Gender, Sexual and Reproductive Health and HIV/AIDS (GEND3600)

Compare and contrast the gender-related HIV risks for males and females in heterosexual and same-sex sexual relations in a named Caribbean country.

STUDENT NAME: ID NUMBER: COURSE NAME & CODE:

Karen A. Lloyd 607005279 Gender, Sexual and Reproductive Health and HIV/AIDS (GEND3600) Institute of Gender and Development Studies Dr. Leith Dunn

DEPARTMENT: LECTURER:

TUTORIAL DAY & TIME:

Mondays 4-5pm

The Caribbean has been affected tremendously by the spread of HIV/AIDS throughout the region. The Caribbean is the most affected region behind sub-Saharan Africa, globally. This has left policy makers spinning and trying to find solutions to this epidemic. Fundamentally, issues and attitudes surrounding sex and sexuality are a major aspect of the HIV/AIDS problem and until these are addressed, we will not eliminate or reduce its prevalence. The intent of this paper is to highlight how gender socialization feeds into stereotypes surrounding masculinity and femininity and how these ultimately affect relations between heterosexual as well as homosexual couples. At the core of this paper is how these gender roles, performed by men and women in society, contribute to the spread of HIV/AIDS and how it fuels the fire that keeps this epidemic on the rise in the region. For the purpose of this paper I have opted to use Jamaica as the territory from which I will draw my examples and make reference. I will first outline the general situation as it pertains to heterosexual and same-sex unions and HIV/AIDS. I will then look more intensely at heterosexual couples, where I will focus on how perceptions of masculinity and femininity and power relations affect the risk factor of men and women. I will then move on to same sex unions and how they operate within the society, focusing on the risks they face in contracting and spreading HIV/AIDS. Throughout the paper I will be comparing and contrasting these two types of relationship and situating them within theories and human rights conventions, while analyzing the gender-related factors that put these men and women at risk for HIV/AIDS. It is important that we start by distinguishing between sex and gender. Sex, as defined by the Online Social Science Dictionary, is the The biological categories of females and males.

It then defines gender as Socially defined behavior regarded as appropriate for the members of each sex. Sex is therefore defined around the genitalia while gender is a social construction that is determined by ones sex. Expectations of femininity and masculinity are then projected unto individuals by the society, which compels them to fall in line. Bandura (1977) explains the acquisition of behavioural patterns by iterating that, Except for elementary reflexes, people are not equipped with inborn repertoires of behavior. They must learn them. New response patterns can be acquired either by direct experience or by observation (p. 16). The social learning theory as posited by Bandura (1977), essentially argues that we learn through interactions with others. This is to say that we are not born with the attitudes and behaviours that we exhibit regarding what it is to be male/female and/or masculine/feminine. We learn and adopt these behaviours which are then reinforced by the different agents of socialization. These include the family, school, church, peers, the media and laws. Heterosexuality, to a large degree, is the acceptable form of coupling in the region and specifically in Jamaica. Little boys and girls are taught from a very early age that this is the right path and are thus socialized accordingly. Gender stereotypes instruct us on how to perform our duties as boys and girls and reinforce positive as well as negative attitudes and behaviours surrounding masculinity and femininity. Girls are expected to be decent and proper while boys are encouraged to be tough, dominant and strong. It is quite a natural occurrence within a household with children of both sexes to see these roles played out. Boys are usually given free rein to play in the streets while girls are more restricted to the household where they are expected to perform household duties and chores. These early introductions to ones acceptable roles and behaviours in society usually inform our attitudes into adulthood.

Patriarchy, defined by the Merriam-Webster online dictionary as, social organization marked by the supremacy of the father in the clan or family, the legal dependence of wives and children, and the reckoning of descent and inheritance in the male line; broadly : control by men of a disproportionately large share of power, which persists in the socio-political culture of Jamaica, is the underlying system that legitimizes the dominance of men in society and in relationships/families. Within this system it is the hegemonic male that is revered and looked upon as the standard for what a man ought to look, act and be like. These are usually referred to as real men and men who do not conform to this stereotype are othered and seen as weak men. Real men are dominant or macho and must possess signs of virility and bravado. This dominance of the hegemonic male has many implications on women as well as on the men themselves. Men are often the breadwinners of their families and this puts them in a unique position to dominate their women on a number of levels, including sexually. This dominance may manifest itself as sexual violence within a relationship. Bem (1997) argues that, violence against women is the inevitable result of a society that is androcentric centered around men men are expected to dominate women in every way physically, emotionally, and sexually and women are expected to satisfy mens needs and desires sexual violence is merely an exaggeration of the traditional sex roles (p. 40). Suffice to say that men, because of their expected and accepted role to display some level of aggression, often extend this to their romantic relationships. Further to this problem is the woman being expected to tend to all the mans needs by being a good woman. So, on the one hand, men are expected to be aggressive while on the other, women are docile. What this does is legitimize the aggression and violence

