……………………………………………………………….89
2.1.8.Knowledge of HIV Services………………………………………………... 89
2.2.MSM Discussion and Conclusions……………………………………………….. 90
2.3.MSM Recommendations…………………………………………………………. 92
3. CSW Reports…………………………………………………………………………. 94
3.1.CSW Survey Discussion and Focus Group Reports……………………………… 94
3.1.1.CSW in Antigua……………………………………………………………. 94
3.1.2.SW Hotspots Mapping Exercise……………………………………………. 94
3.1.3.Condom Use…………………………………………………………………95
3.1.4.HIV Information……………………………………………………………. 96
3.1.5.HIV Test……………………………………………………………………. 97
3.1.6.Access to Healthcare Service……………………………………………….. 99
3.1.7.Discrimination………………………………………………………………103
3.1.8.Knowledge of HIV Services……………………………………………….. 104
3.2.CSW Discussion and Conclusions……………………………………………….. 106
3.3.CSW Recommendations…………………………………………………………. 107
General Discussion and Conclusion…………………………………………………… 109
General Recommendations…………………………………………………………….. 112
1. Policy Aspects………………………………………………………………. 113
2. Organization Capacity Building…………………………………………….. 113
3. Training Recommendations…………………………………………………. 114
4. HIV Prevention and Education Services……………………………………. 115
5. HIV Testing…………………………………………………………………. 116
6. Access to Care………………………………………………………………. 116
7. Treatment and Care………………………………………………………….. 117
8. Support………………………………………………………………………. 117
Annex……………………………………………………………………………………. 119
1. Stakeholder Contact Information…………………………………………………119
2. Non-Governmental Organizations Focus Group Report………………………… 120
3. MSM Reports…………………………………………………………………….. 121
3.1.Focus Group Report…………………………………………………………. 121
3.2.Survey Results……………………………………………………………….. 131
3.2.1. Demographics………………………………………………………... 132
3.2.2. Partner History……………………………………………………….. 137
3.2.3. Condom Use…………………………………………………………..141
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3.2.4. HIV Information and Testing…………………………………………145
3.2.5. Access to Healthcare Services………………………………………...152
3.2.6. Discrimination………………………………………………………...158
3.2.7. Knowledge of Services………………………………………………. 160
4. CSW Reports…………………………………………………………………….. 163
4.1.English-Speaking Focus Group Report……………………………………… 163
4.2.Group Responses…………………………………………………………….. 165
4.3.Spanish-Speaking Focus Group Report……………………………………… 170
4.4.Focus Group Responses……………………………………………………… 171
4.5.Survey Results………………………………………………………………...174
4.5.1. Demographics…………………………………………………………175
4.5.2. Partner History……………………………………………………….. 180
4.5.3. Condom Use…………………………………………………………..183
4.5.4. HIV Information and Testing…………………………………………187
4.5.5. Access to Healthcare Services………………………………………...195
4.5.6. Discrimination………………………………………………………...201
4.5.7. Knowledge of Services………………………………………………. 203
5. MSM Interview Sheet……………………………………………………………. 210
6. CSW Interview Sheet…………………………………………………………….. 217
References……………………………………………………………………………….. 224
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Acknowledgements
A mapping exercise of this magnitude required the input of many persons and it was a team
effort. Firstly I would like to thank the men and women who we interviewed and who opened up
and shared their personal stories and experiences with us. It may not have always been easy to
give such details but they accommodated us and without their input, the project would not have
been possible.
Then I would like to thank members of the stakeholder organizations who shared requested
information with us about their work and daily activities as it relates to members of the migrant
population. Special thanks to the AIDS Secretariat office for the statistics provided.
I would also like to thank the team who worked along with me to make this project a reality –
interviewers, translator, data entry clerk and my research assistant. Your assistance was
invaluable.
Finally, I would like to extend my gratitude to the sponsors at GIZ and EPOS and the staff at
PANCAP. I was happy to be a part of such an important project that has the potential to make a
difference in the lives of many persons. Thanks to Ms. Julia Hasbun, Dr. John Waters and
especially to Dr. Robert Cazal who provided all the necessary guidance, reviewed the entire
project and provided support every step of the way.
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List of Acronyms
AIDS
ABHAN
APPA
ART
ARV
AUA
BBM
BSS
CFPA
CHAI
CHAA
CMO
DFID
DMO
FBO
FSW
GTC
HIV
HHH
IEC
LGBT
M&E
MARPS
MSJMC
MSM
NAC
NAP
NGO
PAHO
Acquired Immune Deficiency Syndrome
Antigua and Barbuda HIV/AIDS Network
Antigua Planned Parenthood Association
Antiretroviral Therapy
Antiretroviral
American University of Antigua
Blackberry Message (Cell Phone Application)
Behavioral Surveillance Survey
Caribbean Family Planning Affiliation
Clinton Foundation HIV/AIDS Initiative
Caribbean HIV/AIDS Alliance
Chief Medical Officer
Department for International Development of the United Kingdom
District Medical Officer
Faith-based Organization
Female Sex Worker
German Technical Cooperation
Human Immunodeficiency Virus
Health, Hope and HIV Network
Information, Education and Communication
Lesbian, Gay, Bisexual, Transgender
Monitoring and Evaluation
Most At Risk Populations
Mount St. John Medical Center
Men who have Sex with Men
National AIDS Committee
National AIDS Programme
Non-Governmental Organization
Pan American Health Organization
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PEP
PITC
PLHIV
PMTCT
PSI
SRH
STI
TB
UNGASS
UNICEF
VCT
WAR
WHO
Post Exposure Prophylaxis
Provider Initiated Testing and Counselling
People Living with HIV
Prevention of Mother-to-Child Transmission
Population Services International
Sexual Reproduction Health
Sexually Transmitted Infections
Tuberculosis
United Nations General Assembly Special Session on HIV and AIDS
United Nation Children’s Fund
Voluntary Counselling and Testing
Women Against Rape
World Health Organization
9

Executive Summary
Background
Due to the prevalence of HIV in the Caribbean, there have been a number of efforts targeted at
reducing that prevalence and also identifying which groups of persons are most at risk for
becoming HIV positive. Two of the groups identified as vulnerable populations are commercial
sex workers (CSW) and men who have sex with men (MSM). These groups were selected in
accordance with the Antiguan AIDS Program due to the high number of persons entering in this
classification. It has also been noted, that these groups, as migrants become more vulnerable
because of their oftentimes limited access to healthcare and HIV related services. This research
project therefore has the following two (2) objectives:
Identify and strengthen organizations with the potential to represent the interests of
migrant populations to HIV services.
Enhance the number of public, private and non-governmental entities offering HIV
services tailored to the specific needs of male, female and adolescent stakeholders among
migrant populations groups, including the identification of evidence based best practice
approaches.
A desk review was conducted to ascertain the extent of the situation. Literature was reviewed to
determine what studies had already been conducted and what was determined to be existing
challenges and best practice models.
Method
It was decided with the NAP and the project team that a mapping exercise would be carried out
from a multi-dimensional viewpoint utilizing quantitative and qualitative research methods. Data
collection tools were designed, validated and tested and interviewers were trained to conduct the
interviews with the target groups, 114 with migrant sex workers and 95 with men who have sex
with men. Face to face interviews were also done with several key stakeholders who provided
services towards members of the migrant population. Then four focus groups were conducted
with members of the target populations – one with MSM’s, one with Spanish-speaking sex
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workers, one with English-speaking sex workers and one with NGOs which yielded a lot of
valuable information.
All the data collected was compiled to get a true picture of the migrant situation in Antigua and
their access to HIV prevention, treatment and care and support services.
Results
The findings showed that while there are some very active agencies in Antigua providing
services, many of the members of the migrant population did not make enough use of the
services for several reasons.
The NAP and CHAA seems to be the agencies that provide the most outreach in the form of
condom distribution and education. As it relates to treatment, the Clinical Care coordinator and
the Mount St. John’s Medical Centre are most used. For support purposes, 3H and ABHAN are
the agencies that cater most to persons who are HIV+.
While many agencies like WAR and Gender Affairs Division provide support, they do not cater
specifically to members of the migrant population; however, their contribution is still noticeable.
The Faith based Organizations do a minimal amount of health education in their facilities and in
some instances offer some support in the form of supplies, but do not do much in terms of
outreach.
Members of the target populations had complaints about stigma and discrimination, lack of
confidentiality and lack of immigration status as barriers to them receiving services. Many of
them preferred to return to their home country if funds allowed, to access services. While many
of them had multiple partners, there was a very low testing rate and not enough condom use.
Condoms were readily available, but due to vulnerability issues, some sex workers were
persuaded to work without condoms for a larger fee and some of the men who had sex with men
were persuaded by more powerful or financially secure partners not to use them. It was noted
that many of the younger MSM’s engaged in transactional sex.
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There is clearly a lot of stigma and discrimination even among healthcare workers towards HIV+
persons. Among the persons interviewed there is a general atmosphere of xenophobia and
homophobia and persons who fall within these groups often felt very disillusioned about
accessing services.
Many of the commercial sex workers interviewed expressed a desire to work in other
professions, but options were limited due to immigration status, language barriers, limited
education or skills and the current situation of unemployment in Antigua. .
Limitations
The study was not without its challenges. While anecdotal evidence suggests a large number of
migrants who are sex workers and men who have sex with men, the documented numbers are
much smaller. As a result, the sample was based on a percentage of the documented population
and while homogenous, is not a true representation of the total core group populations.
It was also difficult getting information from some of the stakeholders who were difficult to
reach or did not have much to report.
Recommendations
Based on all the findings, the recommendations suggested, if executed, could result in the
various stakeholder agencies being more effective in rendering services to members of the target
populations. They are categorized as follows:
Stakeholders – more capacity building is necessary in the form of training and also capital to
expand services. Training in program development and in cultural competence to reduce stigma
and discrimination is important. A guide can be developed for FBO to guide them on how they
can be more effective in the outreach and support process. Better unity and collaboration is also
needed for the various agencies to work together to provide a network of services.
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Access to Care – Improved dialogue with the clinic and health center administration to enable
essential services to be rendered to persons even without a medical benefit card.
Prevention and Education – mobile testing, peer education, empowerment training and better use
of popular media sources were some of the recommendations in this area.
Treatment and Care – recommendation in this category include more availability of prophylaxis
for persons who have been exposed to the HIV virus or who have been sexually assaulted,
teaching risk reduction behavior for persons already HIV+ and greater visibility of the Clinical
Care Coordinator.
Support – psychological or counseling pro-bono services can be set up for members of the
MARP populations and more country associations can be set up to be a support for members of
the migrant populations.
13

Background to Study
A quick search of literature or online articles pertaining to HIV and AIDS in the Caribbean will
show that this area is considered to have the second highest prevalence of HIV in the world. This
of course could raise serious concerns for the Heads of Government of the various Caribbean
islands, the key stakeholders in each country and other relevant regional and international bodies.
With some form of resolution in mind, the Government of Germany supports the Pan Caribbean
Partnership Against HIV and AIDS (PANCAP), the branch of CARICOM responsible for HIV
and AIDS reduction programs. PANCAP’s mission is “to sustainably reduce the spread and
impact of HIV in the Caribbean through sustainable systems of universal access to HIV
prevention, treatment, care and support”. The grant is being executed by the German
International Cooperation (GIZ) and the goal is to identify who the vulnerable members of the
migrant populations are, which organization deal with them and whether or not they have access
to HIV services (prevention, treatment and support) and which are the organizations that deliver
the most adapted care to the needs of these individuals, so that the quality of those services could
be improved and best practices could be identified.
Five countries were selected for a pilot project – Antigua, Guyana, Trinidad, St. Maarten and
Suriname. Studies were not done in Barbuda at this time, due to the limitations in manpower and
resources and it was decided that a sample conducted in Antigua, would provide a representation
of the entire twin-island state. There were four main components, but for the purpose of this
report, the one examined here is:
Component 3: Identify and strengthen organizations with the potential to represent the interests
of migrant populations to HIV services.
This will eventually lead to a report on:
Component 4: Enhance the number of public, private and non-governmental entities offering
HIV services tailored to the specific needs of male, female and adolescent stakeholders among
14

migrant populations groups, including the identification of evidence based best practice
approaches.
Antigua Data
Antigua & Barbuda is a twin-island state located in the Eastern Caribbean and is closest to the
islands of Montserrat, Nevis, Guadeloupe and Dominica. Visitors enter legally via the main VC
Bird International Airport and via entryways by sea from English Harbor, St. John’s Harbour
(Heritage Quay), Jolly Harbour and Deep Water Harbor. All of these ports have an immigration
officer (s) stationed there, but it has been alleged that some persons come illegally via the sea.
Antigua has six parishes, but it was noticed that most of the activities centered around the capital
St. John’s. See map below.
Figure 1 – Map of Antigua with Parishes
15

Table 1 - Population by Parishes
Parish Area (Sq. Miles) Population
St. John’s City 2.9 22,193
St. John’s Rural 25.6 29,054
St. George’s 9.3 7,838
St. Peter’s 12.8 5,307
St. Phillip’s 17 3,490
St. Paul’s 18.5 8,804
St. Mary’s 22.8 7,794
Barbuda 62 1,810
TOTAL 86,295
The island’s population is estimated to be 86,295 based on the last national census conducted in
2011. Of that total population, it is estimated that at least 30% are migrants, with the most
migrants coming from Jamaica, Guyana, Dominican Republic, Dominica and England
(Immigration Department, 2012). Our net migration rate according to the CIA Fact book is 2.29
migrants for every 1,000 persons which makes us number 35 in the world out of 220 countries.
The primary language spoken in Antigua is English, with others speaking Spanish, Patois and
some French and the literacy rate is listed as 99% (World Bank, 2011). The island is considered
a tourist destination and tourism accountsfor 60% of the GDP. The Gross GDP as of 2011 was
1.3 billion (CIA Factbook, 2012). In terms of the labour force, 82% of the employed persons
work in the service sector, 11% in industry and only 17% in agriculture. The Antigua and
Barbuda travel and tourism sector contributed to 78.5% of the GDP in 2010 and to 84.5% of
country employment.
The island is considered to have an upper middle income in the category of Latin American and
Caribbean developing states.
16

Healthcare services centers available on the island of Antigua
HIV prevalence
Table 2 - HIV Prevalence in Antigua and Barbuda
Table 3 - HIV Reported Cases in Antigua and Barbuda
17

Relevance of Study
Several reports have indicated that the populations most at risk for contracting the HIV virus in
Antigua include sex workers, persons engaging in transactional sex, youth, men who have sex
with men and the World Bank 2011 report states that the prevalence rate is 0.8% for persons 15-
49.
In consultation with Sonia Joseph, the Deputy Program Manager at the NAP office, the Project
Team Leader, Dr. Robert Cazal-Gamesly and other members of the team Dr. John Waters, Julia
Hasbun, it was decided that we would focus on two core groups of migrants: men who have sex
with men (MSM) and commercial sex workers (CSW) as these groups were considered to be
vulnerable groups based on various factors, one being the stigma and discrimination they
endured and their limited access to health care.
A Desk Review was conducted to examine what has already been studied and published about
the topic of HIV and AIDS in the Caribbean, specifically Antigua, about vulnerable migrant
populations and about organizations that work with these core groups. It was clear that there are
some push factors that cause persons to leave their home country such as poverty,
unemployment, lack of opportunities, abusive or unmanageable relationships, etc. Then we
discovered that there are pull factors that make other countries that the migrants move to seem
more attractive such as a tourism market where there is the hope of making United States (US)
money, more employment opportunity, hearing success stories from others who are doing
reasonably well there, family and/or friends in the area, or the idea of making it a temporary
stepping stone, as there might seem to be an opportunity to move to an even larger country from
there. The desk review showed that there have not been many studies done about migrant men
who have sex with men and the challenges they face. The few studies indicate that there is a
general intolerance of the lesbian, gay, bisexual and transgender (LGBT) community and this
leads to an issue of stigma and discrimination in the Caribbean society. It also revealed that a
large number of the sex workers in Antigua are from Jamaica, Guyana and the Dominican
Republic and some of them have very limited support systems here. From the research conducted
for the desk review, it is also clear that the NAP office and the Caribbean HIV and AIDS
Alliance appear to be the frontrunners in preventative care for vulnerability to HIV and AIDS.
18

Outline
A mapping exercise was conducted over a period of approximately three (3) months where a
team of interviewers and support staff was trained and intensive interviews were conducted with
a sample of the migrant population core groups mentioned above and with key stakeholders who
worked daily with migrants and mobile populations and others who provided service to migrants
as a key part of their functions.
This report includes the results of a mapping exercise conducted in Antigua and looks at:
• The physical location of members of selected migrant populations – where and how they
live and work and where they access health and support services.
• What services the organizations that have the most contact with the migrant population
offer to help them with their physical and psycho-social needs.
• Which organizations offer the most comprehensive or useful services as it relates to HIV
and AIDS education, prevention strategies, treatment, care and support.
• At which agencies, the members of the core groups of migrant population feel most
comfortable and helped.
• What the barriers are to them receiving the necessary physical and psychosocial care as it
relates to HIV and AIDS.
• What are some recommendations to adapt and improve the quality of care offered to
them.
It was discovered that Antigua does indeed have a high percentage of migrants and because of
the socio-political situation and their lack of documentation they do not always access necessary
services. Some services are available and are being accessed, but there are times when ability to
pay becomes a problem. There are gaps in the system whereby if someone is undocumented,
they cannot access certain services and this puts them at risk for healthcare problems and also
their partners.
Below is an outline of what will follow:
19

‣ Desk Review – a compilation of literature reviews to examine what was already been
published on the topic of migrant and mobile populations in Antigua and their access to
HIV and AIDS services.
‣ Methodology – an outline of the methods used for data collection, justification for
samples and a quick overview of the way forward.
‣ Stakeholder Reports – Results of interviews conducted with key informants who have
much contact with the migrant population.
‣ Focus Group reports – Results of meetings held with members of the core groups and
also NGO’s in an effort to get qualitative information and feedback regarding their
experiences and recommendations.
‣ Survey results – Detailed data about the two core groups studied which presents the
demographics as well as views and experiences related to HIV and AIDS.
‣ Best Practice Models – a comparative view of some of the programs being conducted
around the region.
‣ Conclusion – A mini-report which puts all the information gathered in context.
‣ Recommendations – Suggestions from the consultant based on the data collected on
ways to improve vulnerable migrant population’s access to HIV and AIDS education,
treatment, care and support.
‣ Appendices – Tables, figures and questionnaires.
20

Introduction
Literature Review
Although Antigua is a small island of just 108 sq. miles and a population of about 86,000,
proportionate to its population, it has dominated the Caribbean with the number of migrant
populations that not only visit, but dwell here. Countries leading Antigua with migrants are the
Virgin Islands, Cayman Islands and Aruba (United Nations Population Division, 2010).
With the introduction of the CARICOM Single Market & Economy (CSME) program in 2005,
persons from CARICOM member states who have signed on to the agreement, can apply for a
certificate to be able to use their skills in other CARICOM states, thus ensuring the transfer of
labour (CSME, 2011). Ten categories of CARICOM national workers (CARICOM/CSME,
2011) are entitled to free work without complex procedural barriers of work permits and stay
permits related movement. These ten categories are university graduates - persons who have
obtained at least a bachelor’s degree from a recognized university (or a professional qualification
which is equivalent), media persons, artistes, musicians, sportspersons, nurses, teachers,
managerial staff, technical staff and artists. However, based on reports from the Labour
Department in Antigua, the migrant population is diverse and the level of qualifications varies
(Ambrose, 2012).
The current Prime Minister, Honorable Baldwin Spencer has stated that Antigua and Barbados
are the two countries of CARICOM who have the most migrants and he stated that they are
mostly from Jamaica, Guyana, Dominican Republic and to a lesser extent Dominica.
The link between mobility and HIV risk need clear evidence. CAREC/FHI (2007) stipulates that
there is an urgent need for vulnerability mapping to identify specific segments of the population
that are disproportionately at risk, infected, or affected by HIV. There is also a need to identify
and better understand the role of ‘bridging populations’ in the HIV epidemic (e.g., are mini-bus,
taxi-drivers and migrant and mobile population indeed a ‘high-risk group’ versus a bridging
population or potential gatekeepers to most-at-risk groups such as sex workers).
21

This review attempts to examine some of the research done or documents published to examine
questions related to the migrant and mobile populations and their exposure to HIV and AIDS and
the services and agencies available to take care of them.
Additionally CAREC/FHI (2007) adds that government officials from six OECS member states
(including Antigua & Barbuda) have expressed concern about the increasing spread of HIV
infection in their countries. None of the countries has had at this time reliable national data to
monitor prevalence and behavioral trends.
History of Migration
Roberts (1981) identifies three waves of migration extending from the fifteenth to the early
twentieth century as follows:
I. The introduction of the Europeans;
II. The slave trade which surpassed in scale all other movements into the island and which
has provided the majority of its present population;
III. The introduction of indentured workers which, although small in scale when compared to
the slave trade, had important cultural, social and economic consequences for the
country.
During the indentured period (1835-1884) the island received very few workers. Records show
that 100 Chinese and 2600 persons from Madeira, a total of 2700 persons, was the sum total of
our indentured population.
Table 4 - Official population numbers over the years
Census
Year
Total
Population
Male Female
Sex Ratio
Population Growth
Total Average Annual
Increase Rate of Growth (%)
1871
35,157
15,998
19,159
83.50
-
-
1881
34,964
16,147
18,817
85.81
-193
-0.06
1891
36,819
17,242
19,577
88.07
1,855
0.52
1911
32,269
13,989
18,280
76.53
-4,550
-0.66
1921
29,767
12,542
17,225
72.81
-2,502
-0.81
22

1946
1960
1970
1991*
2001*
2011**
41,757
54,060
64,794
60,840
76,886
83,278
19,011
25,230
30,589
29,638
36,109
N/A
22,746
28,830
34,205
31,202
40,777
N/A
83.58
87.51
89.43
94.99
88.55
N/A
11,990
12,303
10,734
-3,954
16,046
6,392
*Adjusted population
Source: 1990-1991 Population and Housing Census of the Commonwealth Caribbean. National
Census Report, Antigua and Barbuda, 2001. CARICOM Secretariat, 1997. Antigua and Barbuda
Summary: 2001. Statistics Division of the Ministry of Finance and the Economy, July 2004. Antigua and
BarbudaCensus 2011 Preliminary Data Release. Statistics Division of the Ministry of Finance, the
Economy and Public Administration. January/February 2012
1.35
1.84
1.81
-0.30
2.34
0.83
Because of the free movement of people to and from the USA, which was restricted in 1921 and
1924, Welland (1974), and certain major agricultural and infrastructure projects in Latin
America, there was a steady outflow of people from Antigua and the wider Caribbean to these
parts of the world. This was seriously restricted in 1921 because of certain laws passed in the
USA (United States Immigration Act, 1924) and the completion of these projects in Latin
America.
In the early 1900’s, a number of Caribbean nationals migrated to Antigua to work on the sugar
plantations. Padilla (2007) states that a number of Antiguans also journeyed to places like
Guyana, Dominican Republic and Dominica and some even started families there. Many of the
offspring of these Antiguans, came to Antigua later on in hopes of finding family, especially as
migration to Antigua was not difficult and getting work permits and permanent status was
simpler than it is now.
In later years, a strong tendency for the return of high level occupational groups, better economic
conditions and higher rates of pay in Antigua, continued to fuel the inflow of persons into the
country from the surrounding Caribbean territories (Planning Institute of Jamaica, 1994 and
1995).
23

Kempadoo (2010) recalls that “Antiguans became accustomed in the 1980s and 90s to full
employment opportunities. From 2000, with reduced opportunities for employment, increasing
numbers of Antiguan and migrant women are reported to have turned to prostitution.”
Current Migration patterns
In recent years, the island has maintained a very high population of migrants. The Census
figures for 2001 1 show that we have a large population of resident Guyanese, followed by
Dominicans, Jamaicans, USA, Dominicans (Dominican Republic) and Europeans. The
International Organization for Migrants (IOM, 2011) suggests that about one third of the
population of Antigua and Barbuda is migrant from mainly Caribbean countries including
Guyana, Jamaica and Dominican Republic.
Kempadoo (2010) stated that while the global recession does not yet seem to have impacted
heavily on the tourism sector, locally, the arrest of financier Allen Stanford and the closure of
mega projects have led to loss of jobs particularly in construction and road building contracts.
The new government changed police and immigration officials and vigorous efforts are made to
clamp down on illegal immigrants. This, perhaps on top of the economic downturn and
noticeable presence of many foreigners, created a highly xenophobic atmosphere.
In 2008, although statistical data showed that there was 3,000+ Jamaicans living in Antigua (See
table below), the Antiguan Prime Minister, Honourable Baldwin Spencer at a meeting with Hon.
Bruce Golding, Prime Minister of Jamaica and a crowd of Jamaicans in Antigua, stated that he
estimated that the population of Jamaicans living in Antigua were around 12,000 (Official
Website of the Office of the Prime Minister of Jamaica). His estimate appeared to be based on
the fact that there were a large number of undocumented Jamaicans living in Antigua.
Table 5 - Population of Antigua & Barbuda as of 2001 (last census data available).
1 The most recent Census was conducted in 2011, but the full data has not yet been released.
24

Designation Population Total % of Total Population
Total Population 76,886 100%
Guyana 5,410 7.0364%
Dominica 3,966 5.1583%
Jamaica 3,335 4.3376%
USA 2,194 2.8536%
Dominican Republic 1,492 1.9405%
Some of the reasons given for the high number of other Caribbean migrants to Antigua include
push factors in their respective countries such as deteriorating economic and social conditions,
high unemployment, especially for the youth and little hope of things getting better (ECLAC,
2003). The pull factors in Antigua as cited by Martinez-Pizarro (2005) include the possibility of
getting jobs and some social equity. It is interesting to note, that Antigua was one of five out of
sixteen countries polled that thought that their population of migrants was too high (UN
Population Report 2002).
Antiguan are also migrants in other countries
Prof Hope has shown that in 2009, the level of remittances from Antiguan migrants is not
significant in terms of percentage of the GDP: 2.2%
25%
21,2%
20%
15%
15,8%
13,7%
10%
5%
0%
7,4%
Dominican
republic
3,2%
Figure 3 - Remittances as Percentage of the GDP in 2009 (Thomas-Hope (2012)
0,4%
Jamaica Haiti Guyana Barbados Trinidad &
Tobago
5,9%
8,6%
7,4%
5,1%
Belize Grenada St Kitts & Nevis St Vincent and
the Grenadines
2,9%
St. Lucia
2,2%
Antigua &
Barbuda
6,1%
Dominica
25

Table 6 - Remittances as Percentage of the GDP over the Years (Thomas-Hope, 2002):
1986 1987 1988 1989 1990 1991 1992 1993 1994
3,9% 3,2% 2,7% 4,8% 3,1% 1,2% 0,5% 0,1% 0,7%
Migrants in the sex industry
Studies conducted on the topic of migrants in the sex industry indicate that of the over 8,000
estimated nationals from the Dominican Republic residing in Antigua, about 70% of the women are
sex workers (COIN, Centro de Orientacion e Investigacion Integral, Trabajo Sexual, Trata de
Personas VIH/Sida, Abril 2008).
UNGASS 2010 report indicates that due to the heavy influence of tourism which brings foreign
currency and the opening of many casinos and gambling spots, sex work has become more prevalent
in Antigua.
Most women entering Antigua for sex work are from the Dominican Republic, Jamaica, Guyana and
Trinidad (Kempadoo, 2010). According to Immigration, in the last two and a half years there has
been an increase, with some coming as entertainers, bar tenders, or masseurs. Dominicana (known as
‘Spanish’) women set up small shops and live and conduct sex work. Some Dominicana sex workers
operate from homes rather than in brothels. Several years ago, there was more street prostitution, but
that dynamic has changed (Kempadoo. 2010).
According to UNICEF report (2008), in the Caribbean, HIV transmission occurs primarily through
unprotected heterosexual sex, with commercial sex playing a significant role. They also posited that
men who have sex with men (MSM) are vulnerable, because due to stigma and discrimination, they
are not always likely to get tested to know their HIV status, hence they may unknowingly transmit
the virus.
An Epidemiologist from the global AIDS Program, US Centers for Disease Control and Prevention,
Ms. Behel, in working along with The Caribbean HIV and AIDS Alliance (CHAA), noted that the
commercial sex industry participants in Antigua do get tested, though through private laboratories,
as the brothel owners expect to see an HIV- report to allow them to work (Behel, 2010).
26

In Antigua, the highly controlled and regulated environment of the brothels and clubs, coupled with
an increase in raids on the clubs for undocumented migrants, appears to have led to a move of some
Latin American women into home-based sex work, where they also enjoy a greater independence to
organize their business.
Migrants and stigma and discrimination
In a study conducted in 2010 by Dr. Kamala Kempadoo it was reported that some racism is directed
at ethnically noticeable Caribbean immigrants – primarily people from the Dominican Republic. An
informant added that “people assume all Spanish-speaking women are prostitutes” with all the
negative implications that go with the idea of prostitution. Antagonism between local women and
foreign sex workers was noted in several places with a large number of Latinas.
Additionally “female sex workers complain to police about men not paying, however because of
illegal status, some foreigners cannot access police protection” Most Dominicans, both men and
women, however, have been given work permits and many have lived in Antigua for many years.
Some are now being refused by immigration.
Kempadoo (2010) recommend that “given that many female, male and transgender sex workers
experience stigmatization and discrimination in healthcare systems throughout the region, special
training and facilities need to be put in place to deliver affordable and confidential healthcare to sex
worker populations.” “The small size of some of the countries – where “everybody knows
everybody” - and the mobile character of much of the sex work in the region demands discreet and
creative approaches to ensure that sex workers are supported wherever their work takes place.”
Xenophobia and Violence against migrants
The racism/xenophobia in Antigua was escalating to the point of street violence by Antiguan men
against Dominicans, who they feel are illegal immigrants, are taking jobs from Antiguans and are
committing crimes. But crime statistics do not indicate a high percentage of foreigners involved in
crime. Workers at CHAA also mentioned that there have been reports of violent attacks against
27

members of the sex-worker population being reported but not investigated, creating societal
discriminations.
CHAA (2010) has heard testimonies from “a sex worker who was raped, but who was too ashamed
and afraid to access emergency drugs that could help prevent HIV transmission, or medical care
to heal her physical injuries. Silence and fear around these issues leave perpetrators of violent
crimes free to commit acts of violence against women in our society.”
Legal aspects related to sex work in Antigua
Dr. Kamala Kempadoo (2010) “Aside from raids to pick up persons who are undocumented or
who have overstayed, it is either on arrival or at application for an extension of a permit where
many persons who are believed to be sex workers are ‘detected” and refused entry by Immigration
Authorities under the Antigua laws”
In Antigua, deportation is by court order, yet so far “no deportations for prostitution – even if
found at a house -this is difficult to prove” so the person is deemed a prohibited immigrant. “We
would ask [persons suspected of prostitution] to leave. Immigration officers receive tips about
potential sex workers sometimes before they arrive at the airport and may have a lead about the
club, [i.e. bar with exotic dancers] Most persons choose to leave and are placed on a ‘watch list.’”
There have been no male sex workers suspected or denied entry.
Kempadoo (2010) reports that the laws also extend to immigration matters, and with the
mobility of women around the region for work in the sex industry, coupled with xenophobia and a
fear of an influx of migrants from poorer Caribbean nations – especially in Antigua, St. Kitts and
Nevis, Barbados, Suriname, and Trinidad – the sex industry is targeted for raids on undocumented
migrants. Almost invariably it is the undocumented migrant women sex workers who are rounded up
in such raids. One of the institutional informants of the Kempadoo study stated that “HIV test is not
compulsory for work permit and extension in Antigua.”
28

