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• Inequality: Women are often assigned inferior social and economic roles. This makes them less powerful in their relationships with men. As a result they are often unable to resist men’s sexual demands. They cannot negotiate safer sex or refuse unsafe sex, even if their partner engages in high-risk behaviour. Some men may not want to use a condom, or they may want numerous sexual partners. In its most extreme form, this inequality results in violence against women, for example rape, sexual assault and beatings.
• Special vulnerability of girls: The average age of infection for women is much lower than for men. Young girls are especially vulnerable in a number of ways. Until her body is fully physically developed, a girl’s reproductive system is more likely to be torn during sex, making her more vulnerable to STIs (including HIV). Young women are also the least able to assert themselves or protect themselves from 62 the sexual advances or coercion by older men. In some cultures, it is believed that sex with a virgin will cure a man of the virus, and that younger females are less likely to be infected.
• Challenges for men: Men are often expected to be the chief provider of income through work—however dangerous, dirty or unpleasant. They may travel within their country, or even go abroad to find work. Or they may have to accept jobs that mean they are away from their families for long periods. In many societies, men believe that they know, or are expected to know, about sex and what to do, though they may not. This may prevent them from seeking information about sex and are less likely to receive information about HIV and AIDS.
If we want to reduce the vulnerability of women to HIV infection, and the spread of the disease, we must look at ways of enabling men and women to negotiate their relationships on a basis of equality.
MSM refers to “men who have sex with men”. These men may be homosexual and only have sex with men, or they may be bisexual, which means that they have sex with both women and men. Men who have sex with other men, may not want to identify themselves as being either homosexual or bisexual. In addition, some men married to women also have occasional sex with men. Finally, there are men, such as those restricted to remote construction sites or prisons, who sometimes have sex with men because they do not have access to women.
MSM are vulnerable to HIV infection for a number of reasons. One reason is that most HIV prevention campaigns target heterosexuals, and as a result MSM mistakenly think that they are not at risk of being infected with HIV when they have sex with other men. Another reason is that many MSM live a clandestine lifestyle because of society’s views of homosexual activity. As well, few prevention programmes will talk openly and explicitly about safer sex between same-sex couples.
Remember, anal sex (for both men and women) is very risky behaviour, particularly for the receiver. It is recommended that non-oil based lubricants are always used during anal intercourse.
Human Rights Human rights are entitlements that are due to all individuals. Persons living with HIV and AIDS have the same human rights as every other person. These internationally recognized rights include the
• The right to life
• The right to protection against discrimination
• The right to private life
• The right to employment
• The right to education
• The right to health care
• The right to dignity
• The right to shelter
• The right to freedom of movement
• The right to freedom of expression
• The right to freedom of thought and religion
• Mandatory HIV testing as a part of the job application
• Breaches of confidentiality regarding HIV-related personal information
• Denial of promotion/training based on HIV status
• Termination of employment based on HIV status If people are afraid of losing their jobs or being stigmatized, they are more likely to conceal their HIV-positive status.
At the workplace, people living with HIV need and deserve the respect and support of their co-workers in dealing with the challenges of being HIV positive.
Stigma Stigma can be defined as negative thoughts about a person or group based on a prejudice. In the context of HIV and AIDS at the workplace, stigma may lead to workers living with HIV being ostracized by their co-workers because of the co-worker’s misconceptions about HIV and how it is transmitted.
Discrimination is defined as the negative practices that stem from stigma. For instance, an HIV-positive worker is discriminated against if he/she does not get promoted because of his/her HIV-positive status. Stigma is the attitude and discrimination is the behaviour.
66 How to overcome stigma and discrimination at the workplace
• Emphasize that casual contacts do not pose a risk of HIV infection.
• Stress that HIV-positive people can live productive lives.
They can remain in good health and work for years, despite their infection. Work keeps them going and enables them to contribute to productivity and take care of their families.
• Involve people living with HIV in peer-education sessions. Whenever possible, ask people living with HIV to talk about their situation with participants.
➢ • Bring HIV out of the shadow. Most adults have sex.
Many have sexual relations that put them at risk. Young people are particularly vulnerable because many do not have regular partners. Sexual realities that put people at risk need to be talked about openly and honestly.
Employers should not engage in, or permit, any personnel policy or practice that discriminates against workers infected or affected by HIV and AIDS.
HIV/AIDS Workplace Policies The ILO Code of Practice on HIV and AIDS and the world of work has been developed in collaboration with governments and employers’ and workers’ organizations. The ILO Code of Practice has ten key principles to be applied in the development of effective policies and
programmes at the workplace:
1) Recognition of HIV and AIDS as a workplace issue
3) Gender equality
4) Healthy work environment
The Trinidad and Tobago National Workplace Policy for HIV and AIDS is based on the key principles of the ILO Code of Practice on HIV/AIDS and the world of work.
