 |
Facing the Music by Josh Jackson
Community health promoters known as "multipliers" spread the message that AIDS can strike anyone who fails to take the necessary precautions. (Photo ©Nestor Salavarría) |
Coming to terms with their plight has been a wrenching process for most Garífuna, one that is by no means yet complete. Accustomed to varying degrees of discrimination from Honduras' largely mestizo society, some Garífuna at first charged bias and slander when confronted with news of their higher-than-average HIV/AIDS rates. But as the disease has claimed increasing numbers, Garífuna communities have begun to rise to the challenge. "People are talking more openly about it, especially the relatives of the infected person," says Mirtha Colón, a Garífuna AIDS activist living in New York. "Some support groups have been formed in the communities in Honduras, and relatives are looking for help for themselves. Here in New York, when we do an activity, participation is very positive."
For Yolani X., a health promoter from the town of Santa Fé, dealing with the pain and stigma of AIDS has a very personal trial. Before her father returned from New York with AIDS, her mother had never even heard of the disease. When lesions appeared on her mother's arms, Yolani knew she had contracted AIDS, but didn't have the heart to tell her. Yolani's two siblings initially rejected their mother out of fear and misunderstanding. She was sick for three years before following her husband to the grave a few months ago. In an interview, Yolani requested that her last name not be printed with her story.
Yet Yolani is clearly among the more "enlightened" Garífuna when it comes to HIV/AIDS, the result of training through an AIDS-prevention project led by Dr. Manuel Sierra, a professor of medicine in Tegucigalpa with two doctoral degrees from Harvard University. It was Sierra who first discovered the Garífuna's high incidence of AIDS, while heading the HIV.AIDS epidemiological surveillance program at Hondura's Ministry of Health. Sierra's studies found that some Garífuna communities had a cumulative incidence of AIDS cases greater than 2,000 per 100,000 inhabitants, compared with 134 per 100,000 at the national level. He also found that only 20 percent to 40 percent of sexually active Garífuna men regularly use condoms for protection against the disease.
Sierra's findings led him to approach his friend and colleague Dr. Nestor Salavarría, director of the Buen Pastor ("Good Shepherd") clinic, a medical mission based in the neighboring department of Olancho. Together, the pair designed a project and secured grants from UNAIDS through the Pan American Health Organization (PAHO) to raise AIDS awareness and promote preventive measures in Garífuna communities.
The project's focus has been on training community AIDS educators to teach their peers the truth about HIV/AIDS and the need for prevention. Sierra and Salavarría hired Valentin and another local physician and 10 AIDS awareness promoters from the community, who in turn recruited volunteers known as "multipliers" from different social and age groups. "The idea was to identify and mobilize local resources and to create empathy and awareness of the problem," says Sierra. "Those children and teenagers and others who were trained would continue to train others of the same interest and same age."
A young Garífuna man performs a sorting task designed to assess his understanding of AIDS and risky behaviors. (Photo ©James Stansbury) |
Staff members from the Buen Pastor Clinic developed educational materials with input from the community, based on the special circumstances faced by the Garífuna. By involving the communities' own members, the program has managed to continue work even after the international grants were exhausted.
"What was remarkable was that when we visited the communities with our own NGO resources," says Sierra, "most of the multipliers we trained are continually doing activities in spite of the absence of funding. They were really highly motivated."
Their incentive is often personal. One of the health promoters, Inez Alicia Arzú, joined the program after watching her 27-year-old sister die from AIDS. She had married a man who knew he was HIV-positive but didn't reveal the information to his new wife. He was dead within five months, and she followed two years later.
"It's important to get the message out," says Arzú. "We haven't seen the change in conduct that I'd like to see, but I think that it's getting into people's minds, and they're starting to take it."
Part of changing the Garífuna's mindset about HIV/AIDS has involved teaching ways that AIDS is not spread, such as by sharing a cup with someone who is HIV-positive or using the same toilet. Such myths have stirred fear, while the truth seems too often to meet with apathy.
"Knowledge about [the need for] condoms is there," says anthropologist James Stansbury, "at least in the communities that have been surveyed. But this does not hone in on the practices of young men who are initially at high risk. We don't know how available condoms might be when they are most needed or to what extent young men deny or misrecognize their chances for infection. Some good ethnography among Garífuna labor migrants would help us considerably to understand these questions better."
Stansbury also notes the need to address gender dynamics and "the issue of relative power for women in negotiating sexuality....Even when women understand and come to terms with risk, they may be faced with recalcitrant and defensive partners."
For Stansbury, one of the most significant aspects of the current AIDS-prevention efforts is in their focus on Garífuna youth. "PAHO and Buen Pastor's educational work with young people is essential, catching adolescents as they enter stages in the life course when they are exposed to greater risk," he says. "There is a need to better understand and reach young people before they become the migrants who return to communities infected."
 Continue
|
|
| 