Though prostitution is illegal in the State of Antigua and Barbuda, many establishments, once
publicly advertised as brothels, have now rebranded themselves as night clubs and/or apartment
buildings. As such, the owners no longer consider themselves responsible for the activities that take
place at their establishments.
Kempadoo (2010) suggests that decriminalization of sex work and homosexuality could greatly
diminish the level of violence and discrimination that female, male and transgender sex workers
face.
Migrant MSM population
In the Kempadoo study interviewees state that “young boys having transactional sex with men is
increasing” and that amongst 'MSM' “transactional sex has become accepted,” with “multiple
partners for economic reasons”
A significant amount of data is not available for the migrant and mobile population of men who have
sex with men. Due to society’s non-acceptance and discrimination towards this group, the effect of
this discrimination spills over into the healthcare industry. The result is that this often causes some
members of the MSM population to not be inclined to access the health care services available to
them for fear of being ‘outed’ or ill-treated. The 2009 UNICEF HIV prevention reports states
“extreme poverty, migration, homophobia and gender equalities are apparent throughout the
Caribbean region and make young people particularly vulnerable to HIV”.
In a survey conducted by the United Nations Program on HIV/AIDS (UNAIDS 2012) the
Caribbean Men’s Internet survey (CARAMIS), the findings suggested that MSM’s have difficulty
accessing healthcare because the line staff and also nursing personnel treat them differently,
especially if they are HIV+. One MSM was quoted as saying that most of the education is geared
towards the mainstream population, without anything specific for their group.
Felicity Aymer, former AIDS Programme Manager in the Ministry of Health in an interview with
Diana Davidson (2004) stated that Antigua doesn’t have a problem with transmission through the
29

use of intravenous drugs. She states that one of the high risk groups include men who have sex with
men (MSM) and youth.
However the CAREC BSS in the OECS countries confirm that there are a number of highly
stigmatized practices in the Caribbean (e.g., same-sex sexual activity, multiple sex partnerships
among women, transactional/commercial sex, etc.) as a result, it is likely that those practices are
under-reported.
HIV and AIDS Care
The Behavioural Surveillance Surveys (BSS) conducted by CAREC and FHI (March 2007) in
2005-2006 in the Six Countries of the Organization of Eastern Caribbean States (OECS) show that
among the General Population ( 15-24 and 25-49 years old), the Mini Bus and Taxi Drivers and the
in-School Youth 10-14 years old have made the following Key recommendations:
1. Universal access to the latest technology in condoms and other commodities (e.g.,
lubricants), with particular emphasis on access for young people and hard-to-reach
population groups.
2. There is also a need to increase anonymous condom availability e.g., in workplace
bathrooms, hotel rooms, airport bathrooms, shopping malls, etc. through means such as
condom vending machines.
3. Innovative service delivery models for HIV testing and counselling
4. There is a particular need to identify ‘gatekeepers’ and opinion leaders that impact on youth
access to information, commodities, and services
The 2010 UNGASS report specify that no other BSS study have been conducted since the
CAREC/FHI one, so there are no new data available
An International Office of Migration (IOM) seminar was conducted in 2004 and the main topics
surrounded the issue of migrant and mobile populations as it relates to health care. The following
general statistics were published on the Caribbean:
Fewer than one in four people at risk of infection are able to obtain basic information
30

egarding HIV and AIDS
Only one in nine people seeking to know their HIV status have access to voluntary
counseling and testing services
Less than one in 20 pregnant women presenting for antenatal care are able to access
services to prevent mother-to-child transmission of the virus
Less than five percent of those who could benefit from anti-retroviral treatment are
currently able to access such treatment
In the UNAIDS 2011 report it has been noted that the Caribbean has the second highest
prevalence of HIV after sub-Saharan Africa. The PMTCT program for pregnant women has
been responsible for the decline in the number of babies being born with the HIV infection;
however, unprotected sex appears to be the reason for the most transmission.
Kempadoo (2010) recommend that special attention needs to be placed on ensuring that nonnational
sex workers have access to public healthcare services.
HIV and Behaviour in Antigua
The 2010 UNGASS report show that the
CAREC/FHI BSS (2007) findings indicate
that 48% of the Antiguan Population aged
15-24 years identified correctly ways of
preventing the sexual transmission of HIV
and rejected major misconceptions about
HIV transmission.
However Kempadoo (2010) recommend
that “as adult men make up the mainstay of
the sex industry and are the majority of the
persons who provide money or goods for
sex, the education of men in the general
Figure 4 - Key conclusions of the CAREC study were the following
1. There was a gap between knowledge and practices
2. Knowledge of consistent condom use as a prevention method was
lower than knowledge of abstinence and faithfulness.
3. A large gender gap was observed for condom use, indicating high
vulnerability of females.
4. Many in-school youth did not know the ABCs of HIV prevention.
5. Despite high awareness of HIV, myths still prevail around how HIV
is spread.
6. Despite the expansion of PMTCT services, knowledge on the
prevention of mother-to-child transmission was far from optimal.
7. Self-reported STI burden (genital sores/ulcers or genital discharge)
was fairly high
8. Concerns around confidentiality of HIV testing remain a major issue
9. Uptake of HIV testing remains quite low, with more women than
men being tested.
10. Very little testing means that there are actually few opportunities to
get tested for HIV outside of the antenatal care setting.
31

population about their role in the sex industry and in transactional sex is imperative.”
Data and Statistics on HIV & AIDS in Antigua
The first reported case of HIV in Antigua was in 1985 and up to December 2009, there were 815
documented positive persons. There is a Clinical Care Coordinator who is appointed by the AIDS
Secretariat, which is a branch of the Ministry of Health. He was first appointed in 2005 and he heads
the care team for Antigua’s HIV positive persons (UNGASS 2010 Report).
HIV testing is available free for pregnant women when they sign up for antenatal care. Free testing is
also available for members of the public at the AIDS Secretariat office. Persons can access paid
testing at the Antigua Planned Parenthood Association (APPA) office as well as private physicians’
offices and private Laboratories (UNGASS 2010 Report).
Surrat (2007) noted that drug use, commercial sex work and migration all play a role in the spread of
HIV in the Caribbean. In Antigua specifically, reported data from the National AIDS program
(NAP) office shows that over the years the number of reported HIV and AIDS cases have been
increasing except for the year 2009 2 . It also shows that from 1985-2003 more males that females
became infected with HIV. This trend was reversed in 2004 and, except for 2009, has continued. It
was also noted that the age range of the males that become HIV infected is higher than that of
females.
Kempadoo (2010) endorsed that there is a need for better data in the CARICOM on HIV prevalence
and knowledge amongst those who use the services of sex workers – especially male clients
(including professional, businessmen, politicians, development workers, etc), the police,
immigration authorities and military forces, sex industry managers and facilitators, and specific
industry workers such as agricultural workers, fishermen, loggers, miners, ship crew and port
workers, hotel workers, etc – and amongst persons involved in transactional sexual relations,
especially the “Sugar Daddies (older men who patronize younger women or men).” Better data
would allow for more accurate assessments and more effective interventions.
32

Current Concentrated Epidemic
Figure 5 - HIV/AIDS Prevalence in Antigua 2005-2010
2
1,8
1,6
1,4
1,2
1
0,8
0,6
0,4
0,2
0
2005 2006 2007 2008 2009 2010 2011
Table 7 - HIV Newly Reported Cases in Antigua and Barbuda from 2005 to 2011
Year 2005 2006 2007 2008 2009 2010 2011
Male 27 27 31 40 25 32 18
Female 31 35 35 46 21 38 14
Total 58 62 66 86 46 70 32
The reported number of persons leaving with HIV was lower in 2011 possibly because of
the lack of HIV tests due to reduction in Global Fund funding.
According to the Kampoloo study, the HIV prevalence amongst sex workers is unknown. “there
is no good reporting mechanism so no feedback from private doctors – sex worker status is not
known.” “No cases of HIV positive sex workers among English-speakers were reported...”
However if a DR street-based is found to be HIV positive she/he would return to DR. It was the
case of 6 persons in 2008-2009.
33

CHAA, based on an Inter-American Parliamentary Group and United Nations Development
Program (IAPG/UNDP) report, reflect that 21% of the HIV infected population is unemployed
due to discrimination in the society (2011).
Figure 6 - Cumulative HIV Cases by Sex and Age (Adult/Child) 1985-2011 in Antigua
45
40
35
30
25
20
15
10
MALE
FEMALE
BOY
GIRL
UNKNOWN
5
0
Mortality
It must be noted that the Antigua MOH Health Information Division ranks HIV related deaths
about the top eight leading causes of death in Antigua (UNGASS 2010 report).
Figure 7 - HIV&AIDS Mortality in Antigua, 2005-2010 (Per 10,000)
6
5
4
3
MORT/10,000
2
1
0
2005 2006 2007 2008 2009 2010
34

Figure 8 - Total HIV/AIDS Deaths and Cases in Antigua, 2005-2010
120
100
80
60
TOTAL CASES
DEATH
40
20
0
2005 2006 2007 2008 2009 2010
Vertical Transmission
Figure 9 - Vertical Transmission Cases by Sex 2005–2011 Antigua-Barbuda
2,5
2
1,5
1
Male
Female
Total
0,5
0
2005 2006 2007 2008 2009 2010 2011
HIV & AIDS Services and organizations Available in Antigua
35

The Government of Antigua and Barbuda has given its support to the HIV and AIDS work in
Antigua by providing funding for supplies, training, etc., mostly through the Ministry of Health
and specifically through the AIDS Secretariat office.
However Kempadoo (2010) reports that the Antigua law states free service, but there is
“discrimination against non-nationals”. In the Antigua health care system migrant workers
have no benefits or social security. “The public care system is already overburdened”.
Kempadoo (2010) states that “ Despite the proliferation of organizations and agencies in recent
years that work with sex workers and other vulnerable populations, it appeared that many operate
in isolation or with suspicion about each other’s work, rather than interact with, sex workers.
This results in poor knowledge about the sex industry as a whole and can generate suspicion and
resentment among those supposedly being helped and lead to ineffective or wasteful
interventions. A greater coordination of efforts and funding, and a sharing of information
between NGOs, CBOs, INGOs and government authorities on the issue of the sex industry, at
both national and CARICOM levels, would enhance any work being undertaken in this area.
AIDS Secretariat
The AIDS Secretariat is the arm of the Government of Antigua and Barbuda that has been given
the responsibility to provide information to the nation concerning HIV and AIDS, education and
testing. They refer Persons living with HIV to the Clinical Care coordinator for ART.
Medication is also provided for opportunistic infections and free consultation is given to persons
infected with HIV for dental care, eye care, skin care, etc.
In 2008, 340 persons identified as MARPS (members of the MSM, SW and adolescent
population) were tested which was 0.43% of the tested population. In 2009, it went up to 2476
MARPS, which was 3.1% of the total tested population.
The NAP office provides training in Voluntary Counseling and Testing (VCT) and Provider
Initiated Testing and Counseling (PITC) to members of social services agencies, healthcare
workers, etc., and they also offer training sessions and support directly to the most at risk
36

population. During the 2010 carnival period 7,000 prevention packages were distributed to the
revelers of that year. Also, over the two year period from 2009-2010, they distributed 25,000
prevention packages, over 61,000 condoms and 11,000 information booklets.
Caribbean HIV and AIDS Alliance (CHAA)
Since 2008, CHAA, has been providing several services to the Antigua and Barbuda population
as a whole. They have initiated ten capacity building training sessions on the island to date.
Along with their initiative, the groups have also sponsored 14 events that focus on transferring
information on sexual behaviour and HIV and AIDS education and communication.
One of these major undertakings was entitled, “Sexual Reproductive Health and HIV Integration
Female Condom Project for Spanish Speaking Sex Workers.” (CHAA, 2009). Their animators
go out into the communities and provide outreach services to sex workers, pole dancers and men
who have sex with men. They provide free condoms and educational material.
Mobile Counselling Unit
The groups that are considered to be the most at risk of becoming HIV positive in Antigua, do
not appear to capitalize on the opportunities afforded them. This could be because of the stigma
and discrimination present in the society. For this reason, a Mobile Counseling Unit was put in
place by CHAA that attempts to the sex-worker population by meeting them on the streets.
Further, testing and counseling sites have been set up in the sex-worker’s places of employment
(Brothels/Strip Club), further allowing them to access other persons (CHAA 2009).
Health Hope and HIV Network (3H)
This NGO also works along with the NAP to provide support for HIV+ persons, sex workers and
men who have sex with men (UNGASS 2010 Report). Persons are referred to this agency from
the hospital, police department and other agencies and they conduct peer support groups, home
visits, donate food, clothing and other supplies to HIV+ persons. The Human Rights Desk for
HIV related complaints is also located in this office.
37

Population Services International (PSI)
This is a worldwide agency which seeks to promote health in developing countries. In Antigua,
PSI works along with the Antigua Planned Parenthood Association and with The Gender Affairs
Division to provide condoms for distribution (through a social marketing project) as a means of
reducing the likelihood of HIV infection. They also focus on specific target groups like men who
have sex with men, sex workers, men in uniform and youth.
Center for Integrated Training and Research (COIN)
This non-profit organization is headquartered in the Dominican Republic and seeks to conduct
research and provide services in education about reproductive health, sexual behaviour and HIV
and AIDS. This organization has conducted research in Antigua looking at the local dynamics
and also the migrant population and this research has been helpful for the local organizations to
design programs to help vulnerable populations and to assist in the fight against HIV and AIDS
and sexually transmitted infections.
Antigua Planned Parenthood Association (APPA)
Frequently called the “Family Planning” office, the APPA has been in the forefront of education
about sexually transmitted infections. They offer educational programs on the media, in schools
and at their offices. They also sell condoms for 50 cents each and also supply emergency
contraception that can be used in the event of sexual assault. They do not provide services
specifically for any target populations, but have been used by a wide cross-section of persons in
Antigua.
Antiguan Resilience Collective (ARC)
This project was first initiated in 2008 based on support from UNFPA. The decision
to start was made because traditionally, most of the help for vulnerable populations
came from agencies outside of Antigua and the founders thought it best to have a local
project run by persons on the ground. The word “resilience” is used to indicate a
change from vulnerable. The focus is on the sexual and reproductive health of
38

marginalized groups which includes men who have sex with men, sex workers,
prisoners, persons from the migrant population, etc. Funding in the past has also been
provided by CVC and COIN. The group is run by an executive who meets once
monthly and their main objective is to provide education and enhance access to health
care, as well as treatment, care and support. They also have as a goal to work with
members of the LGBT community to build leadership skills and promote
empowerment. The project is currently awaiting funds from a grant awarded by
AMFAR.
Migrant Access to Healthcare in Antigua
Generally speaking, health care in Antigua is subsidized for Antiguans or persons holding a
medical benefit card. For Antiguans over 60 and children 16 and under, it is free. Migrants
without a Medical benefit card must pay for services and seeing that they are often holders of
temporary status or undocumented, in many instances they earn lower than average wages as
they are not in a position to seek high paying jobs or to advocate for themselves. For this reason,
many do not access certain health care (ECLAC Document). There is also a stigma to being a
non-national in Antigua (accentuated for non-English speaking migrants), so persons often wait
until they return home to see a physician.
All services provided by the AIDS Secretariat are made available to the general public without
pre-condition. Some of the programs offered are also specifically geared towards migrant
populations; for example, screenings in areas that are traditionally known to have a high migrant
population, so the services are there for them to access.
Where younger migrants are concerned, it is currently being debated whether condoms would be
distributed in the local schools. Some suggest that it will encourage sexual activity as providing
protection may be seen as condoning the activity among the young. While others are of the view
that since sexual activity will occur among the young we should provide them with the tools and
education necessary to protect themselves.
39

MAPPING METHODOLOGY
Population
Due to numerous findings that suggested that vulnerable migrant and mobile populations
included men who have sex with men (MSM) and commercial sex workers (CSW), it was
decided that those populations would be polled to understand their perception of their ease of
access to services and to get a better understanding of which organizations are most utilized by
these core groups.
Sample Size
Commercial Sex Workers sample size – 114
Men who have sex with men sample size – 95
Justification for sample size
The Ministry of Tourism estimates Antigua’s resident population as approximately 86,295 based
on the 2011 census with the migrant population being 22% of that figure. Men who have sex
with men are estimated to be about 4% of the population which is 3451.The migrant population
is approximately 22 % of the general population, therefore, the migrant MSM population was
tentatively estimated as 22% of 3451, which is 759. The number of documented men who have
sex with men is listed as 300, so that number was used to draw a sample using the formula
included in EPIINFO programs from CDC. If the population size for MSM is 300, and setting
the worst scenario with an expected frequency of 10% of HIV prevalence, and the confidence
limits in 5%, the sample to be drawn at a confidence level of 95% is 95. Hence 85 members of
the MSM population will be polled.
The National AIDS Program receives quarterly reports from the Caribbean HIV and AIDS
Alliance (CHAA) with the number of sex workers that they provide outreach services to. The
documented amount of sex workers served by CHAA is 250. Using a similar formula of a 10%
of HIV prevalence and confidence limits at 5%, the confidence level of the sample at 95% would
be 89. Because several studies have indicated that the numbers were greater, 25 more was added
(oversampled) to the 89 for a total of 114 sex workers to be interviewed.
40

