For this entire semester I have focused on the gender inequality integrated in the HIV/AIDS epidemic that has been going on in Jamaica for a very long time. Just a few years back in 2012, there were 9.3 thousand Jamaican women living with HIV, (Unicef 2013). There are definitely a range of determinants which have caused this issue to accelerate overtime, but I would definitely say that the cultural and social determinants are by far the most influential. In terms of cultural determinants, how Jamaican women are treated as well as how they are expected to act is probably the most impactful. It is also frown upon for most Jamaican women to discuss sexual issues as it goes against certain active Jamaican cultures and social norms that have been embodied overtime. In terms of social determinants, I am talking about factors such as poverty, drug use, working conditions, unemployment and social support, (WHO 2003). Gender integrated inequality is completely present in Jamaica, and the women specifically are being treated differently because of their gender. From an anthropological perspective, I truly believe that feminist theory is definitely the most applicable to solving this HIV/ AIDS epidemic, and I also believe that it is important that we fully examine the cultural and social determinants if we ever want to actually make long term progress.
So to start, how has gender played a part in the Jamaican HIV/AIDS epidemic? Gender inequality has impacted this epidemic in Jamaica mostly through via discrimination, but it has also played a role in quality of health care which goes hand in hand with the ability to access HIV/ AIDS related information (Myrie 2012). Culturally, there has been a lot of variables at play here as well. In Jamaica, it has always been normal for women to be treated poorly or for them to be at least treated inferior to men. This is usually a problem that can be reversed if you catch it early, but once this type of problem becomes a social norm, the reversal is almost impossible. This dominance of men over women goes to a whole new extreme whenever discussing topics such as safe sex or the general use of condoms/ protection. Unfortunately fear and anxiety play too big of a role here. A lot of Jamaican women submit or disregard their feelings immediately because many of them fear losing their relationships with their male partners. Moreover, many of these same Jamaican women fear physical as well as mental abuse from their partners (Gillespie-Johnson 2008). How can we expect these women to ask for help when they are being attacked in this many ways.
In an article, “HIV/AIDS Prevention Practices Among Recent-Immigrant Jamaican Women,” a study was taken from another perspective. This study was on heterosexual Jamaican women who had recently came to the United States. The purpose of the study was to explain how prevention, knowledge, health-beliefs, cultural factors as well as how social factors influence the behaviors of these Jamaican women while utilizing the Health Belief Model, (Gillespie-Johnson 2008). It seemed to always be clear that HIV/ AIDS is a serious matter; however, these Jamaican women did not actually consider themselves to be vulnerable to the disease. It was actually shown that the women in these studies specifically did not use condoms as most of them lacked social related negotiating skills with their partners, (Gillespie-Johnson 2008). In other words, it had been shown that it was socially acceptable for men to treat women poorly and that women in Jamaica generally lack autonomy to make decisions about their own bodies (Myrie 2012). This article also emphasized the issue that Jamaican women had asking for help. The majority of Jamaican women were completely censored on all topics relating to sexual acts. Actually, between the years of 2008 and 2012, only 49.4% of Jamaican women with HIV (between the ages of 15 and 24) said that they utilized condoms and practiced safe sex, (Unicef 2013). This was significantly lower than the same statistic for Jamaican men. Specifically 25% less women in comparison to men had utilized a condom last time that they had sex within the last year, (Unicef 2013). Keep in mind that these are non-marital and non-cohabiting acts, so a lot of obvious bias and unrelated circumstances was eliminated. Now statistics are not always bullet proof, but why would there be such a significant amount of women not saying that they used condoms while most of the male population who participated did? I think gender inequality plays a huge role here. Even though many of the factors that correspond to this difference were not published, I think it is reasonable that the decreased percentage of women not using protection in comparison to men comes from a variety of topics relating to gender inequality.
