A STUDY done in Guyana has shown that fear of violence, discrimination, and poverty can serve as barriers to adaptation of risk reduction for Persons Living with HIV (PLHIV).The paper titled: “Fear of violence increases risk behaviours of persons living with HIV in Guyana” was presented on Day Two of the 60th Caribbean Public Health Agency (CARPA) at St George’s Campus, Grenada.
The study recommended that social programmes must adequately address protection from violence and discrimination against PLHIV.
In Guyana, about 9,000 persons are living with HIV. In 1999, a survey indicated that 27.7 per cent of women reported that they experienced physical abuse. Another in 2008 (Figueroa) shows that transactional sex between older men and younger women is prevalent while Di Clemente (1990) noted that poor women have difficulty negotiating condom use in the face of possible emotional or financial abandonment.
The same researcher in a study in 2008 found that with men having multiple partners, fear of violence and poverty put women at increased risk of HIV infection.
Guyana is classified as an upper-middle income country, having a GDP of US$7,939 per capita in 2012, and ranking 118th out of 187 countries with comparable data on the Human Development Index.
INEQUALITY
In spite of the good rating, President of the Guyana Responsible Parenthood Association (GRPA) Dr Karen Gordon-Boyle said geographic variations in unmet contraceptive needs reflect the geographic inequities in access to health services and products.
A Ministry of Health Statistical Bulletin in 2009 reported that 71 per cent of HIV cases are in the age group 20-44 years.
Presenting the study on People Living with HIV in Guyana, Dr Gordon-Boyle reported that women in Guyana are most likely to have sex for things, fear of violence and have an HIV negative partner.
Based on the study conducted in 2011 on 271 PLHIV, Dr Gordon-Boyle said the respondents who were not afraid to speak out were significantly more likely to use family planning. For those who had a partner tested for HIV, they were significantly more likely to use family planning.
The conference heard that HIV status serves as a confounder to disclosure to a sexual partner and Persons Living with HIV who reported having multiple partners were significantly less likely to disclose their HIV status.
FEAR
The GRPA head related that persons delayed disclosure to sexual partners for months to years due to fear of violence, lack of trust, fear of abandonment.

And HIV positive men in casual sexual relationships felt no need for disclosure. She noted that one such man after being with a younger female of unknown status for five years, felt no need to disclose to her his status, their relationship being transactional.

Quoting the man, Gordon-Boyle reported him as saying:“I am HIV positive; I can’t be her main boyfriend. I can’t tell her that I am HIV positive. So I just going along. She has needs. I help. She is poor. So I help her out with money. Yes, I have other women but not serious relationships. I live by myself, I cook for myself, I am comfortable. I don’t want nobody living with me.”

Pointing to another example, she noted the case of a woman whom she referred to as M37. M37, she related, knew her husband had several other women but did not insist on condom use. She did not hesitate to disclose her status to him when she tested positive.

“He wasn’t surprised. So I just sit down watching him and he ain’t say nothing. He just watching me and I watchin he. So I say let us go to the health centre to make sure and indeed both of us test positive. So I ask him what happen. He say he don’t know. He say he used to feel sick and so and he da shame and feel bad and think I would a go away.”
ABANDONED
After her disclosure, her HIV positive husband abandoned the family, leaving her with no source of income and several children to feed. With no job, no source of income to take care of their four children, M37 went to the Ministry of Social Services for help but was made to feel embarrassed about being HIV positive with several children and no job.
“Having nowhere to live, M37 was forced to move in with relatives where her daughters were almost raped by her uncle. M37 began seeing a married man of unknown HIV status. Two years into the relationship she didn’t feel she could disclose to him despite Prevention with Positives intervention. She was fearful of abandonment or violence and depended on him for support,” Dr Karen-Boyle related.
The non-disclosure of men practising multiple concurrency, she noted, emphasises the power differential between the genders and undermines the ability of the ignorant partner to self-protect.
Individuals in casual sexual relationships need to assume responsibility for their protection, the GRPA head said, stressing that aaggressive campaigns are needed to raise public awareness of the increased risk associated with the cultural practice of multiple concurrency.
The Prevention with Positives Project, Dr Gordon-Boyle said must continue to raise risk perception and promote the need for PLHIV to take shared responsibility for prevention.
The project urges persons living with HIV to be faithful, reduce the number of sexual partners, disclose their status to sexual partners and use or insist on their partners using a condom during intimacy.

By Tajeram Mohabir in Grenada