Figure 10 - Map highlighting hotspots and hot zones
41

Design of Survey Tools
The survey form was designed using the Behavioural Surveillance Survey (BSS) method
and was reviewed by members of the consulting team including research expert Julia
Hasbun. A test run was conducted with five (5) interviewees for the purpose of validation
before the forms were ready for full use. Survey forms were designed for MSM and CSW
core groups, for Stakeholder interviews and separate questions were formulated for the 2
CSW, MSM and NGO focus groups. (See appendix for forms)
Data Analysis
As soon as the interviewers completed their surveys, the data was collected, translated as
necessary and entered into the database using Microsoft Excel. The information was then
cross-checked by someone different from the original data entry person (Validation of
data entry). After being checked, the data was then transferred to table form and graphs
and charts were generated where relevant. The data was then interpreted to present the
findings and implications of those findings.
Personnel
The team was comprised of twelve persons, one lead researcher/consultant, one research
assistant, one Spanish speaking interviewer, one exotic dancer interviewer, four MSM
interviewers, two CSW interviewers, one data entry clerk and one translator.
And while the interviewers were all experienced in conducting surveys and working with
the target populations training was still conducted to explain and discuss the purpose of
the project and to emphasize the need for sensitivity and confidentiality.
Ethical Considerations in the Use of Human Subjects
The mapping study was conducted with adherence to the principles that dictate that
human subjects be protected during research.
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The interviewers who conducted the survey were all experienced with conducting
surveys, but were still trained before approaching and speaking with the interviewees.
They introduced themselves and explained the purpose of the research. They also gave a
preamble where they explained to the interviewee that the questions asked could be
personal and there might be some discomfort. Interviewees were given the option of not
continuing if they did not want to. They were also told that their identity would be
protected and that they would be paid for their time.
Interviewees were also told that if after the interview they were experiencing any
emotions that they wanted to discuss or unload, they could do so with a professional
counselor.
All information received has been maintained in a confidential manner.
Limitations of Study
Based on previous studies done and anecdotal information, due to the under-documented
numbers of the target populations in Antigua, we had to use a representative sample
which might not be a true representation of the total numbers.
Also, efforts to speak with Mrs. Coralita Joseph, the Superintendent of Public Health
Nurses proved futile, so much formal information was not available on clinics and health
centers.
Even with experienced interviewers and translators, a very limited number of questions
were answered in a different way than the question asked. These answers therefore, do
not perfectly reflect the correct information, for example questions 13 and 14. Some of
the interviewees seemed to confuse the question of how many of their sex partners were
clients and some put zero which indicated they could have confused question 13 and 14. .
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STAKEHOLDERS REPORT
For this project, key stakeholders are considered to be organizations who work directly
with mobile and migrant populations generally and also in terms of prevention, treatment
and care or support of HIV+ persons. Several stakeholders were interviewed. Some were
from Government and some from the NGO and FBO sectors. The results of the
interviews follow.
Governmental Stakeholders
Former Clinical Care Coordinator
Independence Avenue
Dr. Ramsey has been working in the field of HIV and AIDS since 1986 and was the first
person to be appointed to the position of Clinical Care Coordinator in 2005. He served in
this position until 2011 until Dr. Goodwin took over. The Care Coordinator is responsible
for administering Antiretroviral (ARV) medication to patients who are HIV+ and also for
providing follow-up care and monitoring of these patients. If a patient’s CD4 count is
higher than 3.5, they do not receive medication but are still monitored and seen about
once every three months. Dr. Ramsey sees patients at his private office located in St.
John’s at the Ramco Building, Independence Avenue. This office is not more than 5
minutes on foot from the two main bus terminals.
Dr. Ramsey does preventative work by educating the public and also healthcare
personnel. He conducts lectures and trainings on a regular basis around Antigua and also
in conjunction with the other agencies who work with vulnerable populations. His target
population includes not only persons who are HIV+ but also those who are at risk. He
offers pre and post counseling for persons who are being tested and if positive, while he
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provided the medical interventions, he refers them to the Mount St. John’s Hospital if
further care is needed and to the Health Hope and HIV (3H) network for support.
In 2011, Dr. Ramsey saw an average of 60 – 80 persons monthly and he says that at least
81% of his clients receiving ARV treatment were non-Antiguans; that 81% includes men
who have sex with men and sex workers. He states that in 2001, Antigua was the only
Caribbean country where HIV treatment was completely free. He further says stated
that that could be one reason for already HIV+ migrants to move to Antigua. He states
that the majority of his non-Antiguan clientele are from Jamaica and Guyana. Dr.
Ramsey notes that many Antiguans do not access his services and he is of the opinion
that it could be due to fear of stigma and discrimination as they would be better known
locally, so he believes they access treatment overseas. He also states that some clients
(Antiguan as well as migrants) as soon as they feel better, stop taking the medication.
Services are not offered based on ability to pay as they are all free and Dr. Ramsey’s staff
is trained in confidentiality and informally in cultural competence, so there are no
complaints of stigma and discrimination or of patients being treated differently. Although
his main staff is only English speaking, he does have access to Spanish speaking
translators if necessary, but reports that most of his Spanish speaking clients can speak
enough English so there is minimal need of an interpreter. He does not provide any
mobile medical services, all patients see him at his office. He is not aware of any of his
HIV+ patients working as sex workers post exposure.
Ministry of Health
The Ministry of Health is the body that is responsible for overseeing the National AIDS
Program. The Chief Medical Officer (CMO) is responsible for the Medical officer of
Health/District Medical Officer (DMO) who is responsible for the District physicians.
Then we have Ms. Coralita Joseph who is responsible for the Nursing staff in the district
clinics.
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AIDS Secretariat/NAP office
Redcliffe Street
This office is directly responsible for the national AIDS program. The office is headed by
Delcora Williams and employs a number of educators, counselors and support staff. The
office is located on Redcliffe Street in the heart of St. John’s and is easily accessible. The
Services offered include HIV counselling and testing, HIV prevention education,
distribution of condoms and referral for support. The agency’s target population is the
general public, but sometimes special outreach programs are organized for youth,
women, out of school youth and most at risk populations which includes migrants, sex
workers and men who have sex with men. Services are free and not offered based on the
client’s ability to pay. Persons are not asked their immigration status and in testing cases,
names are not required.
The staff at the AIDS Secretariat is trained in how to work with vulnerable populations;
for example, women, youth and children, migrants, commercial sex workers, men who
have sex with men, unemployed, etc., and all staff are required to be confidential. Only
one staff member is trained specifically in diversity and Cultural competence, which was
a part of her Master’s Degree in Social Sciences.
As it relates to HIV testing, counseling is offered before and after testing and if tested
positive, persons are referred to the Clinical Care Coordinator for medication and to 3H
for support. The office sees approximately 40 to 50 new persons monthly with 5 to 10
of them (10 to 20%) being migrants. While conducting outreach in the community in
the form of street fairs or mobile testing, they make contact with other persons
distributing condoms items.
The AIDS Secretariat keeps a suggestion box to keep track of client perception of their
services. Via this method, they have been able to find out that while the majority of their
clients are happy with their services, there have been complaints/suggestions which
included the following:
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• There is need for improved customer service at the entry point to the office
• Clients would like hours of operation to extend to weekends
• More reproductive health services are needed
Many of their clients are repeats and some of the reasons they give for coming back are:
• Confidentiality
• Ease of access to services because the office location is ideal and the registration
process is simple
• Good customer service
• Lack of stigma and discrimination.
• Services are free (mostly testing).
There are plans in place to improve their services and to reach more persons; these
include:
• Having a website so clients can access anonymously as some clients are fearful of
coming into the office to ask questions or get information. This website could be
in English as well as Spanish.
• Creating a newsletter to highlight programme activity
• Undertaking research to look at best practices to improve services
When referrals have to be made, staff connects clients with NGO’s and FBO’s in their
community. Commercial sex workers and men who have sex with men are referred to
Gender Affairs and Caribbean HIV and AIDS Alliance (CHAA).
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Mount St. John’s Medical Centre
Michael’s Mount
This is the main hospital in Antigua where most persons go for care. The target
population is the general population and outreach is not done to any particular population.
Hundreds of patients are seen monthly in the Emergency Department and Outpatient
clinics. Persons with a Medical Benefit card are entitled to most services with a small copay
of EC$20 or EC$30 with the exception of persons who are 16 and under or 60 or
over who are Antiguan, can be seen free. Persons not holding a Medical Benefit card or
private insurance must pay all the fees out of pocket and this is frequently a problem as
many persons from the migrant population are unable to pay the bills.
The hospital does not provide a lot of preventative education, but free condoms are
distributed in the Social Services department, the maternity Ward and some other places.
Pre and post HIV test counseling is provided. In the counseling office, approximately
10 - 15 migrants are seen monthly for various reasons. There is an Infection control
Unit which overseas most HIV and AIDS related matters. The person heading that
department as well as the social worker, counselor, Employee Health Nurse and other
nurses are trained in working with vulnerable populations like trafficked persons and also
in VCT. When a client is first diagnosed, they are referred to the Social Services
Department who contacts the AIDS Secretariat and 3H network. The AIDS Secretariat
refers them to the clinical Care Coordinator and 3H provides support.
Members of the migrant population and vulnerable persons are also referred for free
treatment. There have been about 5 cases of trafficked sex workers coming through the
emergency department and 3 were referred to Gender Affairs who were able to assist
them with retrieving their passports and leaving the island freely while 2 absconded after
medical care was administered.
All staff is exposed to training on Diversity and Cultural Competence at orientation;
however, there are still some complaints of stigma and discrimination against members of
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the migrant population, sex workers and men who have sex with men. At least two
complaints have been made to the Human Rights Desk about patients being discriminated
against. One Spanish speaking sex worker was told “why don’t you go back to Santo
Domingo to access services”. There was one instance where the Immigration Department
was called for a patient who was suspected of being HIV+ and who was of Guyanese
origin.
The hospital does have Spanish and French speaking staff so interpreter services are
available for clients whose first language is not English. Suggestion boxes and evaluation
cards are placed strategically all over the hospital. Some of the complaints received,
speak about the low level of customer service displayed by staff who do not appear to be
empathetic etc. It is therefore clear that this is an area that needs to be improved.
Provision should also be made for undocumented migrants without a Medical Benefit
Card to be able to access care at the hospital.
Ministry of Labour
Thames & Long Street
The Ministry of Labour is the arm of government dedicated to facilitating
employer/employee relations process, processing work permits, processing CSME skilled
certificates and conducting workplace inspections as well as inspection of migrant nondeclared
workers. The department’s target population is all employees and employers.
The only costs that are attached to the services are payment for work permits and skilled
certificates.
The department caters to the migrant population when they are coming to the office for
the purpose of applying for a work permit or renewing a work permit. These services are
dependent on the migrant’s ability to pay. The cost is usually dependent upon the
category and level of the job and the salary scale. Work permits are not issued for sex
workers as that is considered prostitution, which is illegal in Antigua. However, there is
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suspicion in the department of some establishments who request several work permits for
young ladies for the position of domestic help in one small establishment. However,
because there is no valid evidence of wrong-doing, no further action is taken.
The staff is not trained in working with vulnerable populations or in diversity and cultural
competency and there is no plan in place to offer any of these services in the near future.
The office sees over a 100 persons monthly and there is no way of telling who is a MSM
or CSW. All clients must come to the main office as there is no a subsidiary office or
mobile service. There is an interpreter available for Spanish speaking clients. No outreach
is done and no education or any other HIV related services are offered in-house. The only
external service offered is the policing of the National HIV and AIDS related policy in
the workplace for the ministry staff. The staff’s expertise is in labour relations and
labour inspectors. It is not known of any staff members are of the MSM vulnerable
group, but there is no one from the migrant population working as a staff member.
All clients are required to give their name and other identifying information
Immigration Department
Thames & Long Streets
The Antigua Immigration Department is a government organization located downtown
St. John’s and serves the migrant population in Antigua. This department is responsible
for the entry and exit of persons into and out of Antigua and Barbuda.
The supervisors in the department do play a part in the planning and decision making
processes. The staff has had no formal training in dealing with vulnerable populations
and there is nothing in place for this type of training to be made available in the
foreseeable future.
Some services offered are extension of time, citizenship status updates, temporary
resident status updates and cater primarily to Jamaicans, Guyanese and persons from the
Dominican Republic and all other migrants. There are costs attached to these services
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thus, an individual’s ability or inability to pay does play a role in their accessibility.
Also, on staff is an interpreter to facilitate interaction with the Spanish speaking
population.
No outreach is done, as migrants are expected to come into the department.
Approximately 1,200 persons are seen on a monthly basis all from the migrant
population.
Gender Affairs Division
Director: Shelia Roseau
This department based downtown functions under the Ministry of Education, Gender,
Sports and Youth Affairs. Some of the services offered include:
Crisis Center walk in service for individuals who are experiencing any form of
abuse and social issues ,
Court Advocacy,
Counseling,
24hrs Crisis hotline,
Victim Support services,
Temporary housing,
Empowerment programme,
referrals and Escort to services.
Reproductive health and Social commodity discussions, demonstration and
distribution.
Public education and capacity building programmes,
Research and Data collection.
The target population is the general public but outreach is often done for trafficked
persons, survivors of domestic violence and sexual assault. All services are free and an
individual does not have to disclose their immigration status. However in some
instances, some of the persons served have issues with being unable to pay for certain
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services as this does act as a barrier to receiving care. A staff member made this
declaration as it relates to health and other services: “Since access to health care is
universal all of such services must be made available to all and sundry. However, if it is
made mandatory for all to pay, then a system can be put into place for individuals who
cannot afford it to apply for assistance. Criterions can be used to qualify individuals
after an assessment is conducted to determine their ability to pay or not. But while the
assessment is conducted the services must still be made accessible until the final
determination .Additionally, a fund can be set up to invite organizations, the private
sector, and also individuals to contribute to this fund for such causes”
All clients are asked for their name and contact information, but the Gender Affairs.
However staff members do not single out persons considered to be MARPS, nor ask them
their sexual preference or status, but if it becomes disclosed during the course of offering
the services, then those issues are handled based on the need of the individual. Some of
the services offered to MARPS are calls from sex workers who access the services of the
Crisis Center via the hotline, which is considered a mobile services as it can be accessed
24/7 and from anywhere. These women would then be encouraged to come in for an inoffice
discussion and then if they are being trafficked or victimized, they are
accompanied to the Police Station to make a report and an Order of Protection can be
issued to the trafficked person.
The specialized staff like the Director, Program officers and Research Officers as well as
some of the support clerical staff have been trained in sociology, cultural diversity, VCT,
support for HIV+ persons, gender development, capacity building and other relevant
areas. As it relates to HIV and AIDS services, this department offers education,
prevention (condom distribution) and support.
The office sees approximately 27 to 30 new clients a month but while they know that a
high number are migrants because of the issues raised, they cannot give a fixed number
as they do not ask for that information for documentation purposes. Interpreter Services
are available for Spanish speaking clients.
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The Gender Affairs Division hopes to improve its services by continuing to network with
regional and international organizations to look at best practices, continue with
programmes so as to make clients more self-reliant and empowered, build the capacity of
staff members and social partners so as to help provide better services to the general
public and target population.
While there are some repeat clients, most clients are encouraged to work on their own
after a stipulated period of time but are welcome to return if new issues arise or old issues
are not resolved.
Some places were referrals are made include:
• Antigua Planned Parenthood Association
• Welfare division
• AIDS Secretariat
• Legal Aid
• Police Department
The majority of their referrals come from:
• Clients
• Magistrate’s court
• 911 emergency line
• Attorneys
• Churches
• Police Department
• Other agencies and organizations.
• Hospital social worker
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Non-Governmental Organizations (NGO)
Health Hope and HIV Network (3H)
Ramco Building
Independence Avenue
The Health, Hope & HIV Network located in the Ramco building on Independence Drive
is an HIV/AIDS organization furnished with staff and volunteers who have been formally
trained in diversity and cultural competence. Their services are offered to the general
population in Antigua. These services include HIV education/prevention: for example
IEC material & face to face discussions to mention a few. Also offered are HIV
counselling, peer counselling, PITC –provider initiated testing and counseling and
referral to the NAP for testing, advocacy, Human Rights Desk (S&D/HR violations
complaints), condom distribution and demonstration, lubricant distribution, psychosocial
support, HIV case management, nutritional counselling, an efficient referral system and
behavior change, harm reduction and adherence counselling.
The main target for these services are people living with and are affected by HIV, men
who have sex with men, gays and transgender, commercial sex workers and youth. The
position of executive director & programme manager enables one to be a part of the
planning and decision making processes of the organization.
Though the services offered by the Health, Hope & HIV Network are all free for the
migrant and most at risk populations, there are other organizations which also cater to
them where their inability to pay for services is a barrier. This can be changed if the cost
associated is minimal or totally absorbed by the agency itself or the government. A great
deal of persons from the most at risk population is affected by the cost of services.
The services that are offered to the most at risk population are HIV counselling, training,
advocacy, support group (provide a safe space), personal development initiative
(Volunteer at the office are trained to conduct focus group discussion- prepare, develop
and present topics - conduct interviews etc.), peer counselling, psychosocial support,
hospital visitation, community-based peer education and outreach, risk reduction
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counseling (delivered through peer outreach), male and female condoms and lubricant
promotion and distribution, HIV counselling, behaviour change and adherence
counselling, HIV care, support and treatment referral, access to health/social services –
referral, structural issues (both community mobilization initiatives and those which
address stigma and discrimination).
Where HIV and/or AIDS is concerned, services such as education, prevention, care and
treatment referral and support are offered. Along with these services also offered are
adherence counseling, food and personal care items distribution, HIV case management,
nutritional assessment, referrals, hospital, home and prison visits, pick-up and deliver
medication, weekly support meetings, advocacy, human rights desk for PLHIV and
weight, blood pressure and blood sugar management.
Ninety nine percent of the staff is part of the target population, which is MSM’s or
CSW’s. The network sees approximately 45 clients monthly and about 20 clients who
are migrants from the MSM and CSW population. The network gets lots of repeat clients
though not necessarily for the same services and about 50% of the repeat clients are a part
of the target population. Questionnaires are issued, suggestion boxes are utilized and
other methods of receiving feedback on quality of services and from this we have learned
that the services offered have been very effective as a one-stop shop.
It has been indicated though feedback that repeat clients come back because of
confidentiality, ease of access to services, they receive good customer service, lack of
stigma and discrimination, and a wide range of services are available and if service that is
unavailable is requested referrals are made to the appropriate agencies, there is also a
sense of ownership and belonging and they are totally comfortable being themselves.
Most of referrals come from previous clients and for follow-up services, clients are
referred to AIDS Clinical Care Coordinator, AIDS Secretariat, Hospital e.g. Nutritionist
for Body Index Assessment, Counselors, Planned-Parenthood Association, Pharmacist
(that works along with the network) and Caribbean HIV/AIDS Alliance. Also the CSW’s
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and MSM’s are referred to Directorate of Gender Affairs- Government, Division of
Labour – Government, Red Cross, Lions Club and Rotary Club.
Caribbean HIV and AIDS Alliance (CHAA)
Newgate Street
The Caribbean HIV and AIDS Alliance office has been in Antigua for four years and
offers services for prevention and education for persons at risk of becoming HIV+. They
provide Information, education and communication (IEC) materials, and also
commodities (dental dams -a piece of rubber or plastic used as a barrier between the
mouth and the female genital when performing oral sex, condoms and lubricant). The
target population includes commercial sex workers, persons involved in transactional sex,
men who have sex with men who include openly gay, bisexual men, men who are “on the
down low” and transgendered men. All services are free whether the person is Antigua or
part of the migrant population.
Clients are not required to give their names as a unique identifier code is used.
Staff and outreach volunteers that are recruited as peers of the target population and most
have a background in working with the particular population. They are trained in
Diversity and cultural competence and some of the staff is trained in VCT. HIV testing is
not done at the office, but staff and outreach workers sometimes accompany clients to get
tested.
They do have Spanish speaking staff and offer mobile services where they go into the
community – the bars, clubs, brothels and other areas where members of the vulnerable
populations might be found. While they work in St. John’s, mobile services have
extended as far as English Harbour, Jolly Harbour, Cedar Gove, Liberta and New
Winthropes. Focus group discussions are conducted with clients to get feedback on the
efficiency and usefulness of their services and based on the feedback; they use the
information to be able to make improvements.
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At least 60% of the populations reached are MSM’s and CSW’s and a lot of clients are
repeats. They complete the agency on their confidentiality, ease of access to services,
good customer service and lack of stigma and discrimination and support.
Client referrals are mostly made to the NAP, Social Welfare division, Clinical Care
Coordinator and Antigua Family Planning Association.
Antigua & Barbuda HIV and AIDS Network (ABHAN)
Holberton Hospital Compound
The Antigua and Barbuda HIV/AIDS Network (ABHAN) was founded in 2007 and is an
organization dedicated to educating, empowering and advocating for individuals infected
and affected by HIV and AIDS.
Their prevention programme focuses on reducing the number of individuals infected with
HIV especially targeting the sexual and reproductive health of the most vulnerable groups
including women and youth.
Some of the services provided include distribution of home based care kits (HBC kits),
delivery of cooked meals, distribution of food packages, weekly counselling sessions for
members and their families, donation of cooking gas and distribution of condoms.
ABHAN has also teamed up with the American University of Antigua (AUA) to form an
HIV and AIDS Peer/Buddy Treatment Adherence Programme (PBTAP). The goals of
this programme are to recruit and retain patients into treatment and care and ensure that
they adhere to their treatment and to deliver a comprehensive package of services
including case management leading to decreased risky sexual behaviour, improved
immune system functioning and general health improvements. They also conduct peer
training three or four times per year and that covers topics like stigma and discrimination,
ART’s and opportunistic infections, human rights and confidentiality issues, techniques
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in navigating the health care system, recruitment of other HIV positive individuals and
self-empowerment and about three thousand condoms are distributed annually.
There are no special arrangements made for the migrant population and but the charity
did have a number of clients which are men who have sex with men (MSMs)
Antigua Planned Parenthood Association (APPA)
Bishopgate Street
St. John’s
This agency is one of the most well-known for providing family services. These services
include the provision of contraceptives, DNA testing, education, pregnancy tests and
other services related to sexual reproductive health (SRH). Their services are offered
mainly on the compound and in most cases for a small fee; for example, a condom costs
fifty cents. Free services include family life education offered to schools, churches and
community organizations. They do not do any particular outreach to the migrant
population and no one is asked about their country of origin when they access services.
Education about HIV prevention and safe sex is the key thrust of the organization. They
are a part of the Caribbean Family Planning Affiliation (CFPA)
Women Against Rape (WAR)
Redcliffe Street
Women Against Rape (WAR) is a Non-Governmental Organization (NGO) which serves
the general population of Antigua offering counselling, education and training, legal
referrals and support though its target population is primarily women and families
affected by sexual violence and secondarily to the vulnerable. The office is located in
Redcliffe Quay and there is also a support network in the urban and rural areas.
The director of the organization plays a part in the planning and decision making
processes and have made all costs for services free to the population thus, services
offered to the migrant population are not affected by their ability or inability to pay.
Though the staff has not been formally trained, there is a plan to offer training soon, but
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ased on resource mobilization. The staff has not been formally trained in diversity and
cultural competence because to acquire and/or maintain cultural competence training
must be ongoing, but here are those who have received formal training in Health,
Spirituality and Law.
WAR’s staff is comprised of Miss Wong, one full time and several part time volunteers,
some of whom are a part of the target population being men who have sex with men and
sex workers. She recently trained a group of Spanish-Speaking volunteers on how to be
in a buddy and support programme for Spanish-Speaking persons who have been
sexually assaulted.
Services are also offered to the most at risk persons which would be the men who have
sex with men and the commercial sex workers. These services include education and
training, counselling, support and referrals. Also, counselling is offered before and after
HIV testing and approximately 25 clients are seen on a monthly basis of which 10 to 15
are migrants, 90% of which are part of the target population. There is also an interpreter
on staff who assists in dealing with the Spanish speaking clients. HIV/AIDS legal advice
and referrals services are also provided. Reach programmes have been undertaken in the
villages of Willikies, Golden Grove, Gray’s Farm and the Point Area.
In the event that follow-up services are necessary, clients are referred to the Directorate
of Gender Affairs, Antigua Planned Parenthood Association and private Sensitive or user
friendly agencies among others. In the case of the organization though, most of the
referrals received are from the general public. Clients are required to give their name and
other identifying information where necessary.
Bearing in mind that there is always room for improvement, measures are being
undertaken to improve the frequency, quality and content of training and education
though this is based on the availability of resources.
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Questionnaires are issued and there is also a suggestion box for feedback while feedback
is also received from both current and former clients who have been sending referrals to
the organization. From this feedback it was learnt that the clinic is said to be accessible
and clients are also satisfied with the level of confidentiality exercised by the staff and
there are those who would prefer to have testing related sexual health services provided
on site.
Faith Based Organizations (FBO)
Pentecostal Church
The Pentecostal Church has been catering to the physical and spiritual needs of the
Antigua community with its main branch located in the Woods area just outside of St.
John’s city. The offices may be accessed Monday through Friday between the hours of
8:00am and 4:30pm.
This church organization has staff and members who are trained to deal with vulnerable
populations. This training equips some members and staff to deal with women, youth
and children and even the migrant population and commercial sex workers and training
has also been had in diversity and cultural competence. Though the staff has not received
formal HIV&AIDS training and there is nothing in place to make this service available in
the foreseeable future, prevention education and support is offered as far as this
population is concerned.
Though referrals don’t come from a particular group approximately 20 clients are seen on
a monthly basis for social support but on Sundays there are quite a significant number of
visitors to the regularly scheduled services with a rate of approximately 75% repeat
visitors. About 4% of the staff is from the target population of MSM or CSW. Visitors
tend to frequent the church though they are required to give names or other identifying
information. The staff and members tend not to discriminate and stigmatize individuals,
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are confidential and extend good customer service. There are no questionnaires available
for feedback neither is there a drop box but feedback is received word of mouth from
persons who have openly expressed their thoughts on the subject.
Catholic Church
The Catholic Church has been servicing the community of Antigua offering programs to
the vulnerable populations though the key members have not had formal training in this
area. Programs range from elderly day care to home for orphan and delinquent girls and
also programs for the Hispanic population.
Outside of regularly scheduled worship services the organization has no specific opening
days nor hours though pastoral care is offered.
At the home for teenage girls, talks are done about preventing HIV and AIDS and sexual
behaviour that is not age-appropriate. No other outreach is done.
The Seventh-day Adventist Church
The Seventh-day Adventist Church serves the community of Antigua with its key
members, being the leaders of the Health and Temperance Departmental having been
trained in VCT. The programs offered by the department aren’t geared solely to the
vulnerable populations but to the general population. The leaders seek to engage in
counselling which encourages the general population to get tested but actual testing sites
have not been set up by the church. The position that the interviewee holds does afford
her the privilege to take part in the planning and decision making processes of the
organization and they have been putting measures in place to afford a wider population of
the church to receive training in dealing with the vulnerable populations though not in the
immediate future.
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There are costs attached to the programs but the cost is absorbed by the church and is free
to the vulnerable populations. There are quite a number of persons who access social
services and care through the organization on a monthly basis due to ongoing programs
offered though there are none specifically geared towards the MSMs and CSWs. HIV
and AIDS and STI information is shared with the church membership and the community
in general on a regular basis but condom distribution and support is not offered. There
are some barriers to services where condom distribution is concerned because of the
philosophy and doctrines of the church.
There are no interpreters on staff within the organization but there are two Spanish
speaking churches and there are members of the congregation who do speak Spanish and
are called upon from time to time to assist in interaction with the Spanish speaking
population.
Though questionnaires aren’t issued and there is no suggestion box the church does get
quite a large percentage of repeat visitors. This, some has said is because the visitors
always feel welcomed and are well treated and they don’t feel discriminated against and
the range of services that the church offers outside of the regularly scheduled worship
services are always made accessible by the community.
Private Medical Practitioner
WOMEN’S CLINIC
Dr. Dane Abbott
Dickenson Bay Street
The Women’s Clinic, located on Dickenson Bay Street is a private clinic that offers
obstetrics and gynecology services to females 16 years and older. The services offered to
the migrant population along with the nationals are all accessible depending on one’s
ability to pay. The services provided are consultation, delivery, various procedures and
surgical. The clinic does not offer any services specifically to the most at risk persons –
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men who have sex with men and commercial sex workers because that is not the focus of
the clinic and there are no projected plans to offer any such services.
Other services offered include HIV and AIDS education, prevention and care and
treatment. There is also on staff an interpreter who caters to the Spanish speaking
population.
The staff at the Women’s clinic has not received training in dealing with vulnerable
populations nor have they received training in diversity and cultural competence. On
staff there is a trained receptionist and a registered nurse.
The clinic receives many repeat clients for antenatal care and of these repeat clients, 25%
are from the migrant population. The clients who are HIV positive are referred to AIDS
Secretariat and to the AIDS Clinical Care Coordinator. Referrals to the clinic are
generally made by practitioners.
Counselling is offered before and after HIV testing. The clinic sees approximately 200
clients monthly of which 50 are a part of the migrant population. Although they might
be, it is not known for sure how many are MSM or CSW as that question is not asked.
Dr. Nabis Sanchez
Medical Doctor
Gambles Terrace
Dr. Sanchez is a bilingual – Spanish and English speaking physician who is originally
from Cuba. She is located on the outskirts of St. John’s, two minutes’ drive from the
Popeshead Street Area hotspot and about three minutes derive from the Antigua Planned
Parenthood Association (Family Planning). She provides general services to all persons
but she provides but is utilized a lot by the Spanish-Speaking population, including many
sex workers. While there are charges for her services, some clients have reported being
able to get discounted fees. She has even provided pro bono services to clients referred
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to her by the social worker at the Mount St. John Medical Center. She has attended
training on dealing with vulnerable populations and as part of her practice she offers HIV
Counselling.
Other
Guyana Consulate
Mr. Robert Reis – Honorary Consul
Corn alley & Long Street
Mr. Reis is the representative in Antigua for the Guyana government as his target
population to offer services to are the Guyanese nationals residing in Antigua and
Barbuda. He has been functioning in this capacity from August 2003. He offers support
to the residents by listening to their concerns and passing them over to his supervisors in
Guyana. He is also responsible for the renewing of passports and birth certificates.
Support services are free and the only costs attached to his services are the costs to renew
official documents. Therefore, the only barrier to services is if a client does not have the
funds, but he cannot control that as there is no fund to assist those with limited cash.
Clients give their identifying information and when necessary, confidentiality is
maintained if a client discloses personal information.
He has been called to intervene for clients with Immigration issues and does the best he
can to advocate for clients. He is also aware that a number of Guyanese migrants work as
sex workers, but does not interfere unless something is required of him.
He was asked to help to find funds to bury one Guyanese young lady who died from
AIDS related complications and he did so, but he does not education or provides any
other HIV or AIDS related services.
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He does not plan to offer any services to any specific populations who are perceived to be
at risk because he believes that everyone should be treated the same. He sees
approximately 150 persons monthly.
Grupo de Apoyo al Poder (GAAP) Support Group
This support group meets twice monthly at the Gender Affairs Office and members take
turns facilitating the meetings. It is made up of Spanish-Speaking sex workers and the
main aims are for support and capacity building. The group is sponsored by COIN.
While many of the discussions focus on safe sex, minimizing risky behaviour, and
sharing their experiences with each other, they have also had training in human
trafficking, etiquette and other important areas.
This group has regular access to the local Spanish radio station, which in 2009, received a
grant from PANCAP and was able to get a spot to play regular programming information
from the Dominican Republic. As a result of this public education initiative, one member
reports that there has been improvement in the migrant population’s access to service as
they were given guidance on where to go for specific services.
Conclusions of the stakeholder interviews
It is apparent from the numerous stakeholder interviews that some of the organizations
that have the widest reach to the migrant populations, does not do much to address some
of their vulnerabilities. This could be because of their job mandate and limitations. For
example, quite a number of the migrant population utilized the services of the
Immigration Department and Ministry of Labour but there is no pamphlet or poster or no
other visual or other aid to reach out to them that speak to their social or health needs.
The AIDS Secretariat (NAP office) has been the forerunner in testing and the output of
information related to HIV and AIDS. One of their main challenges include lack of
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funding, but they are still very functional and active and have staff that are well qualified
in working with vulnerable populations. They target the general population, and do not
ask a lot of specific question as it relates to country of origin or sexual orientation so
some vulnerable migrants might not be identified: hence, their specific needs might not
be met.
CHAA and the 3H network are very prominent in the community for working with
migrant and mobile populations. CHAA has a wider circle of reach and that could be
because they have more staff and outreach volunteers. They also have a larger budget
which enables them to have more mobile workers. 3H has a limited budget, no reliable
form of transportation and except for the Director their staff is trained internally. Their
impact on the community however is quite remarkable.
The Faith based organizations (FBO) do very little outreach in the communities but do
offer internal educational sessions for their members. They however accept referrals from
various community organizations.
Table 8- Most Utilized Agencies
1 st 2 nd
Agencies that serves the most
migrants
Immigration Dept. of
Labour
Agencies that Sex
CHAA 3H
targets the MARP
population most
workers
MSM 3H CHAA
Agencies that give the most
NAP CHAA
education/preventative services
Agencies that offer most Clinical Care MSJMC
medical treatment
coordinator
Agencies that offer most HIV &
AIDS Support
3H ABHAN
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Recommendations based on the stakeholder interviews
More governmental assistance should be given to the NGO’s as they work to help
reduce some of the load of support from the NAP. This assistance could be in the
form of finances, transportation, office space etc.
Training could also be accessed for the stakeholders from PAHO/WHO as these
agencies offer technical support and many stakeholders would like to have more
training for their staff.
The volume of migrants at the Immigration office and Labour department should
be taken into consideration so that outreach programs can be undertaken there.
Posters and pamphlets can be left there to reach them.
3H could be set up as a station to implement best practice models as carried out
successfully elsewhere in the region and AHBAN Peer/Buddy program could be
