Towards an AIDS Free Caribbean

Dr. Carolyn Gomes is Executive Director of the Caribbean Vulnerable Communities Coalition

By Dr Carolyn Gomes

Last week the Caribbean Vulnerable Communities Coalition (CVC) wrote to the administration of the University of the West Indies (UWI) on behalf of over 30 diverse civil society groups across the region, to thank them for preserving the University’s ability to continue to be a leader in the regional response to HIV, by insisting that those who lead its HIV initiatives are accountable to its principles and are advocates of sound public health policy.

20131028diasporaIn a release on Tuesday May 19, 2014, UWI made clear the reason it terminated its contractual arrangement with our colleague retired Prof. Brendan Bain to direct its Caribbean HIV/AIDS Regional Training Centre Network (CHART) : “Professor Bain has lost the confidence and support of a significant sector of the community which the CHART programme is expected to reach, including the loss of his leadership status in PANCAP, thereby undermining the ability of this programme to effectively deliver on its mandate”. The University’s communiqué further noted:

● “The majority of HIV and public health experts believe that criminalising men having sex with men and discriminating against them violates their human rights, puts them at even higher risk, reduces their access to services, forces the HIV epidemic underground thereby increasing the HIV risk. These are the positions advocated by the UN, UNAIDS, WHO, PAHO, the international human rights communities and PANCAP (The Pan Caribbean Partnership against AIDS).”

● “in a high-profile case in Belize in which Caleb Orozco, a gay man in Belize, challenged the constitutionality of an 1861 law that criminalises men having sex with men…Professor Brendan Bain provided a Statement on behalf of a group of churches seeking to retain the 1861 Law.”

● “Many authorities familiar with the Brief presented believe that Professor Bain’s testimony supported arguments for retention of the law, thereby contributing to the continued criminalisation and stigmatisation of MSM.”

We are deeply troubled that public perception and reporting by responsible media houses continues to indicate that Prof. Bain was fired as a professor, and that this was for factual statements about the epidemiology of HIV. We also note that our colleague Prof. Bain provided his expert testimony not at the request of the state but a group of churches that intervened in the case in a way that has painfully polarised rational discourse about sexuality and citizenship across the Caribbean region.

We thank retired professor Brendan Bain, with whom many of us once worked productively and collegially, for his acknowledged contributions to fighting HIV in the region, and we reaffirm our respect for his freedom to express his personal views in academic and other settings. It is not his right to have deeply held views that has been at issue, but the evident conflict of his action in the Belize court case with his capacity to represent UWI’s values in leading an HIV movement working for health and justice for all.

The University has been careful to note the hurt Prof. Bain’s advocacy has done to gay and lesbian persons in the Caribbean and to others in the region who are affected by discrimination and stigma. But that should not be misconstrued. His dismissal is no victory of anyone over anyone else. There is one Caribbean in which we all find ourselves— those who supported Prof. Bain, and the diverse groups who engaged CARICOM, UWI and others to point out that his continued leadership had become untenable and was damaging the University — a Caribbean we are committed to building. We share with the University a commitment to inclusion of everyone, in law, in health, in dignity. We are pleased that these principles have won over the notion of a region where some people’s humanity is inconvenient to others.

Professor Bain spoke no inconvenient truth in his testimony. The fact that men who have sex with men have significantly higher rates of HIV is widely known and acknowledged, and one reason for an urgent and more unified regional response. Where our colleague Prof. Bain erred was in linking without evidence those high HIV rates to the removal of laws that criminalise homosexuality in France, the Netherlands and the United States, while ignoring that neither laws nor Jamaica’s notorious hostility to homosexuality have protected us from having one of the highest rates of HIV infection among men who have sex with men in the world.

The research cited by Professor Bain is not his own; it comes from Johns Hopkins University, and in fact, the actual conclusions of the study he cited (which are also widely accepted) were that criminalizing same-sex sexual acts is a barrier to decreasing the prevalence rate of HIV in MSM, in complete opposition to the position he presented in his affidavit.

