The HIV/AIDS epidemic in Jamaica

A historical comparative perspective of the HIV/AIDS pandemic and its impact on the Jamaican adolescents.

By Jamar Davis and Paul Bourne B.Sc. (Hons.), Dip. Edu



Introduction/Background

In Jamaica, the HIV/AIDS pandemic has unleashed its influence over the general populace. The virus has eliminated many peoples of the productive sector. Despite the many social marketing campaign that have been aired on local media, the issue of HIV/AIDS has seemingly not reached the social consciousness of the average person. This paper seeks to provide scientific depth on the HIV/AIDS discourse through the vantage point of the Jamaican adolescents.

In 2003, 12-13 persons died weekly of virus (Ministry of Health, 2004). Is this a frightening experience or deafening one? This is even more alarming when we disaggregate the total statistics. As a significant number of cases are adolescents. It should be noted that Jamaica's highest rate of HIV/AIDS occurs among youth ages 15-24 years (USAID, 2000). Moreover, the estimated prevalence rate among youth is 0.44 percent for young women and 0.70 percent for young men (USAIDS, 2000). Between 1982 and 2001 close to one out of sixty AIDS cases were people between the ages of 10 and 19 ( Ministry of Health Aids Report, 2002)

The sexual behavior of Jamaican adolescents has come under severe scrutiny in regards to the increase of HIV/AIDS infections among that group. According to the Jamaica Reproductive Health Survey (1997), the mean age of sexual initiation among youth ages 15-24 was 13.5 for males and 15.9 for females. This is a clear indication that our young adults began their sexual experience before 16 years of age. According to the Adolescent Contraceptive Survey 2001, 41 percent of sexually active boys ages 15-19 are at a higher risk of contracting sexually transmitted infections. This is primary because they had more than one partner in the previous year and did not consistently use a condom (Hope Enterprises, 2001). What are some the contributory factors of this social behaviour of young adults?

There are many social misnomers and a lack of awareness about sexually transmitted infections. This reality has also promoted the highly risky sexual behaviour that is embraced by the Jamaican adolescents. In a study carried out by Kempadoo and Dunn (2001), concerning factors that relate to initiated sexual activity among adolescent boys and girls in three communities in Jamaica, an adolescent girl from Montego Bay believed that sexually transmitted infections were spread through mosquito bites. It is evident from this statement made by an adolescent, that many adolescents are not conscious of the basics concerning STI's/HIV viruses. Even though the type of response offered by the previously mentioned teen may not be typical, the general ignorance of HIV/AIDS continues to challenge the general populace and more so the adolescents.

In response to the increase of HIV/AIDS infections among Jamaican adolescents, a number of social agencies and governmental institutions have instituted AIDS education and prevention programmes in an attempt to transform the sexual behavioral patterns of adolescents. Several advertisements have been seen on television promoting condom use and abstinence. In an effort to address both the ignorance of sexual behaviour of people of Jamaica and the social stereotypes of the society, the government through the Ministry of Health has sponsored a series of social marketing campaign that are specifically geared towards better understanding and a drastic transformation of old social behaviour in regards to peoples sexual behaviour. The Ministry of health has created a Jamaica National HIV/STI prevention programme and a peer education programme. The question that needs to be addressed is: why have adolescents sexual behaviour not change for the better?


The historical comparative perspective of the HIV/AIDS pandemic affecting young adults

The relationship between HIV/AIDS awareness and sexual behaviour change among adolescents has attracted considerable attention over recent years. Consequently, several studies have been carried out which sought to assess the knowledge regarding AIDS, attitudes of people toward AIDS and AIDS victims and the sexual behavior of the young adults. These studies referred to as KAP studies, along with other literature on the topic will be reviewed for this paper.

One KAP study which was carried out by medicals students at the University of the West Indies, Mona Campus, showed that high school students still put themselves at risk of sexually transmitted infections despite having a good knowledge of how to prevent them.( Daily Gleaner, October 7th, 2003),. It was discovered that 71.4 knew about HIV/ AIDS and that condoms could help prevent it, but 40 per cent of students did not use a condom during their first sexual experience. Similarly, the results of a study carried out in South Africa by Mathews in 1990 on township high school students revealed the same thing. Students had a superficially high level of knowledge but did not practice safe sex. (Simbayi, 1999). One must consider though, that the history of the majority black population of South Africa prior to April 1994 was dominated by whites who did nothing to stymie the AIDS pandemic initially ,as they saw it as a gay and black man's disease, but later started education programmes. Although the public would have acquired a high knowledge about HIV/AIDS as a result of these programmes, their suspicions about the intentions of the white minority would have hindered any changes in behaviour (Simbayi, 1999).

Singhall & Rogers(2003) posits that just as many people continue to smoke despite knowledge of smoking's adverse health effects, many teenagers continue to engage in unprotected sex despite knowledge of risk behaviors associated with HIV transmission. Simbayi(1999) purports this view as well, as she states that since risks tend to lie in the future, some people take the view that we will all die some day anyhow and as such, see AIDS as one of those things some people will inevitably get and thus, they suppress the knowledge they possess about the threat of aids. This point can be compared to marijuana smoking. Adolescents are aware of the negatives of such an activity, but they enjoy the feeling so they perpetually do it and this could be the situation when it comes to sexuality.