utilized as a best practice model by other NGO’s.
Trainings around the issue of Stigma and discrimination and cultural sensitivity
should be conducted for all healthcare workers, especially at the Mount. St.
John’s Medical Center.
Cultural sensitivity training should be ongoing with the Police department.
A fund could be set up to help migrants with financial issues as it relates to access
to services. Research staff could seek out grants that are available worldwide.
The Guyana Consul should be included in some of the national planning meetings
so that he can have some understanding of the number of migrants from Guyana
who are included in the vulnerable populations and he can have some say in the
decision-making process.
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Encouragement should be made to civic government to appoint counsels for
Jamaica and the Dominican Republic because of the large number of residents
represented here.
Members of the MARPS populations should also be on some of the committees
that make decisions for migrant and mobile populations.
More persons can be referred to the GAAP support group and it can be utilized as
a best practice model to be duplicated around the island.
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NGO Focus Group Report
At a meeting held with the main NGOs in Antigua with the exception of CHAA (who
were unavailable), the following issues were raised and discussed:
What are some of the issues/challenges you face offering those services?
The challenges faced were many, but for most NGO’s finances was the biggest
problem, especially because the services offered were mostly free, except for
APPA.
Transportation was the second biggest problem as most NGO’s would like to be
able to transport the persons they support to medical appointments, etc. but founds
themselves unable to do so.
One participant stated she had received a donation of equipment to test viral load
and it was sitting in Puerto Rico for 3 years due to Government’s lack of vision,
initiative and support.
No national protocol for prophylactics – everyone does their own thing
District physicians are not available 24/7 so victims of sexual assault who are
attacked at night or early morning, must wait until the clinics open. If they go to
the hospital, they are not treated as an emergency.
Payment has to be made for post exposure prophylaxis (PEP) if MSM’s or CSW’s
go to a private doctor.
Antenatal clinic is EC$100.00 so if pregnant mothers who are migrants, don’t
have the money, they do not find out their status.
MSM’s are not offered prophylactics.
Clinics and health centers ask for ID, so that members of the migrant population
cannot always access services. Some brothels keep their sex workers ID.
HIV+ persons have to pay for medical care for their opportunistic infections.
It is expensive to make phone calls to offer phone support/counselling and to
remind MARPS about their appointments, etc.
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Where are the places that you provide services?
Clinic/office. All persons offered services from their primary location. They were
all located in the St. John’s areas which were easily accessible by public
transportation. 3H is on Independence Avenue, APPA is located on Bishopgate
Street, WAR is located in popular Redcliffe Street and ABHAN is housed at
Holberton, the old hospital compound.
Homes – WAR, ABHAN and 3H network all visited clients at home if necessary.
Sometimes the clients were ill and needed food or some other form of assistance
that required visitation. They also picked clients up at home to take them to
appointments if necessary.
Outreach –ABHAN, 3H and WAR did outreach in the community. APPA was the
only NGO that did not move from their office on Bishopgate Street and did not
engage in any outreach.
How do you conduct outreach for new clients?
All of the NGO’s accepted referrals. ABHAN complained that most of the referrals of
HIV+ persons went to 3H and AIDS Secretariat. It was explained that 3H and the
secretariat had direct links to the Care Coordinator so that could be one reason. Also, the
question was asked that if ABHAN did not send in their statistics to the AIDS secretariat,
how would the Secretariat be able to document their work to get a true idea of what the
statistics were of migrant population helped in Antigua? WAR and 3H network reported
that they attended street fairs on a regular basis. All of the NGO’s except APPA went on
the World AIDS Day March and also the Violence Against Women march hosted by the
Gender Affairs Division.
WAR and 3H were the NGO’s most often referred to by the Police department for
migrant populations that needed support or counselling. None of the NGO’s had paid
advertisements or did any other form of public advertising.
Do you provide condoms? Do you provide information on how to use condoms?
All of the groups provided condoms. At APPA, they were 50 cents each and the other
NGO’s offered them free. ABHAN imported theirs from the United States – they got
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some free and bought some, while 3H and WAR received from the AIDS Secretariat.
WAR said they did not get enough as they always ran out of supplies. They all provided
information on how to consistently use the male condoms. Only 3H reported providing
information on female condoms.
Do you provide information on HIV and/or AIDS?
YES! All NGO’s provided information on HIV&AIDS. 3H network distributed
pamphlets on safe sex, condom use, etc., and did educational sessions on prevention,
counseled persons who were newly diagnosed and held support groups for MSM’s and
Sex workers. They stated that they need more training on testing for their volunteer staff.
WAR – also distributed pamphlets on safe sex, accompanied clients to be tested and did
pre and post counseling. They reported that their volunteers were VCT trained, but that
they did not have the testing equipment.
ABHAN dealt primarily with persons who were living with HIV and AIDS, but did have
some members who were not. They provided information to all members about living
with HIV and opportunistic infections.
Are any of your services free? Which ones?
All of the services provided were free, except those provided by APPA.
Do you try to reach any particular population? Any services specifically targeted to
migrants?
APPA – they try to reach all populations. No services specifically for migrants.
3H – they did outreach to most at risk populations including MSM and SW. The majority
of their volunteers were from the migrant population but their outreach was inclusive to
migrants and locals.
WAR – their outreach were geared to all populations, but they did work with a large
number of migrant population.
ABHAN – they were completely inclusive of all populations in their outreach. None of
their services were targeted specifically to migrants.
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Do you collaborate with any other agencies to provide care?
Yes all of the agencies collaborated with AIDS Secretariat:
WAR – MSJMC, Police department, Immigration department, legal Aid, Gender Affairs
ABHAN – American University of Antigua (AUA). They have started a peer support and
buddy program for HIV+ migrant and non-migrant population and the medical students
donate free screening time.
3H – MSJMC, Human rights desk, private donors, Care coordinator, etc
What ideas and suggestions do you have to improve HIV/AIDS prevention
(education), treatment and support in Antigua?
a. Train the health care providers to give care that is free from stigma and
discrimination
b. Consider the need for MSM sexual assault victims for prophylactics
c. Get a better accountability from the NAP office
d. Provide more VCT training and provide VCT testing equipment to persons who
are trained.
e. ARV’s should be available at all the clinics and pharmacies
f. The clinics should stop asking persons for Antigua ID or medical benefit card as a
precursor for care
g. More funding/grant opportunities should be shared with the NGO’s
Is there anything that would help you to give free services or more services to
vulnerable groups?
Most of the groups represented stated that if they had more finances, they would be able
to do a lot more. The groups also called for unity and felt sometimes like they were
working against each other. One NGO felt that the NAP office did not offer enough
support to them and did a terrible job of keeping statistics. That participant had no faith in
the numbers put forward by the NAP office and felt that they grossly underrepresented
the true picture.
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Discussion and Conclusions based upon the NGO Focus Group
The various NGO’s all offer very good services, some exclusively and others overlap.
Apart from the Antigua Planned Parenthood Association (APPA) who could not identify
the origin of many clients, the others all do work with a large migrant population and
they all work with persons who are at risk of becoming HIV+.
The contact information for some of these agencies is not easily accessible, except
someone knows what they are looking for. One gets the impression listening to the group
that they did not receive adequate support from the government and this hampered their
ability to give more care.
Recommendations based upon the NGO Focus Group
Create a database of referral information so that when migrant populations have
certain needs, the various NGO’s would know where to refer them. A flyer in
English and Spanish with all available organizations and their role will be very
useful.
NGO’s can come together to create a policy document on procedures for
o Meeting the needs of migrants.
o The use of prophylaxis and present it to the AIDS secretariat to present to
the Ministry of health.
Grant writing could be conducted as a group to ensure that more funding is filtered
through the NGO’s so that they will be able to provide more or improved services
Provide train-the-trainers workshops for NGO directors so that they can further train
the staff in best practices to offer support to members of the most at risk populations
including migrants.
Encourage collaboration of NGO’s so that there is better teamwork so that the
migrant and mobile populations could be better served.
The NAP office could assist NGO’s with procuring condoms since they all seem to
have a good history of distribution, but sometimes are unable to due to lack of
supplies.
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MSM Survey and Focus Group Report
MSMs in Antigua
For this section, the report is based on a survey conducted with 95 self-identified
men who have sex with men and they range in age from 18 to 51 with the average being
28.7. Their average length of time in Antigua was from less than a month to over two
years. The report also includes the findings from a focus group discussion conducted with
8 persons from the migrant MSM population. The respondents live all over Antigua, but
the majority are located in St. John’s.
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From the survey, 70.5% of the respondents do have family living here in Antigua and
65.2% came because of that fact while another 20.0% came because they had friends
living here. 7.3% came as a result of a job offer and 6.3% came alone. The majority
(83.1%) of the respondents had friends who they socialized with and 24% utilized church
as a part of their social circle. This indicates the importance of their peers and the
potential for developing FBOs as a support mechanism. As it relates to their employment,
the largest percentage of the employed work as security officers (16.8%), while the
highest percentage of the guys are unemployed (27.3%). The respondents spent social
time at their homes and homes of friends, in Gunthropes, Abracadabra Bar and at Jolly
harbor.
Condom Use
While the vast majority (72.6%), of the respondents report condom use for all their sexual
encounters, 20% said that they only use condoms sometimes. This is somewhat
disturbing because 67.3% said they had casual sex in the past year, 16.7% reported to
have engaged in sex for pay in the last year and 15.7% have other partners while 44.2%
of the respondents did not know if their partner had other sexual partners. This could put
them in a position of vulnerability.
Figure 12- Condom sources
Clinic /PP
3H /partner /friends
AIDS Secretariat
Hospital
CHAA
Pharmacy /Supermarket
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Free Condoms
Figure 13- Free condom sources
60
50
40
30
20
10
0
Receive free condoms from who?
HIV Information
Availability of HIV/AIDS information
75% of respondents disclosed that they did receive HIV and AIDS information within the
last year and the sources are listed below. When asked if in their opinion, HIV testing or
education is readily available 85.2% of respondents answered in the affirmative.
Source of HIV and AIDS information
Of the respondents who did receive information, the sources are mainly the AIDS
Secretariat at 43.1% and the media at 23.1%. Other sources were friends and family and
CHAA. The 21% who stated other mentioned 3H and the animators (who are a part of
CHAA). From the FGD, some of the members reported getting their information from the
internet, NAP, 3H, CHAA and one member mentioned getting a pamphlet from the
Antigua Planned Parenthood Association (APPA). Some members would use Google to
check symptoms they were experiencing to see if it fit the description for HIV or AIDS.
Consciousness of being at risk for HIV infections
The majority of the men felt that they were not at risk of becoming HIV positive for one
or more of the following reasons; they use condoms in their sexual encounters (49.4%) or
they were monogamous (14.7%) or they chose their sexual partner carefully (17.8%).
17.7% felt that they were at risk of becoming HIV positive. Collectively 32.5% of the
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participants felt they were not at risk because they were monogamous or chose partners
carefully, but they did not take into consideration their partner’s sexual behaviour.
Figure 14 - Reasons why persons felt at risk for becoming HIV+
CONDOMS NOT
100% SAFE; 1; 5%
PRACTICE RISKY
SEXUAL ACTS
6%
YES I AM SEXUALLY
ACTIVE; 1; 6%
YES, MORE THAN
ONE PARTNER; 1;
5%
OTHER; 3; 17%
YES, SEXUALLY
ACTIVE; 3; 17%
YES, NOT ALWAYS
PROTECTED; 7; 39%
YES, SCARCELY
USES PROTECTION;
1; 5%
HIV Testing
When last test was done
52.4 % of the survey respondents were tested in the last year, 11.5% reported never
being tested and 21% cannot recall when they were tested. These numbers indicate that
in spite of all the outreach being done by the various groups and with 75% of the guys
knowing that free testing is available, we still have persons who are not being tested.
Their reasons are listed below.
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Table 9- Reasons for not having an HIV test
Responses Number Percentage
Did not know where to go 4 4.2
Afraid of the answer 14 14.7
I do not need one 15 15.7
They don’t speak my language 0 0.0
Can’t afford it 0 0.0
Didn’t think about it 17 17.8
Other 12 12.6
Not applicable (were tested) 33 34.7
Total 95 99.7
Free HIV Testing
75.7% of the survey respondents who had been tested for HIV, report getting free testing.
20% of the participants reported that their ability to pay for the test was a problem. This
means that having the knowledge of where to get free testing and knowing it would be
confidential, could mean more of the MSM’s getting tested.
HIV testing locations
When respondents were asked where they would go for HIV testing 47.3% stated that
they would go to the AIDS Secretariat while another 33.6% said that they would visit a
private medical doctor. 8.4% would go to the hospital and 6.3% to the clinic. 2% said
they do not know where to go.
Ability to pay
Ability to pay was a problem for 20% of the MSM population. It is interesting that
although ability to pay was a problem, at least one third of the population preferred to see
a private physician as they often felt there was more confidentiality and better customer
service.
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Access to Healthcare Services
Figure 15-
History of Medical check-up
40.9% of the respondents quite possibly did not know their current medical status
because they either had never had a medical check-up (15.7%) or they could not recall if
they had (25.2%). 12.6% had medical checks over a year ago and the other combined
46% had had a medical check-up in the past year or less.
Means of covering medical expenses
The majority of 46.3% of the respondents paid out of pocket for medical care.
43.1% used the national Medical Benefit card and 6.3% only went where they got free
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care. Some had no answer as they had not attempted to access any medical care. So
clearly, ability to pay definitely affects access to health care.
Experience during medical check-up
The 25.2% who stated that the services they received were excellent gave reasons such as
good service, good staff, fellow countrymen attended to them, etc.
The 35.7% who reported good service said it was because of friendly staff,
professionalism, okay service, friendly, caring, helpful, etc.
5.2% reported poor service because of lack of professionalism, not helpful, unfriendly
staff, etc.
Willingness to recommend facility and reasons why
Figure 16- Why to recommend facility
Price
8.4%
other foreigners
there 12.6%
NA
Friendly Staff
43.1%
location 5.2%
Good med care
12.6%
Speak my language
4.2%
Other 4.2%
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Reasons for not recommending facility
81% of the participants did not answer this question, but for the 19% who did, the reasons
for not recommending the facility where they received medical care would be:
- Unfriendly
- Did not treat foreigners well
- Location
- Price
Characteristics of an excellent health care system
Based on the FGD, characteristics of an excellent health care facility include free health
care, confidentiality, respect for MSM, clean environment and friendly staff.
Table 10- characteristics of an excellent health care facility
Responses Number Percentage
Free or inexpensive 22 23.1
Better opening hours 14 14.7
Staff who speak my language 10 10.5
Friendly and helpful staff 43 45.2
Confidentiality 57 60.0
Other 2 2.1
No answer 4 4.2
Clearly, price and confidentiality and helpful staff are the most important factors for
accessing medical care. This information must be shared with the health care facilities
and taken into consideration when training is conducted.
Other issues
When questioned about what other members in their core group complained about, 60%
of the guys said that their core group suffered from the effects of stigma and
discrimination and 18.9% said that the cost of health care was a issue. The guys in the
FGD stated that they did not have enough access to counseling for personal issues like
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coming out or dealing with the stigma and discrimination. They also wished there were
more persons advocating for them and they wished there were more free supplies like
lubricants, etc. they also thought a men’s health care clinic would be a good idea.
Services that they felt should be more available included:
o Gay doctor
o Bladder/Renal testing
o Eye exams
o CD4 counts
o ENT specialist
o Computer class
o Treatment for depression
o Counseling
o Better treatment for HIV+ persons
Discrimination
Discrimination faced
Based upon the survey at least 25.2% of the MSM’s felt discriminated against because of
their nationality and 8.4% because they were MSM. 12.6% stated that they felt
discriminated against because of their gender. We have to bear in mind that some use
this term to refer to their sexual orientation. The discrimination was displayed in the
following ways:
• “Finger pointing”
• “Against nationality”
• “Against sexual orientation”
• “Name calling (most common)”
• “Not receiving health service”
• “Look of disapproval”
• “Prejudice”
• “Negative comments”
• “Stone throwing”
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• “Family abandonment”
• “People shouting “battyman” in the streets”
• “People shouting other things in the streets”
Knowledge of HIV Services
Knowledge of STI education, treatment and support
All of the members from the survey and the focus group were aware of where they could
access information on STI treatment and support. The places more frequently mentioned
were AIDS Secretariat, 3H, CHAA, MSMJC, Clinics and Private Physician’s office.
Only one respondent mentioned the FBO’s which emphasizes that they church was not
perceived as being a source of support for the MSM population.
Type of facility frequented for treatments
When ill, most of the participants go to private facilities (56.8%) while 23.1% said that
they go to a public facility. The majority of the respondents chose to go to the private
facilities because they feel more comfortable because they are of the opinion that they are
more confidential.
Table 11- Type of facility used
Responses Number Percentage
Public facility 22 23.1
Private facility 54 56.8
No response 16 16.8
Total 92 96.7
Referral of HIV positive peers
Where referring persons that they know to be HIV+, 41% of the respondents indicated
that they would recommend the AIDS Secretariat and another 30.5% and 29.4% stated
that they would refer persons to the hospital and 3H respectively.
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Misconceptions
At least 90% of the participants were clear that HIV could not be contracted from being
bitten by a mosquito, sharing a toilet or sharing a meal and over 90% were aware that a
healthy looking person could be HIV positive. This may be due to the fact that the
information that has been made available has reached the population.
Discussion and Conclusions based upon MSM Focus Group and Survey
It is clear without a doubt that stigma and discrimination is an issue for the migrant MSM
population interviewed, emphasized by the fact that they are foreigners. Because of this,
the guys had difficulty being in public, accessing health care services, mingling with the
mainstream population and they have trust issues. The downside to this is that they often
did not seek medical care. It appears that a lot of members of the public did not
understand MSM concerns and often assume that they are all HIV+. They feel that they
can “catch” something if they associate with them on a regular basis. It is clear that the
public does not always have the right information. Some of this attitude is fed by the
reggae music, misconceptions and not enough discussions from persons who know better.
Due to the fact that Antigua is a small community many of the guys interviewed knew
each other and there were a lot of issues among them so sometimes there is limited peer
group support within their circle. There is a lack of unity, so it is difficult to move ahead
and represent their issues to the relevant stakeholders when there is no cohesion or “one
voice”. It seems like many are pulling in different directions and have different loyalties
to different agencies without recognizing that they all share similar issues and often want
the same things.
Some of the MSM’s of the study engaged in multiple relationships involving sex which
expose them to more risk of contracting HIV and other sexually transmitted diseases. It
appears that the younger ones are more vulnerable and also the unemployed ones and the
ones who do not get adequate family support.
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They did recognize the importance of good health care and of getting tested regularly,
but because of fear of what they will find out, bad attitude of the health care providers or
lack of money, many choose not to get tested. This causes them a lot of stress and it was
generally acknowledged that some improvement must be made in this area.
It appears that the same pamphlets are being issued by Gender Affairs, CHAA, 3H and
the AIDS Secretariat. Most of the information in the pamphlets speaks to safe sex and
they all already know how to use a condom. The participants need new and updated
information on how to negotiate safe sex, how to empower themselves and where to go
with particular issues. The information disseminated must have more variety.
Recommendations based upon MSM Focus Group and Survey
Public education to reduce stigma and discrimination to MSM’s and other
marginalized groups. This will help people to understand that they cannot “catch”
anything from associating with or being close to a MSM. Education will also help
to foster a spirit of inclusiveness to all persons.
Mobile testing & Screening center – A mobile unit could visit highly populated
MSM areas and bars and clubs frequently utilized by MSM’s providing testing
and free condoms and lubricants.
Develop a support center for MSM which could be run by trained volunteers or
peer educators to offer counseling, referrals, advocacy, education, safe sex
negotiation training and support.
Create a database with MSM-friendly physicians, health centers, employers,
hairdressers & barbers, places to hang out, etc. This does not mean that the
MSM’s will not go other places, but for the ones who are newly coming out or are
self-conscious, they will have places to go where they feel comfortable.
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Create a job bank – having a job could create a sense of empowerment in some
MSM’s which could lead to them making more healthy choices as they would not
be as financially vulnerable as if they were unemployed. They could also learn
how to write resumes, how to present themselves at an interview and where they
could sign up for free courses or get inexpensive training.
Training for healthcare workers at MSJMC or the government clinics so that
they are more sensitive to the needs of MSM’s.
Strengthen the Human Rights desk – the human rights desk as it currently
exists is only for issues related to HIV and AIDS. It should also include advocacy
and reporting for persons who are a part of the core group of a MARP.
Create a website focused specifically on the MSM population. This way, they
have access to actual information and can interact. Sometimes the internet has a
lot of information and a person can get lost or get misinformation.
Have a MARP team. This group will be responsible for carrying out the new initiatives,
for maintaining the website, writing policy to present to the legislators and would train
and educate the public, etc. This could be made up of a physician, nurse, social worker,
MSM’s and a research or policy specialist.
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CSW Survey Discussion and Focus Group Report
CSW in Antigua
This section is based upon the mass of information received from the Survey
respondents. Participating were 114 females whose age ranged from 18 to 48 year old.
A FGD with English speaking SWs and also a small group discussion with Spanish
speaking SWs in the St. John’s Area. The countries of origin of the survey respondents
were primarily the Dominican Republic (73.63%), Jamaica (31%) and Guyana (6.5%).
62.2% said that they had completed secondary school. 68.4% speak Spanish only, while
others speak English only or Spanish and English. The Length of time in Antigua gives
an indication of their vulnerability. 34.2% of the respondents were here for more than two
years, and 35.8% between 6 months and 2 year. One of the English-speaking FGD
participants explained that she had just started sex work five months prior and said that
she is afraid because it is a difficult and somewhat dangerous profession.
Figure 17-
Most of the sex workers came to Antigua because of friends and not family (59.6%). The
majority of them live and work in or around the St. John’s area. 34.2% of the SWs had
between six and ten partners in the past month and 31.5% had 5 or less partners while
14.9% had between 11 and 15 partners. 9.6% had between 16 and 20 partners monthly
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57.8% of the young ladies work on the weekends only when most of the bars are more
active and patrons are more likely to be present. Most of the SWs (52.6%) meet their
clients at the sex club or on the street (41.2%).
Condom use
When asked if in the past 12 months a condom was used in sexual relations with partner
(boyfriend or girlfriend), only 42.1% stated that they always used a condom and a
significant 29.8% provided no response to this question. 87.7% of them always use a
condom with non-partner sexual activity.
53.5% of the participants normally get their condoms from CHAA. Quite a large
percentage also gets their condoms from the AIDS Secretariat and the pharmacy or
supermarket. That accounts for 48.2% and 45.6% respectively.
Figure 18 – Where SW get their condoms
CHAA
33%
Where get your condoms
Clinic/PP
5%
Others
5%
AIDS Secretariat
29%
Pharmacy/Superm
arket
28%
The English-speaking FGD confirmed that the participants get their condoms from
CHAA who distributes at the clubs and bars where they work. However If they fall short
when they were scheduled to work, they would buy them for a higher price at the bar
where they worked. One of the girls mentioned that she believes that “the bar owner gets
them free and then sells it back to us” and requested that her reporting of that
information remain anonymous. They all have had unprotected sex at least twice
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within their first year in Antigua. They all complained of clients wanting to pay extra
to have unprotected sex and all girls stated that they are receiving an increased amount of
requests for anal and oral sex without a condom.
The Spanish-speaking group discussion members reported that they receive most of the
condoms from the AIDS Secretariat; They all said that they often have the experience of
condoms bursting or rupturing and have doubts about the quality of some condoms in
Antigua.
Free condoms
Most received free condoms from CHAA and the AIDS Secretariat,
Figure 19– Where respondents got free condoms
80
70
60
50
40
30
20
10
0
CHAA AIDS Secr Outreach
workers
Receive free condoms from who?
Friends Hospital Other Priv Phys
HIV INFORMATION
Availability of HIV/AIDS information
When asked if in the past 12 months HIV/AIDS information was received 86.8% of the
participants responded in the affirmative.
Source of HIV and AIDS information
50.8% and 48.2% of the participants from CHAA and AIDS Secretariat accessed HIV
and AIDS information respectively, which mean that 99% of the respondents access
those two agencies. Unanimously, the English speaking FGD acknowledged that most
of them came from CHAA outreach workers, who would talk to them and leave stuff for
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them to read. “Only CHAA really went out of their way to reach us where we are”. The
participants felt comfortable talking to the animators at CHAA because they felt as
though they were peers.
Consciousness of being at risk for HIV infections
63.1% believe that they are at risk for HIV infections while another 24.5% who think that
they are not at risk because they always use condoms. One young lady explained that
once when she was having strange physical symptoms – vomiting and weight loss, she
went on the internet to look to see if she had HIV/AIDS. She says, “after torturing
myself fa (for) two weeks, I went to the AIDS Secretariat and they tell me I was clean”.
The Spanish-speaking group discussion identified the support group for female sex
workers called GAAP as an organizations dealing with Dominican sex workers. They
discuss and receive help with issues related to immigration, human trafficking etc. The
group is hosted by the Gender Affairs Division.
HIV TEST
No more than 3/4 of them were tested once in the last 12 months. With this in mind,
more outreach programs may be necessary to encourage more frequent HIV testing
within the participant’s core group.
Figure 20- When last HIV test was done
35
30
25
20
15
10
5
0
This week this month 1-3 month 3-6 months 6-12 Month 1-2 years NEVER Don't recall
When last HIV…
Free HIV testing
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Some 59.6% of the respondents accessed the government services and received free
testing. Though HIV testing is a free service offered by governmental organizations
to the entire population, 27.1% of respondents paid for their testing to be done.
Some of the participants preferred to have their testing done at a private physician or
laboratory where they might have had the perception of less stigma and discrimination.
Ability to Pay
In spite of the fact that HIV testing may be accessed free from the NAP, 37.7% of the
participants admitted that their ability to pay for testing would be a problem and 53.5%
don’t face this problem.
HIV testing locations
HIV testing would be accessed at the AIDS Secretariat by 64% of the participants while
23.6% access this service at the clinics. 3.5% of respondents don’t know where to go to
access testing. Clearly the hospital is underutilized as only 1.7% would go there for
testing.
Figure 21- Preferred HIV testing location
Lab, 1, 1%
Dominican
Republic, 11, 8%
MSJMC, 2, 2%
Don’t know where
to go, 4, 3%
Clinic, 27, 21%
Medical doctor, 11,
8%
AIDS Secretariat,
64%
Reasons for not having had a recent HIV test.
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It is quite evident that fear has crippled quite a significant percentage of the
respondents, 32.4% confessed that they were afraid of the answer or result. While on
the other hand, another 20.1% just didn’t think about it
Issues related to HIV Test
The Spanish-speaking group discussion confirmed that there is no sharing of information
between members of the community but more a sense of secrecy between them; they
don’t know who among their peer community is HIV positive or not. If someone is
diagnosed as HIV positive they mostly keep it a secrets since they are of the belief that
they have no access to public service where the drugs are free. “Two or three years ago,
two girls from the Dominican SW community died of AIDS without treatment, without
their colleagues/peers knowing that there were HIV+”. The participants stated that most
of them do not get tested frequently.
Availability of HIV testing or education
Of the participants 61.4% think that HIV testing or education is readily available and
18.4% think that it is not. There is too the 17.5% that is still uncertain. Because of this
fact, it may be timely to have more VCT outreach programs and testing sites set up if it is
at all feasible.
ACCESS TO HEALTHCARE SERVICES
When the participants of the FGD with the English-speaking ladies were asked “Which
health care providers gives good care?” none of them mentioned the hospital; They all
mentioned Caribbean HIV and AIDS Alliance (CHAA) as being supportive even if
CHAA is not a health care provider. Actually CHAA gave them free condoms and the
outreach workers have offered to accompany them to the doctor if they needed to go.
They seemed to equate those services with good care. A few also mentioned the AIDS
secretariat. Because they gave free HIV testing, free condoms and they believed them to
be confidential. Most of the participants did not access much health care because of the
high cost of private health care and their perception that Mount St. John’s Medical Centre
(the country’s main hospital) was mostly for emergency care.
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Figure 22-
History of medical check-up
Only 56.8% of the respondents had a medical check-up in the past year or less. Of the
remaining respondents 12.2% have never had a medical check-up.
Figure 23– When was the most recent medical checkup
30
25
20
15
10
5
0
This week this month 1-3 month 3-6 months 6-12 Month 1-2 years NEVER Don't recall NA
Experience during medical check-up
Of the participants, 27.1% reported that they received excellent treatment during their
medical checkup. According to findings it is reported that a clean facility, good customer
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care and an inviting friendly atmosphere coupled with quality medical service and
confidentiality is considered excellence. The 50% that had a good experience stated that
there was a measure of friendliness and the doctor was nice. Only 1.7% said that they
received poor service citing lack of manners and the use of swabs while conducting the
tests.
Willingness to recommend facility to friend and Reasons why
71.9% of the respondents would recommend the facility to which they went for services
to a friend. 38.5% of respondents indicated that they would recommend the facility to
which they last went because they received good medical care. Friendly and helpful staff
was the reason given by 21.9% of the respondents, location/accessibility accounted for
17.5% being willing to refer the facility. 14.9% were impressed with the price and 7.8%
were happy that their language was being spoken.
Characteristics of an excellent health care system
The ladies all felt that confidentiality was the most important thing to them.
Confidentiality for them meant not only did they not want to hear their story outside, they
also wanted the staff where they went to be discreet. This was confirmed by 64.9% of the
survey respondents who also thinks that confidentiality is key. They don’t want their
names to be called loudly or have to give out too much personal information.
They also wanted to encounter friendly staff (like the lady at AIDS secretariat who
proffered a warm smile). 45.6% of the survey respondents also said that they want
friendly and helpful staff. 38.5% of the survey respondents would like the facility to be
able to cater for a wider cross section of the mixed society in which we live and offer
more bilingual or multilingual staff.
The Spanish-speaking FGD wanted someplace inexpensive, especially since they did not
have medical benefit cards and would have to pay cash – out of pocket. Some of them
also wished that the clinic or health center would be in close proximity to them and offer
better opening hours.
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6 out of the 7 English-speaking girls said during the FGD that if accompanied by an
outreach worker or someone else, they are more likely to go to the doctor.
Figure 24- What makes a health facility excellent
Features of an excellent health facility
Confidentiality, 74
More testing, 1
Free or
inexpensive, 25
Better opening
hours, 25
Friendly and
helpful staff, 52
Staff who speak
my language, 44
Means of covering medical expenses
Medical bills are paid for by 69.2% of the participants out of pocket while a surprising
12.2% said that they have private health insurance. Another 9.6% subscribe to the
National Medical Benefit Scheme that takes care of their expenses (which was actually
the case with the four Spanish SW with whom we had the short group discussion) and
another 7% only go where free care is offered.
Each of the interviewees of the Spanish-speaking group discussion pay the social security
benefits but admitted that not all sex workers are able to get such insurances. In addition
they stated that they meet difficulties in accessing services: for example:
It is very difficult for them to access all of the services offered at the hospital. Even if
they have the necessary insurance they feel as if they have to wait much longer than
other patients, just because they are Hispanic.
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They need to be able to access a gynecologist for sexual reproductive health services:
for example pap smear. It seems very difficult for them to find such a service.
DISCRIMINATION
Discrimination faced
It would appear that generally, the Antiguan society is not the most accepting of its
Caribbean counterparts. Though 40.3% state that they have not experienced any acts of
discrimination at all, the other 59.4% do experience discrimination against them for
various reasons. Alarmingly, 48.2% of the respondents were discriminated against
because of their nationality which accounts for 80.8% of those facing discrimination.
After nationality discrimination is most experienced because of the participant’s
profession which accounts for 7.8% of respondents.
One of the English speaking sex workers explained during the FGD that while she was
buying a pen and a notebook to make her accountability, she heard “she ah wan whore,
so why she buying school book”? Then another participant added, “Is not only whore
they say, one call me bitch because her boyfriend comes to Wendy’s”.
When we asked if they have difficulty have friendships with non CSW’s? the response
was clear “I have no time with those women because they think they better than us”.
The situation is even more alarming with the Spanish speaking SW. During the group
discussion, they all strongly insisted on the fact that stigma and discrimination against the
Spanish speaking young ladies is much stronger than against any other English speaking
migrant Sex Workers. “When I speak in English, they ask me to speak English, they
say they don’t understand”. The Antiguan females discriminate against them a lot. They
often hear: “fuck your ass, fucking Spanish”. They say that the people have no respect
for them. They treat them badly and they are sometimes called “mother’s cunt”. The
worst is that they feel unsecure in the country. They have no access to police and justice
services. They have the feeling that Guyanese and Jamaican sex workers are given more
consideration than they are by immigration and police officers and by health care
providers.
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They actually don’t know where to go when they are facing a serious issue. The
Dominican SWs have even the feeling that the situation is worst than years ago. Under
the previous government some of them got residence permits for ten years. The new
government removed this permit before the expiry date. “Which is against the
international laws”
Frequency of discrimination
It is interesting to note that 27.1% of the survey participants report that they have been
discriminated against on a regular basis while another 21.9% sometimes experience
discrimination. Together 53.5% of the participants do experience a measure of
discrimination, which can be interpreted, based upon evidence, that the Antiguan society
displays acts of discrimination on a regular basis against commercial sex workers. “At
the Immigration Department and at the hospital they treat me badly because I don’t
speak English” or “I was accused of being a prostitute simply because I am Spanish”
or “On the street I am called a whore and asked how much I am worth simply because
I am Spanish” or “They often say that I am a bitch and the Santo Domingans come
here to take their husbands”
The stigmatization is associated to violence due to their work or citizenship
Each of the four discussion participants of the Spanish-speaking group discussion had to
face violence against them in the street. “Once I was wounded on the face, I didn’t
receive any consideration at the police station”. They have the feeling as though the
Dominican government does not care about them and has abandoned them. They do not
receive any care and support on this side.
KNOWLEDGE OF HIV SERVICES
Knowledge of STI education, treatment and support
19.2% of the participants indicated that Government agencies such as AIDS Secretariat
would be a good place to get information, treatment and support. 36.8% indicated NGO’s
like 3H and CHAA.
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Type of facility frequented for treatments
For treatment when ill, 57% of participants go to private facilities. The participants have
a wealth of confidence in the private physicians having spoken of their efficiency,
experience and they are also of the opinion that they are more confidential that are the
public facilities.
However most of the English speaking SW mentioned during the FGD that they have
never been to any doctors in Antigua as they could not afford the EC$150.00 cost and
they preferred to wait until they went back home on vacation where they would be able to
get free or cheaper medical care. When asked about MSJMC, they all said they had no
interest in going there, unless it was an emergency.
On their side the Spanish-speaking group discussion reported that most of the Dominican
girls go to Dr. Nagabis Sanchez, a physician who they find to be very committed and who
responds very positively to their needs. Previously, they often visited a Cuban doctor but
he is no longer on island.
Referral of HIV+ peer
49% of the participants would refer someone to the NAP for support, if they were tested
HIV positive. Second was the Mount St. John Medical Center at 28%. The Englishspeaking
FDG would like that free medications are provided to all residents who are HIV
positive.
Misconceptions
Some 79.8% of the participants disagreed with the statement which says that one can
become infected with HIV if they share a meal with someone who is infected and 88.5%
agree that a healthy-looking person can have HIV thus safer practices might be adopted.
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Discussion and Conclusions for CSW
The English speaking CSW Focus Group express that they welcomed the interaction to
talk about how they felt and their daily experiences. For some of the girls, the first month
or so was “scary” as one put it, because they did not know if Immigration was going to
find them and send them home. After a while, that was not a fear anymore as they paid
extra to their landlord and his contacts, for getting their time in their passports for them.
None of the participant’s family members knew what they were doing in Antigua. One of
the ladies from Jamaica has a thirteen year old daughter and she is afraid that her
daughter won’t take it well if she finds out the type of work she is doing. It is apparent
that the participants left families back home who were struggling financially and
welcomed the money that was sent back home by them. They saw themselves as helping
their family and while some felt some shame at what they were doing, for the most part
they saw it as necessary.
Generally speaking the use of condom is not consistent enough among SW. If services
provided by the NAP are well considered however HIV tests and medical check-up are
not done frequently enough on a periodic basis
