Access to HIV Services for Mobile and Migrant Populations in Antigua

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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
Page 1 and 2: APRIL 2012 A Mapping Study on Acces
Page 3 and 4: FACTS ABOUT ANTIGUA • Capital - S
Page 5 and 6: 5. Design of Survey Tools………
Page 7 and 8: 3.2.4. HIV Information and Testing
Page 9 and 10: List of Acronyms AIDS ABHAN APPA AR
Page 11 and 12: Executive Summary Background Due to
Page 13 and 14: There is clearly a lot of stigma an
Page 15 and 16: Background to Study A quick search
Page 17 and 18: Table 1 - Population by Parishes Pa
Page 19 and 20: Relevance of Study Several reports
Page 21 and 22: ‣ Desk Review - a compilation of
Page 23 and 24: This review attempts to examine som
Page 25 and 26: Kempadoo (2010) recalls that “Ant
Page 27 and 28: Table 6 - Remittances as Percentage
Page 29: members of the sex-worker populatio
Page 33 and 34: population about their role in the
Page 35 and 36: CHAA, based on an Inter-American Pa
Page 37 and 38: The Government of Antigua and Barbu
Page 39 and 40: Population Services International (
Page 41 and 42: MAPPING METHODOLOGY Population Due
Page 43 and 44: Design of Survey Tools The survey f
Page 45 and 46: STAKEHOLDERS REPORT For this projec
Page 47 and 48: AIDS Secretariat/NAP office Redclif
Page 49 and 50: Mount St. John’s Medical Centre M
Page 51 and 52: suspicion in the department of some
Page 53 and 54: services as this does act as a barr
Page 55 and 56: Non-Governmental Organizations (NGO
Page 57 and 58: and MSM’s are referred to Directo
Page 59 and 60: in navigating the health care syste
Page 61 and 62: Questionnaires are issued and there
Page 63 and 64: There are costs attached to the pro
Page 65 and 66: to her by the social worker at the
Page 67 and 68: funding, but they are still very fu
Page 69 and 70: Encouragement should be made to civ
Page 71 and 72: Where are the places that you provi
Page 73 and 74: Do you collaborate with any other a
Page 75 and 76: MSM Survey and Focus Group Report M
Page 77 and 78: Free Condoms Figure 13- Free condom
Page 79 and 80: Table 9- Reasons for not having an
Page 81 and 82:
care. Some had no answer as they ha
Page 83 and 84:
coming out or dealing with the stig
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Misconceptions At least 90% of the
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Create a job bank - having a job co
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57.8% of the young ladies work on t
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them to read. “Only CHAA really w
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It is quite evident that fear has c
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care and an inviting friendly atmos
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They need to be able to access a gy
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Type of facility frequented for tre
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Their expectations for their core g
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General Discussion and Conclusion T
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Many of the ladies expressed a desi
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Policy Aspects The National
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target population. Purpose: this wo
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information on existing testing sit
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ANNEX _____________________________
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Support Clothes Populations Served
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Demographic 8 participants Sex: Mal
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3. Where are the places/spots that
Page 121 and 122:
that most MSM’s are very particul
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‣ Men’s health care clinic - wh
Page 125 and 126:
‣ Confidential organizations wher
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French 3 3.1 Other 0 0.0 Total 105
Page 129 and 130:
their country as a group. 5.2% of t
Page 131 and 132:
Partner History Partners in Antigua
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Sex for pay (how many of the sexual
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Table No. 25- Partner has spouse or
Page 137 and 138:
Condom Supply The majority of the p
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How to use condoms/Instructional co
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percentage when one considers that
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Ability to pay for HIV testing Tabl
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They don’t speak my language 0 0.
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Never 15 15.7 Don’t recall 24 25.
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Other foreigners are there 12 12.6
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Facility not clean and tidy 4 4.2 O
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Sometimes 24 25.2 Rarely 16 16.8 Ne
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Responses Number Percentage Public
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No response 1 1.0 Total 95 99.8 Tab
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Focus Group Responses 1- What are s
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5- What are some of the factors tha
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oyfriends. One participant also sai
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Marital Status: All were unmarried
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They face a lot of difficulties whe
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Figure35 - Breakdown of country of
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Table No. 61- Length of time in Ant
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groups of other persons from their
Page 175 and 176:
Number of Respondents Number of Res
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Table 70- Showing how clients are c
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Condom Supply When asked where they
Page 181 and 182:
How to use condoms /Instructional c
Page 183 and 184:
Table 79- Showing amount of persons
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discrimination. Some 59.6% of the r
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Reasons for not having had a recent
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Availability of HIV testing or educ
Page 191 and 192:
Table 90- Showing their perception
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Reasons for not recommending facili
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DISCRIMINATION Discrimination faced
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“They call me Spanish and they al
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Back to school program Back to scho
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Training center where we can learn
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Disagree 91 79.8 Don’t know 20 17
Page 205 and 206:
7. What social connections do you h
Page 207 and 208:
c. Between 1and 3 months ago g. Nev
Page 209 and 210:
. Stigma and discrimination e. Faci
Page 211 and 212:
CSW INTERVIEW SHEET Date of Intervi
Page 213 and 214:
18. In the past 12 months, have you
Page 215 and 216:
36. Would you go back yourself or r
Page 217 and 218:
52. If you could implement a progra
Page 219 and 220:
The CARICOM single Market and Econo
Page 221 and 222:
CHAA (2012) International Day: Stop
Page 223 and 224:
Thomas-Hope, Elizabeth (1986),”Tr
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Access to HIV Services for Mobile and Migrant Populations in Antigua

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