As I traveled to Jamaica for a South to South Learning Exchange, my head was full of all the numbers- HIV prevalence of 1.6%, 29,000 persons living with the disease, 81% of these know their HIV status, 43% of those on treatment and amongst those with 61% with viral suppression. I paid particular attention to the data on key populations and noted that Jamaica has one of the lowest HIV prevalence among the sex worker population in the region. In 2014, HIV prevalence among sex workers is 8.7% in Haiti, 5.5% in Guyana and comparatively low, 2.9% in Jamaica. Additionally, Jamaica’s data is suggesting that the prevalence among the population is declining, from 4.9% in 2008 to 2.9% in 2014. I was intrigued- what is different in Jamaica? What is contributing to this success? I had many questions and I was looking for some answers.
We spent the first two days of our four-day South to South Learning Exchange understanding the principles that guide Jamaica AIDS Support for Life (JASL) prevention programmes with a focus on key populations, defined as those having the highest risk of contracting and transmitting HIV. Having received a solid foundation and armed with the theoretical concepts, it was time to see their work in action. With much excitement, we “hit the road”. The teams coming from Guyana, Barbados and The Bahamas were eager to experience first-hand the uniqueness of JASL’s sex worker intervention and I was anxious to get some answers to my questions.
After a long journey, we arrived at “Back Road”. The long stretch of road was dark, with a constant flow of traffic both ways. Loud Jamaican music emanated from well-lit nearby bars. Numerous male patrons were seen hanging around with beer bottles in their hands, but only a few sex workers were standing along the roadside. The experienced JASL team quickly concluded that it was a “slow night” because it was mid-week. Nevertheless, we stopped at a point where there were a few commercial sex workers. JASLs team comprising of their peer navigator and HIV counselor/ tester approached them with ease and confidence. The sex workers willingly engaged the team and shared personal experiences on strategies they have used to protect themselves, including having the lights on. A lot of the discussion was on condom use, focusing on the size of the condoms and use of water based versus oil based lubricants. The peer educators were ready with their responses and once again I saw a condom blown as a balloon demystifying “small condoms”. We stayed for about an hour and a half, spoke with five-seven sex workers and tested four. As we concluded, it was clear to me that the sex workers were well educated on HIV and STI risk reduction and JASLs team has the expertise and experience for this type of work.
We departed “Back Road” at around 11 pm. It had been a long day for us and we were all tired. The bus was quiet – the music low and everyone deep in thought. I felt a renewed sense of commitment to serve the people who need our services most. I acknowledged the challenges of outreach work and had a greater appreciation and admiration for the work of civil society organisations. I applauded the field workers who spend many hours in the evenings combing the venues, seeking out persons to share techniques on the correct and consistent use of condoms, discuss HIV and STI risk reduction and test for HIV.
I drew from my experience as a former National AIDS Programme Manager and thought about a similar sex worker intervention in Guyana. I realized that there were as many commonalities as there were differences. I acknowledge that we are one Caribbean with similar cultures, but when it comes to HIV, the uniqueness of our specific context plays an important role in designing indigenous interventions that will change lives.
As I reflected on my questions, I realized that there is still more that I need to know. A little rest and I will be ready for the Day 3!