The Spanish-speaking sex workers encountered a lot of discrimination in public and also
when trying to access healthcare. Their inability to pay is a huge barrier and as a result,
they often have to deal with illness in isolation.
It was also noteworthy, that their perception of good health care included being able to
receive free condoms, free services and being treated kindly and with respect. None of
them cared about the doctor’s qualifications or reputation, but rather how they were
treated.
The general consensus is that all of the respondents of the survey and participants of the
focus groups want to be anonymous and not easily identified when they go for HIV
testing, which is the case at the AIDS Secretariat.
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Their expectations for their core group were limited. While they were happy with the
services provided by CHAA, the impression of the principal investigator is that most of
the time the ladies felt isolated and alone like no one understood them. It appears
that they did not think they deserved to have any high expectations. Many of the sex
workers seemed resigned to their fate and did not seem to have much hope for change or
for things to get much better.
The Spanish speaking SW expressed that they live in an extremely discriminating and
violent environment. Their main needs would be services provided by Spanish speaking
staff in St Johns and available 24/7.
It was also interesting to hear from them that they play a public health role in diagnosing
STIs among their client and orienting them to the most relevant health facility. They have
the feeling that there is a serious lack of basic sexual and health education among men. In
their opinion, men in Antigua do not receive sufficient education about STI’s.
Recommendations for CSW (From Focus Group and Survey)
A policy should be put in place to ensure periodic STI tests and check-ups for all
sex workers. To be discussed with component 1 consultants.
Public services including immigration and police officers and health care providers
need to be trained in culturally appropriate manners of relating to Spanish
speaking migrant sex workers who are sometimes very vulnerable and who utilize
their services. The precise content of the training will be identified.
A health center or clinic based in St Johns should have late opening hours to
provide sex workers with SRH services including periodic STI tests with Spanish
speaking staff. The consultancy for component 4 will identify the most
appropriate facility to ply this role.
Distribute as many free condoms as possible, in the bar, dancing and brothels.
The sex workers need education on the consequences of anal or vaginal
unprotected intercourse with multiple partners. After that, then empowerment so
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that they do not give in to having non-condom sex even if it means more money
since their life will be at risk. COIN could support self-esteem programs for SWs.
As it relates to their health care, it is a serious problem that they do not seek
medical attention; therefore the girls should be given a list of CSW-friendly
medical care providers so that they have a choice. Information on testing centers
should be circulated to the girls on a regular basis.
They should be afforded a minimum of one free health care visit per quarter.
If the facilities permitted, a physician could visit them once monthly to offer inhouse
medical care.
CHAA should consider expanding their program since it seemed to be so effective
and they could use their animators to conduct support groups for the girls or offer
some individual counseling.
A hotline should be set up to answer queries in English and Spanish that the girls
might have as many of them did not know their way around, nor were they
familiar with all the services offered.
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General Discussion and Conclusion
This mapping exercise was indeed a very useful one and revealed a lot of information.
Some systems work well, some could be improved and some need to be totally revamped.
The NAP office in Antigua is quite accessible has well trained staff and is quite active
with its prevention program in the form of street fairs, free testing, community outreach,
etc. Treatment has also been readily available from the Clinical Care Coordinator who
works along with the NAP. The NAP is also supported by governmental organizations
like the Gender Affairs Division, which works with vulnerable populations. Support also
comes from a number of NGO’s – particularly CHAA and 3H who are very active
and are almost ‘household’ names within the migrant circles. Also active are other
NGO’s like WAR who has limited resources and ABHAN who caters to a specific
population, but their support is noticeable.
While there has been some media appearances by staff of the NAP office and the Clinical
Care coordinator, the media could be more utilized as a means of educating the public
about HIV and AIDS. There is still a lot of public misconception about HIV and AIDS
and some persons, even in the healthcare profession still use the terms casually and
interchangeably, so that one frequently heard the phrase “catch AIDS”. Many persons
still think that a person had to have been living an abnormal or “loose” lifestyle to have
contracted the HIV virus; hence they seem to view vulnerable persons or clients with
some degree of distaste. Again, while speaking with stakeholders, it was not uncommon
to hear them refer to vulnerable migrants as “those people” and on more than one
occasion the question was asked, “Why don’t they just go back to their home?” It was
clear from speaking with the Stakeholder organizations that in many instances, stigma
and discrimination against migrants and vulnerable populations and towards HIV and
AIDS starts at the top with management.
Another area of underutilization is the district clinics and health centers. Considering the
placement in the various areas around the island, if properly utilized, they could be a hub
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for care, but for persons who are undocumented or without a valid medical benefit card,
care is often limited.
There is clearly a wide gap between the expectations and mission of the various
Faith Based Organizations and what they are actually doing. As a result,
organizations that might be expected to lead in compassion and care often are the ones
who exercise a lot of judgment and bias. Most of the organizations’ spoke-persons stated
that will offer emotional and in some cases financial support to members who request it,
but apart from talks on safe sex with the youth, there is not that much outreach. Not many
of the FBO’s were able to answer the question on when last they had a physician or nurse
in to speak on HIV and AIDS. Generally, there is room for improvement. Amazingly, just
conducting the interviews with the FBO’s raised a level of awareness, so that they all
committed to making an effort to do more.
Despite several sensitivity trainings conducted with members of the Police Force by the
NAP office, 3H and Gender Affairs Division, a large percentage of the Officers still seem
to have some challenges understanding the needs of vulnerable groups and how they have
created barriers by “blaming the victim” when members of the two core groups
identified go into the stations to make reports. This causes less reporting when some of
the migrants are victimized as they are uncertain of how they will be received.
In discussions with the members of the MSM and CSW populations, there was some
initial hesitancy about revealing information for fear that it would end up in the hands of
the Immigration Department – that seemed to be the No. 1 fear of the migrant
population – being deported. This fear was also obvious in those who had valid
documentation to be in Antigua. There was also fear of public perception. Some of the
migrants appeared to feel some general unfriendliness and disapproval, overt and subtle.
However, when they were convinced that the information was confidential, most opened
up in ways that were heartrending, about their circumstances in their country of origin
and wanting to have a better life in Antigua.
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Many of the ladies expressed a desire not to engage in commercial sex work. One woman
in particular said “I had not done it in 2 months, but when my mother called to say that
my “bambino” was sick, I took two clients to get quick money to send back home to the
Dominican Republic”. It appeared that some of the persons engaged in sex work
were doing it because they felt they had no choice and their options were limited.
A few of the sex workers appeared to have come to Antigua with the promise of a
different kind of job and things turned out differently. They were not comfortable
speaking out as they were often not believed.
Another highlighted fact was that there is an unacceptable too little number of HIV
testing done within the core groups surveyed. The fact that quite a significant
percentage has indicated that they have multiple sexual partners and that quite a few of
them don’t use condoms it would have been better to see a greater percentage being
tested within the last three months. There is also needs for more empowerment training
so that members of vulnerable migrant population can stand their ground about the use of
condoms and understand what safety measures means for their lives.
Members of the MSM group seem to make more use of the media than the CSW
population as it relates to their source of information for HIV and AIDS. They appear to
go online, use social networking programs and communicate using technology more. One
reason for this could be that there are less language barriers among the MSM groups and
another could be that they have more ‘mainstream’, less self-employed type of work,
there they have access to computers, etc.
In a number of the survey questions, participants admit to receiving support, supplies and
information from friends. This speaks to the usefulness of peer counseling. Some
participants also had little confidence in the public health system and instead preferred
to go back to their home country for medical care. Others preferred to rely on the
NGO outreach staff that they seemed to have a connection with for support.
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Some members of vulnerable groups were uncertain of HIV transmission methods and
this could prove risky if they minimized certain behaviors. They also did not place a lot
of emphasis on recognizing or treating STI’s and other indicators that they could be at
risk.
All in all, the work is progressing and continued discussion coupled with positive action
will make a difference. With the change of mindsets of certain key persons, hopefully
there will be a trickle-down effect that will affect others. If we can work to minimize
stigma and discrimination and to increase the access to healthcare and motivate persons
to practice self-care and minimize risky behaviours, we will be in an even better position.
In addition, when key stakeholders work together to provide a stronger framework, then
we would be well on our way to accomplishing Goal 6 of the World Health
Organization’s millennium goals which seeks to combat HIV and AIDS.
General Recommendations
Considering:
1- The indicator of the project for component 4: Increase the number of regional and
national bodies/committees which are relevant for HIV/AIDS, and in which
persons representing migrants are heard.
2- The general aims of this study are to enhance the quality of organizations that
represent the interests of the migrant and mobile population and to increase the
migrant and mobile population accessibility to prevention, treatment and support
for HIV services.
3- Reports and data collected,
Please note the following recommendations:
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Policy Aspects
The National AIDS Program, the Global Fund CCMs and other major national
agencies need to involve a representation of migrant MARP’s in their decision
making committees.
For the purpose of referrals, some of the NGOs, especially 3H and CHAA need to
clearly indicate in their status that migrants and mobile persons are part of their
targeted populations. (For example, if a faith based organization needs for refer
someone they will know where to send them.)
Use best practice experiences from other countries.
Consulates should be appointed to represent the interests of the main migrant
countries represented in Antigua and they should be involved in discussion on
migrant issues..
Migrants should be considered as one of the main vulnerable groups in all
national HIV strategic plans and in future proposals for any funding international
agency.
NGO’s should come together to create a policy document on procedures for
providing service to migrants
Strengthen the Human Rights desk. It should include advocacy and reporting for
persons who are a part of the core group of a MARP.
Develop health economic mechanism to reduce the out of pocket contribution of
noninsured migrants. At a policy level, regulations need to be put in place at the
various stakeholders’ offices to ensure that all persons are treated fairly regardless
of nationality, age, sex/gender, migration status etc. Persons’ confidentiality and
human rights must be respected. This must be the first step to ensure protection
of vulnerable groups.
Organizations Capacity Building
The level of stigma, discrimination, xenophobia and homophobia in Antigua is
unacceptable. Public education needs to be conducted to reduce stigma and
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discrimination to marginalized groups such as SW, MSM’s and migrants.
Education will also help to foster a spirit of inclusiveness to all persons.
More governmental assistance could be extended to the NGO’s and FBOs in the
form of non-financial assistance like technical support and training or based on a
needs assessment of the particular NGO with regards to most vulnerable migrants.
Training Recommendations
Training of trainers’ workshops should be conducted for the directors of all
agencies that work with migrant and mobile populations, so they in turn can train
their staff to minimize stigma and discrimination and also to understand the
cultural challenges the target populations face.
Training should be conducted at least annually for healthcare workers (including
MSJMC and government clinics) on diversity and cultural competency. Purpose:
To reduce stigma and discrimination towards MARP’s and mainly migrant
MSM’s and SW in the health services and to be more sensitive to the needs and
questions related to migrants.
Training should be done with the Police, the immigration and the labour
departments on Stigma & Discrimination and cultural sensitivity.
Place informational brochures in Spanish, English and maybe Creole at the
Immigration Department, at the Work Permit Office in the Ministry of Labour, as
well as other relevant administrative offices.
Transportation should be made available for the NGO’s. Perhaps it could be
shared transportation that would reduce maintenance costs. A driving schedule
could be maintained and driving duties could be rotated among members of the
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target population. Purpose: this would greatly impact persons getting a ride to
appointments, to get tested, etc.
HIV Prevention & Educational Services
Create a pamphlet with a directory of VCT centers in English, Spanish and Creole
to distribute to the Migrant and mobile populations. It is necessary to ensure that
adequate VCT training is done for healthcare workers. This pamphlet should be
provided with the one on care & treatment services.
Make HIV and AIDS education information more readily available through a
variety of sources – websites, Facebook, media, etc. A reasonable percentage of
the population uses the two cinemas in Antigua, yet no HIV or AIDS prevention
of support messages are shown there. Radio in Spanish is an excellent means to
provide information to the Dominican vulnerable migrants and should be used for
IEC purpose to the targeted population
The instrument used most to make contact, could be the instrument used for
outreach. For example, Short Text Messages (SMS) can be sent to SW’s and
MSM’s with positive messages reminding them to use condoms, get tested, etc.
Selected MSM and SW should be trained to be peer educators, who will further
educate other members of their core group on risk factors, risk reduction
behaviours and empowerment.
Migrant SW and MSM need to be given the necessary support and tools to build
empowerment, which in turn is likely to increase their self-esteem helping them to
make better choices.
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HIV TESTING
Create more consistent and reliable mobile testing and screening centers at
community level that go around to hot spots with volunteer staff to provide free
services.
Access to Care
In one of the most adapted health facility to the needs of migrants, the service
should be organize in order to facilitate the periodic free check-up of male and
female SW.
Basic Gynecology and SRH care should be available for all SW, including STI
tests and Pap Smear
The NAP office should provide to all organizations working with migrants and to
the migrants themselves a constantly upgraded directory of places to refer
members of the migrant population who are at risk for HIV or who have already
tested positive. This list could include other governmental organizations, NGO’s,
FBO’s and individuals.
A database of physicians could be created that
o Speak Spanish
o Are MSM friendly
o Are willing to volunteer their time; this could be utilized to create a
schedule whereby vulnerable persons can have access to medicalcheckups
and other health related services.
A selection of Health Care Provider should be trained in functional Spanish.
Informational pamphlets and posters in English, Spanish and possibly Creole
should be distributed to vulnerable populations. This material should give referral
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information on existing testing sites, free clinics and MARP-friendly physicians.
The migrant project should support the development of such pamphlet.
Improved dialogue with the clinic and health center administration to enable
essential services to be rendered to persons even without a medical benefit card.
A fund could be set up to help migrants with health related expenses. Monies
could be accessed from a small tax of one USD on cruise ship passengers and
flights or on remittances or on grants that might be available worldwide.
Subsidized health care would be ideal.
NGO’s or NAP should develop policy and should advocate for migrants to be
able to access health care without being asked immigration status.
Longer or different opening hours for one or some facilities that are frequented by
members of the MSM or CSW populations mainly after normal working hours.
Treatment & Care
Increased visibility of the Care Coordinator. This could be done by the individual
visiting the various clinics on a rotation schedule or having educational sessions
on National TV or elsewhere. Purpose: To sensitize members of the migrant
population of the availability of free services for persons who are HIV+.
Provide transport and peer escort if needed for sex workers to get to medical
appointments
MSM’s and SW’s under care and/or treatment should be guided in minimizing
risk behaviours that would affect them and their partners.
Support
Support groups should be conducted more frequently in the language of the target
population for both studied vulnerable groups, conducted with volunteer
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counselors that do not have to necessarily be affiliated with any specific
organization.
Representative consulate or country association should be established for the
countries with the largest migrant populations in Antigua, for the purpose of
advocacy, support and social connections.
Provide literacy classes for the non-English speaking migrants. Purpose: This will
help them to be able to read and write in English so that they are more informed
of their options and opportunities.
Vocational classes in English/Spanish can be provided for the sex workers.
Purpose: this will help them to learn extra skills to be more marketable and
change their profession if they so desire. These training could be provided by
NGO, FBO, GO or private organizations.
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ANNEX
________________________________________________
KEY STAKEHOLDERS
Organizations that provide services to the migrant population.
Name of Agency Type of Type of Service Contact Person Title
Agency
provided
Ministry of Labour Government Work permits Paulette Ambrose Labour Officer
Immigration
Department
Government Time in country Ms. J. Johnson Immigration
Officer
Organizations and agencies that provide HIV and AIDS services in Antigua and Barbuda.
Name of Agency Type of Agency Type of Service
provided
Contact Person
Title
Mount St. John’s
Medical Centre
Hospital Prevention, Care Sister Morrisey Nurse Supervisor
Counselor
AIDS Secretariat Government Prevention, support Oswald Counsellor/Educator
Hannays
Health, Hope & NGO Prevention, support Karen
Program Manager
HIV Network
Brotherson
Caribbean HIV & NGO Prevention Svenn Grant Program Officer
AIDS Alliance
Antigua & Barbuda NGO (grassroots) Support Eleanor Director
HIV & AIDS
Network (ABHAN)
Frederick
HIV/AIDS Care
Coordinator
Government Care, support Dr. Prince
Ramsey
Gender Affairs Government Prevention, Alverna Inniss Program Officer
Division
Advocacy
Women’s Clinic Private Physican Care Dr. Dane Abbott Gynacologist
Private Physician Care Dr. Sanchez General Practitioner
Guyana consulate Diplomatic K Support Bobby Reis
Women Against
Rape
CBO K
Education, support,
advocacy
Alexandrina
Wong
Director
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NGO FOCUS GROUP REPORT
Participants
Alexandrina Wong - Women Against Rape (WAR)
Eleanor Frederick - Antigua & Barbuda HIV/AIDS Network (ABHAN)
Elisha Walker - ABHAN
Lyndale Weaver - Antigua Planned Parenthood Association (APPA)
Ryando Anderson - Health Hope & HIV Network (3H)
Patricia Galloway - ABHAN
Date/Time
Session was held on 27 th February, 2012 from 10:00 am to 1:00pm
Our NGO focus group discussion was made up of representatives of the six (6) NGO’s in
Antigua with the exception of CHAA, who could not make it. The members were very
interactive and all felt as though we are definitely not doing enough
We started off looking at what services were offered by the various NGO’s and the
combined answers included:
HIV Testing
Education and Training
Legal referrals
Counseling
ARV treatment adherence
Escort and transportation to and from medical appointments
Advocacy
Hot meals ~ Food
Support
Cooking gas
Condom distribution
Contraception in all forms
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Support
Clothes
Populations Served
HIV+ persons
Everyone
Marginalized youth
Men who have sex with men (MSM)
Commercial sex workers
Trafficked women
Victims of sexual violence (male and female)
MSM REPORTS
MSM FOCUS GROUP REPORT
Introduction
The session was conducted by Ryando Anderson, a self-identified MSM who works with
the 3H (Health, hope and HIV network) and who has been working with vulnerable
populations (MARPs) for a few years. He has also conducted focus groups before, under
the tutelage of Karen Brotherson, director and program manager at 3H. He took control
of the sessions, while we took a backseat.
Everyone was thanked for coming and the goals for the project were explained as
follows:
To understand the challenges faced by migrant MSM’s in Antigua, especially as it
relates to access to healthcare and HIV/AIDS.
To know what are the services that they feel like are offered in a professional and
helpful manner and what services they do not feel are offered well.
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To know
To improve services for this core group going forward.
Establish Group Rules
Ryando explained that the group was for everyone to give their input and that everyone
needed to make their voices heard. He stated that he was there as a guide. Some of the
rules of the group discussion included:
a. Confidentiality – what was discussed should not be disclosed to other parties,
especially if someone gave direct quotes or shared their personal experiences.
b. No cross talking – it is easier to listen if only one person at a time speaks.
c. Respect every person’s views – even if opinions are different, we still have to
listen to each other and agree to disagree if necessary.
d. Be open so we can learn from each other – the more information is shared, the
better we understand what the problems are being faced and the more likely we
are to find solutions.
Methodology
Recruitment criteria: Participants were chosen by 3H worker Ryando Anderson and the
names were approved by the principal investigator/consultant and 3H program manager,
Pastor Karen Brotherson. The participants were all self-identified men who have sex with
men (MSM) and they were all born outside of Antigua. With the exception of one person,
they others had only been living in Antigua for three years and less. One of the persons
was known to be HIV positive.
Geographic location: The participants lived all over Antigua. The session was conducted
at the Ramco Building on Independence Avenue in St. John’s.
Timing: The MSM focus group was scheduled for two hours but went from 10:20 am to
12:30 pm.
At the end of the session each participant received the amount of EC$ 40
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Demographic
8 participants
Sex: Male. One guy identified as Transgendered
Age: 18 – 38
Country of origin: 4 Jamaican, 2 Guyanese, 1 Dominican, 1 Vincentian
Language: All were English speaking
Marital Status: All were unmarried, some had no steady partner, some were in
relationships with one partner and some had multiple relationships.
Educational Level: This was not discussed
Work Status: Five of the participants were employed and three were unemployed. One
worked in law enforcement. Three of them had done outreach work with other MARPs.
Focus Group Responses
1. What are some of the general issues you face being an MSM in Antigua
All of the participants complained of discrimination more than any other issue.
Discrimination is felt because of their being non-Antiguan and also because
sometimes people recognize them as being gay (sic). It is felt when people shout
things out on the streets, when they are looked at with raised eyebrows and when they
feel like people are talking behind their back. The transgendered guy admitted to
being harassed almost daily with men in groups being the most verbally cruel. He
even admitted to being physically attacked on one occasion.
The guys stated that it is difficult to get a job because of their sexual orientation.
People feel like they will keep away male customers who do not want to be identified
with them. One of them already employed guys stated that often times there are
comments made at his workplace when he passes by and men have refused to deal
with him and to ask for another employee instead. He says “my supervisor didn’t
even stand up for me; he just allowed someone else to deal with the person instead
of saying I was the only one available”.
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One guy explained that when he goes to get his hair done, the hairdresser tells him he
has to be the last customer or he should come on Sundays when not many other
customers are there because when he leaves, the men says she need to clean the chair
properly so they don’t “catch any bottom disease”. Some of the men refuse to come
into the hair salon when he is there, for fear of being seen in the same space with him.
He feels very insulted by that.
Two guys reported discrimination at the police station when they went to report an
attack on them physically in one case and sexually in another. They were not treated
with respect and their concerns were not taken seriously.
The MSM’s also discussed their manner of dress and they seemed to disagree on this
issue with some feeling that the way the others dress reflects badly on all of them.
This was directly mostly to the transgendered female.
2. What are some of the issues related to health care?
One of the guys reported a negative experience as a hospital patient whereby the staff
used gloves with him and did not use with the other two patients in his room. Another
one stated that one of the kitchen staff who brought his meals left it far away and
shortly after the guy left, he saw several persons come to the room and he felt like the
guy went and told persons that he was there. He complained of feel like “like a freak
show” in his words.
One of the older guys stated that when he went for a prostate screening, the nurse
mentioned to him, “Oh you will love that”. He felt uncomfortable because he thought
to himself that he was not a “whore” so he would not just want any and every finger
in his bottom.
Some of the guys said they just preferred not to go to any government clinics because
they are always crowded and they did not like the attention. They wished they could
afford to go to private doctors ONLY. This was unanimous.
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3. Where are the places/spots that you feel comfortable hanging out?
‣ Home – most of the guys felt comfortable at their own home. Two of them
said they had not ‘come out” to the people they lived with, so they did feel
stifled sometimes as they could not bring friends over and they had to feel
pressured to pretend they liked females. Some felt comfortable at the homes
of other MSM’s
‣ Gunthropes – a few of the guys lived there and those homes were a hangout
for other guys.
‣ Parties – they felt comfortable going to parties thrown by MSM’s because
everyone was similar to them, so they could be open and be themselves.
‣ Jolly Harbor bar – this was a location where they hung out and felt
comfortable.
‣ Abracadabra night club (English harbor)
The guys felt comfortable in places where people were used to seeing them, so
they did not feel like they stood out they felt accepted. They also preferred to be
around other MSM’s so there was less judgment.
4. Which health care providers give good care?
One MSM reported a good experience at Mount St. John’s Medical Center, the main
hospital in Antigua. He stated that in the emergency room he was helped by another
MSM and he did not have any problems with the service. No one else had anything
positive to say about the hospital. Three others had negative things to say about the length
of time they had to wait for services, discrimination by having meals placed far away
instead of being brought to him and one who felt his confidentiality was compromised as
someone came and saw him and told others he was there.
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AIDS Secretariat – The participants felt that this office had a high degree of
confidentiality when they did testing and they appreciated that.
Private physician – Dr. Pereira who is a dermatologist and also functioned as the
assistant Care Coordinator in the absence of Dr. Ramsey, was mentioned as being a
physician that was MSM friendly. They felt she was non-judgmental and comfortable
to talk to. She is located at the Medical Surgical Associates office close to the Woods
Center.
Private physicians - Dr. Stevens located on Long Street and Dr. Philmore Benjamin
on All Saints Road were also utilized by some of the guys.
5. What are some of the factors that make a clinic or health center good?
a. Free health care – because some of them were unemployed, they said if
health care was free, they would be able to access it more. They did not
have a Medical Benefit card, so they had to pay for everything.
b. Confidentiality – they want to know that “their business would not leave
the building right after they do”. They felt like Antigua was a small place
and rumours got started easily, so they prefer to know their information
will be kept privately. They stated that the health centers should hire
people who were more mature as they felt that they were more likely to be
confidential.
c. Good customer service – this meant that the staff should be nice and
should be caring toward MSM. For the participants, good customer service
also meant the caregivers should be helpful.
d. Clean environment – the health care office should be clean and equipment
used should be properly washed. One participant mentioned that gloves
should be used when they are checking people. Another participant stated
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that most MSM’s are very particular and in his opinion, more cleanconscious
than some women.
e. Respect towards MSM – “We want to be treated the same as anyone else
who is spending our money at their business place”.
“We don’t want to be looked at differently or have to put up with any
snide comments”
f. Friendly staff – the participant who mentioned this, when asked what he
meant, he stated “people who greet us nicely and don’t ignore us”.
6. Where do you get condoms?
• 3H Network - free
• Bars – buy them
• Caribbean HIV/AIDS Alliance (CHAA) - free
• Supermarket – buy them
7. Where do you get information on HIV/AIDS?
Internet – most participants explained feeling self-conscious asking about
HIV/AIDS for fear that people thought that they “had it”. So if they had night
of unsafe sex and felt sick after, they would Google whatever symptom they
were experiencing to see if it fit the description of an HIV+ person. That led to
a side discussion on the fear most of them experienced at having to get tested
for HIV. Six of them had been tested at least once in their lives and two had
not. They felt very anxious about being tested, but one stated “if I got precounselling,
he felt slightly better”. Most of them said that if they used
condoms all the time, they didn’t feel like they needed to get tested again. The
older MSM in the group reminded them that they needed to get tested
periodically as even if you are positive, it might not show up right away.
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Health, Hope & HIV (3H) Network – pamphlets are given out and sometimes
they have support group meetings where information is shared.
Caribbean HIV/AIDS alliance (CHAA) – they do outreach and also give out
pamphlets and condoms. The animators also talk to them about safe sex
practices.
Antigua Planned Parenthood Association (APPA) – the participant who
mentioned this agency said the staff member didn’t really talk to him but just
gave him some written information.
AIDS Secretariat –written information, counseling before and after HIV
testing
8. Which of your needs as a core group are not being met?
The participants felt that they have a need to be more together in unity. They felt that
among the core group, they talk about each other too much and there is too much
fighting. They also said many of the persons who are MSM’s have multiple partners so
they need to be spoken to about that, because that can cause the spread of HIV. They also
mentioned that some of the guys go with older men for money and this means they
become unfaithful to their partners. Other things mentioned were:
‣ Counseling – some of the younger MSM need counseling to be able to deal with the
stigma and discrimination and also with coming out to their families. Some of them
need help with self-esteem issues.
‣ Advocacy – they need representation to deal with Immigration, as the Immigration
officers are unkind in a more subtle kind of way.
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‣ Men’s health care clinic – where they can get free condoms and check-ups and deal
with whatever health issues they have.
‣ No steady supply of commodities (lubricants) – one participant commented that they
need access to these things as without them, there is tearing, which can result in
more infections.
‣ Someone said at the last minute they need people to understand them and the
frustrations they have to deal with.
9. Which agencies do you find trying to reach this core group?
‣ Health Hope & HIV (3H) Network – this agency provides condoms, holds support
groups, gives information and helps with food and other forms of support. Pastor
Brotherson is also a good counselor.
‣ Gender Affairs – They provide information and support.
‣ Caribbean HIV/AIDS Alliance (CHAA) – “they provide support by talking to use
about safe sex, providing condoms and the staff are helpful”
‣ Women Against Rape (WAR) – “Ms. Wong followed my friend to the hospital and
police station after he had been sexually assaulted by an older man. That was very
nice of her”.
10. Do you have difficulty have friendships with non MSM’s?
“Yes some ‘straight’ guys do not want to be seen with us. They might be friends with us
on What’s App or BBM (phone programs) but they don’t want to talk out in public”.
“We do get along better with females and they also have some good advice on how to
deal with guys”.
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“MSM’s who are on the down low are also a problem because they want to have
hidden relationships with MSM’s and still have female relationships and it is not
known if they are practicing safe sex with the females which could put us at risk of
contracting HIV”.
11. What kind of family and friend and social support do you have?
The following responses were given
‣ Family
‣ Friends
‣ Partner
12. What ideas and suggestions do you have to improve HIV/AIDS prevention
(education), treatment and support in Antigua?
‣ MSM focus groups like this should be held twice a month to be able to talk about
issues they are facing. The participants felt good being able to express
themselves in an open manner and they also felt it was good to get to learn about
each other. One participant said, “Well it’s good to know that I am not the only
one going through that” when a concern was raised about their partner having
another partner. They also wanted to know that when surveys are done, that some
benefit will come out of it.
‣ Half-way house for young men – some participants complained that there is
nowhere for young men to do if their family realizes that they are positive and
that is why they would go “bareback” for money – to survive. If they had an
alternate place to live, they would not need to engage in behaviour that leaves
them vulnerable.
‣ More outreach. One participant also mentioned that he had a HIV+ MSM friend
who was living in the bushes and not accessing services. He wished that someone
would go to him and help him to reintegrate into society.
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‣ Confidential organizations where people can go for counselling, treatment and
support - The participants said that while there is 3H, CHAA and AIDS
Secretariat, they all focused on everyone. They felt like an organization
specifically for MSM’s would be a good idea, especially if it would be staffed by
other MSM’s who were trained to deal with their issues. When asked if such a
place would not cause them to be targeted and vandalized, they said not if it was
discreetly and properly managed.
At the end of the meeting the participants were thanked for their time and they were
reminded of the confidentiality agreement they agreed to and encouraged to stick together
as there is strength in unity.
MSM SURVEY RESULTS
Respondents:
The survey was conducted by members of the peer group who met with the respondents
at their homes, in public places and other areas where they socialize.
Sample consisted of 95 male respondents. Their ages ranged from 18 to 51 with the
average being age 28.7. Their geographical location varied but quite a significant
percentage was located in the St. John’s area and the suburbs. Their average time in
Antigua was from less than a month to over two years.
Each Interviewee had to respond to 58 questions. Each interviewee received either cash
or topup.
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Demographics
Education level completed
The majority of the respondents (57.8%) had completed secondary school, with the
second largest amount completing technical or vocational school (16.8%). We had 18 or
18.9% completing some form of college. Only 3 or 3.1% had never been schooled. The
implication here is that men who have sex with men are not limited to any particular
educational status but can be anyone across the educational spectrum as any other
resident in Antigua .
Table No. 12 – Level of Education (Q1). MSM Study. 2012.
Responses Number Percentage
None 3 3.1
Primary School 3 3.1
Secondary School 55 57.8
Technical/Vocational School 16 16.8
Some College 8 8.4
Completed College 10 10.5
Other 0 0.0
Totals 95 99.7
Language spoken
All of the men spoke English with 7.3% also speaking Spanish and 3.1% being English-
French bilingual. All of the men who spoke French were from Dominica and this could
be attributed to the fact that their patois dialect is broken French. The 7 English and
Spanish speaking men were distributed as follows: 1 from Dominican Republic, 2 from
Jamaica and 4 from Guyana.
Table No. 13 – Language spoken (Q2). MSM Study. 2012.
Responses Number Percentage
English 95 100.0
Spanish 7 7.3
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French 3 3.1
Other 0 0.0
Total 105
Length of time in Antigua
73% of the respondents have been in Antigua over two years and 13.6% have been here
between one and two years. With 5.2% being here between six and twelve months, only a
combined 7.3% have been here under 6 months.
Table No. 14 – Length of time in Antigua (Q3). MSM Study. 2012.
Responses Number Percentage
Less than one month 3 3.1
Between one and three months 2 2.1
Between 3 and 6 months 2 2.1
Between 6 and 12 months 5 5.2
Between 1 and 2 years 13 13.6
Over 2 years 70 73.6
Total 95 99.7
Person who brought respondent to Antigua
The majority of the MSM migrant population interviewed (62%) reported that their
family brought them to Antigua. Friends brought 20% of the respondents and 7.3% came
because of a job offer. Only 6.3% of them came alone without being invited to Antigua or
having anyone meet them.
Table No. 15 – Person who brought respondent to Antigua (Q4). MSM Study. 2012.
Responses Number Percentage
Friends 19 20.0
Family 62 65.2
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Job Offer 7 7.3
Came alone 6 6.3
Other 0 0.0
No response 1 1.0
Totals 95 99.8
Family in Antigua
70.5% of the respondents had family in Antigua and of that number 40% was a parent or
parents. A significant 32.6% had extended family of cousins or Aunts. 17.8% had
siblings and 9.4% had a spouse or partner either in the form of a wife or male partner. Of
the 29.4 whom had no family in Antigua, most reported having friends.
Table 16- Do you have any family here with you? Q5. MSM Study. 2012.
Responses Number Percentage
Yes 67 70.5
No 28 29.4
Total 95 99.9
Table No. 17- If yes, who is it? (Q6). MSM Study. 2012.
Responses Number Percentage
Spouse/Partner 9 9.4
Parents 40 42.1
Siblings 17 17.8
Others 31 32.6
Total 97
Social life in Antigua
Some of the respondents had more than one means of socializing. The majority (83.1%)
had friends whom they socialized with and 24% utilized church as part of their social
circle. 17.8% of them had a core social group and 5% socialized with other members of
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their country as a group. 5.2% of the guys indicated having no form of social support.
The majority of the guys (74.7%) spent time working and socializing with a combination
of locals and people from their home country while 12.6% only worked and socialized
with locals. A small group of 3.1% only mingled with persons from their country.
Table No. 18 What social connections do you have in Antigua? (Q7). MSM Study.
2012.
Responses Number Percentage
Friends 79 83.1
Church 24 25.2
Country association 5 5.2
Social group 17 17.8
None 5 5.2
Other 1 1.0
Total 131
Table No. 19- With whom do you work and socialize in Antigua? (Q8). MSM Study.
2012.
Responses Number Percentage
People from your country alone 3 3.1
Mostly local people 12 12.6
A mixture 71 74.7
Other 9 9.4
Total 95 99.8
Occupation & Employment status
A large percentage of the men (27.3%) were unemployed and the next largest group was
the ones who worked as security guards (16.8%) and the rest of the occupations varied.
Some of the men who were students also held some part-time positions.
Figure 25 – Occupation and Employment Status
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Profession
Occupation and Employment Status
ACCOUNTANT
ACCOUNTS CLERK
BAR TENDER
BUS DRIVER
CARPENTER
CHEF
CONSTRUCTION
CUSTOMER SERVICE REP
EVENT CO ORDINATOR
GARDENER
MAINTENANCE
MANAGER
MASON
MECHANIC
POLICE OFFICER
REFRIDGERATOR TECHNICHAN
SALES REPRESENTATIVE
SANITATION WORKER
SECURITY OFFICER
SELF EMPLOYED
STORE ASSISTANT
STUDENT
TEACHER
UNEMPLOYED
VOLUNTEER
WAITER
0 5 10 15 20 25 30
Number of Persons
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Partner History
Partners in Antigua
While all of the men confirmed that they were men who had sex with men, 14.7 of them
also reported having a girlfriend. The majority of 46.3% had a male partner in Antigua
and 5.2% had multiple partners. A significant 38.9% had no partner here. Having no
partner here could affect their vulnerability in some cases as they might be more likely to
engage in casual sex with someone who is not a steady partner.
Table No. 20- Do you have a partner (boyfriend or girlfriend) here in Antigua with
you? (Q10). MSM Study. 2012.
Responses Number Percentage
Boyfriend 44 46.3
Girlfriend 14 14.7
More than one 5 5.2
None 37 38.9
Total 100
Length of time with partner
35.7% of the respondents have been with their partner between 1 and 2 years, while
31.4% have been with their partner more than 5 years. 28.5% have been with their partner
for a year or under and 4.2% between 2 and 5 years. It is important to note that while in
the previous question only 63 men reported having partners, for 5 of them, it was more
than one partner, hence the higher number of 70 persons here.
Table No. 21- Length of time with partner. (Q11). MSM Study. 2012.
Responses Number Percentage
Between 1 and 12 months 20 28.5
Between 1 and 2 years 25 35.7
Between 2 and 5 years 3 4.2
More than 5 years 22 31.4
Total 70 99.8
130