that men portray by projecting it as a normal and natural behaviour while rendering women inadvertently impotent in defending themselves against this behaviour. Jones et al (2009) argues that, culturally-sanctioned sexual gender roles are instrumental in defining human sexuality for both men and women in the Caribbean. The social construction of masculinity and femininity shapes ones sexual expectations (pp. 126). Paraphrasing Moore and Rosenthal (1992), they continue, Individuals who subscribe to a traditional sexual gender role script allow for unequal power sharing within the intimate relationship. Women become submissive participants, whereas men become dominant participants within the intimate relationship. This acting out of prescribed gender roles can lead to a myriad of problems including the risk of contracting and spreading HIV/AIDS. Gender norms affect womens relationship to power on both personal and public levels. In the private realm, women are seen as the subordinates of men and are subjected to their dominance. This dominance robs women of their right to make decisions about their sexual and reproductive health. The prevalence of sexual violence and abuse are much too high throughout the region and betrays the way men abuse the power afforded them by patriarchy at an enormous cost to women. Since women often do not have the power to negotiate sexual relations, they therefore do not have the opportunity to make decisions in their best interests. One symptom of this is their failure to negotiate condom use and the resulting high rates of HIV/AIDS among Caribbean and specifically Jamaican women. Dunn (2006), who argued in a presentation to the National HIV/STI Control Programme Consultation on Gender, that the issue of inequality in sexual relations between men and women is important in light of the findings of the UNFPA which found that, "The attitudes and behaviours of men are critical to prevention

efforts [and] men hold overwhelming power in decisions on sexual matters, including whether to use condoms". A lot of men have multiple partners and this puts women at a great risk of contracting HIV/AIDS. Men are encouraged, through various mediums including dancehall, which is a part of the popular culture and therefore a good reflection of societal norms, to have 'nuff gyal and gyal inna bungle' because this supposedly proves that they are 'real men'. Connected to this issue is the fact that getting an offspring(s) is a rite of passage for men and gives credence to their claims of virility. In essence, these men are partnering with many women and procreating, while creating chances of spreading HIV/AIDS to a wide pool of individuals. Women are also unable to make decisions concerning their reproductive health and are generally forbidden from having abortions. In Jamaica, for example, abortions are illegal unless her medical practitioner deems it necessary from a medical perspective. This robs the woman of her right to choose what happens to her body and increasingly put women in more disadvantaged positions. Many women are forced, directly and indirectly (stigma) to carry children that they are not in the position to take care of economically or emotionally. This is usually the beginning of a vicious cycle of dependency which increases her likelihood of living in poverty. Poverty then puts the woman at risk of contracting HIV/AIDS and other sexually transmitted diseases. As shown in the arguments above, both men and women are affected by HIV/AIDS in ways that can be linked to the gender norms they subscribe to, which is inadvertently linked to their sex. Men and women, because of the pressure they face in living up to gender roles and

norms, often put themselves and others at risk of contracting HIV/AIDS. A gendered approach is important in understanding the way how heterosexual relationships operate and how inequalities and inequities are created and fed through the expectations we have of men and women. Women, as can be seen in preceding arguments, are more vulnerable to this disease and a commonly held view is that HIV is gendered and increasingly feminized. There have been continued efforts to raise the standard of women's lives and there are a number of Human Rights Conventions (HRC), policies and agreements that deal with these issues. These are important insofar as these issues are not just national or regional but are more international in scope. These international global governance frameworks therefore give more potency to the approaches and can be assessed more critically. One such convention is the Convention on the Elimination of All forms of Discrimination Against Women (CEDAW), which utilizes sixteen articles to essentially advocate for the recognition of the human rights of women and outlines the means (eg. Article 2 - Policy Measures and Legislation) through which these rights are to be enhanced and protected by the state and private entities/individuals. The International Conference on Population and Development (ICPD) is also an important tool through which women are empowered, especially with regard to its focus on access to reproductive and sexual health services including family planning, which is critical in reducing the risk factors of women and their partners in contracting and spreading HIV/AIDS. As it relates to same-sex unions and gender-related HIV risks, homosexuality remains a taboo subject in Jamaica insofar as heterosexuality is seen as the ideal and anything outside of this is deemed 'unnatural'. Because of the masculinization of the state, homosexuality (especially male homosexuality) is seen as abhorrent and is systematically repressed. The state,