Acquired Immune Deficiency Syndrome (AIDS): A condition caused by infection with the Human Immunodeficiency Virus (HIV).
HIV injures cells in the immune system. This impairs the body’s ability to fight disease. People with AIDS are susceptible to a wide range of potentially life-threatening diseases and infections. AIDS is the last and most severe stage of the clinical spectrum of HIVrelated disease.
Antiretroviral therapy: Antiretroviral (ARV) drugs inhibit the replication of HIV. When antiretroviral drugs are given in combination, HIV replication and immune system deterioration can be delayed, and survival and quality of life improved.
Asymptomatic: Without signs or symptoms of disease or illness.
Most people who are HIV positive show no symptoms for five to ten years.
Behaviour Change: An interactive process to develop tailored messages and approaches for a specific group, to enable them to develop positive and sustained behaviour.
Behaviour Change Communication (BCC): A strategy that involves various tactics such as peer education to inspire behaviour change.
CD4 cells: Cells that are responsible for attacking and killing many other disease-causing germs. These are the cells that HIV attacks and destroys.
Human immunodeficiency virus (HIV): The virus that causes AIDS.
The virus remains in the body for five to ten years before the full symptoms of opportunistic infections or AIDS appear.
Interpersonal communication: Exchange between people regarding information or experience related to HIV and AIDS. Peer education is one example of interpersonal communication.
69 Opportunistic infections: Illnesses that afflict people with weak immune systems. Common opportunistic infections include tuberculosis, certain kinds of pneumonia, fungal infections, viral infections and lymphoma.
Peers: A group of people who share common characteristics such as age, gender, socioeconomic status or occupation.
Peer Educator: Person at the workplace who is trained to facilitate discussions on high-risk behaviours relating to HIV, and leads his or her peers in the examination of solutions.
People living with HIV (PLHIV): People who have contracted the virus that causes AIDS.
Stigma: Negative thoughts about a person or group, based on a prejudice.
Universal precautions: A set of standard infection-control practices to be used to minimize the risk of infection or disease from blood-borne organisms which cause disease.
Voluntary counselling and testing (VCT): A service provided to anyone who wants to be tested for HIV, to find out if HIV antibodies are present in his/her blood. The test should only be done with the full consent of the individual, and pre- and post-test counselling.
Contacts for Care and Support TRINIDAD Caribbean Regional Network of Positive Persons (CRN+) 627-8741 Community Action Resource (CARe) 625-0632 Cyril Ross Nursery 662-8975
The Rap Port Youth Information Centre :
Port of Spain branch 627 1240 Ext. 242 Arima branch 667 5774 South AIDS Support (SAS) 652-AIDS(2437) Trinidad and Tobago HIV and AIDS Alliance (TTHAA) 623-9714 Voice of One: Overcomer’s Club 679-6747 TOBAGO Tobago AIDS Society (TAS) 635-1024 Tobago Oasis Foundation 635-1088
HIV and AIDS Hotline:
625-AIDS (2437) or 800-4HIV(4448)
Further Reading Caribbean Epidemiology Centre (Carec)/PAHO/WHO Special Programme on Sexually Transmitted Infections/the National AIDS Coordinating Committee of Trinidad and Tobago. 2002. FAQ (Frequently Asked Questions) Some facts about AIDS and HIV Centers for Disease Control and Prevention. 1986. Universal Precautions for Prevention of Transmission of HIV and Other Bloodborne Infections. (Department of Health and Human Services, USA).
Government of the Republic of Trinidad and Tobago, Ministry of Health, National Surveillance Unit 2006. Annual Report 2006.
Government of the Republic of Trinidad and Tobago.2008. National Workplace Policy on HIV and AIDS.
ILO, 2001. An ILO Code of Practice on HIV/AIDS and the world of work. (Geneva), ILO/Family Health International. 2006. HIV/AIDS behaviour change communication: A toolkit for the workplace. (Geneva).
ILO. 2002. Implementing the ILO Code of Practice on HIV/AIDS and the world of work: an education and training manual (Geneva).
ILO/World Health Organization. 2005. Joint ILO/WHO guidelines on health services and HIV/AIDS (Geneva).
http://www.ilo.org/aids ILO Programme on HIV/AIDS and the World of Work (ILOAIDS) http://www.unaids.org Joint United Nations Programme on HIV/AIDS http://www.nacctt.com National AIDS Coordinating Committee, Trinidad and Tobago