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Central American region. The first case of AIDS in Belize was diagnosed in 1986, and HIV has since spread into the general population. Transmission is fueled by poverty, low levels of condom use, and cultural attitudes that promote multiple sexual partnerships for men. The Prime Minister of Belize said during the June 2001 United Nations General Assembly Special Session on AIDS that young people, especially those of poor and migrant families, are at greatest risk for contracting and transmitting HIV/AIDS across Belize. According to the Joint United Nations Programme on HIV/AIDS (UNAIDS), by the end of 1999: • 2400 adults (prevalence of 2.01 percent) were living with HIV/AIDS. (Belize’s National Health Information System reported a 4.01 percent prevalence rate in June 2001); • Men accounted for 75 percent of HIV/AIDS cases; • Fewer than 100 children under 15 were infected; • 420 children had lost their mother or both parents since the beginning of the epidemic; and • 170 people died of AIDS in 1999 alone. With infection rates in the general population estimated to be between 2 and 4 percent, the epidemic is growing quickly among the heterosexual population. Available data from Belize District shows that in 1994 less than 1 percent of pregnant women using antenatal services tested positive for HIV; by 1997 this number was 2.5 percent. Sex between men is also thought to be a major risk factor for HIV trans-mission in Belize.
According the Government of Belize, the country faces the following challenges in implementing HIV/AIDS prevention and care programs: • Gender inequality leading to women’s inability to negotiate condom use; • A growing heterosexual epidemic; • Increasing rates of MTCT; and • Misconceptions about how HIV is spread and stigma surrounding the disease. HIV/AIDS in Belize Population, 2007 People living with HIV/AIDS, 2005 Women (aged 15+) with HIV/AIDS, 2005 Children with HIV/AIDS, 2005 Adult HIV prevalence (%), 2005 New HIV infections, 2005 AIDS deaths, 2005 Migration and AIDS in Belize Roy Young Belize has a population of approximately 240,000 in an area of 8,867 square miles with almost one-fifth of this population concentrated in Belize City. The official language is English but almost everyone speaks Creole and more than 50% speaks Spanish. The literacy rate of the country in 2000 was 42% (source: Ministry of Education) which is due largely to migrants. Primary education is compulsory and there are not enough high school spaces for aspirants. There is one university in the country, with 2,700 students. There is a thin middle management capacity in the country. The study was completed in Belize City and Benque Viejo del Carmen, and, in many ways, reveals clear and distinct patterns of vulnerability (both economic and in terms of exposure to STIs including HIV/AIDS) for the port city of 45,584 and the inland border town of 5,096. 'Vulnerabilities', in the case of this report, refers to situations which place individuals at risk either economically, and/or for exposure to sexually transmitted infections (STIs) including HIV/AIDS. Mobile population groups Most of the mobile and migrant populations sampled were from Honduras (53%) and Guatemala (30%). These individuals come to Belize to work as commercial sex workers (CSW), laborers in agriculture, traders, studcnts, truck drivers, and tourists, all year round except for the agriculture workers who come when crops are in season. The migrants from Central America come mainly by road because they say it is cheaper and many of the CSW and laborers enter the country illegally with assistance from coyotes. Many also come on invitation of a friend or relative from his/her country that is here and said they do so because they want to work to make money. 300,000 3,700 1,000 <100 2.5 nd <500
All said they did not experience any health problems during their trip to Belize. When asked if they know some diseases that are sexually transmitted 90% (n=54) said AIDS. Approximately one-quarter of the migrants interviewed said they could not get AIDS because they are not sexually active. On the other hand, some (15%) said they know what a condom is hut do not use it because they or their partners like to have sex naturally. The easiest way for information to reach them would be by radio, television and booklet. Forty-eight of them indicated that they would be willing to participate in a campaign for the prevention of AIDS transmission because they would like to explain to all young people how to prevent AIDS (n=48) and they don’t want others to see people suffer (n=9). Commercial Sex Workers All the thirty-five commercial sex workers were from Central America. Similar to the migrant population interviewed, most of the commercial sex workers (CSW) sampled were from Honduras (65%) and Guatemala (17.5%) but others came from El Salvador, and Nicaragua. Approximately 75% entered the country legally and the other entered the country with assistance from coyotes. The CSW are in this job because they need to support their family, most back in their country, and they have no skill to get other jobs. Most of them speak little English and did not complete primary school. The majority (n=28) listened to radio and music and believed the radio and television are best for transmitting information on health-related issues. The CSW are required to use condoms at the largest brothels in Belize City according to the owner and CSW. However, the CSW said they don’t use a condom with their lover (boy friend) or with a customer they have grown to like. Most of the transactional sex takes place at the premises but some of the experienced girls have the option to leave if the clients desires. Most of the CSW (94%, n=33) know how STD and AIDS are transmitted and they know that they are vulnerable to contracting these diseases due to the work they do, as is expressed in the following statement: in a sexual relation it is important to use condom because you never know how the problem with AIDS comes on. It also helps to prevent diseases like gonorrhea. (Source: 34CSWBZEBC) Doctors visit two of the three brothels surveyed to educate, give check-ups, medication and provide condoms in some cases. Twelve (34%) had some information on places they can go for the protection of their rights as is expressed in the following: If we need information, the people from public health would come around and invite us to visit them or call them at their office. If we have a problem and are not from this country we are told that we should visit the Human Rights Office. (Source: 31CSWBZEBC) There is a preference to do other jobs like starting their own business (selling clothes, grocery shop, etc.) but they need capital to start. So they continue in this job until they can do something else. Forty-six percent said they would be willing to participate in a campaign for the prevention of HIV/AIDS contraction. Interaction between mobile population and local population Approximately 25% of all the respondents to the population survey said they are related to migrants and mobile population and more than half of them interact with them everyday in service, employer/employee, shops, friends, work companion/school, and night clubs/bars. Thirty-seven percent of the general population surveyed believe migrants and people who leave the community to go to other places contribute money and labor to the community; fewer than 15% said they cause drug and crime problems in the community. The ethnographic study shows that many young migrant females, especially young girls, allow themselves to he used by locals for sexual favors outside the formal commercial sex landscape because they need money for self and in many cases family survival. This predominantly happens during the individual’s early arrival in Belize with little or no finance, knowing very few people, and speaking little or no Creole or English. Situation of HIV/AIDS in Belize City and Benque The first case of HIV in the country was reported in 1986 in Belize City and since then there have been a total of 1,773 cases of HIV, 420 cases of AIDS and 292 AIDS-related deaths. Belize City has the highest number of HIV/AIDS cases in the country with an average of approximately 51 reported new cases per quarter. No case is reported for Benque Viejo. These statistics are however not an accurate reflection of the disease in the country because they give numbers from only the government laboratories, and do not include information from private medical practices or unreported cases.