As the author of that study and epidemiologist Chris Beyrer wrote in the Jamaica Gleaner last year, “People who are afraid and feel threatened avoid health care, do not seek or get HIV testing or other services which can help reduce risks, and are less likely to be treated for HIV if they are living with the virus. Punitive and hostile policies do not reduce HIV risks – they increase them.” There is broad public health consensus that, rather than retaining laws that punish some and increase HIV risks, we make the region safer for all by “making condoms and lubricants widely available and cheap, by treating STI in settings of dignity, safety, and quality of care, so that people at risk will seek and use the services they need. We also do so by listening to patients, being non-judgmental, and helping them reduce their real risks -which they will not disclose if they are afraid.”

Professor Bain is free to draw his own conclusions and recommendations from the published studies but cannot then expect to continue to enjoy the confidence of the communities it is his job to reach, who have diametrically opposed conclusions and recommendations. He should have seen that this would pose a problem of conflict and trust and stepped aside. As so eloquently expressed by Kei Miller “I’m not sure how anyone can provide leadership to people who expressly do not want to be led by that person. Such a situation is simply and tragically untenable.”

Prof. Bain undermined his own leadership position with his affidavit. He did so in ways that damaged the University’s reputation, lacked professional forethought, and betrayed the mission of the UWI unit he was asked to lead — “to strengthen the capacity of national health-care personnel and systems to provide access to quality HIV & AIDS prevention, care, treatment, and support services for all Caribbean people”. We need strong, credible UWI leadership in the regional epidemic.

When the dust settles on this issue perhaps we, the people of the Caribbean, will finally have had the frank and open discussion which will allow us to take a significant step forward. A step forward for understanding and exposing and addressing prejudice, be it on the basis of race, or religion, or sexual orientation or HIV status. A step forward for being an inclusive region where in the words of Trinidad’s anthem ‘every creed and race finds an equal place’.   A step forward towards an AIDS free Caribbean.

Excerpts from a Q&A regarding the termination of Professor Bain

Are gay men more at risk of becoming infected with HIV or not?

 

Yes. A combination of biological and structural factors put men who have sex with men (MSM) at higher risk for HIV. The two regions in the world with the highest rates of HIV infection are Sub-Sahara Africa and the Caribbean. Our region also has the most unsupportive legal framework for addressing the HIV and AIDS epidemic compared with any other region in the world, according to a Harvard School of Public Health. Criminalization of MSM and high HIV prevalence are intrinsically related.

 

What does the public health science say about homosexuality, buggery laws and HIV?

 

There is an authoritative global body of science supporting the removal of punitive laws which criminalize sex between consenting men, accepted by the UN, UNAIDS, WHO, the Pan Caribbean Partnership against HIV and AIDS, and the Johns Hopkins School of Human Rights and Public Health, among many other important academic institutions and global agencies. Criminalizing laws can intimidate MSM, leading them to avoid healthcare out of fear of arrest or threats of violence.

 

The research that Professor Bain cites in his witness statement was produced by various scientists and then published in the respected scientific journal The Lancet in 2012. The studies all show that legal barriers complicate the delivery of HIV prevention and that policies which criminalize homosexuality, notably in the Caribbean, are associated with increased prevalence of HIV infection in black MSM.

 

The same research culminates by making a series of recommendations, including the decriminalization of same-sex sexual relations and targeted programs to reduce homophobia. It shows that even the best biomedical and behaviour change interventions fail without spaces in which men can safely seek care and services and communicate openly about their sexual lives. To suggest the science supports retention of colonial buggery laws is misrepresentation and misuse of the information.

What about freedom of expression?

If the HIV and AIDS epidemic has taught us anything, it is that respect for all people’s human rights is critical. Everyone has the right to the freedom of expression and different points of view. In open societies, people may and do disapprove of homosexuality. Yet people who choose to take leadership positions in the response to HIV should not expect to express views in direct opposition to accepted science and best practice and continue to retain the confidence of the communities they are meant to benefit and of regional actors in the response to HIV. This is a conflict of interest.

On Professor Bain

Professor Bain is a good man who has worked in the field of HIV for many years. He was not fired as a Professor, he is retired. His contract with CHART was terminated.

 

Who are we?

Civil society’s role in the HIV epidemic is critical in developing strong community systems for front-line responses to HIV. This is recognized globally. We are a diverse civil society group formed of groups of people living with HIV, women, civil liberties groups, as well as LGBT people. We came together to protect strong, credible UWI leadership in the regional epidemic.

 

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