Issues such as sex work can also be very applicable to this issue of gender inequality. No sex worker, who relies on the illegal work and money, is going to reach out for help if their consequences could possibly lead to their arrest. Let’s take a second to examine this issue. Why are these sex workers active? To start, a lot of them are in economic distress. This could be because of unemployment or because they are simply not making enough. Less money for Jamaican women means that their access to health care also suffers (Myrie 2012). When the cost of healthcare is relatively too high, then medical care, examinations and medical knowledge is almost impossible to achieve. The infrastructure of Jamaica is nothing in comparison to the United States, and I know that simply from traveling there. Moreover, many do not understand the toll that poverty can have on a person especially if they are a woman. The situation can get even more difficult when kids are involved. Like a lot of other moms out there, regardless of culture or race, Jamaican women are willing to do whatever it takes to make sure that their children are in good health. Imagine living each day with the thought that your children might starve. Would you break the law to prevent this? Would you do things that you were not proud of?
Another example of social determinants of this HIV/ AIDS epidemic can be expressed through an article that I ran across titled, “Social and Health Determinants of Well Being and Life Satisfaction in Jamaica.” This article summarized a study that was conducted where interviews were given to Jamaican adults ranging between the ages of 15 & 50. The goal was to measure a psychological Centre of Epidemiological Studies of Depression (CES-D) utilizing a Likert scale (Hutchinson, Simeon, Bain, Wyatt, Tucker & Lefranc 2004). Information was collected and analyzed on over 2500 Jamaicans where approximately ⅔ of this 2500 were women. Findings were best predicted by social determinants such as employment and financial wellbeing. Moreover these social variables have been shown to impact behavioral choices as well as overall health, (Hutchinson, Simeon, Bain, Wyatt, Tucker & Lefranc 2004). By the end of the study, it was concluded that Jamaican women had lower levels of psychological well being than Jamaican men, (Hutchinson, Simeon, Bain, Wyatt, Tucker & Lefranc 2004). Furthermore, these Jamaican women had an overall lower level of satisfaction with their lives, (Hutchinson, Simeon, Bain, Wyatt, Tucker & Lefranc 2004). These correlations were not concrete findings, but based on what I have read, I personally believe that these results go hand in hand with how these women are treated. I also believe that the social determinants which have helped shape these issues need to be understood from the feminist perspective if we want any chance of progress.
Other social factors that could integrate from migration can play a role as well as help explain why a lot of other countries suffer through similar epidemics. These social variables, derived from migration, include language barriers, poverty and the use of access to welfare, (Gillespie-Johnson 2008). Is is hard to ask for help if no one understands you, and it is hard when you have no money to your name. It is even harder when you are a woman who has been accustomed to being treated poorly by all of society your entire life. Imagine how these social factors can shape these Jamaican women long term. I surely can relate to how bullying has affected me long term. Obviously this situation is different, but the idea is the same.
These social factors integrated from gender inequality can also lead to why sex work is such an issue in Jamaica. Now a lot of the information that I had found on migration was geared toward the Jamaican population as a whole, so by no means is migration directly responsible for the epidemic nor does it explain why the epidemic is an issue in Jamaica, but this is a true result of gender inequality. By not making action to end gender inequality within Jamaica, the consequences can cascade and get harder to resolve overtime.
So how should we attack this problem of gender inequality? To start, I find it best to attack a social issue with a social answer. Meaning that we should at the very least start aiding this problem by offering support to these women, and we can start supporting these women by simply listening to them. While listening, it is important to be culturally sensitive as well. It comes to no surprise that these Jamaican women have emphasized their need for more support while in the health care setting (Myrie 2012). While this might sound trivial, women have been traditionally treated like dogs by medical professionals in Jamaica which clearly roots from gender inequality. Along with gender inequality, these Jamaican women sometimes are just treated poorly based on their work or on their HIV status. These women should not be treated differently just because of their gender, work or their health status. Unfortunately, there is a stigma that goes hand in hand with HIV positive women, and this stigma is that they are “dirty and promiscuous” and that they deserve to be infected (Myrie 2012). Even safe sex educated sex workers who were fully aware about their HIV status from the get go were still at a disadvantage. These Jamaican women were known to be treated so poorly that they refused to re-seek medical professionals for health advice or health rehabilitation. Additionally, there have been some Jamaican women who have never seen a medical professional ever because of their fears which include but are not limited to gender discrimination and breached confidentiality which could have some serious consequences. For example, if word came out that a woman had HIV, they could possibly lose their jobs. Why? Well apparently it has always been assumed that an infected HIV Jamaican woman could risk business or pose a comfort liability with a client depending on the occupation (Myrie 2012). Sounds like gender inequality as well as discrimination to me. I find it quite heartbreaking that so many Jamaican women are victim to such disrespect. Women should be empowered about their HIV status not discriminated.