The preceding studies mentioned have failed to explore the aspect of a change choice of sexual activity as a part of behavioral change. Lewin says in her article Teeenagers Alter Sexual Practices , thinking risks will be avoided, that in part because of the fear of contracting AIDS, oral sex has become a common place initiation into sexual activity widely perceived by many young people as less intimate and less risky that vaginal intercourse. She makes this assumption based on a study conducted by Dr. Schuster published in November in the American Journal of Public Health which stated that even among high school students in Los Angeles who were virgins, 10 percent had engaged in oral sex. This is an area which requires further research as adolescents' knowledge about contracting STI's may be only related to vaginal sex and this may put them at risk.

There have been some instances where AIDS awareness has had an impact on the sexual behaviour of high risk groups in a population. One such country is Tanzania where they introduced a radio soap opera called "Twende na Wataki" which was a form of AIDS entertainment education. This programme started in 1993. In 1994,some 72 per cent of the listeners in1994 said that they had adopted an HIV prevention behaviour because of listening to the programme. Furthermore in 1995, a survey revealed an increase to 82 percent, 77 per cent reduced the number of partners they had and 16 per cent started using condoms( Singhal & Rogers 2003). Ogunbanjo and Henbests' (1998) research on the knowledge, attitudes, and behavior of adolescents with regard to HIV/AIDS proved that an AIDS program can significantly increase awareness and knowledge and decrease high-risk sexual behavior. A study was conducted in Kwaggafontein in which 352 students from three high schools were used as study and control groups. Following the AIDS education program, the percentage of students in the study group showed a dramatic increase in awareness of AIDS as a problem in their community (from 44% to 74%) and knowledge about AIDS as a preventable (48% to 88%) and an incurable disease (41% to 87%). Most importantly, the study group showed a significant decrease in reported high-risk sexual behavior following the program.


Simbayi( 1999) states that aids awareness in some countries may be ineffective in some countries as it mostly theoretical as opposed to practical. In eastern and central Africa, people have a high level awareness due to the fact that people are dying all around them. Consequently, they may take the illness more seriously and alter their risk behaviours accordingly. In countries like Jamaica, people do not die as a result of AIDS as frequently as in Africa; thus, high risk groups do not take the illness as seriously.

Kirsch (1983) perceives the effectiveness of AIDS awareness programmes as being explained by the health belief model which is used in Health psychology. According to this model, people will engage in risk reduction behaviour if they feel threatened by an illness. Novia Connell, a behaviour change communication specialist at the ministry of education in Jamaica has a similar opinion as she opines that adolescents are not internalizing prevention messages because they do perceive themselves as being at risk.( Daily Gleaner , October 7th , 2003)

Most studies conducted on this topic reveal a weak correlation between HIV/AIDS awareness and sexual behavioural change. Diclement(1991) strongly opines that HIV/AIDS awareness needs to move beyond simply educating adolescents about modes of transmission and prevention measures, but should emphasize the growing susceptibility of adolescents to infection. Furthermore, it should deal with the training of parents, self esteem issues, peer pressure and negotiating safe sex as these are all important factors in promoting risk -reduction behaviour.

The issue of peoples' sexual behaviour cannot be easily change as though we are experimenting on lab animals and so we hope that this paper was just the beginning of many discourse on an issue that affects the lives of people our most precious resources. As such, we implore all parties to openly debate the matter with frankness and the desire to effectively address this pandemic before it changes into a September 11.



Terminologies used in this paper:
HIV/AIDS Awareness: the knowledge and beliefs about HIV/AIDS transmission
(Ordinal variable) high risk behaviour associated with the virus,
the incubation period and prevention measures.



Sexual behaviour: beliefs, and practices concerning sexual activity.



AIDS: a disease caused by HIV which breaks down the body's defense system,



HIV: the infectious agent which causes AIDS.


Adolescents: males and females between the ages of 14 and 24 (United Nation)


References

Babbie, E. (2004) The Practice of Social Research. Wadsworth: USA

Diclemente, R J. ( 1991) Predictors Of HIV Preventive Sexual Behaviour in a High Risk Adolescent Population. Journal of Adolescent Health

Hope Enterprises( 2001), Report of the Adolescent Condom Survey, 2001. Kingston, Jamaica.

Kempandoo & Dunn ( 2001). A study into the factors which shape the initiation of early sexual activity among adolescent boys and girls.

Kirscht, J.P.( 1983). Preventive Health Behaviour: A Review of Research and Issues. Journal of Health Psychology

Lewin, Tamar. (1997). Teenagers Alter Sexual practices, thinking risks will be reduced. New York Times Company

Mc Farlane et al. (1997) Reproductive Health Survey. Jamaica Family Planning Association. Kinston , Jamaica.

Ministry of Health AIDS Report (2002). Retrieved on April 2nd 2004 from http://www.moh.org.jm/

Ministry of Health AIDS Report (2004). Retrieved on April 2nd 2005 from http://www.moh.org.jm/


Ogunbanjo, G. A., & Henbes, R. J. (1998). Can AIDS education change sexual behavior? South Africa Family Practice

Simbayi,L C.(1999) Aids Awareness and Sexual Behaviour Change in South Africa. USA: Haworth Press

Simpson , T( October 7th, 2003) Risky Business. Retrieved on April 6th, 2005 from http://jamaica-gleaner.com/archives

Singhal, A. Rogers E.( 2003) Combating AIDS. California: Sage Publications.

USAID( 2000) . Jamaica Country Profile. Retrieved on April 5th 2005 from http;// www.usaid.gov/country/jamaica