The general perception in the community is that youths and females who work as CSW are the most vulnerable because of the prostitution, ignorance, experimenting and poverty. However the statistics from the Ministry of Health show that those between 30 and 49 years are most affected. Everyone interviewed in the population survey said they have heard about AIDS and 94% said there is something a person can do to prevent contracting AIDS, of whom 78% identified the use of condoms. The responses though to a number of questions lead to the conclusion that the population is not well educated about the disease and are in fear of contracting it. Everyone surveyed knew what condoms are used for; 82% said to prevent infection by STD/AIDS and 12% said to prevent pregnancy. However, 23% said they would not be willing to use a condom even though they are available in drug stores (89%), hospital/clinic/health centers (69%), stores (67%) and other places. Table 2: What can a person do to avoid getting AlDS? Action Use condom Not having sexual relations Have sexual relations only with partner Others: abstinence, avoid KHMH, avoid needles, do not drink/eat from same utensils SOURCE: Population Survey, M&A, 2001 Frequency (%) 78.3 5.8 5.8 2.6
The responses to the questions set out in Table 3 lead to the conclusion that the respondents are not well educated about the disease and are in fear of contracting it. Table 3: Response to questions about AIDS Question Would you consult a doctor that had AIDS If you had to employ someone to work in your house, would you employ someone who had AIDS? Would you be willing to allow your small children to play with the children of people who had AIDS? In your opinion, do you consider the possibility of your acquiring AIDS or another STD to be High Regular Low Not possible SOURCE: Population Survey, M & A, 2001 Social response to HIV/AIDS and mobile population Alliance Against AIDS (AAA), Belize Family Life Association (BFLA), Red Cross, and Young Women Christian Association (YMCA) are NGOs involved in HIV/AIDs education and distribution of condoms, and in some cases peer counseling, hot line, and assistance to AIDS patients. The Government of Belize has taken an integrated approach for a proactive fight against HIV/AIDS. Yes(%) 25 21 47 22.3 8.3 33.7 21.2
Government has established a National AIDS Commission, a Mother-to-Child Transmission and Control Project, and a law, which criminalizcs sexual and other conduct likely to cause the transmission of HIV/AIDS. This latter approach criminalizes some AIDS victims; may drive the disease further underground, and may also open the door to human abuses. Recommendations The following are recommendations to promote an intervention to reduce the vulnerability of the population to HIV/AIDS. 1. Since 95% of the respondents (Belize City and Benque Viejo) agreed with their children, brothers or sisters, receiving information at school on sex education and AIDS; target schools to empower children from early. This can be done by training the teachers and incorporating the topic of AIDS in the primary school curriculum and/or by having itinerant teachers visit the schools to teach the topic. The use of video should he considered. In addition to the formal setting. more printed materials are needed in Benque Viejo because this aspect of education is virtually non-existent here. These should be made available at clinics, schools, hotels and brothels and in taxis. Creative means of disseminating information should be explored, e.g., training and using taxi drivers, youth groups, bar tenders, peers and colleagues, etc. This also applies to Belize City. Forty-five percent of the sample surveyed said they have heard a talk or received information about aspects related to AIDS prevention via TV and radio from the National AIDS Commission, Alliance Against AIDS and a teacher. Campaigns should be done mainly through TV and radio to maximize coverage. The newspapers are continuously carrying articles related to HIV/AIDS. However very few of these articles are related to how to prevent contracting the disease. Therefore it is recommended that the newspapers be influenced by the NGOs and GO, especially NAC, to carry articles on "safer" sex. Strengthen the capacity of families to cope with their problems. Migrants might be poor, lonely and isolated.
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Considerations for intervention The following are considerations that should be made in considering any intervention to reduce the vulnerability of the population towards STDs including HIV/AIDS. 1. 2. There will always be vulnerable groups to HIV/AIDS. Therefore there will always be need for intervention. Sustainability: What will drive the intervention? If it is the project, what will happen after the funding for the projects disappears? So there is a need for an organization or a group of organizations that have the fight against AIDS as a part of their major functions to lead this effort. The private sector is critical to sustainability. It could provide resources and support (e.g., time off for employees to participate in campaigns, printed materials) for campaigns. Consider a team approach rather than using one group to reach more people and for support. One group could be complemented by other groups to enhance its capacity. Cross border campaigns: Efforts in Benque should be coordinated with those of the Guatemalans in Melchor and beyond in Honduras and Salvador. Groups and action should be targeted: Transmission of AIDS in the two transit stations is by sexual intercourse, (there are few needles in Belize City) so the places outside of the home where this is done should be where education is done (e.g., pamphlets) and condoms are made available.
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