Number of persons they had sex with in the past month
44.2% of the men had sex with only one person, while 8.4% reported having no sex.
17.8% of them had sex with 2 partners and a combined 41.8% of the men had sex with
more than one person for the month, with 1 percent of them having as many as 8 partners
for the month. Sex included anal or vaginal penetration.
Table No. 22- In the past month, approximately how many partners did you have
sex with? (Q12). MSM Study. 2012.
Responses (# of partners) Number Percentage
0 8 8.4
1 42 44.2
2 17 17.8
3 4 4.2
4 8 8.4
5 5 5.2
6 5 5.2
7 0 0.0
8 1 1.0
Not applicable 5 5.2
Total 95 99.6
Figure 26 - Number of partners in the last month
45
40
35
30
25
20
15
10
5
0
0 1 2 3 4 5 6 7 8 9 na
Nb of partners
131

Sex for pay (how many of the sexual partners were clients)
A large percentage of the men did not have sex for pay (84.2%) while 9.5% had sex with
one person for pay. 2.1% had sex with 2 persons and 2.1% had sex with 4 persons, in
both cases for pay. 1% had sex with 3 persons and 1% had sex with 5 persons for pay.
Pay includes money or goods.
Table No. 23- How many of them were clients? (Q14). MSM Study. 2012.
Responses Number Percentage
0 25 26.3
1 9 9.5
2 2 2.1
3 1 1.0
4 2 2.1
5 1 1.0
Not applicable 55 57.9
Total 95 99.9
Frequency of sex for pay
Although only 15 men reported in the previous questions that they had sex for money or
goods in the past month, 16 of them responded to the frequency. Of the 16 men, 4.2% did
it daily, 2.1% only on weekends, 3.1% occasionally and 7.3% did it on rare occasions.
The men who had sex for pay did not consider themselves to be sex workers, but rather
considered it as assistance from their sex partner who knew they were unemployed. It is
still noticeable that 16.7% have had sex for pay in the last year. This could put them in a
position of vulnerability, giving the payer the control of the sexual contact and the payer
could then demand sex without condom or some other service that the receiver would not
have done, where he not being paid.
132

Table No. 24- In the past 12 months, how frequently have you had sex for money or
goods in Antigua? (Q15). MSM Study. 2012.
Response Number Percentage
Daily 4 4.2
Weekends 2 2.1
Occasionally 3 3.1
Rarely 7 7.3
Not at all 54 56.8
No answer 25 26.2
Total 95 99.7
Figure 27 - Frequency of having sex for money
Daily Week Ends
NA
Occasionnaly
Rarely
Never
Partner has spouse or other partner
27.3 of the respondents stated that their sexual partner did not have sex with anyone else.
13.6% said that their partner had one other person and 2.1% said that their partner had
more than one other partner. 44.2% of them did not know if their sexual partner had other
sexual partners and 12.6% of the guys preferred not to answer that particular question. In
other words, a combined 15.7% knew their partners were involved with others, male or
female.
133

Table No. 25- Partner has spouse or other partner. (Q16). MSM Study. 2012.
Responses Number Percentage
No other partner 26 27.3
Yes, one other partner 13 13.6
More than one other partner 2 2.1
Don’t know 42 44.2
No answer 12 12.6
Total 95 99.8
Condom Use
Use of condom
An encouraging 72.6 percent reported always using condoms in their sexual activity
while 1 percent used condoms almost all of the time. 20% of the guys said they only used
condoms sometimes and with some of them having multiple partners and some not
knowing if their partners had other partners that could be interpreted to be risky
behaviour.
Table No. 26- In the past 12 months, have you used a condom in sexual relations
with your partner (boyfriend or girlfriend)? (Q17). MSM Study. 2012.
Responses Number Percentage
Always 69 72.6
Almost always 1 1.0
Sometimes 19 20.0
Almost never 0 0.0
Never 0 0.0
No answer 3 3.1
No partner 3 3.1
Total 95 99.8
Random sexual activity
In the past year, 67.3% of the guys said they had casual sex and 32.6 % said they did not.
Casual sex was defined as sex without a steady partner (or what some of the guy’s
134

eferred to as a “hook-up’). Some engaged in casual sex for pleasure and some for money
or goods.
Table No. 27- In the past 12 months, have you had sex with someone who is not a
steady partner? (occasional with no money or goods involved). (Q18). MSM Study.
2012.
Responses Number Percentage
Yes 64 67.3
No 31 32.6
Total 95 99.9
Condom use with random sexual activity
62.1% of the men used condom when having casual sex and 10.55% only used
sometimes. 2.1% said they almost never used and 1% said he never used condoms with
casual sex. 23.1% of the respondents did not have a response as they did not have casual
sex in the past year. It is interesting to note that 31 of the guys reported no casual sex in
the previous question, but only 22 reported not using a condom in casual sex, so 9 of the
guys might have been talking about their behaviour in past casual sexual activity.
Table No. 28- If yes, did you use a condom? (Q19). MSM Study. 2012.
Responses Number Percentage
Always 59 62.1
Almost always 1 1.0
Sometimes 10 10.5
Almost never 2 2.1
Never 1 1.0
No answer 22 23.1
Total 95 99.8
135

Condom Supply
The majority of the participants (almost half 48.4%) received their condoms from the
AIDS Secretariat (NAP). 41% bought their condoms from the pharmacy or supermarket
and 10.5% respectively from CHAA and Mount St. John’s Medical Center. Only 2.1%
reported receiving condoms from the government clinic or Antigua Planned Parenthood
Association. The remaining 17.8% received their condoms from 3H network, partners,
friends and bars. Some got their condoms from multiple sources which is a very good
indicator that they have options.
Table No. 29- Where do you normally get condoms? (Q20). MSM Study. 2012.
Responses Number Percentage
AIDS Secretariat 46 48.4
CHAA 10 10.5
MSJMC 10 10.5
Clinic/Planned Parenthood 2 2.1
Pharmacy/Supermarket 39 41.0
Other 17 17.8
Total 124
Figure 28 - Place where you get free condoms from
Clinic /PP
3H /partner
/friends
Hospital
AIDS Secretariat
CHAA
Pharmacy
/Supermarket
136

Free condoms
Free condoms were available from multiple sources, but 52.6 % of free condoms came
from the AIDS secretariat. It is interesting that 14.7% stated receiving free condoms from
a club or bar as other reports have stated that they club and bar owners receive free
condoms and sell them. Also to be noted is that 10.5% report receiving free condoms
from CHAA and 8.4% named outreach workers as their source, when often times, the
outreached workers were from CHAA. The 8.4% who listed as other were broken up
between 3H and animators. Animators are also outreach workers from CHAA. Therefore,
it would stand to reason, that after AIDS Secretariat, the second largest distributor of free
condoms appeared to be CHAA.
Table No. 30- Did you receive any free condoms in the past 12 months? If yes, from
who? (Q21). MSM Study. 2012.
Responses Number Percentage
AIDS Secretariat 50 52.6
Outreach worker 8 8.4
District Clinic 0 0.0
CHAA 10 10.5
Private Physician 2 2.1
Club/Bar 14 14.7
From friend or family 11 11.5
Hospital 7 7.3
Other 8 8.4
Total 110
Figure 29– Source of Free Condoms
60
50
40
30
20
10
0
137
Receive free condoms from who?

How to use condoms/Instructional condom use
Almost half (48.4%) of the men had been instructed on how to use a condom by a health
institution. 16.8% learnt from school and from family and friends respectively. 15.7%
stated other and that included other sources like seeing it on television or from a sexual
partner or an outreach worker. Only 8.4% had never been instructed on how to properly
use a condom (We did not conduct any demonstrations on correct condom use: we
basically enquired as to whether they had been taught how to use a condom).
Table No. 31- Have you ever been instructed on how to use a condom? (Q22). MSM
Study. 2012.
Responses Number Percentage
No 8 8.4
Yes, at school 16 16.8
Yes, from my employer 0 0.0
Yes, from a health institution 46 48.4
Yes, from family or friends 16 16.8
Other 15 15.7
Total 101
HIV INFORMATION AND TESTING
Consciousness of being at risk for HIV infections
49.4% of the men felt sure that they were not at risk for becoming HIV+ because they
always used condoms in their sexual encounters. 14.7% of the men felt that because they
were being monogamous, they were safe. They were not taking into consideration that
maybe their partner had another sexual partner. 17.8% of the men think that choosing
their partner carefully minimizes their risk of being exposed to HIV infection. 3.1% were
already HIV+, so they did not feel the question was relevant to them. 17.7% felt that they
were at risk of becoming HIV+ and the reasons are outlined below in Figure 2.
138

Figure 30- Reasons why persons felt at risk for becoming HIV+
OTHER
17%
CONDOMS NOT
100% SAFE
5%
PRACTICE RISKY
SEXUAL ACTS
6%
YES I AM
SEXUALLY
ACTIVE
6%
YES, MORE THAN
ONE PARTNER
5%
YES, SEXUALLY
ACTIVE
17%
YES, NOT ALWAYS
PROTECTED
39%
YES, SCARCELY USES
PROTECTION
5%
Table No. 32- Do you think you are at risk for HIV infections or not? (Q23). MSM
Study. 2012.
Responses Number Percentage
Yes, because (figure 2 above) 17 17.8
No, because I always use condoms 47 49.4
No, because I only have one sex partner 14 14.7
No, because I choose my partner carefully 17 17.8
Other reason 3 3.1
Total 98
Last HIV test
21% of the respondents cannot remember when they were last tested which seems like a
large amount considering we asked for ranges and not exact dates. Was it that some felt
uncomfortable saying they were never tested? 11.5% reported never being tested. A high
139

percentage when one considers that free testing is available in Antigua. 14.7% were
tested over a year ago. The others were tested from as little as within the last week to
between 6 and 12 months ago.
Table No. 33- When was your last HIV test? (Q25). MSM Study. 2012.
Responses Number Percentage
This past week 3 3.1
This past month 6 6.3
Between 1 and 3 months ago 13 13.6
Between 3 and 6 months ago 14 14.7
Between 6 and 12 months ago 14 14.7
Between 1 and 2 years ago 14 14.7
Never 11 11.5
Don’t recall 20 21.0
Total 95 99.5
25
Figure 31- Last HIV test done
20
15
10
When last HIV test
5
0
This week this month 1-3 month 3-6 months 6-12 Month 1-2 years NEVER Don't recall
Pre and Post HIV test Counselling
43.1 % received counseling before and after their test and 25.2% received only before
they got tested. 1% received after he was tested and it turns out that he was HIV+. 12.6%
were tested without any counseling before or after and the other 17.8% had not been
tested or could not recall. It was unclear if their tests were done in Antigua or in their
country of origin. If done in Antigua, the AIDS Secretariat offers counselling but most of
the private Laboratories do not do so.
140

Table No. 34- Did you receive counseling before and/or after your test? (Q26). MSM
Study. 2012.
Responses Number Percentage
Yes, before 24 25.2
Yes, after 1 1.0
Yes, both times 41 43.1
Neither 12 12.6
Not Applicable 17 17.8
Total 95 99.7
Free HIV testing
75.7% of the respondents reported getting free testing, but of that number 73.6 got free
condoms and 2.1% pay for condoms. 11.5% pay for their test and for condoms and
12.6% did not consider the question relevant to them as they had not been tested. It
appears that not having to pay for tests, would make the respondents more likely to get
tested as in Table 25, 20 percent or one-fifth of the respondents claimed that they cannot
afford to pay for their own test. Most private labs charge in the range of EC$75 per test.
Table No. 35- Did you have to pay for the test? (Q27). MSM Study. 2012.
Responses Number Percentage
No, everything is free 70 73.6
Yes, test is free but I pay for condoms 2 2.1
Yes, I pay for everything 11 11.5
Not Applicable 12 12.6
Total 95 99.8
141

Ability to pay for HIV testing
Table No. 36- Is your ability to pay a problem? (Q28). MSM Study. 2012.
Responses Number Percentage
No 69 72.6
Yes, I can’t afford it 19 20.0
No Answer 7 7.3
Total 95 99.9
HIV testing location
Clearly, some persons thought they had options so they selected more than one answer.
The majority of 47.3% stated that they would go to the AIDS Secretariat and this could
be because testing is free and easily accessible. One third (33.6%) of the respondents
would pay a private physician to conduct their test and 8.4% would utilize the services at
the Mount St. John’s Medical Centre. 2.1% of the respondents did not know where to go
to for HIV testing. The others mentioned Overseas to their home country and Antigua
Planned Parenthood Association.
Table No. 37- Where would you go for HIV testing? (Q). MSM Study. 2012.
Responses Number Percentage
MSJMC 8 8.4
AIDS Secretariat 45 47.3
Medical doctor 32 33.6
Clinic 6 6.3
Other 7 7.3
Don’t know where to go 2 2.1
No response 4 4.2
Total 104
142

Figure 32- Where to go for HIV testing
Don't know
Clinic
other
NA
Hospilal
AIDS Secr
Priv phys
Reasons for not having had a recent HIV test
17.8% of the respondents did not think of having an HIV test while 15.7% did not think
that they needed one. 14.7% of the respondents were afraid of the answer they would get.
It is interesting to note that language was not a barrier to being tested although earlier
ability to pay was listed as a problem, in this question, it was not given as a reason. 33%
did not find the question applicable as they had been recently tested. For the other reasons
why 12.6 % did not get tested, the reasons were:
• No confidentiality (3)
• Tests limited to 5 (1)
• No interest (1)
• No time (2)
• In a relationship (1)
Table No. 38- If you did not do an HIV test recently, what is the most likely reason?
(Q). MSM Study. 2012.
Responses Number Percentage
Did not know where to go 4 4.2
Afraid of the answer 14 14.7
I do not need one 15 15.7
143

They don’t speak my language 0 0.0
Can’t afford it 0 0.0
Didn’t think about it 17 17.8
Other 12 12.6
Not applicable 33 34.7
Total 95 99.7
As it relates to the issue of information and education on HIV and AIDS, 75% of the
respondents did receive information within the last year and 13.6% did not receive any in
spite of the messages on television, public awareness marches and outreach activities..
7.3% were unsure. Of the ones, who did receive information, the sources (Table 29) are
mainly the AIDS Secretariat, the media, friends and family and CHAA. The 21% who
stated other mentioned 3H and the animators (who are a part of CHAA). All in all, 81%
of the respondents thought that HIV testing and/or education was readily available while
5% said it was not readily available and 9.45 were not sure (Table 30).
Table No. 39- Availability of HIV/AIDS info. (Q31). MSM Study. 2012.
Responses Number Percentage
Yes 75 78.9
No 13 13.6
Don’t know 7 7.3
Total 95 99.8
Table No. 40- HIV/AIDS information sites accessed. (Q32). MSM Study. 2012.
Responses Number Percentage
AIDS Secretariat 41 43.1
Media 22 23.1
District Clinic 0 0.0
CHAA 6 6.3
Private physician 0 0.0
144

Employer 0 0.0
From friend or family 8 8.4
Hospital 1 1.0
Other 20 21.0
Total 98
Table No. 41- Availability of HIV testing or education. (Q33). MSM Study. 2012.
Responses Number Percentage
Yes 81 85.2
No 5 5.2
Don’t know 9 9.4
Total 95 99.8
Access to Healthcare Services
History of medical check-up
15.7% of the men had never had a medical check-up and 25.2% cannot recall if they ever
did; that totals 40.9% who likely did not know their current medical status. 12.6% had
medical checks over a year ago and the other combined 46% had had a medical check-up
in the past year or less.
Table No. 42- When was your last medical check-up? (Q34). MSM Study. 2012.
Responses Number Percentage
This past week 2 2.1
This past month 9 9.4
Between 1 and 3 months ago 17 17.8
Between 3 and 6 months ago 11 11.5
Between 6 and 12 months ago 5 5.2
Between 1 and 2 years ago 12 12.6
145

Never 15 15.7
Don’t recall 24 25.2
Total 95 99.5
Figure 33- Last medical check-up
30
When last Check-up
25
20
15
10
5
0
This week this month 1-3 month 3-6 months 6-12 Month 1-2 years NEVER Don't recall
Experience during medical check-up
A quarter of the men stated that their experience was excellent while 35.7 stated that
theirs was good. 5.2% thought their experiences were poor and the others did not have
any check-ups. Details of their responses follow:
Excellent because of – kindness, good service, it was quick and easy, felt loved, familiar
with doctor, friendly staff, good service, learnt something new, caring doctor, fellow
countrymen were there, helpful staff, surgery was successful. (Good service was the
overwhelming response).
Good because of – professionalism, results were good, service was ok, friendly, caring,
helpful, competent, comfortable environment, felt at home, felt safe, explanation was
given, clarifying doubt. (Friendly staff was the most overwhelming answer).
Poor because – lack of professionalism, time consuming, not helpful, unclean
environment and unfriendly staff, feeling of discomfort.
Other included – unsure, can’t recall, it was overseas, was a while back, it was
satisfactory.
146

Table No. 43- How was your check-up experience? (Q35). MSM Study. 2012.
Responses Number Percentage
Excellent, because 24 25.2
Good, because 34 35.7
Poor, because 5 5.2
Other 31 32.6
Not Applicable 2 2.1
Total 96
Willingness to recommend facility to friend
68.4% said they would recommend the facility to a friend and Table 36 gives some of the
reasons why with some respondents giving multiple reasons. 6.3% said definitely no and
Table 37 gave reasons why not. 24.2% were not sure if they would recommend the
facility or not.
Table No. 44- Would you go back or recommend this place to friends? (Q36). MSM
Study. 2012.
Responses Number Percentage
Yes 65 68.4
No 6 6.3
No Response 23 24.2
Total 94 98.9
Table No. 45- Why recommend facility? (Q37). MSM Study. 2012.
Responses Number Percentage
Price 8 8.4
Friendly helpful staff 41 43.1
Location 5 5.2
Other reason 4 4.2
Speak my language 4 4.2
Good medical care 12 12.6
147

Other foreigners are there 12 12.6
No answer 26 30.5
Total 112
Figure 34- Reasons for recommending a place where to get a check-up
Price
other foreigners are there
NA
Friendly Staff
Other
location
Good med care
Speak my language
Table No. 46- Reasons for not recommending facility. (Q38). MSM Study. 2012.
Responses Number Percentage
Price 1 1.0
Unfriendly/not helpful staff 4 4.2
Location 3 3.1
Other reason 4 4.2
Don’t speak my language 0 0.0
Medical care not good 1 1.0
Don’t treat foreigners well 3 3.1
No answer 77 81.0
Total 93 97.6
Characteristics of an excellent health care facility
148

The most valuable characteristic of a good health care facility for the respondents was
confidentiality (60%). They also wanted friendly and helpful staff (45.2%) and 23.1%
thought that cost was an important factor. It was important for some to have extended
opening hours to facilitate them and there were also cultural factors as 10.5% of the
respondents wanted persons who spoke their language.
Table No. 47- What do you think would be the characteristics of an excellent
healthcare facility? (Q40). MSM Study. 2012.
Responses Number Percentage
Free or inexpensive 22 23.1
Better opening hours 14 14.7
Staff who speak my language 10 10.5
Friendly and helpful staff 43 45.2
Confidentiality 57 60.0
Other 2 2.1
No answer 4 4.2
Complaints about HIV and AIDS medical care in core group
For the men who have sex with men (MSM) population, 60% were bothered by stigma
and discrimination and 18.9% were concerned about the cost of health care services.
Unhelpful staff affected 15.7% of the group and they were to a lesser extent concerned
about geographical area and the cleanliness of the facility. Many did not have an answer
to this question as they did not know what their peers were dissatisfied with.
Table No. 48- What do other persons in your core group complain about as it
relates to medical or HIV care? (Q41). MSM Study. 2012.
Responses Number Percentage
Price 18 18.9
Stigma and discrimination 57 60.0
Geographical location 3 3.1
Staff not helpful 15 15.7
149

Facility not clean and tidy 4 4.2
Other 13 13.6
No answer 10 10.5
Ability to meet medical expenses
The majority of 46.3% of the respondents paid out of pocket for medical care.
43.1% used the national Medical Benefit card and 6.3% only went where they got free
care. A small 4.2% had private medical insurance and for 4.2%, their employers covered
their medical expenses. Some had no answer as they had not attempted to access any
medical care. So clearly, ability to pay definitely affects access to health care.
Table No. 49- Ability to meet medical expenses (Q42). MSM Study. 2012.
Responses Number Percentage
I have health insurance 4 4.2
I use my medical benefit card 41 43.1
I pay out of pocket 44 46.3
My employer pays for me 4 4.2
I only go where I get free care 6 6.3
Other 1 1.0
No answer 9 9.4
Services that they felt should be more available included:
o Gay doctor
o Bladder/Renal testing
o Eye exams
o CD4 counts
o ENT specialist
o Computer class
o Treatment for depression
o Counseling
o Better treatment for HIV+ persons
DISCRIMINATION
150

Discrimination faced
50.5% of the men reported no discrimination while 25.2% felt discriminated against
because of their nationality. 12.6% felt discrimination because of their gender and some
of these used to term to refer to their sexual orientation. The 8.4% who reported other, all
felt discriminated against because they were MSM. 3.1% respectively felt they were
discriminated against because of their ethnicity or profession.
Table No. 50- Discrimination faced (Q46). MSM Study. 2012.
Responses Number Percentage
No not at all 48 50.5
Yes, because of my nationality 24 25.2
Yes, because of my ethnicity 3 3.1
Yes, because of my profession 3 3.1
Yes, because of my gender 12 12.6
Other 8 8.4
No answer 4 4.2
Total 102
Frequency of discrimination
4.2% reported feeling discriminated against daily, which was impacting their lives and
behavior as they were constantly conscious of being observed. 5.2% said regularly and
25.2% said sometimes. 23.1 said they never felt discrimination but no further enquires
were done to see if they were known to be MSM. 20% said they were unsure how often
they were discriminated against, but did feel the effects at time.
Table No. 51- How often do you feel discriminated against? (Q48). MSM Study.
2012.
Responses Number Percentage
Every day 4 4.2
Regularly 5 5.2
151

Sometimes 24 25.2
Rarely 16 16.8
Never 22 23.1
Unsure 19 20.0
No answer 7 7.3
Total 97
How was discrimination displayed?
• “Finger pointing”
• “Against nationality”
• “Against sexual orientation”
• “Name calling (most common)”
• “Not receiving health service”
• “Look of disapproval”
• “Prejudice”
• “Negative comments”
• “Stone throwing”
• “Family abandonment”
• “People shouting “battyman” in the streets”
• “People shouting other things in the streets”
Who would you take your concerns to?
• Best friend
• Girlfriend
• Church
• Other gays
• Cousin
• Sister
• Do not trust anyone
• Doctor
• 3H
152

• Aids Secretariat
• Family
• Friends
• Private Counselor
• Guidance Counselor
• Human Rights office
• Health counselor
• Animator
KNOWLEDGE OF SERVICES
STI education, treatment and support
All of the respondents knew where to get information on STI treatment and support. 38.9
would go to government agencies which included AIDS secretariat, 30.5% would go to
NGO’s and 30.5% would go to a medical facility which included the hospitals and
clinics. Only 1% would go to a church. 8.4 would go to private agencies which included
private physicians’ offices.
Table No. 52- Do you know where to go to get information on STI education,
treatment and support? (Q51). MSM Study. 2012.
Responses Number Percentage
Government agencies 37 38.9
Medical organizations 29 30.5
Private agencies 8 8.4
Non-governmental organizations 29 30.5
Churches 1 1.0
Other 7 7.3
Total 111
Type of facility frequented for treatments
Table No. 53- When you are ill, where do you go? (Q53). MSM Study. 2012.
153

Responses Number Percentage
Public facility 22 23.1
Private facility 54 56.8
No response 16 16.8
Total 92 96.7
Referral of HIV+ person
41% of the respondents said they would referral someone to the AIDS Secretariat (NAP
Office) if they were HIV+. 30.5% would send them to the Mount St. John’s Medical
Center and 29.4% would send them to 3H. 3.1% would send the person back to their
home country. This does not speak well of our system if someone could be referred back
to another country
Table No. 54- If someone you know is HIV positive, where would you refer them for
support? (Q54). MSM Study. 2012.
Responses Number Percentage
Back home 3 3.1
AIDS Secretariat 39 41.0
Hospital 29 30.5
HHH 28 29.4
Other 6 6.3
Don’t know 5 5.2
Total 110
The participants were questioned about their views on contracting HIV through casual
contact. 90% knew that one cannot contract the virus from being bitten by a mosquito,
93% knew HIV could not be contracted by sharing a meal, 87% knew they could not
contact HIV from sharing a toilet and 92% were aware that a healthy looking person
could be HIV+.
21% thought that they could become HIV+ via mosquito bite and 3.1% weren’t sure. No
one said definitively that they could acquire HIV from sharing a meal but 2% were not
154

sure. It is interesting that 5.2% of persons thought that the HIV virus could be contracted
from sharing a toilet with someone who was HIV+. 3.15 were unsure. 1% of respondents
thought that a healthy-looking person could not be HIV+ and 2% were not sure if they
could tell someone’s status just by their appearance.
While these numbers are encouraging, there is clearly need for more information to
clarify issues surrounding how someone contracts the HIV virus. The wrong perception
could lead to stigma and discrimination even within the core group.
Table No. 55- Contracting HIV from mosquito. (Q55). MSM Study. 2012.
Responses Number Percentage
Agree 2 2.1
Disagree 90 94.7
Don’t know 2 2.1
No response 1 1.0
Total 95 99.9
Table No. 56- Contracting HIV from sharing a meal. (Q56). MSM Study. 2012.
Responses Number Percentage
Agree 0 0.0
Disagree 93 97.8
Don’t know 1 1.0
No response 1 1.0
Total 95 99.8
Table No. 57- Contracting HIV from sharing a toilet. (Q57). MSM Study. 2012.
Responses Number Percentage
Agree 5 5.2
Disagree 87 91.5
Don’t know 2 2.1
155