Support is everything as it creates a safe space for the Jamaican woman to be able to truly express any health concerns that they may have. It does not matter the methodology either; however, different people respond to different types of treatments. Overtime, Jamaican women have shown interest in one-on-one intervention as the optimal methodology for educating/ spreading awareness on HIV/AIDS (Gillespie-Johnson 2008). Group discussion has also been an intervention topic of interest. That being said, like anybody else, Jamaican women would prefer if these group discussions included additional variables that would help make them more comfortable attending (Gillespie-Johnson 2008). For example, when an alcoholic struggles staying sober, they do not want advice from people who have never drank before. These alcoholics want to share stories with recovering alcoholics or atleast people recovery with addiction. It is no different for this situation. Abused women want to talk to abused women.
There has been speculation on other causes that may affect this HIV/AIDS issue, and a lot of times gender inequality is linked to other gender related issues. For example, there is gender inequality present in the Jamaican education system. Morrison, Johnetta Wade, and Valentine Milner (1995) have shown that the majority of top performing secondary education schools, based on core subject examinations, are all-girl schools (Morrison, Johnetta Wade & Valentine Milner 1995). In other words, there is obvious male underachievement and under-representation. This trend somewhat continues in tertiary education as well. Now, I can see how you may think that this is not an argument for my stance, but if you explore the topic a little deeper, Morrison, Johnetta Wade, and Valentine Milner (1995) also note how girls’ education in Jamaica is correlated to “improved health, additude, economic status and social status (Morrison, Johnetta Wade & Valentine Milner 1995), so maybe it would definitely be worth while to work on this issue. It has clearly helped Jamaican women in the past, and I feel there is never enough people being educated. Moreover, I think that straightening out this gender inequality for both men and women in education could possibly be another step in fixing gender inequality for Jamaican women in other situations including this HIV epidemic. How? Well personally I believe that it is hard to respect others if you do not respect yourself. If these Jamaican men push themselves to become better then the overall disrespect that these Jamaican women are getting from these men on an everyday basis may decrease. Now that is just my opinion, but I think there is definitely something to be said about the effects of not being educated.
In conclusion the HIV/ AIDS epidemic in Jamaica is directly derived from cultural and social determinants which derive even further from gender inequality. By both understanding and utilizing the feminist theoretical perspective, it is a lot easier to visualize and reinforce recommendations that have been made for this particular issue. For example, it has been suggested that Jamaica should adopt a gender mainstream as part of their national HIV/ AIDS strategy as well as to find ways to ensure valuable participation from women who are infected (Myrie, 2012). Obviously support should be addressed too. Jamaican women need people to listen to, and we must listen to them with open arms and with sensitive feedback. I also think it is important to note that all attempts of intervention with these Jamaican women should be strategically tailored to their issues. Meaning that it would be more effective if social determinants of Jamaican health issues were mediated through social forms of intervention, (Marmot 2005). This includes both the methods such as one-on-one as well as group intervention. Like I had said before, once social norms become “normal,” it is harder to fix the problem. The fact is simple, Jamaican women are treated poorly! Social norms such as abuse, economic distress and cultural barriers, these Jamaican women are put into a very vulnerable position. From how Jamaican women are normally treated to how Jamaican women are specifically given opportunities to grow, I hope it is clear that by fixing one gender inequality issue, we have potential to create a butterfly effect which could change social norms. Progress has been made on this issue in the last decade, but it is important that we continue to attack the issue until the issue is no longer existent. Moreover, it is important that we do not forget on why issues like this are important otherwise history will just repeat itself.
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