through patriarchy, has institutionalized intolerance, hetero-normativity and rigid sexuality. Homophobia is then a very common response to homosexual unions by the general heterosexual population. Legislation outlawing the act of buggery does nothing but exacerbate this problem. This legislation essentially criminalizes homosexuality as it is the sexual act that is most like performed by MSMs. This legislation therefore gives credence to those who use it against homosexuals to stigmatize and oppress them. Kempadoo (2004), in discussing homosexuality and homophobia in the region, argues that, "Jamaican dancehall and reggae music, for example, is known to be replete with violently anti-gay sentiments, which advocate hostilities toward "Chi-Chi Men" or even the murder of the "battybwoy"... Male homosexuality is explicitly and violently renunciated and defined as a corruption of masculinity, where anything considered feminine is seen to damage the "Real Man" identity of Caribbean men" (p. 46). This framing of homosexuality puts the men and women involved in these types of relationships at great risk. According to the Ministry of Health National HIV/STI Program: Jamaica HIV Epidemic Update (January to December 2009), "In 2007, a survey of 201 men who have sex with men (MSM) found that approximately 1 out of every 3 MSM was HIV infected." This is an alarming figure and the factors that are affecting this community need to be explored further. Much of the problem faced by MSM in Jamaica can be situated within the framework of stigma and discrimination. Many homosexuals are forced underground because of the stigma they face. Legally, they cannot get married and it is usually very hard or impossible to live in long-term monogamous relationships. This is so because it will raise suspicion and put them at

risk for violence at the hands of those who oppose their lifestyle. As a symptom of this larger problem, many homosexual men (and women) lead double lives. That is, they are involved in heterosexual unions, whether married or common-law, while at the same time engaging in homosexual activities. This is out of a need for stability and acceptance in a society that is not very accepting of the personal sexual choices of individuals but insists on rigidity in what is acceptable. In an article published by the Jamaica Observer on July 2, 2012, entitled "Closet Gays Push up HIV" Wilson (reporter) asserts that,

According to Jamaica's National HIV Strategic Plan for 2012-2017, there are an estimated 33,000 MSMs in the country, but health officials say interventions targeted at this group have mostly failed because these men fear discrimination if their sexual activities are revealed. A survey of the MSM community in 2007 showed that as many as 56 per cent had at least one female partner in the course of that year and almost 64 per cent identified themselves as bi-sexual. Only 57 per cent had ever done an HIV test, although almost 30 per cent of them had sex with multiple male partners within the four weeks prior to the survey. Only 67 per cent reported using a condom during their last sexual encounter with their main male partner, while 62 per cent reported doing so with their female partner.

Out of fear of discrimination, MSM also have problems accessing healthcare that is important to their sexual and reproductive health - including access to condoms and other contraceptives. The risk of their sexuality being made public seems a lot more dangerous to these individuals than getting proper healthcare services and information regarding HIV/AIDS and other STDs.

It is evident that there needs to be a more critical assessment of the risks of HIV/AIDS to individuals who identify as homosexuals. Stigma and discrimination is very harmful and directly impacts on the transmission rate of the disease and puts the entire population at risk. As such, de-stigmatizing homosexuality might be an unpopular but necessary step in curtailing this deadly disease and ensuring the protection of all persons within the society. As Kempadoo (2009) puts it, Recommendations that emerge from critical research on HIV/AIDS point to a need for Caribbean governments and health agencies to conduct widescale retraining programmes of service providers, teachers and police to reduce stigmas about sexuality; for governments to lift the laws that outlaw certain sexual acts that serve to maintain stigmas and secrecy (pp. 21)

Although there are no human rights conventions that speak specifically to homosexuals (as opposed to the case of women) there are claims to be made under the Universal Declaration of Human Rights. Article 2, for example, states that, Everyone is entitled to all the rights and freedoms set forth in this Declaration, without distinction of any kind, such as race, colour, sex, language, religion, political or other opinion, national or social origin, property, birth or other status. Furthermore, no distinction shall be made on the basis of the political, jurisdictional or international status of the country or territory to which a person belongs, whether it be independent, trust, non-self-governing or under any other limitation of sovereignty.

It has been argued that 'sex' in this article can and does include sexual orientation and that people should not be discriminated against because of their sexual choices/preferences. Article 7, which states that, "All are equal before the law and are entitled without any discrimination to equal protection of the law. All are entitled to equal protection against any discrimination in

violation of this Declaration and against any incitement to such discrimination", is also important in the case of Jamaica insofar as the buggery law discriminates and promotes inequality before the law, of homo and heterosexuals. In conclusion, males and females in heterosexual and same-sex sexual relations in Jamaica, face many different gender-related HIV risks. Heterosexual unions are at risk to a large extent due to the gender roles and norms that they operate within, while same-sex unions face these, through hetero-normativity, as well as stigma and discrimination in a society that generally only sees heterosexuality as legitimate and acceptable. In this light, it is important that we pay attention to and apply human rights conventions that address these issues as HIV/AIDS gravely impacts productivity, development and growth.

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