No response 1 1.0
Total 95 99.8
Table No. 58- Healthy-looking person may have HIV. (Q58). MSM Study. 2012.
Responses Number Percentage
Agree 92 96.8
Disagree 1 1.0
Don’t know 1 1.0
No response 1 1.0
Total 95 99.8
CSW REPORTS
English-Speaking CSW Focus Group Report
Introduction
The focus group session convened with a welcome and everyone was thanked for being
there. Group rules were established which were:
Whatever happened there should be confidential
No cross talking
Respect every person’s views
The purpose and goals for the focus group was then explained:
To understand what are some of the challenges faced by this core group as a
migrant in Antigua, especially as it relates to HIV/AIDS?
To know what are the services that are being received well and not so well?
To know how they access health care services and HIV/AIDS services as they
relate to prevention, treatment and support.
To improve services for this core group going forward.
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Methodology
Recruitment criteria: Participants were chosen by CHAA animator and outreach worker,
Kezreen Ettechson. Persons were chosen who considered themselves to be commercial
sex workers because their primary source of income was from selling sex in various
forms for money. Participants had to be born in another country and be living in Antigua
for a year and under. The selected participants were from Jamaica and Guyana. Due to
language barriers, we did not engage any CSW’s from the Dominican Republic.
Geographic location: Most of the participants lived around the point or villa area and
worked either at home or at the Wendy’s club on Popeshead Street.
Timing: The CSW focus group was scheduled for two hours but we went over the time to
allow for some discussion.
At the end of the session each participant received compensation of EC$ 40.
Demographic
7 participants
Sex: Female
Age: 19 – 24
Country of origin: 5 Jamaican, 2 Guyanese
Language: All were English speaking
Marital Status: All were single. One participant has a boyfriend in Jamaica, but he is not
aware of the type of work she is doing.
Educational Level: Five (5) of the seven (7) girls had completed secondary school
Work Status: Two of the participants had work permits; one as a domestic helper and one
as a waitress. The others did not have work permits, but got assistance with getting time
extensions from their landlord who knew someone at the Immigration Department.
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Focus Group Responses
1- What are some of the challenges you face being a CSW in Antigua?
The participants complained about stigma and discrimination. Some said that
people would call them “whore” even when they were in their non-working
environments. For example, one participant stated that when she was in Shouls
Toys Gifts and Housewares Store on Newgate Street and she was buying 2 books
and some pens to write down how many client she sees, when she heard a woman
say to another, “she ah wan whore, so why she buying school book”? They then
laughed and she felt very uncomfortable but stayed on the line until she was
finished her purchase. Then another participant added, “Is not only whore they
say, one call me bitch because her boyfriend comes to Wendy’s”. Others
complained of also being called “bitch” and one said she was called “dutty foot”.
Other clients complain that some of the men steal back the money that they paid
them for sex.
2- What are some of the issues related to health care?
Only one of the participants said she had no issues related to health care as she
has seen a physician here and was comfortable. One of the others stated that she
did not like doctors because they asked personal questions which she did not want
to answer. Her situation was that she thought she had a sexually transmitted
infection and wanted the doctor to just give her a prescription, but instead of just
writing it, he kept asking questions about the number of partners she had, whether
she engaged in unprotected sex or not and she thought the questions were too
personal. We explained to her that was the correct way for the doctor to do the
job, but she said she already knew what she had so she didn’t need him to “dig”,
just to give her the antibiotic prescription. Upon further exploration, we
discovered, it was not the questions he asked alone that made her upset, but his
seemingly impersonal manner that did not show any care for her as a person. All
of the others said they have never been to any doctors in Antigua as they could
not afford the $150.00 cost and they preferred to wait until they went back home
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on vacation where they would be able to get free or cheaper medical care. When
asked about MSJMC, they all said they had no interest in going there, unless it
was an emergency.
3- Where are the places/spots that you feel comfortable hanging out?
All of the ladies said most of their free time was spent at home (in their personal
space) as they worked all night and sometimes they were tired during the day.
Some hung out where they worked and would just sit in the club to relax. Some of
the other places they went out to were the movies, bars, boat cruise and one young
lady said she enjoyed shopping. She specifically mentioned that she liked going
into the Chinese stores since things were cheap there to look around and she also
enjoyed buying “sexy clothes”.
4- Which health care providers give good care?
None of the ladies mentioned the hospital; all of them mentioned Caribbean HIV
and AIDS Alliance (CHAA) as being supportive. It was surprising that they
mentioned CHAA in the context of health care as that organization is an NGO and
not a health care provider. When asked, they mentioned that the CHAA workers
are persons who could identify with them. CHAA gave them free condoms and
the outreach workers have offered to accompany them to the doctor if they needed
to go. They seemed to equate those services with good care. A few also
mentioned the AIDS secretariat. When asked what was good about the Secretariat
office, they stated that they gave free HIV testing, free condoms and that they
believed them to be confidential. One mentioned going there about four months
after she came to Antigua and was surprised that the lady that greeted her there
gave her a warm smile. She was not expecting that as she had heard from another
worker that Antiguans did not like foreigners. As mentioned before, most of the
participants did not access much health care because of the high cost of private
health care and their perception that Mount St. John’s Medical Centre (the
country’s main hospital) was mostly for emergency care
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5- What are some of the factors that make a clinic or health center good?
The ladies all felt that confidentiality was the most important thing to them.
Confidentiality for them meant not only did they not want to hear their story
outside, they also wanted the staff where they went to be discreet. They don’t
want their names to be called loudly or have to give out too much personal
information. They also wanted to encounter friendly staff (like the lady at AIDS
secretariat who proffered a warm smile). They said they wanted someplace
inexpensive, especially since they did not have medical benefit cards and would
have to pay cash – out of pocket. Some of them also wished that the clinic or
health center would be in close proximity to them since a few of them did not
know the island very well. One person said she did not like big signs so everyone
didn’t have to know where they were going if they went into the building. AIDS
Secretariat was again used as an example. Another person responded that
everyone in Antigua knew what that office was anyway. The young lady then
responded “I waited a few buildings away until no one was close by then I
quickly went in.”
6- Where do you get condoms? Where do you get information on HIV/AIDS?
The participants get their condoms from CHAA who distributes at the clubs and bars
where they work. One girl said that she has gotten from the AIDS Secretariat. If they
did not have any more free ones, they would buy from the pharmacy. If they fall short
when they were scheduled to work, they would buy them for a higher price at the bar
where they worked. One of the girls mentioned that she believes “the bar owner gets
them free and then sells it back to us” and wants to report that information
anonymously. As it relates to information on HIV/AIDS, most of them said it came
from CHAA outreach workers, who would talk to them and leave stuff for them to
read. Two girls mentioned that they also see HIV/AIDS information in the media. One
young lady explained that once when she was having strange physical symptoms –
vomiting and weight loss, she went on the internet to look to see if she had HIV/AIDS.
She says, “After torturing myself fa (for) two weeks, I went to the AIDS Secretariat
and they tell me I was clean”.
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7- Which of your needs as a core group are not being met?
The participants did not have a ready answer for this. The principal researcher
explained some examples of needs and they stated that they all have a place to
sleep and food to eat. They all wished the overseas phone calls on their cell was
not so expensive so they could speak with their families more and they also
wished that they earned more money, but they did not have too much else to say.
In terms of non-material needs, their biggest issue was being misunderstood and
looked down on (this means they felt like people saw them as less than others
because of the kind of work they do). One girl who was in Antigua the longest
stated that a lot of non-CSW women go with married men, so they are no different
from them. They even felt they were better since they were not really breaking up
anyone’s marriage since the men come and then go the same night. In other
words, they had a need not to be stigmatized, but they did not put it in those
words.
8- Which agencies do you see trying to reach your core group?
The unanimous answer was CHAA only. After being probed about AIDS
Secretariat, HHH, Churches or other organizations, they maintained that while 3H
did show some interest, only CHAA really went out of their way to reach them
where they are. They did say members of church groups have dropped off tracts
(religious reading material), but make no effort to communicate with them.
9- Do you have difficulty have friendships with non CSW’s?
One person said no, she has non CSW friends and their relationship is fairly good.
Three felt like it was too difficult to have non CSW friends. One of those three
stated, “I have no time with those women because they think they better than
us”. Three said that they don’t really communicate with women outside of their
job because the first thing people ask is “what kind of work do you do?” They are
fearful of reaching out for fear of how they will be viewed or for fear of rejection.
They also said that they don’t have much time to make friends outside of each
other because other females are uncomfortable having them around their
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oyfriends. One participant also said at the end “besides when they get off work
is when we preparing to start work”. That was referring to non-CSW women.
10- What kind of family and friend and social support do you have?
Four of the participants stated that their co-workers were their greatest source of
support because they understood them, knew what they did and accepted them
anyway. They could talk about their experiences and borrow condoms from each
other. One person stated that her boyfriend was supportive from overseas and she
would call, text and bb with him, but he did not know that she was a sex worker in
Antigua. Most of the participants said that they sent money home to their families
but their families at home had too much of their own stress to support them
emotionally and one of the Guyanese participants said that her family thought it
was easy being in Antigua and that she had lots of access to US dollars because
her mother believed that she was working at a hotel. One of the girls stated that
she had a few friends in Antigua as her social support.
11- What ideas and suggestions do you have to improve HIV&AIDS prevention,
education, treatment and support in Antigua?
The participants were hesitant to answer this question as they did not feel like
their suggestions had much weight. They clearly were not empowered about their
situation. When they were reassured that their voices will be heard, they ventured
their opinions.
Free condoms and free medication for people who are HIV positive. Not just the
HIV medication, but also for when they were afflicted with opportunistic
infections. (Flu and cold was mentioned as well as gynecological issues like yeast
infections or urinary tract infections).
Counselors for when dancers and sex workers are stressed out. They felt like their
challenges were not understood or acknowledged enough. They go through
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competition, body image issues, stigma and discrimination, shame and guilt and
have no one to talk to about these issues.
More peer educator like the ones at CHAA. The participants felt comfortable
talking to the animators at CHAA because they felt like peers. They felt like the
animators understood them because they had worked in the same job as them
before. They also said they were friendly, approachable and came to them where
they were and did not preach at them.
Spanish-Speaking CSW Group Report
Methodology
An open and free discussion was held with four Dominican women living in Antigua
since more than five years and working as sex workers. Two of them were also actresses
in a play on HIV.
Recruitment criteria: Participants were chosen by Craig Rijkaard from the Gender
Affairs Division. The participants all self-identified as Sex Workers and they were all
originally from the Dominican Republic.
Geographic location: The participants lived mainly in St John’s. The session was
conducted at the Gender Affairs Division on Market & Redcliffe Streets.
Timing: The interview/discussion was conducted for the duration of one hour and
30minutes; At the end of the session each participant received the amount of EC$ 40.
Demographic
4 participants
Sex: Female
Age: Late 20’s early 30’s
Country of origin: Dominican Republic from the cities of Santo Domingo, San Pedro de
Macorís and La Romana
Language: All were Spanish speaking and partially English speaking
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Marital Status: All were unmarried and some had steady partner.
Educational Level: one of them completed high school but ended her education just
before the university level.
Work Status: They all have temporary residence and work permits.
Duration in Antigua: From two to seven years
The following were clearly expressed:
Main challenges faced in Antigua
Stigma and discrimination
They all strongly insisted on the fact that stigma and discrimination against the Spanish
speaking young ladies is much stronger than against any other English speaking migrant
Sex Workers.
“When I speak in English, they ask me to speak English, they say they don’t
understand”
The Antiguan females discriminate against them a lot. They often hear:
“fuck your ass, fucking Spanish”
They say that the people have no respect for them. They treat them badly and they are
sometimes called
“mother’s cunt”
The worst is that they feel unsecure in the country. They have no access to police and
justice services.
Violence due to their work or citizenship
Each of the four discussion participants had to face violence against them in the street.
“Once I was wounded on the face, I didn’t receive any consideration at the police
station”.
Issues related to their status
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Under the previous government some of them got residence permits for ten years.
The new government removed this permit before the expiry date. “Which is
against the international laws”
They have the feeling that Guyanese and Jamaican sex workers are given more
considered than they are by immigration and police officers and by health care
providers.
Each of the interviewees pay the social security benefits but admitted that not all
sex workers is able to get such insurances.
They feel as though the Dominican government does not care about them and has
abandoned them. They do not receive any care and support on this side.
They don’t know where to go when they are facing a serious issue
Issues related to HIV Test
They participants stated that several years ago HIV test results were given to the brothel
owner directly and he made the decision whether or not to send them back to the
Dominican Republic. At this time there is no sharing of information but a sense of
secrecy between them; they don’t know who among their peer community is HIV
positive or not. If someone is diagnosed as HIV positive they mostly keep it a secrets
since they are of the belief that they have no access to public service where the drugs are
free. Two or three years ago, two girls from the Dominican SW community died of AIDS
without treatment, without their colleagues/peers knowing that there were HIV+. The
participants stated that most of them do not get tested frequently.
Social issues
Lack of inexpensive schools for Spanish speaking adult to allow them to learn
other job skills or to improve their English. Requests have been made to the
Antigua government, to private schools and also to the Dominican government
with no results.
They play an important social and educational role with the younger sex workers
who recently arrived in the country. They explain to them what to do to get their
health insurance, work permit, etc.
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They face a lot of difficulties where social integrated in Antiguan society is
concerned.
Health Services.
Existing services
They receive most of the condoms from the AIDS Secretariat; however they all
said that they often have the experience condoms bursting or rupturing and have
doubts on the quality of some condoms in Antigua.
Most of the Dominican girls go to Dr. Carmen GABY, a physician who they find
to be very committed and who responds very positively to their needs.
Previously, they often visited a Cuban doctor but he is no longer on island.
They repost receiving some support from persons on island which helps them to
feel respected and help them to receive some services. One such person is the
social worker at the hospital who is also very committed to lending support.
Difficulties in accessing services and Needs
It is very difficult for them to access all of the services offered at the hospital.
Even if they have the necessary insurance they feel as if they have to wait much
longer than other patients, just because they are Hispanic.
There is a serious lack of basic sexual and health education among men.
Sometimes the social workers are able to identify that their client has a sexually
transmitted infection (STI) and refer them to the clinic. In their opinion, men in
Antigua do not receive sufficient education about STI’s.
There is a serious need to be able to access a gynecologist for sexual reproductive
health for example pap smear. It seems almost impossible to find such a service.
A clinic that is open 24/7 is needed in St. John’s.
Organizations dealing with Dominican sex workers
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There is a support group for female sex workers called GAT. They
discuss and receive help with issues related to immigration, human
trafficking etc. The group is hosted by the Gender Affairs Division.
CSW Survey Report
Respondents:
The survey was conducted by members of the peer group as well as other trained
interviewers who met the respondents in their home, place of work and in public places.
Two of the interviewers were bilingual (Spanish-English). The interviewers did not give
the respondents the questionnaire but rather, asked the questions in a conversational
manner.
Sample consisted of 114 respondents, all female. The age ranged from 18 to 48 with the
average age being 28.9. Their geographical location varied but they were all located in
the St. John’s Area. Their average time in Antigua was from one month to two years. The
countries of origin of the respondents were primarily Jamaica, Guyana and Dominican
Republic, with one from Dominica.
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Figure35 - Breakdown of country of origin of the commercial sex workers
Dominica, 1, 1% No answer, 3, 3%
Country of Origin
Jamaica, 31, 27%
Dom. Rep, 73, 64%
Guyana, 6, 5%
Demographics
Education level completed
When asked about the highest level of educational attainment, 71 of the respondents or
62.2% said that they had completed secondary school. There is one person who said that
they were a University graduate. It demonstrates that someone who is highly educated
could be placed also in vulnerable circumstances. It is also noteworthy that seven persons
had no schooling . (See detailed data in Table 2. 1).
Table 59- Educational level of respondents. (Q1). CSW Study. 2012.
Responses Number Percentage
None 7 6.1
Primary School 21 18.4
Secondary School 71 62.3
Technical/vocational School 1 0.9
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Some College 8 7.0
Completed college 5 4.3
Other 1 0.9
Totals 114 99.8
Language spoken
Of the 114 respondents, the majority claimed to speak Spanish with English being the
second most widely used language and Creole being spoken by four persons (this was
indicated as other on the questionnaires. Only one person admitted to speaking French.
Some respondents spoke more than one language.
Table 60- Breakdown of language spoken. (Q2). CSW Study. 2012.
Responses Number Percentage
English 61 53.5
Spanish 78 68.4
French 1 0.9
Other 4 3.5
Length of time in Antigua
It is important to know how long the migrants have been in Antigua, as this gives an
indication sometimes of their vulnerability – the shorter the time, the more vulnerable
they appear to be. Also, for the purpose of this survey, it was useful to know how long
they stayed in the country. The majority of the respondents were here for more than two
years, which indicates that being in the country for a long time, does not necessarily
lessen vulnerability.
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Table No. 61- Length of time in Antigua. (Q3). CSW Study. 2012.
Responses Number Percentage
Less than one month 8 7.0
Between one and three months 13 11.4
Between 3 and 6 months 13 11.4
Between 6 and 12 months 23 20.1
Between 1 and 2 years 18 15.7
Over 2 years 39 34.2
Total 114 99.8
Person who brought respondent to Antigua
It was interesting to note that the vast majority of sex workers came to Antigua because
of friends and not family (59.6%). One reason for this that came out in the interviews was
that their friend would tell them of opportunities here or help them, while some of them
did not want their family to know the type of work they were doing. 16.6% were brought
by family and 10.5% came because of a job offer. 12.2% came on their own.
Table No. 62- Shows who is responsible for respondent coming to Antigua. (Q4).
CSW Study. 2012.
Responses Number Percentage
Friends 68 59.6
Family 19 16.6
Job Offer 12 10.5
Came alone 14 12.2
Other 1 0.9
Totals 114 99.8
Family in Antigua
28.9% of the respondents had family in Antigua and 67.4% had none. Four of the
respondents did not want to answer. Many of the respondents stated that their family
members were “back home” and they often were the ones responsible for sending back
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money as the breadwinner. For those with family, when asked who the family members
were, the majority siblings, followed by parents. For the ones who stated other – they
were divided between aunts and cousins and sister-in-law. Only 1.7% of the 114 girls had
a partner here in Antigua with them and only 1.7% had children here with them (See
Table 1.6). It was surprising that only 2 persons mentioned having 2 family members
and in both instances it was a parent and a child.
Table 63- Shows how many of the persons surveyed had family in Antigua. (Q5).
CSW Study. 2012.
Responses Number Percentage
Yes 35 30.7
No 77 67.5
Did not answer 2 1.7
Total 114 99.9
Table 64- Shows the breakdown of who the family members were here with
respondents. (Q6). CSW Study. 2012.
Responses Number % of w/family % of total
Spouse /partner 2 6.0 1.7
Children 2 6.0 1.7
Parents 8 24.2 7.0
Siblings 13 39.3 11.4
Others 10 24.2 7.0
N/A 81 71.0
Social life in Antigua
The majority of the respondents spent their spare time with friends and 20% spent social
time with a social group made up of persons they spent time with regularly – some from
their core group of other sex workers. It was noticeable that 17.5% had social connections
at church and this could be in part due to the fact that a large percentage of the ladies
from the Dominican Republic had a strong Catholic background. 6.1% socialized with
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groups of other persons from their country of origin. 18.4% had no social connections. So
while some persons had more than one ways of enjoying social support, some had none at
all.
Table 65- Showing social connections in Antigua. (Q7). CSW Study. 2012.
Responses Number Percentage
Friends 79 69.2
Church 20 17.5
Country association 7 6.1
Social group 23 20.0
None 21 18.4
Other 0 0.0
Occupation
65.7% of the girls worked as a sex worker alone while the others had other jobs
simultaneously. 24.5% of them worked as pole dancers and 17.5% worked in homes as
domestic workers. 10.5% worked in beauty salons and the 3 persons under other worked
as seamstress, a construction worker and in business. The one who worked in business
worked selling products.
Table 66- Showing occupation of the respondents. (Q8). CSW Study. 2012.
Responses Number Percentage
Dancer 28 24.5
Sex Worker 75 65.7
Domestic help 20 17.5
Beauty Salon worker 12 10.5
Other 3 2.6
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Partner History
Partners in Antigua
More than a third of the sex workers are in relationships but it was unclear if their
partners knew what line of work they were involved in. The fact that 25% of the ladies
had multiple partners indicates that they could be exposing themselves to HIV infection if
they had unprotected sex with clients and also with other partners. 34.2% of the girls had
no partner in Antigua, while 4.3% had a female partner.
Table 67- Showing the partners the respondents had in Antigua. (Q10). CSW Study.
2012.
Responses Number Percentage
Boyfriend 41 35.9
Girlfriend 5 4.3
More than one 29 25.4
None 39 34.2
Total 114 99.8
Number of sexual partners
The majority of workers had between six and ten partners in the past month (34.2%).
Some of the ladies stated in the interviews that had multiple encounters with the same
partner but only listed the amount of partners they had, not the amount of times they had
sex with any one partner. 31.5% had 5 or less partners while 14.9% had between 11 and
15 partners. 9.6% had between 16 and 20 partners monthly and the numbers varied with
only 1.7% admitting to having over 40 partners in the past month. 1.7% also was unsure
and did not want to estimate.
Table 68- Shows the amount of sexual partners in the past month. (Q12). CSW
Study. 2012.
Responses Number Percentage
0 – 5 36 31.5
6 – 10 39 34.2
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Number of Respondents
Number of Respondents
11 – 15 17 14.9
16 – 20 11 9.6
21 – 25 1 0.8
26 – 30 3 2.6
31 – 35 0 0
36 – 40 3 2.6
Over 40 2 1.7
Uncertain 2 1.7
Figures 36 - shows the number of sexual partners in the past month
14
12
10
8
6
4
2
0
Non-Clients
Number of Partners
Figure 37 - shows the number of sexual partners for pay in the past month
14
12
10
8
6
4
2
0
Sexual Clients
Number of Partners
For approximately 50% of the girls, all of their sexual partners were for pay and 72% of
them at least 75% of their sexual encounters were for pay. While some of the ladies had
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partners in their lives it was clear that most of their sexual encounters were for money or
goods. This is not surprising considering that the majority of respondents considered
commercial sex as their primary source income.
Frequency of sex
57.8% of our respondents had sex for money or goods on the weekends only when most
of the bars were more active and patrons were likely to be present. A few of the girls
answered that they did it every weekend and occasionally on a week-day in the month, so
there were more than 114 responses. 22.8% had sex daily for money or goods and 2.6%
or 3 of the respondents did not engage in having sex for money in the past month. Based
on their responses, it was likely that some were trying to do other more “legitimate” jobs
and only did commercial sex work when they were very desperate.
Table 69- Showing how often the respondents engaged in commercial sex. (Q15).
CSW Study. 2012.
Responses Number Percentage
Daily 26 22.8
Weekends 66 57.8
Occasionally 18 15.7
Rarely 3 2.6
Not at all 3 2.6
No answer 2 1.7
Client contact
Most of the workers meet their clients at the sex club and some on the street. The
majority of the others made contact by phone especially as it related to repeat contacts.
Only one respondent related that her contact reached at her home. Clearly, the internet is
not a useful contact point.
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Table 70- Showing how clients are contacted. (Q16). CSW Study. 2012.
Responses Number Percentage
Sex club 60 52.6
Street 47 41.2
Internet 0 0.0
Other 37 32.4
Condom use
Use of condom
When asked if in the past 12 months a condom was used in sexual relations with partner
(boyfriend or girlfriend), only 42.1% stated that they always used a condom and a
significant 29.8% provided no response to this question. Of the 63% of those who did
use condoms at some point or another 11.4% used sometimes and 8.7% almost always
and 0.8% almost never uses. What does cause significant concern though is that there is
7% that has never used a condom with their partner.
Table 71- Showing frequency of condom use. (Q17). CSW Study. 2012.
Responses Number Percentage
Always 48 42.1
Almost always 10 8.7
Sometimes 13 11.4
Almost never 1 0.8
Never 8 7.0
No answer 34 29.8
Total 114 99.7
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Random sexual activity
When the participants were asked if within the past 12 months they had sex with
someone who is not a steady partner with no money nor goods involved 91.2%
responded yes and 0.8% did not respond at all which means that the remaining 7.8%
responded by saying no. Table 1.15 indicates that 87.7% of the ladies always used a
condom when they engaged in sex without a steady partner or client. 6.1% stated almost
always and 4.3% said sometimes and .8% or 1 participant said she never used condoms in
those situations.
Table 72- Showing sexual activity outside of regular partner or paid client. (Q18).
CSW Study. 2012.
Responses Number Percentage
Yes 104 91.2
No 9 7.8
No response 1 0.8
Total 114 99.8
Table 73- Showing frequency of condom use during non-partner sexual activity.
(Q19). CSW Study. 2012.
Responses Number Percentage
Always 100 87.7
Almost always 7 6.1
Sometimes 5 4.3
Almost never 0 0.0
Never 1 0.8
No answer 0 0.0
No response 1 0.8
Total 114 99.7
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Condom Supply
When asked where they normally get their condoms from the majority of the participants
which accounts for 53.5% responded CHAA. Quite a large percentage also gets their
condoms from the AIDS Secretariat and the pharmacy or supermarket. That accounts for
48.2% and 45.6% respectively. 7.8% of the respondents got their condoms from the
clinic/health centers or Antigua Planned parenthood Association. The other category
included bar/clubs and one person said “anywhere”.
Table 74- Showing where respondents got their condoms. (Q20). CSW Study. 2012.
Responses Number Percentage
AIDS Secretariat 55 48.2
CHAA 61 53.5
MSJMC 0 0.0
Clinic/Planned Parenthood 9 7.8
Pharmacy/Supermarket 52 45.6
Other 9 7.8
Figure 38 – showing where respondents who indicated other got their condoms
Clinic /PP
Hospital
3H /partner
/friends
AIDS Secretariat
CHAA
Pharmacy
/Supermarket
Free condoms
Of the participants 58.7% received free condoms from CHAA in the past 12 months and
27.1% from AIDS Secretariat, 24.5% from outreach workers and another 24.5% from
friends or family. 3.5% of the participants received condoms from the district clinics and
178

another 3.5% received from the hospital. From the clubs or bars only a mere 2.6%
received free condoms. In the category of other are those persons who did not receive
free condoms in the past year. Some of the participants who said outreach worker were
not able to readily identify if the worker was from the NAP, CHAA or another agency.
Table 75- Showing where respondents got free condoms. (Q21). CSW Study. 2012.
Responses Number Percentage
AIDS Secretariat 31 27.1
Outreach worker 28 24.5
District Clinic 4 3.5
CHAA 67 58.7
Private Physician 1 0.8
Club/Bar 3 2.6
From friend or family 28 24.5
Hospital 4 3.5
Other 9 7.8
Figure 76– showing where respondents got free condoms
80
70
60
50
40
30
20
10
0
Receive free condoms from who?
179

How to use condoms /Instructional condom use
Having received instructional condom use sessions from a health institution, 51.7% of the
participants hopefully, should know how to use condoms effectively. Another 29.8%
received similar instructional sessions mainly from CHAA while 20.1% received friends
or family. Interestingly though, 10.5% said that they have never received condom use
instruction.
Table 77- Showing whether and from where participants were instructed in condom
use. (Q22). CSW Study. 2012.
Responses Number Percentage
No 12 10.5
Yes, at school 4 3.5
Yes, from my employer 0 0.0
Yes, from a health institution 59 51.7
Yes, from family or friends 23 20.1
Other 34 29.8
HIV INFORMATION AND TESTING
Consciousness of being at risk for HIV infections
Though 72 participants or 63.1% believe that they are at risk for HIV infections there is
another 28 or 24.5% who think that they are not at risk because they always use condoms.
A small 1.7% feels they are not at risk because they only have one sex partner and 9.6
feels that choosing your partner carefully minimizes risk. The sole person who said other
responded that she visits her physician often so she does not believe that she is at risk.
Table 78- Indicating respondents perceived vulnerability to HIV infection. (Q23).
CSW Study. 2012.
Responses Number Percentage
Yes 72 63.1
No, because I always use condoms 28 24.5
No, because I only have one sex partner 2 1.7
180

No, because I choose my partner carefully 11 9.6
Other reason 1 0.8
Total 114 99.7
For those that said yes, because…., below is an example of reasons given
A few broken condoms
Anything is possibly
Condoms break
Condoms may burst
Having unprotected sex
I don’t always use condoms with my boyfriend
I don’t use condoms
I don’t use condoms with my boyfriend
I get paid extra not to use condoms
I have many partners and condoms break
I have multiple partners and I don’t use condoms
I have sex daily
I have sex frequently
I have sex very frequently
I have unprotected sex with clients but not with my boyfriend
I have unprotected sex with my boyfriend
If the condom should burst
I'm having sex
I'm having sex with more than one man
Multiple men
Multiple partner
My job is high risk
My work
Sometimes condoms break
Sometimes the condoms burst
The condoms aren't 100% guaranteed
Identifying HIV+ persons
Out of the 114 participants 102 respondents or 89.4% share the opinion that one cannot
look at someone and know whether they are HIV positive or not. This does go to show
that the HIV education and information has made an impact. However the 8.7% who are
of the perception that appearance can be an indicator of HIV status is still cause for
concern.
181

Table 79- Showing amount of persons who feel that HIV status is apparent in
appearance. (Q24). CSW Study. 2012.
Responses Number Percentage
Yes 10 8.7
No 102 89.4
No response 2 1.7
Total 114 99.8
Last HIV test
Knowing your HIV status is very important and 6.1% has of the respondents have never
been tested and 3.5% don’t remember when they were tested, which indicates that it is
probably too long ago. As it stands only 2.6% was tested in the past week and 10% in the
past month. 27.1% have been tested in the past 3 to 6 months and 21.9% within 6 and 12
months of being polled. With this in mind, more outreach programs may be necessary to
encourage more frequent HIV testing within the participant’s core group.
Table 80- Showing the Last HIV Test Done. (Q25). CSW Study. 2012.
Responses Number Percentage
This past week 3 2.6
This past month 12 10.5
Between 1 and 3 months ago 11 9.6
Between 3 and 6 months ago 31 27.1
Between 6 and 12 months ago 25 21.9
Between 1 and 2 years ago 21 18.4
Never 7 6.1
Don’t recall 4 3.5
Total 114 99.7
182

Figure 40 Showing last HIV test. (Q34). CSW Study. 2012.
35
30
25
20
15
10
5
0
This week this month 1-3 month 3-6 months 6-12 Month 1-2 years NEVER Don't recall
When last HIV…
HIV/AIDS Counselling
Where HIV/AIDS counselling is concerned 32.4% of participants stated that they
received counselling before the testing procedure was carried out, 14% received
counseling after while 28.9% received counselling both before and after testing. What is
striking though is that 29.8% of the respondents did not receive any counselling
whatsoever. There is cause for concern with the lack of counselling processes because it
is important for persons that are being voluntarily tested to understand responsible/risky
behaviour and how to develop a lifestyle of healthy sexual habits.
Table 81- Showing whether participants received counseling before or after being
tested for HIV. (Q26). CSW Study. 2012.
Responses Number Percentage
Yes, before 37 32.4
Yes, after 16 14.0
Yes, both times 33 28.9
Neither 34 29.8
Free HIV testing
Though HIV testing is a free service offered by governmental organizations to the
entire population 27.1% of respondents paid for their testing to be done. This could
be because some of the participants preferred to have their testing done at a private
physician or laboratory where they might have had the perception of less stigma and
183

discrimination. Some 59.6% of the respondents accessed the government services and
received free testing.
Table 82- Indicating participant’s access to free HIV testing. (27). CSW Study. 2012.
Responses Number Percentage
No, everything is free 68 59.6
Yes, test is free but I pay for condoms 5 4.3
Yes, I pay for everything 31 27.1
Not Applicable 10 8.7
Total 114 99.7
Ability to Pay
Bearing in mind that HIV testing may be accessed free from the NAP, 37.7% or the
participants admitted that their ability to pay for testing is a problem. 53.5% don’t
face this problem and 8.7% declined to answer.
Table 83- Showing participants ability to pay for HIV testing. (Q28). CSW Study.
2012.
Responses Number Percentage
No 61 53.5
Yes, I can’t afford it 43 37.7
No Answer 10 8.7
Total 114 99.9
HIV testing locations
HIV testing would be accessed at the AIDS Secretariat by 64% of the participants while
23.6% access this service at the clinics. Of the 10.5% of respondents who would go to
other locations for testing 9.6% said that they would go home to the Dominican Republic
to access HIV testing. What is alarming though is that 3.5% of respondents don’t know
184

where to go to access testing. Clearly the hospital is underutilized as only 1.7% would go
there for testing.
Table 84- Showing where participants preferred to go for HIV testing. (Q29). CSW
Study. 2012.
Responses Number Percentage
MSJMC 2 1.7
AIDS Secretariat 73 64.0
Medical doctor 11 9.6
Clinic 27 23.6
Other 12 10.5
Don’t know where to go 4 3.5
Figure 41 - Q29 - Showing comparison of preferred testing
Série1; Lab; 1; 1%
Série1; Dominican
Republic; 11; 8%
Série1; Don’t know
where to go; 4; 3%
Série1; MSJMC;
2; 2%
Série1; Clinic; 27;
21%
Série1; AIDS
Secretariat; 73;
57%
Série1; Medical
doctor; 11; 8%
Preferred HIV Testing location
185

Reasons for not having had a recent HIV test.
It is quite evident that fear has crippled quite a significant percentage of the
respondents because when asked to indicate reasons why they have not had a recent HIV
test 32.4% confessed that they were afraid of the answer or result. While on the other
hand, another 20.1% just didn’t think about it and 3.5% did not know where to go and
1.7% thinks that they did not need one which too is cause for concern, none of the
participants said that not being able to afford it was reason that they had not accessed
testing. 4.3% indicated that language barriers affected them. The Not Applicable
respondents were the ones who had been recently tested.
Table 85- Showing reasons why participants have not been tested. (Q30). CSW
Study. 2012.
Responses Number Percentage
Did not know where to go 4 3.5
Afraid of the answer 37 32.4
I do not need one 2 1.7
They don’t speak my language 5 4.3
Can’t afford it 0 0.0
Didn’t think about it 23 20.1
Other 19 16.6
Not applicable 24 21.0
Total 114 99.6
Availability of HIV/AIDS information
When asked if in the past 12 months HIV/AIDS information was received 86.8% of
participants responded in the affirmative while 8.7% responded by saying that they did
not. This indicates that the stakeholders have been doing a good job of keeping the
population up to date with current HIV/AIDS education and information but more work
still has to be done to reach 100% education. For those who received information, the
majority came from
186

Table 86- Indicating whether participants received HIV and AIDS information.
(Q31). CSW Study. 2012.
Responses Number Percentage
Yes 99 86.8
No 10 8.7
Don’t recall 2 1.7
No response 3 2.6
Total 114 99.8
Source of HIV and AIDS information
HIV and AIDS information was accessed by 50.8% and 48.2% of the participants from
CHAA and AIDS Secretariat respectively which mean that 99% of the respondents
access those two agencies. The next major access point for HIV/AIDS related
information is from friends and family (14.9%). Only a few of the commercial sex
workers got information from the media, district clinics or the hospital.
Table 87- Indicating the source of information received on HIV and AIDS. (Q32).
CSW Study. 2012.
Responses Number Percentage
AIDS Secretariat 55 48.2
Media 1 0.8
District Clinic 2 1.7
CHAA 58 50.8
Private physician 2 1.7
Employer 0 0.0
From friend or family 17 14.9
Hospital 3 2.6
Other 3 2.6
187

Availability of HIV testing or education
Of the participants 61.4% think that HIV testing or education is readily available and
18.4% think that it is not. There is too the 17.5% that is still uncertain. Because of this
fact, it may be timely to have more VCT outreach programs and testing sites set up if it is
at all feasible.
Table 88- Showing whether respondents think HIV testing and education is readily
available enough. (Q33). CSW Study. 2012.
Responses Number Percentage
Yes 70 61.4
No 21 18.4
Don’t know 20 17.5
No response 3 2.6
Total 114 99.9
ACCESS TO HEALTHCARE SERVICES
History of medical check-up
Having medical checkups is an important practice. Based upon findings in the table
below slightly more than half or 56.8% of the respondents had a medical check-up in the
past year or less. Of the remaining respondents, 21% had their over a year ago, 7% don’t
recall when they had had their last checkup and an amazing 12.2% have never had a
medical check-up.
Table 89- Showing the most recent medical check-ups the respondents have had.
(Q34). CSW Study. 2012.
Responses Number Percentage
This past week 1 0.8
This past month 3 2.6
Between 1 and 3 months ago 10 8.7
188

Between 3 and 6 months ago 26 22.8
Between 6 and 12 months ago 25 21.9
Between 1 and 2 years ago 24 21.0
Never 14 12.2
Don’t recall 8 7.0
No response 3 2.6
Total 114 99.6
30
Figure 42 – showing most recent medical checkup
25
20
15
10
5
0
This week this month 1-3 month 3-6 months 6-12 Month 1-2 years NEVER Don't recall NA
Experience during medical check-up
Of the participants, 27.1% reported that they received excellent treatment during their
medical checkup. According to findings it is reported that a clean facility, good customer
care and an inviting friendly atmosphere coupled with quality medical service and
confidentiality is considered excellence. Others reported that the service was excellent
because the checkup was done in the Dominican Republic. The 50% that had a good
experience stated that there was a measure of friendliness and the doctor was nice, though
quite a few indicated that this was because their most recent checkup was in their country
of origin. 1.7% said that they received poor service citing lack of manners and the use of
swabs while 18.4% of the persons indicated that the question was not applicable to them
because they did not seek any services.
189

