End-of-term evaluation

People with Disabilities

Interviewees appeared to possess very basic knowledge of HIV and little knowledge of STIs. They said that HIV and STI prevention messages were not geared towards persons with disabilities (PWD). They also spoke of the assumptions that able bodied people have about PWD and their sexual and reproductive health needs and rights. Therefore families and professionals alike believe that PWD should not be sexually active and in turn PWD internalize this and tend to hide their sexual needs and reproductive aspirations with others for fear of disapproval. Therefore they believe PWD lack confidence and are in need of support to talk to their families about their SRH health needs, because they feel they are doing wrong and they will be judged harshly.

Sex Workers

Sex workers were very knowledgeable about HIV and STIs and were able to relay in-depth information about prevention, risk behaviours and risk reduction, high risk groups, age groups and the epidemic in general. They learnt this information from a combination of sources including TV, school and a particular named outreach worker. They spoke of the outreach worker teaching them the ‘Four H’s” and explaining that this stands for HIV, Herpes and Hepatitis. One person said:

“She does do a very good thing, because for all the years I was on the road, I never see anybody come out and teach us how to use condoms…she was the first, she come and tell us to do the test and she share the condoms…”

They went on to explain that this outreach programme was delivered fairly recently through the Caribbean HIV/AIDS Alliance (CHAA) and expressed deep concern about what they consider a critical intervention coming to an end.
As far as other services targeting SW, this group of women attended a BCC programme ‘Life with a Purpose’ for women wanting to leave sex work. Many spoke of the difficulties of trying to leave sex work and often having to return to it because of financial pressures, as most of the women have children. The BCC programme they said assisted them to build their self-esteem, modify their behaviour, particularly in relation to anger management. It has also provided them with skills, assisted with literacy and numeracy and gaining qualifications and one woman said she has gone on to further her studies as she would like to train to be a social worker. Two other women said they have gotten jobs, which they attributed to their increased confidence as beneficiaries of the programme that motivated them to even attempt applying for jobs. One woman said “The encouragement that [name of worker] gave to me made me know I can go further than what I be doing”
But they also spoke about the number of women and girls on the streets that are not engaged with any services and their heightened vulnerability to violence and drugs. One woman said:

“Girls on [name] street don’t protect themselves [outreach person name] gotta work over time for real to get them girls to use condoms, I mean like she’s gotta work real hard with them…”

Among the group they all reported high condom use with paying partners and said that nobody would be able to coerce them with large sums of money to go without condoms. But they also admitted that they tend not to use condoms with their boyfriends/non-paying partners, even though they know that they should.
When they were asked if there were any support groups or other places that SW can go to seek help apart from Life with a Purpose, one woman said, “Nobody don’t really want talk to sex workers, them skinning up them face”. They spoke of general stigma and discrimination associated with being involved in sex work and the need to conceal this from those outside of the profession. Therefore none of them has ever disclosed they sell sex to a health professional at a clinic.
All of the women spoke of witnessing or experiencing sexual exploitation by Police Officers on the street. None of the women has ever reported this as they are fearful of the consequences given that sex work is illegal. Similarly one woman said she was gang raped at gun point by a group of adult males, but for same reason she didn’t report it to the Police. She also spoke of the trafficking of women from other countries in the region to Barbados for sex work and that many non ‘Bajan’ nationals in sex work are extremely vulnerable as they cannot leave as their passports have been taken away.
None of the woman knew of any sex worker associations, policies or legislative changes that have been introduced to protect sex workers in the past five years.
As far as they are concerned the NSP objective are the right ones, but they felt that much more needs to done to support sex workers in reducing their risk and vulnerability. One young woman said “We want [name outreach worker] back and we want more people like her”. They also said that sex workers who are HIV positive also need to be targeted and supported as they are more likely not to use condoms. Additionally they expressed the desire to have access to a specialist clinic for sex workers, with staff that are trained and sensitive to their situation and their sexual health needs.

