Cultural Dimensions of HIV Prevention in Guyana

GEORGETOWN, Guyana—Anesa Barnes (17), is a peer educator in a HIV prevention programme in Parika, a town on the banks of Guyana’s huge Essequibo River. But in this multi-cultural and multi-ethnic community, she doesn’t even mention condoms until she learns something about her peers’ religious views and perspectives on pre-marital sex.

This may seem surprising, in a project that aims to prevent HIV. But it is in keeping with the ‘culturally sensitive approach’ that has long been promoted by UNFPA, the United Nations Population Fund, which supports Anesa’s peer education training. Such approaches call for a cultural fluency – an understanding of how cultures work and how to work with them.

This is important in Guyana, a multi-cultural slice of South America located on the continent’s Atlantic coast. Guyana has one of the highest HIV-prevalence rates in the region, according to UNAIDS (2008 figures). It is also a deeply religious society dominated by three main groups: Christians, Hindus and Muslims. Indigenous groups, known as Amerindians, are also part of the ethnic mix, but they are not prominent in the country’s capital and coastal areas.

A mix of religions and cultures

Messages about HIV prevention must take into account the cultural context of each group. UNFPA has teamed up with a range of ethnic and religious leaders who act as ‘cultural gatekeepers’ and guides to the country’s many subcultures. They help shape the various messages promulgated by members of various youth educational organizations. The idea is to work from a deep understanding of community beliefs, establish a connection between these beliefs and human rights, build trust and minimize conflicts.

This year’s State of World Population report, entitled ‘Reaching Common Ground: Culture, Gender and Human Rights’, argues that cultural attitudes and practices are not always in tune with the goals of gender equality and human rights. However, these attitudes and practices must be understood in order to appreciate why people make the choices they do. Without this kind of understanding, it is difficult to motivate behavioural changes that can, in turn, lead to better reproductive health and greater equality among women and men, girls and boys.

A space of their own

Donnette Joseph, an Afro-Guyanese woman, has a pragmatic view of promoting condoms and preventing HIV: “We live in the real world, and we have to act accordingly.” She heads an ‘adolescent and youth-friendly space’ in the low-income Beterverwachting area, an Afro-Guyanese and Indo-Guyanese community about ten miles outside of Georgetown, Guyana’s capital. In a neighbourhood with low levels of awareness about AIDS, her group provides information about methods to prevent HIV infection and distributes condoms.

Seon Bury (16) peer educator of African descent in Sophia, one of Georgetown’s more marginalized communities, says young people need talk about issues like HIV with people their own age. “Most of my friends think it’s OK to talk about it,” he says, though he admits that some also walk away and call him stupid when he tries to talk to them about prevention methods.

Nevertheless, Seon likes the programme in part, not only because he wants to be of help to his peers, but also because of the leisure activities it offers, such as opportunities to play music in one of the youth-friendly spaces sponsored by UNFPA. These youth centres are based in more than 20 locations throughout the country, some of them affiliated with places of worship, such as Hindu temples, churches, or mosques.

“You have to give them [youth] a reason to go to the centres,” said Patrice Lafleur, UNFPA Liaison Officer for Guyana. So the centres offer activities ranging from sports to board games and from computer science to steel pan music. Students can also get help with their homework.

Abstinence only?

Hindus accept sexual relations only after marriage, explains Krishnadatt Rampersaud, President of the Eccles/Bagotstown Vishnu Mandir [temple]. But even in this cultural milieu, the ‘abstinence only’ message is not always effective among older teenagers, according to Sandra Balac, the coordinator of the youth project based at the temple. “We can’t just tell them not to have sex,” she says.

Youth at the St. Sidwell’s Anglican Church also emphasize that abstinence from sexual activities is their preferred way to prevent HIV infection. But the group does distribute condoms when they organize events outside of the church.

Even strong opinions can give way to pragmatic solutions: “We see promoting condoms as promoting promiscuity,” says Mohamed Imran of the central Islamic Organization of Guyana. “We promote marriage as an institution, and we only approve of condom use if one or both partners are HIV-positive.” At the same time, he acknowledges: “But you can’t tell people how to live their lives.” And he sent his own son to a peer education session, because he wanted him to know how to protect himself from the virus, but did not feel comfortable talking to him about it.

Romel Daniels (16), an Afro- Guyanese, of African descent, volunteers as a peer educator in the Beterverwachting youth-friendly space. He says the outreach work helps him keep out of trouble. He also sees abstinence from sex as the best way to prevent HIV and other sexually transmitted infections.

Dr. Leslie Ramsammy, Guyana’s Minister of Health, says there is now a downward trend in the HIV prevalence, thanks in large part to the beefed-up prevention campaign led by the Government with support from UNFPA. HIV prevalence among pregnant women was 1.6 per cent in 2007, while the same figure for 2004 was 2.3 per cent, according to UNAIDS. However, comparisons should be made with caution, because of the different methodologies used in the two surveys. But not all statistics look promising: a stunning 26.6 per cent of sex workers in Guyana are HIV positive, based on national statistics from 2004.

In a diverse country like Guyana, understanding different cultural perspectives can be key to preventing HIV. But it seems that culturally sensitive efforts to create more openness about sexuality and HIV are paying off.

—Trygve Olfarnes

When parenthood equals manhood

People and communities ascribe a wide variety of meanings to sexual and reproductive functions, as the State of the World Population report describes. Understanding these meanings is crucial to communicating in a way that is likely to inspire changes in behaviour.

For example, a study on men and family planning by two researchers at the University of Guyana, Derek Fields and Andrew Hicks, illustrates the way in which deeply embedded cultural beliefs impact condom use. They found a strong, culturally conditioned disincentive among the young, male Afro-Guyanese population to use condoms or other types of contraceptives, because they want to become fathers. In their culture, parenthood signifies manhood.

“This motivates young males to become parents as soon as they can,” says Fields. “In contrast, adulthood in the Indo-Guyanese society is defined through marriage.” Hence, it may be easier to persuade these young males to use a condom.

To illustrate the point further, Fields says that Father’s Day in one Afro-Guyanese community is often celebrated by a football match between fathers and those who are not yet fathers.

“Chances are that those who are not fathers will do everything they can to be on the other team the following year,” he says. “The peer pressure is strong and not conducive to using contraceptives.”

According to a Ministry of Health study conducted in 2005, 11 per cent of girls between 15 and 19 were already mothers and nearly 3 per cent were pregnant with their first child

“There is also a bias against testing for HIV,” says Fields. “Males define health by physical strength, and they consider that testing is not necessary as long as they feel strong.” They also often consider that it is better not to know their HIV status in order to avoid rejection, should the test come out as positive.