Table 90- Showing their perception of the quality of care received at medical checkcup.
(Q35). CSW Study. 2012.
Responses Number Percentage
Excellent 31 27.1
Good 57 50.0
Poor 2 1.7
Other 3 2.6
Not Applicable 21 18.4
Total 114 99.8
Reasons given why healthcare is considered excellent were:
Results were clean and healthy
Was a private doctor
Saw doctor at home in the Dominican Republic
They are clean
They are efficient and better quality
Staff is confidential
Friendly service
Everything went well
They were nicer
Healthcare is considered good because:
Results were good
It was in Dominican Republic
Was a personal doctor
Friendlier
Service was good
Service was liked
Spoken to nicely
They could tell me whatever
They dealt with me well
They did what they had to do
They treated me normally
Efficient and quick
Some reasons given why healthcare is poor are:
Bad customer service
Lack manners
They used swabs and not blood
190

Willingness to recommend facility to friend
71.9% of the respondents would recommend the facility to which they went for services
to a friend, and only 4.3% said that they would not. The other 23.6% of participants did
not respond to the question.
Table 91- Indicating willingness to refer medical facility to someone else or return.
(Q36). CSW Study. 2012.
Responses Number Percentage
Yes 82 71.9
No 5 4.3
No Response 27 23.6
Total 114 99.8
Reasons for recommending facility
38.5% of respondents indicated that they would recommend the facility to which they last
went because they received good medical care. Friendly and helpful staff was the reason
given by 21.9% of the respondents, location/accessibility accounted for 17.5% being
willing to refer the facility. 14.9% were impressed with the price and 7.8% were happy
that their language was being spoken.
Table 92- Outlining positive reasons for referring someone to a health care facility.
(Q37). CSW Study. 2012.
Responses Number Percentage
Price 16 14.0
Friendly helpful staff 25 21.9
Location 20 17.5
Other reason 5 4.3
Speak my language 9 7.8
Good medical care 44 38.5
Other foreigners are there 1 0.8
191

Reasons for not recommending facility
It is interesting that 56.1% of participants did not respond to this question and 21% said
that they would not recommend the facility that they used for their last checkup to a
friend because of the price. Location was the reason cited by 7.8% of the participants and
4.3% for poor quality medical care. The two cultural factors were 4.3% who said their
language was not spoken and 1.7% who stated that foreigners were not treated well.
Table 93- Showing reasons for not referring someone to health-care facility
previously used. (Q38). CSW Study. 2012.
Responses Number Percentage
Price 24 21.0
Unfriendly/not helpful staff 4 3.5
Location 9 7.8
Other reason 1 0.8
Don’t speak my language 5 4.3
Medical care not good 5 4.3
Don’t treat foreigners well 2 1.7
No response 64 56.1
Total 114 99.5
Characteristics of an excellent health care system
To the participants a major player in ascertaining whether a health care system is
characterized as being excellent is confidentiality. The largest percentage of respondents
thinks that confidentiality is key, which accounts for 64.9% of participants. Next in line
is friendly and helpful staff, which 45.6% thought also a key player. Third in line is the
facility being able to cater for a wider cross section of the mixed society in which we live
and offer more bilingual or multilingual staff. 38.5% said that this bears importance.
This was followed by cost of services and better opening hours.
192

Figure 43 - Showing the respondents views on what makes a health facility excellent
Features of an excellent health facility
Série1;
Confidentiality; 74
Série1; Friendly
and helpful staff;
52
Série1; Staff who
speak my language;
44
Série1; Free or
inexpensive; 25
Série1; Better
opening hours; 25
Série1; More
testing; 1
Means of covering medical expenses
Medical bills for 69.2% of the participants are paid out of pocket while a surprising
12.2% said that they have private health insurance. Another 9.6% subscribe to the
National Medical Benefit Scheme which takes care of their expenses and another 7%
only go where free care is offered.
Table 94- Showing how respondents cover medical care. (Q42). CSW Study. 2012.
Responses Number Percentage
I have health insurance 14 12.2
I use my medical benefit card 11 9.6
I pay out of pocket 79 69.2
My employer pays for me 0 0.0
I only go where I get free care 8 7.0
No response 2 1.7
Total 114 99.7
193

DISCRIMINATION
Discrimination faced
It would appear that generally, the Antiguan society is not the most accepting of its
Caribbean counterparts. Though 40.3% state that they have not experienced any acts of
discrimination at all, the other 59.4% do experience discrimination against them for
various reasons. Alarmingly, 48.2% of the respondents were discriminated against
because of their nationality which accounts for 80.8% of those facing discrimination.
After nationality, discrimination is most experienced because of the participant’s
profession which accounts for 7.8% of all participants
Table 95- Showing how the respondents are discriminated against. (Q46). CSW
Study. 2012.
Responses Number Percentage
No not at all 46 40.3
Yes, because of my nationality 55 48.2
Yes, because of my ethnicity 2 1.7
Yes, because of my profession 9 7.8
Yes, because of my gender 2 1.7
Total 114 99.7
Frequency of discrimination
It is interesting to note that 27.1% of participants report that they have been discriminated
against on a regular basis while another 21.9% sometimes experience discrimination. To
a lesser extent, 2.6% rarely experience discrimination and 1.7% on a daily basis.
Together 53.5% of the participants do experience a measure of discrimination which can
be interpreted, based upon evidence, that the Antiguan society displays acts of
discrimination on a regular basis against commercial sex workers. While only 15% of
the English speaking sex workers reported being discriminated against 56% of Spanish
speaking sex workers reported being discriminated against.
194

Table 96- Showing frequency of discrimination received. (Q48). CSW Study. 2012.
Responses Number Percentage
Every day 2 1.7
Regularly 31 27.1
Sometimes 25 21.9
Rarely 3 2.6
Never 18 15.7
Unsure 10 8.7
No response 25 21.9
Total 114 99.6
Here are some of the comments from participants explain how they feel discriminated
against:
“At Immigration Office the people don’t treat me well”
“At the Immigration Department and at the hospital they treat me badly because I
don’t speak English”
“Because I am a foreigner”
“Because I am Spanish”
“Because of my language”
“Dirty looks when I am out”
“Gestures”
“Harsh words”
“I get attitude when I go to public places”
“I was accused of being a prostitute simply because I am Spanish”
“Indecent language”
“Looks and the way I'm spoken to”
“My nationality”
“On the street I am called a whore and asked how much I am worth simply because I
am Spanish”
“People ask me forward questions”
“People's faces change”
“Perhaps because I am an immigrant”
“Sometimes because I don’t speak the language”
“The way in which people act”
“The way that I am spoken to and the attitude that I get”
“The way that they call me Spanish”
“The way that they look at me”
“The way they speak their language”
“They call me names”
“They call me Spanish”
195

“They call me Spanish and they also call me bitch”
“They call me Spanish and when they see me on the road the curse me bad words”
“They curse me and give me dirty looks”
“They curse me bad words and offend me”
“They say that I am a bitch and the Santo Domingans come here to take their
husbands”
“They speak nastily to me and give me attitude”
“Things that they say”
“When I am referred to as Spanish”
“When I go to the city people look down on me”
“When the English speaking call me Spanish it's like discrimination”
“Words used and looks I get”
KNOWLEDGE OF SERVICES
Knowledge of STI education, treatment and support
19.2% of the participants indicated that Government agencies such as AIDS secretariat
would be a good place to get information, treatment and support. 7.8% indicated private
agencies like private doctors and laboratories, 36.8% indicated NGO’s like 3H, 2.6%
indicated churches and 33.3% indicated other and further mentioned CHAA and AIDS
Secretariat.
Upon reflection this question should have been broken down into separate sections for
education, treatment and support and a better classification should have been given to the
respondents since clearly some of them did not necessarily know that CHAA was
considered NGO, etc.
Table 97- Showing where participants would go for STI information, treatment and
support. (Q51). CSW Study. 2012.
Responses Number Percentage
Government agencies 22 19.2
Private agencies 9 7.8
Non-governmental organizations 42 36.8
Churches 3 2.6
196

Other 38 33.3
Total 114 99.7
Figure 44 - Breakdown of other
17,7
20,9
1,6
6,4
AIDS Secretariat
CHAA
Gender Affairs
Unsure
No
53,2
Needs of Commercial Sex Workers
These are the verbatim comments of respondents when asked what program could be
implemented to benefit their core group:
24 hour clinic
24 hour clinic that offers care in Spanish
A bit of everything
A learning center
A program where free STI testing is done
A public hospital
A school for young women
Access to all benefits
Access to free Spanish speaking Gynecologists
An institute where CSW's can learn English and express what they feel
Any public service
197

Back to school program
Back to school program to help get jobs
Better public medical services
Can't think of any right now
Can’t think of one right now
Clinics
Computer classes and English classes
Drug Rehabilitation Center
Empowerment for women
English and Computer classes
Family abuse counselling and
Free classes or skills
Free education or classes for those who need it
Free food and a place to stay for those who can't afford it
Free health care services once annually
Free living facilities - lobby for club owners to give girls a night off
Free schooling for female drop outs
Friends for change - similar to Disney program
Gynecologist
Gynecologist
Hairdressing and Nail Classes
Help for the drug addicted
Help to find jobs
Helping the Spanish to get time
Hospital
I counselling for the drug addicts
Information Clinic
Jobs and training on how to get jobs
Make them more capable
Medical specialists
More clinics
198

More confidential doctors
More educational centers
More free clinics
More medical assistance
More outreach programs for the most at risk population
More public clinics
More public hospitals
More Spanish speaking clinics
More women's clinics and services
None that I can think of
Prescriptions written in Spanish
Programs to improve the ladies
Psychologist
Public clinic where my language is spoken
Public health center
School fee assistance for young girls still in school
School programs and inexpensive health care
Somewhere where we can develop ourselves and contribute and be accepted in
society
Somewhere where we can get emotional support in Spanish
Spanish speaking personnel
Spanish speaking person who can help the community to get access to health care
Support for drug addicts
Support group for CSW's that will teach us to be more useful in finding noble jobs
Support to get HIV and STI information
Technical vocational Classes like sewing
Technical educational programs/classes
The Spanish radio station needs to speak-up more about STI's and HIV
Theaters
Training center for women
Training center for young pregnant women
199

Training center where we can learn English and Cosmetology
Type of facility frequented for treatments
For treatment when ill, 57% of participants go to private facilities while 26.3% go to
public facilities. The participants have a wealth of confidence in the private physicians
having spoken of their efficiency, experience and they also are also of the opinion that
they are more confidential that are the public facilities. The public facilities are accessed
also mostly due to the fact that it is more cost effective. Some persons did not respond as
they have not accessed care in Antigua.
Table 98- Indicating where respondents would go if they are ill. (Q53). CSW Study.
2012.
Responses Number Percentage
Public facility 30 26.3
Private facility 65 57.0
No response 19 16.6
Total 114 99.9
Referral of HIV+ peer
It is surprising that only 49% of the participants would refer someone to the NAP for
support, if they were tested HIV positive. Second was the Mount St. John Medical
Center at 28%. What should be noted though is that 19.2 percent would recommend to
that individual that they go back home for support while another 28% don’t know where
to they would refer someone for support.
Table 99- Showing where respondents would refer someone who was HIV+. (Q54).
CSW Study. 2012.
Responses Number Percentage
Back home 22 19.2
AIDS Secretariat 56 49.1
Hospital 32 28.0
200

HHH 2 1.7
Other 7 6.1
Don’t know 32 28.0
As it relates to the contracting of HIV, a few questions were asked which common
perceptions among the general public are. Responses are below:
Contracting HIV from mosquito
Though HIV related information and education is so readily available 4.3% of
participants agree that one can become infected with HIV from a mosquito bite. The
information and educational programs have proven effective though because 93.8%
disagree.
Table 100- Indicating whether respondents though HIV could be spread by
mosquitoes. (Q55). CSW Study. 2012.
Responses Number Percentage
Agree 5 4.3
Disagree 107 93.8
Don’t know 1 0.8
No response 1 0.8
Total 114 99.7
Contracting HIV from sharing a meal
Some 79.8% of the participants disagreed with the statement which says that one can
become infected with HIV if they share a meal with someone who is infected, and while
17.5% does not know whether to agree or disagree with the statement 2.6% agrees.
Table 101- Indicating persons who thought they could become HIV+ by sharing a
meal. (Q56). CSW Study. 2012.
Responses Number Percentage
Agree 3 2.6
201

Disagree 91 79.8
Don’t know 20 17.5
Total 114 99.9
Contracting HIV from sharing a toilet
When the statement that one can become infected with HIV if they share a toilet with
someone who is infected was made, 61.4% of the participants disagree while 36.8% did
not know whether to agree or disagree with the statement.
Table 102- Indicating if someone could become HIV+ by using a toilet with someone
who is HIV+. (Q57). CSW Study. 2012.
Responses Number Percentage
Agree 2 1.7
Disagree 70 61.4
Don’t know 42 36.8
Total 114 99.9
Healthy-looking person may have HIV
It is comforting to know that 88.5% of the ladies in the commercial sex work industry
agree that a healthy-looking person can have HIV thus safer practices might be adopted.
What is noticeable though is that another 7.8% are unsure and 2.6% disagree.
Table 103- Showing if respondents thought a healthy looking person could be HIV+.
(Q58). CSW Study. 2012.
Responses Number Percentage
Agree 101 88.5
Disagree 3 2.6
Don’t know 9 7.8
No response 1 0.8
Total 114 99.7
202

MSM INTERVIEW SHEET
Date of Interview:_______________
Form ID: ______________________
(last initial, first initial, year of birth)
Date of Birth: __________________
Address: ______________________
Location: _________________________
Sex: _____________________________
Age: _____________________________
Country of origin: ___________________
Demographics
1. What is the highest level of education you have completed?
a. None e. Some college
b. Primary school f. Completed college
c. Secondary School g. Other (specify) _____________________
d. Technical/vocational school
2. What languages do you speak?
a. English
b. Spanish
c. French
d. Other ___________________________________
3. How long have you been in Antigua?
a. Less than 1 month d. Between 6 and 12 months
b. Between1and 3 months e. Between 1 and 2 years
c. Between 3 and 6 months f. Over 2 years
4. Who brought you to Antigua?
a. Friend
b. Family
c. Someone offered you a job
d. Came alone
e. Other (specify) __________________________________________
5. Do you have any family here with you?
a. Yes b. No
6. If yes, who is it?
a. Spouse/partner
b. Parents
c. Siblings
d. Other (specify) __________________________________________
203

7. What social connections do you have in Antigua? (choose all that apply)
a. Friends d. Social group
b. Church e. None
c. Country association f. Other (specify) _______________
8. With whom do you work and socialize with in Antigua?
a. People from your country alone
b. Mostly local people
c. A mixture
d. Other
9. What is your profession?
__________________________________________________________________
Partner History
10. Do you have a partner (boyfriend or girlfriend) here in Antigua with you?
a. Boyfriend c. More than one
b. Girlfriend d. None
11. If yes, how long have you been together?
a. Between 1 and 12 months c. Between 2 – 5 years
b. Between 1 and 2 years d. 5+ years
12. In the past month, approximately how many partners did you have sex with? ____
13. How many were occasional partners with no money or goods involved? ________
14. How many were clients? ______________
15. In the past 12 months, how frequently have you had sex for money or goods in
Antigua?
a. Daily c. Occasionally (once or twice a month) e. Not at all
b. Weekends d. Rarely f. No answer
16. To the best of your knowledge, are you aware of whether your partner has a
spouse or other partners?
a. No other partners c. More than one other partner
b. Yes, one other partner d. Don’t know
____________________
204

Condom Use
17. In the past 12 months, have you used a condom in sexual relations with your
partner (boyfriend or girlfriend)?
a. Always c. Sometimes e. Never
b. Almost always d. Almost never f. No answer
18. In the past 12 months, have you had sex with someone who is not a steady
partner? (occasional with no money or goods involved)
a. Yes b. No
19. If yes, did you use a condom?
a. Always c. Sometimes e. Never
b. Almost always d. Almost never f. No answer
20. Where do normally you get condoms? (check all that apply)
a. AIDS Secretariat c. MSJMC e. Pharmacy/supermarket
b. CHAA d. Clinic/ Planned parenthood f. Other (specify) ______
21. Did you receive any free condoms in the past 12 months? If yes, from who?
a. AIDS Secretariat d. CHAA g. From friend or family
b. Outreach worker e. Private physician h. Hospital
c. District Clinic f. Club/bar i. Other (specify) ________
22. Have you ever been instructed on how to use a condom?
a. No d. yes, from a health institution
b. Yes, at school e. yes, from family or friends
c. Yes, from my employer f. Other
HIV Information
23. Do you think you are at risk for HIV infections or not?
a. Yes, because _________________________________________________
b. No, because I always use condoms
c. No, because I only have one sex partner
d. No, because I choose my partners carefully
e. Other reason: ________________________________________________
24. Do you think you can tell by looking at someone if he/she is HIV+?
a. Yes.
b. No
25. When was your last HIV test?
a. This past week e. Between 6 and 12 months ago
b. This past month f. Between 1 and 2 years ago
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c. Between 1and 3 months ago g. Never
d. Between 3 and 6 months ago h. Don’t recall
26. Did you receive counseling before and/or after your test?
a. Yes, before c. yes, both times
b. Yes, after d. Neither
27. Did you have to pay for the test?
a. No, everything is free
b. Yes, test is free but I pay for condoms
c. Yes, I pay for everything
28. Is your ability to pay a problem?
a. No
b. Yes, I can’t afford it
29. Where would you go for HIV testing?
a. MSJMC c. Medical doctor e. Other (specify)_________
b. AIDS Secretariat d. Clinic f. Don’t know where to go
30. If you did not do an HIV test recently, what is the most likely reason?
a. Did not know where to go
b. Afraid of the answer
c. I do not need one
d. They don’t speak my language
e. Can’t afford it
f. Didn’t think about it
g. Other reason
__________________________________________________
31. In the past 12 months, did you receive any information on HIV/AIDS?
a. Yes b. No c. don’t recall
32. If yes, from where?
a. AIDS Secretariat d. CHAA g. From friend or
family
b. Media e. Private physician h. Hospital
c. District Clinic f. Employer i. Other
33. Do you think that HIV testing or education is readily available?
a. Yes b. No c. Don’t know
206

Access to Healthcare Services
34. When was your last medical check-up?
a. This past week d. Between 3 and 6 months ago g. Never
b. This past month e. Between 6 and 12 months ago h. Don’t recall
c. Between 1and 3 months ago f. Between 1 and 2 years ago
35. What was your experience like there?
a. Excellent, because____________________________________________
b. Good, because _______________________________________________
c. Poor, because ________________________________________________
d. Other (specify) _______________________________________________
36. Would you go back yourself or recommend this place to friends?
a. Yes b. No
37. If yes, why?
a. Price e. speak my language
b. Friendly helpful staff f. good medical care
c. Location g. Other foreigners are there
d. Other reason _________________________________________________
38. If no, why not?
a. Price e. Don’t speak my language
b. Unfriendly/not helpful staff f. Medical care not good
c. Location g. Don’t treat foreigners well
d. Other reason _________________________________________________
39. Do you think that the staff at the health service facilities had enough skills to give
care?
a. Yes, because _________________________________________________
b. No, because _________________________________________________
c. Don’t know
40. What do you think would be the characteristics of an excellent health facility?
a. Free or inexpensive
b. Better opening hours
c. Staff who speak my language
d. Friendly and helpful staff
e. Confidentiality
f. Other
________________________________________________________
41. What do other persons in your core group complain about as it relates to medical or
HIV care?
a. Price d. staff not helpful
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. Stigma and discrimination e. Facility not clean and tidy
c. Geographical location f. other (specify) ______________________
42. How do you cover your medical bills?
a. I have health insurance d. My employer pays for me
b. I use my medical benefit card e. I only go where I get free care
c. I pay out of pocket f. Other _______________________
43. What other health centers/clinics have you visited in the past 12 months?
_____________________________________________________________________
44. What government services did you use in the past year?
________________________________________________________________________
45. What medical or non-medical services do you need that are not readily available to
you?
_____________________________________________________________________
_____________________________________________________________________
Discrimination
46. Do you feel discriminated against in Antigua or not?
a. No not at all d. Yes, because of my profession
b. Yes, because of my nationality e. Yes, because of my gender
c. Yes because of my ethnicity f. other reason _________________
47. How was the discrimination displayed? (Go deep by asking for examples)
_____________________________________________________________________
_____________________________________________________________________
48. How often do you feel discriminated against?
a. Every day c. Sometimes e. Never
b. Regularly d. Rarely f. Unsure
49. If you did not feel discrimination, what about your colleagues of the same nationality;
did they feel discriminated against?
a. Every day c. Sometimes e. Never
b. Regularly d. Rarely f. Unsure
50. Is there any place or to anyone where you feel safe taking your concerns?
________________________________________________________________________
208

Knowledge of Services
51. Do you know where to go to get information on STI education, treatment and support?
a. Government agencies (Gender Affairs or AIDS Secretariat)
b. Medical organizations (hospitals or clinics)
c. Private agencies (doctor’s offices)
d. NGO’s (Planned parenthood, HHH, ABHAN)
e. Churches
f. Other (specify) _______________________________________
52. If you could implement a program that would best meet the needs of other persons in
your group, what would it entail?
_____________________________________________________________________
_____________________________________________________________________
53. When you are ill, do you go to a public (hospital or clinic) or private (physician)
facility for treatment? Which facility do you go to for what service?
a. Public facility:________________________________________________
b. Private physician: ____________________________________________
54. If someone you knew was HIV positive, where would you refer them for support?
a. Back home c. Hospital e. Other _________________
b. AIDS Secretariat d. HHH f. Don’t know
Do you agree or disagree with the following statements?
55. One can HIV from a mosquito bite
56. One can become infected with HIV if they share a
meal with someone who is infected
57. One can become infected with HIV if they share a
toilet with someone who is infected
58. A healthy –looking person can have HIV
Agree Disagree Don’t
know
209

CSW INTERVIEW SHEET
Date of Interview:________________
Form ID: _______________________
(last initial, first initial, year of birth)
Date of Birth: ___________________
Address: ________________________
Location: _________________________
Sex: _____________________________
Age: _____________________________
Country of origin: ___________________
Demographics
1. What is the highest level of education you have completed?
a. None e. Some college
b. Primary school f. Completed college
c. Secondary School g. Other (specify) _____________________
d. Technical/vocational school
2. What languages do you speak?
a. English
b. Spanish
c. French
d. Other ___________________________________
3. How long have you been in Antigua?
a. Less than 1 month d. Between 6 and 12 months
b. Between1and 3 months e. Between 1 and 2 years
c. Between 3 and 6 months f. Over 2 years
4. Who brought you to Antigua?
a. Friend
b. Family
c. Someone offered you a job
d. Came alone
e. Other (specify) __________________________________________
5. Do you have any family here with you?
a. Yes b. No
6. If yes, who is it?
a. Spouse
b. Children
c. Parents or siblings
d. Other (specify) __________________________________________
210

7. What social connections do you have in Antigua? (choose all that apply)
a. Friends d. Social group
b. Church e. None
c. Country association f. Other (specify) _______________
8. With whom do you work and socialize with in Antigua?
a. People from your country alone
b. Mostly local people
c. A mixture
d. Other
9. What is your profession?
a. Dancer d. Beauty salon worker
b. Sex worker e. Other (specify) _______________
c. Domestic help
Partner History
10. Do you have a partner (boyfriend or girlfriend) here in Antigua with you?
a. Boyfriend c. More than one
b. Girlfriend d. None
11. If yes, how long have you been together?
a. Between 1 and 12 months c. Between 2 – 5 years
b. Between 1 and 2 years d. 5+ years
12. In the past month, approximately how many partners did you have sex with? ____
13. How many were occasional partners with no money or goods involved? ________
14. How many were clients? ______________
15. In the past 12 months, how frequently have you had sex for money or goods in
Antigua?
a. Daily c. Occasionally (once or twice a month) e. Not at all
b. Weekends d. Rarely f. No answer
16. Where do you contact your clients? (Choose all that apply)
a. Sex club b. Street c. Internet d. other (specify) ___
Condom Use
17. In the past 12 months, have you used a condom in sexual relations with your
partner (boyfriend or girlfriend)?
a. Always c. Sometimes e. Never
b. Almost always d. Almost never f. No answer
211

18. In the past 12 months, have you had sex with someone who is not a steady
partner? (occasional with no money or goods involved)
a. Yes b. No
19. If yes, did you use a condom?
a. Always c. Sometimes e. Never
b. Almost always d. Almost never f. No answer
20. Where do normally you get condoms? (check all that apply)
a. AIDS Secretariat c. MSJMC e. Pharmacy/supermarket
b. CHAA d. Clinic/ Planned parenthood f. Other (specify)______
21. Did you receive any free condoms in the past 12 months? If yes, from who?
a. AIDS Secretariat d. CHAA g. From friend or family
b. Outreach worker e. Private physician h. Hospital
c. District Clinic f. Club/bar i. Other (specify) ________
22. Have you ever been instructed on how to use a condom?
a. No d. yes, from a health institution
b. Yes, at school e. yes, from family or friends
c. Yes, from my employer f. Other
HIV Information
23. Do you think you are at risk for HIV infections or not?
a. Yes, because _________________________________________________
b. No, because I always use condoms
c. No, because I only have one sex partner
d. No, because I choose my partners carefully
e. Other reason: ________________________________________________
24. Do you think you can tell by looking at someone if he/she is HIV+?
a. Yes.
b. No
25. When was your last HIV test?
a. This past week e. Between 6 and 12 months ago
b. This past month f. Between 1 and 2 years ago
c. Between 1and 3 months ago g. Never
d. Between 3 and 6 months ago h. Don’t recall
26. Did you receive counseling before and/or after your test?
a. Yes, before c. yes, both times
b. Yes, after d. Neither
212

27. Did you have to pay for the test?
a. No, everything is free
b. Yes, test is free but I pay for condoms
c. Yes, I pay for everything
28. Is your ability to pay a problem?
a. No
b. Yes, I can’t afford it
29. Where would you go for HIV testing?
a. MSJMC c. Medical doctor e. Other (specify)_________
b. AIDS Secretariat d. Clinic f. Don’t know where to go
30. If you did not do an HIV test recently, what is the most likely reason?
a. Did not know where to go
b. Afraid of the answer
c. I do not need one
d. They don’t speak my language
e. Can’t afford it
f. Didn’t think about it
g. Other reason _________________________________________________
31. In the past 12 months, did you receive any information on HIV/AIDS?
a. Yes b. No c. don’t recall
32. If yes, from where?
a. AIDS Secretariat d. CHAA g. From friend or family
b. Media e. Private physician h. Hospital
c. District Clinic f. Employer i. Other
33. Do you think that HIV testing or education is readily available?
a. Yes b. No c. Don’t know
Access to Healthcare Services
34. When was your last medical check-up?
a. This past week d. Between 3 and 6 months ago g. Never
b. This past month e. Between 6 and 12 months ago h. Don’t recall
c. Between 1and 3 months ago f. Between 1 and 2 years ago
35. What was your experience like there?
a. Excellent, because_____________________________________________
b. Good, because _______________________________________________
c. Poor, because ________________________________________________
d. Other (specify) _______________________________________________
213

36. Would you go back yourself or recommend this place to friends?
a. Yes b. No
37. If yes, why?
a. Price e. speak my language
b. Friendly helpful staff f. good medical care
c. Location g. Other foreigners are there
d. Other reason _________________________________________________
38. If no, why not?
a. Price e. Don’t speak my language
b. Unfriendly/not helpful staff f. Medical care not good
c. Location g. Don’t treat foreigners well
d. Other reason _________________________________________________
39. Do you think that the staff at the health service facilities had enough skills to give
care?
a. Yes, because _________________________________________________
b. No, because _________________________________________________
c. Don’t know
40. What do you think would be the characteristics of an excellent health facility?
a. Free or inexpensive?
b. Better opening hours
c. Staff who speak my language
d. Friendly and helpful staff
e. Confidentiality
f. Other ______________________________________________________
41. What do other persons in your core group complain about as it relates to medical or
HIV care?
a. Price d. staff not helpful
b. Stigma and discrimination e. Facility not clean and tidy
c. Geographical location f. other (specify) ______________________
42. How do you cover your medical bills?
a. I have health insurance d. My employer pays for me
b. I use my medical benefit card e. I only go where I get free care
c. I pay out of pocket f. Other _______________________
43. What other health centers/clinics have you visited in the past 12 months?
_____________________________________________________________________
214

44. What government services did you use in the past year?
________________________________________________________________________
45. What medical or non-medical services do you need that are not readily available to
you?
_____________________________________________________________________
_____________________________________________________________________
Discrimination
46. Do you feel discriminated against in Antigua or not?
a. No not at all d. Yes, because of my profession
b. Yes, because of my nationality e. Yes, because of my gender
c. Yes because of my ethnicity f. other reason _________________
47. How was the discrimination displayed? (Go deep by asking for examples)
_____________________________________________________________________
_____________________________________________________________________
48. How often do you feel discriminated against?
a. Every day c. Sometimes e. Never
b. Regularly d. Rarely f. Unsure
49. If you did not feel discrimination, what about your colleagues of the same nationality;
did they feel discriminated against?
a. Every day c. Sometimes e. Never
b. Regularly d. Rarely f. Unsure
50. Is there any place or to anyone where you feel safe taking your concerns?
________________________________________________________________________
Knowledge of Services
51. Do you know where to go to get information on STI education, treatment and support?
a. Government agencies (hospital or clinics)
b. Private agencies (doctor’s offices)
c. NGO’s (Planned parenthood, HHH, ABHAN)
d. Churches
e. Other (specify) _______________________________________
215

52. If you could implement a program that would best meet the needs of other persons in
your group, what would it entail?
_____________________________________________________________________
_____________________________________________________________________
53. When you are ill, do you go to a public (hospital or clinic) or private (physician)
facility for treatment? Which facility do you go to for what service?
a. Public
facility:__________________________________________________
b. Private physician: ____________________________________________
54. If someone you knew was HIV positive, where would you refer them for support?
a. Back home c. Hospital e. Other _________________
b. AIDS Secretariat d. HHH f. Don’t know
Do you agree or disagree with the following statements?
55. One can HIV from a mosquito bite
56. One can become infected with HIV if they share a
meal with someone who is infected
57. One can become infected with HIV if they share a
toilet with someone who is infected
58. A healthy –looking person can have HIV
Agree Disagree Don’t
know
216

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Behel, Stephanie (2010). CHAA Empowers Most At Risk Population with Training.
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ADHERENCE PROGRAM (PBTAP). Retrieved Feb 10, 2012 from
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Holder, A. (2011) HIV/AIDS Statistics Among Highest On Record.
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IAPG/UNDP (2011). Parliamentary Advocacy Interventions in Response to the HIV
Epidemic in the Caribbean. Retrieved March 25, 2012 from
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CHAA (2012) International Day: Stop Violence Against Sex Workers December 16,
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4
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KN Consulting
P.O. Box 2788
St. John’s, Antigua
Phone: 268-764-5574
korenkardia@hotmail.com
223