Men who Have Sex with Men

The men in the group had basic knowledge of HIV and methods of prevention and the importance of testing and knowing their own and their partners HIV status. Lubricants were not mentioned, but on prompting they acknowledged that they knew that lubricants should also be used, but gave very little feedback on this topic. One man said: “So many of the LGBT community are mis-educated about what HIV and other sexually transmitted diseases are, so it’s like, it’s still a long way to go”. The group also noted that MSM are not included in local health promotion campaigns and materials, so in this regard this information does not speak to them. He went on to say, “When they talk about HIV it’s always that it is a homosexual thing, but yet if a person of a different status becomes infected it is different for them”.
This was in reference to a perception that people who are not MSM receive better treatment and are less stigmatized when they are HIV positive and that many MSMs that are not accessing the treatment that they need because of negative attitudes towards them. They said services for MSM are few and the few civil society organizations (CSO) that do exist and they named several groups, are not well developed, lack leadership and direction, are disorganized and are in need of being revamped. They also mentioned the MSM community is divided along class lines, such is implied in labels such as ‘Ghetto’s and Bougies’. When asked about where MSM would go if they needed support it was agreed as one person said there is “Nothing like that”.
As far as they are aware there are no outreach services for MSM. One man in the group who is also a sex worker said that CHAA and Red Cross come out about once per week to issue condoms, talk to the male sex workers (MSW) and encourage HIV testing.
Discussions about S&D were divided among the group. Some members insisted that Barbados is a “tolerant” society at it relates to gay men, but conversely they said that MSMs are not accessing services for fear of being labelled when going to certain locations to access support. They also spoke of people not being able to tell that they are gay when accessing services, so they would not disclose this. One person said “A very effeminate male is at the bottom of the food chain” as it relates to seeking health services. They said non-disclosure of sexual orientation and ‘toning down’ mannerisms and behaviour ensures that they are not confronted with S&D. One person said: “Sometimes we have to hide within our own selves to access services” Another man said: “You have to hide sexual preference form the world…there are still people who believe it is the force of man’s destruction”.
However a couple of members also gave some good examples of incidents of stigma and discrimination that occurred in the commercial sector, as it related to their rights as gay men to demand equal treatment. In both instances the men complained to the establishment heads about being ridiculed by their staff and they were subsequently fired. However it was acknowledged that Barbados still has the ‘buggery law’ that effectively criminalizes homosexuality and noted that openly gay and transgender persons are seldom seen in front line jobs.
When asked about empowerment opportunities over the past five years through the HIV programme, Community Education Empowerment & Development (CEED) was the only initiative mentioned. CEED offers skill training and educational classes to all key affected groups including MSM, although they said few MSM engaged in this programme, despite its existence being well known among MSM. Views on why MSM were not accessing these services ranged from believing it is their fear of going to the location and being branded as gay, being “lazy and worthless” [older member of the group] and to preferring to earn a living from sex work instead.
One young man said, “The problem is that the older people always judge them, its’ like they don’t really know what is constructive criticism…so everyone wants to say ok its free come…but if there is no spirit behind it to bring them into it and keep them there, they aint going return…people that have needs have feelings, it’s how you approach a person, especially young people…you gotta target young people different…”
When asked what approach he would like to see, he said: “You have to get them to join the group first before you start with the rules and regulations”.
On the question of the introduction of new policy or legislative changes to support MSM, the groups were not aware that there have been any over the past 5 years, although one person said they are being debated at the national level, the group felt that there is no action following these talks. Similarly no one could recall a national redress system to report incidents of S&D against MSM.
Moving forward into the next phase of the NSP, the group said that there must be more emphasis on support for MSM at the community level. They would also like a shelter for MSM who are HIV positive and sick, as many of these men have nowhere permanent to live and cannot return to their families when they get ill and are in need of respite. It was generally felt that a unified strategy and changes in approach are required to engage and meet the needs of MSM in HIV programming.

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