Turning the tide on tradition
by Catherine Lengyel

Teresa is a trim, petite Dominicana. Her face is lively and her eyes sparkle as she agrees, after the briefest of hesitations, to tell us her story. It is a story like so many others, although the pain - and the courage - are uniquely her own.

"Something was wrong. I could tell. So I listened on the phone extension. That's how I found out that my husband had AIDS. He had known about it for months and had not told me. I felt cold all over. I knew that I must have it too. Six months later, he died."

The statistics are alarming. The Caribbean is the second most affected region in the world, with an overall prevalence of HIV/AIDS of approximately 2.2 per cent among adults. According to the latest UNAIDS/ World Health Organization (WHO) figures, at the end of 2001 there were approximately 420,000 people in the area living with the virus - although some put this figure at closer to 700,000. Today, AIDS is the leading cause of death among 15-44 year olds.

The truth about AIDS

As the HIV/AIDS pandemic in the Caribbean and throughout the world reaches massive proportions with little sign of abating, the need for a global response is vital.

This year the Federation, in collaboration with 60 National Societies, launched a worldwide campaign to reduce HIV/AIDS-related stigma and discrimination, "The truth About AIDS. Pass it on...". The tragedy of AIDS is that while stigma and discrimination have many different forms, the end result is the same. The infected and sick - and often their families - are shunned, ostracized, even denied access to social and medical services.

Attacking stigma and discrimination against those living with HIV/AIDS is not enough on its own. That is why this campaign includes a three-fold approach that also supports prevention programmes and care and support for those already infected by the disease.

As secretary general, Didier Cherpitel, explained in his speech to launch the global campaign, "For 'The truth about AIDS…' is that it is sweeping away whole generations of young people; it is making orphans of millions of children; it is destroying communities; it is impoverishing countries. 'The truth about AIDS' is that stigma and discrimination against people living with the disease are fuelling the pandemic and condemning millions to misery, fear and loneliness."

For more information on the campaign visit the Federation's web site at www.ifrc.org

Price of silence

In the Caribbean, HIV/AIDS is something one simply does not talk about. Strong cultural taboos prevent people from dealing with the problem openly.

Support, back in 1997 when Teresa found out, was not readily available and remains insufficient. Teresa is quite graphic: "There was a lot of whispering in the neighbourhood, but I carried on as if nothing was wrong. I made sure that I looked good and smiled a lot. After three months, my neighbours started talking to me again. But not about HIV. I haven't told my family either. I only allow myself to cry at night, when my children are asleep."

In some ways, Teresa is one of the lucky ones. The Dominican Republic, which has the third highest rate of reported HIV/AIDS in the Caribbean (estimated at 2.8 per cent) after Haiti and the Bahamas, is one of the countries that is trying to face up to the problem. There is HIV testing for pregnant women and a law on HIV/AIDS which deals with diagnosis and reporting, prevention measures, and individual and collective rights and responsibilities.

For Teresa, there was eventually a helping hand that pulled her into the Dominican Network of People Living with HIV/AIDS (REDOVIH+). From there, she arrived at the Dominican Red Cross, where she now acts as a volunteer counsellor.

Franklin Gomez, national director of the Dominican Red Cross's health department, explains that the National Society has been active on the HIV/AIDS issue since the epidemic was first identified in the early 1980s. "Today, I can say that the Dominican Red Cross is one of the institutions most readily identified with HIV/AIDS-related work - because of the security of our blood bank, our readily accessible and confidential testing facilities, our volunteer training programme, as well as our growing commitment to advocacy." He is proud of the changes he has seen within the organization over the years and of the National Society's continuing commitment.

Ruben del Prado, UNAIDS inter-country programme advisor for the Caribbean, does not mince his words. "The Red Cross is traditional, it has dignity, it has respect. It has National Societies everywhere and volunteers who actually capture the power of humanity. It is one of our most important partners in the Caribbean."

A woman's problem

As always though, there are crucial gaps in the system and women are particularly prone to them. Of particular concern is the dramatic and constant increase of HIV/AIDS among women and girls. In the Dominican Republic alone, ten years ago there were seven men living with the virus for every woman similarly affected. Today, women have achieved an unhappy parity - a result of both their greater physical vulnerability and lack of power to negotiate safer sex practices with their male partners. Furthermore, as the number of HIV-infected women grows, the number of children born with virus also increases.

Lissette, ex-president of REDO VIH+, explains that although treatment for HIV-positive pregnant women is now available in the Dominican Republic, free access to milk is not. Many women cannot afford to buy it and, again, attitudes play their part. "In the same way that 'real' men do not use condoms in our culture, because it's not macho, so women have no option but to breastfeed despite the risks to their newborn. They are often frightened to admit to their husbands that they are HIV-positive - even though he is most likely the cause of their infection," she explains wryly.

The numbers coldly reflect the attitudes. At the end of 2001, UNAIDS estimated that there were more than 20,000 children living with HIV/AIDS in the Caribbean - of whom 5,800 were in the Dominican Republic.

Youth initiatives

"If our parents hadn't had so many taboos, there would not be so many problems in our communities today", says Jonathan Sanchez, a youth educator with the Dominican NGO PROFAMILIA. "The problem is that youth don't want to know. They think condoms are uncomfortable and they certainly don't want to be preached at adults. They think it's all a lie, a strategy to get them to 'behave'."

Reaching out to young people is a national priority and the Red Cross is a key partner for youth-related prevention programmes. Federation regional health delegate, Raul Gallegos, confirms that providing young people with candid information and lifeskills is a prerequisite for success in any AIDS response, especially in a region where more than half the population is under 24, and where teenage pregnancy rates can reach 25 per cent.

This is where an innovative programme, initiated by the Netherlands Red Cross in partnership with the Dominican Red Cross, comes into the picture. Through sports and other leisure activities, it attracts vulnerable youth from the barrios and provides them with information on, among other things, drug abuse and HIV/AIDS. These youngsters are then trained to carry the message on to others.

The dust and swarms of mosquitoes cannot dim the bright faces and enthusiasm of this group in La Caleta, a suburb of the Dominican capital. Talking to them, it is obvious that the programme is a success. Gaby, a gangly 18-year-old who can't sit still, is quite candid. "I was 100 per cent at risk. If it hadn't been for this project, I know I would be HIV-positive by now." The others giggle, yet nod their heads in agreement.

Obviously, such initiatives will need to be multiplied if the Caribbean is to see a wave of change. The Red Cross clearly recognizes this. Teresa sees herself as part of this change. She may be out of work and certainly cannot afford treatment, but as she says, she is "doing OK".