HIV/AIDS is a social disease. It has no barriers and does not discriminate when it comes to gender, race, class, location, education or sexual orientation. In the Caribbean, we are still reported as the second-highest area of transmission, globally.
In Trinidad and Tobago, due to this high rate of infection, "What's your position? The ABC's of prevention" has become one of the many taglines used to promote awareness by the National AIDS Coordinating Committee.
However, due to many years of cultural conditioning, behaviour change is still a serious obstacle towards reducing transmission. HIV and AIDS infection targets the vulnerable and is attached to many other social ills, including domestic abuse, violence, incest, infidelity and sexual irresponsibility. In our "tropical paradise," where sex is merged with everything under the sun, many "high risk" groups develop with all-encompassing acronyms like CSW (commercial sex workers) and MSM (men who have sex with men).
When I first became involved in prevention work five years ago, I began to hear about the MSM group - the fastest-growing sexual group and also a well-travelled avenue to HIV and other STIs. When I first heard the term, it made me think of the candy that melts in your mouth, not your hands (M&Ms). I then made the common assumption that MSM were all homosexuals, or gays, in denial about their sexual proclivities. However, more research and work with this population showed me I was wrong - on both counts.
I came to discover that MSM is only a generic name or unfortunate label for many different kinds of men. Some are, of course, homosexual and/or gay men, either in or out of the closet. But they are also bisexual men, curious guys with homoerotic tendencies and male sex workers who tend to the needs of other men.
MSM are also men who follow the standard of a heterosexual life style: with a girlfriend, a wife or a girlfriend and a wife, but indulge in a sexual experience with guys from time to time. Simply put, they do not see having sex with a guy as ‘gay' because they are not, and stay as far away from the term as their testosterone can keep them
Often, in fact, MSM will condemn homosexuals and the public display of "gay" life style. For this reason, they rarely admit they have sex with other men to other people - or even to themselves.
When we promote focus groups or interventions "for the MSM community", I experience the same public misconception again and again: that these groups are all homosexual or gay men. Having sex with other men is far more complex and compressing MSM into one narrowly defined group would be much like labelling MSW (or men who have sex with women). We need to address this complexity and these differences if we are going to solve the problem of HIV.
Faithfulness and Denial
For a variety of reasons, condom use is not part of the MSM reality. For example, men who are in secure relationships with their wives and girlfriends often practice "being faithful" as a way of HIV/AIDS prevention. So, carrying condoms in their wallet is taboo and does not go along with the image of the perfect couple next door. They do not view their casual sex with other men as breaking those vows.
This is also the result of the "skin on skin" culture that characterises sex of any kind in the Caribbean. Couples in general equate trust and commitment with no condom use. They are sometimes used at the beginning of the relationship and thrown away after "trust" is gained in a couple of months. So why should they consider precautions when condoms represent an acknowledgement of risky sexual activity - something they "don't engage in."
This leads to liaisons that may include cruising areas other MSM frequent, posting an ad on a website for another "discreet male", or carrying a friendship a bit further with another straight, "willing" guy. This increase in proactive sexual behaviour can also be associated with the trend of globalisation - cable television, cell phones and Internet open the way to anonymous, easy access to other guys who may share the same inclinations. One night stands or casual encounters are seen as just an erotic activity. They never acknowledge the names or the sex because anything resembling an expression of gay sex is seen to them as alien. And the shame due to years of conditioning by the church in a developing country solidifies their fears.
Sex and sexuality are as widespread and diverse throughout the Caribbean as mangoes hanging on a tree, but some are hidden away due to the stigma created by the church and legal status. The ban against homosexuality is seldom enforced in Trinidad and Tobago, but is still a law. Despite all the sensual bliss of island life, carnival and other cultural aphrodisiacs, men indulging in same-sex experiences is still taboo and highly surrounded by shame.
Moreover, the consequences of HIV transmission cannot be contained within a group. MSM who engage in unprotected sex and acquire HIV do the injustice of transferring the infection to their other relationships. They may infect their wives, girlfriends and other male partners, thus creating an entire line of infection that will be hard to trace or identify over time, and may lead to other social problems, including orphaned children. But who is to bear the burden when it comes to growing up in a society that drives your feelings underground and makes your attraction an all-but criminal activity?
HIV is Everybody's Business
How then can men who do not acknowledge that they have sex with other men be expected to take on safe sex responsibilities? We in HIV/STI prevention have the challenge of mapping and reducing transmission in a prevalent sexual group that remains sexually incognito. Risk reduction intervention is the key to preventing infection and saving lives for men - gay, straight, bisexual, male CSW and undetermined. But the challenges are not with addressing the identity of the sexual group, but rather the health issue of prevention. Too much time is wasted on getting people to acknowledge what we ourselves can't pigeonhole.
Rather than labelling them by aligning their behaviour to something that is shameful and taboo, we should be broadening the outlines so that for everyone it is "just sex".
Sexuality is fluid and cannot be contained in jars and shelved. MSM seem to be more sexually promiscuous than their straight counterparts only because the partners involved have no time or avenue for courting and heterosexual foreplay. When I speak to guys or run focus groups, I do not address their sexual preference but ask them to look at what they are doing to protect their own lives and those of their families. Speaking to men is just that, not trying to get them to choose a side or a lifestyle that they do not have.
HIV and STI prevention is the same for all men. It includes proper condom use each and every time, negotiating condom use with sexual partners, risk reduction, relationship mitigation, getting tested and self-esteem development. This means getting guys to access condoms and use them when they have sex with whomever they choose.
As this hurricane of sexuality is sweeping across the Caribbean culture, it leaves in its wake HIV and STI transmission, not only to men who have sex with each other, but to all the relationships that surround them. This calls to mind a slogan we use frequently in Trinidad and Tobago: "HIV is everyone's business," confirming that that we all are vulnerable to infection, no matter what sex we choose to be identified with. Sex is part of who we are in the Caribbean. It is a part of us, but it does not define us. Being responsible, tolerant and knowledgeable will.