Life-saving drugs are finally getting through
to Jamaicans living with HIV, writes Dr Jeanette Meadway
Jamaica
is a country of contrasts. In the hills around Kingston you see mile upon
mile of large gated houses with driveways and security systems. Thirty minutes
away, in central Kingston, there are shanty towns comparable to any in India.
There is no free basic health care and employers provide health insurance
for the whole family on a yearly basis. A typical family can quickly use up
their whole annual entitlement leaving them to foot the full cost of health
care for the rest of the year. Insurance specifically excludes cover for any
HIV-related illnesses or antiretroviral medication.
Pills and bills
HIV positive people living in the large detached houses could afford even
the most expensive HIV drugs or fly to countries where treatment is widely
available. But most people can barely afford a trip to the doctor, while working
people, with or without health insurance, cannot afford the life-long cost
of HIV meds.
Less than a year ago, Jamaica introduced subsidised ARVs, funded by the Global
Fund for TB, Aids and Malaria, and the World Bank through the Jamaican Ministry
of Health. Patients contribute 1,000 Jamaican dollars a month (about £8)
towards their medication, but those unable to pay still receive it free.
Generic solutions
Dr Hylton Kong, consultant at the Comprehensive Clinic, in Kingston, told
me all the antiretrovirals were generic, apart from lopinavir (Kaletra). The
generics were from Cipla and Ranbaxy in India; mainly the AZT/3TC combo Duovir,
or D4T/3TC, with separate nevirapine or efavirenz. No triple combos are used.
The alternative first line treatment with a protease inhibitor is indinavir,
either eight-hourly as a single drug or twice daily with ritonavir; lopinavir
(Kaletra) is used as a second line PI. Other drugs can be ordered if a doctor
specifies they are needed, including nelfinavir, tenofovir, abacavir, and
atazanavir, but the dual ARVs used as ‘backbone’ to most first
line therapy in the UK are not used at all. So no Kivexa (lamivudine plus
abacavir) and no Truvada (emtricitabine plus tenofovir).
Baby-mammas
Jamaican mothers-to-be get offered HIV testing and drugs to prevent mother-to-child
transmission. The percentage of antenatal HIV testing is in the high nineties,
with positives running at one to two per cent. There is no single-dose nevirapine;
all women who test positive get zidovudine/lamivudine plus either nevirapine
or nelfinavir. Babies receive a single dose of nevirapine and one month of
zidovudine. There were no maternal deaths at St Catherine’s hospital
last year and the number of babies requiring the special care nursery fell.
Why bother?
Many Jamaicans do not believe HIV drugs actually work. Most are unaware of
anyone living well on ARVs because so few are able to be open about their
treatment. One man was told by a family member: “Don’t bother
with the treatment, you’re going to die anyway,” when refusing
them help to attend the clinic to get fresh supplies.
Stigma is rife because many assume all men with HIV are gay and all HIV positive
women are prostitutes. People with HIV have been beaten in the street, and
people tell of police joining in rather than stopping the attack. Some people
with HIV have been forced out of their community and their homes burnt. One
well-known rap song encouraged people to set fire to gay men: “Batty
boy, bon fe”.
During my visit I found some cause for hope. I helped to promote two key messages:
ARVs work and people with HIV should not be stigmatised. TV, radio and church
congregations were used to get the message across, and 70 Jamaican policemen
received HIV training.
• Dr Jeanette Meadway is a physician at the Mildmay Mission Hospital,
London.
People living with HIV are going public to tackle Jamaica’s deep prejudices,
says AnneMarie Dobson
If the Ministry of Health’s recent anti-stigma campaign, ‘Getting
on with Life’, is anything to go by, Jamaican society’s attitude
to Aids has definitely come of age. Today, Jamaicans wake up to the handsome
faces of a man and woman speaking publicly about their real personal experiences
of living with HIV.
Myth and prejudice
Yet people living with HIV believe stigma and discrimination still permeates
Jamaican culture. As 26 year old Annesha Taylor, the woman featured in the
TV ads, put it: “There are still Jamaicans who would prefer not to be
in the same space as someone living with the virus. Nevertheless, there is
a strong feeling that life goes on for all of us with HIV.”
One man living with HIV, who hails from the inner city, agreed: “I know
I cannot just let everybody know about it as I will be discriminated against.
There are people who believe that you got the virus because you were not being
an upright citizen.”
People in deep rural parishes, where there is little or no access to radio
or TV, face even higher levels of discrimination.
“The pace at which stigma is changing in many of these communities is
very slow, but there are still significant changes,” explained Daniel
Townsend, advocacy officer at the Jamaica Aids Support for Life. He said it
was still widely thought HIV mainly affects gay men.
“But to a large extent people are changing their views, as they now
recognise the majority of HIV cases here are among heterosexuals,” said
Townsend.
HIV
tests at work
While employers are changing their attitudes to HIV positive people in the
workplace, they are still pushing for their right to test staff. Recently,
the Jamaica Employers’ Federation announced employers should have the
right to test for HIV to enable them provide the ‘necessary assistance
to persons who are HIV positive.’ Many HIV advocates fear this will
lead to more discrimination. Daniel Townsend said mandatory testing would
deepen the perception of discrimination and alienate people with the virus.
Another man, living with the virus for more than 10 years, was dismissed from
his job at a well respected engineering firm after they found out he was HIV
positive.
“It was not a good feeling. In fact I never had any support at the time.
I think employers should try and help people like myself and not stigmatise
us,” he said
Sex workers
Stigma and discrimination is especially bad for disabled and vulnerable groups,
including sex workers. People often regard Jamaican women involved in sex
work as worthless and deserving of any virus, including HIV. Men who sleep
with men face similar stigma and cannot readily report their cases to the
health clinics for fear of abuse and discrimination. It is widely thought
people with disabilities should not be involved in sexual activities let alone
contract HIV. Many deaf women have been sexually abused mainly as a result
of myths associated with them.
“A great number of deaf people who are HIV positive are afraid to tell
anyone as they are afraid of what may happen. A lot of work needs to be done
to sensitise the public,” said Donavan Leslie, a deaf outreach officer
at the Jamaica Aids Support for Life.
• AnnMarie Dobson is a freelance writer and public education co-ordinator
for Jamaica Aids Support for Life.
• adobson@jamaicaaidssupport.com
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