Worse Than We Know:
AIDS and the Federation

Part I

Printed in The Observer, June 2, 1996

'm not sure that we think we really have a problem," conceded Dr. Kathleen Allen-Ferdinand, speaking about the public perception of AIDS in St. Kitts and Nevis. This perspective--that AIDS isn't really a major issue here--makes it very difficult to stop the spread of this deadly disease and to provide needed services to those suffering from AIDS.

Unfortunately, both statistics and the personal experiences of doctors and educators working on the problem reveal a dangerously different story. Between 1982 and 1995 there were 53 people with AIDS reported in the Federation; 31 of them died during that period. In the first two months of this year alone, the Ministry of Health reported that 14 people tested positive for HIV, the virus which causes AIDS. Although statistics never tell the whole story, this massive increase is probably just the tip of the iceberg.

According to the World Health Organization (WHO) Global Programme on AIDS, the virus "is spread primarily by having sexual intercourse with someone who is already infected with HIV. HIV can also be transmitted by infected blood or blood products." However, the fatal nature of the disease has caused many people to fear any contact with someone who has the HIV virus. (See sidebar for detailed information about how the virus is spread.)

AIDS (Acquired ImmunoDeficiency Syndrome) is the late stage of infection caused by the Human Immunodeficiency Virus (HIV). Someone who is infected with AIDS can look and feel healthy for ten years or more before signs of AIDS appear. But during this time, he or she is still carrying the virus and can infect others.

Medical personnel believe that everyone infected with HIV will eventually develop AIDS as their body's immune system is steadily weakened by the virus. At some point, the body is no longer able to fight off the "secondary infections," like pneumonia, diarrhea and tumors which generally occur with AIDS. It is these infections which ultimately cause death.

There is no vaccine to protect people against HIV infection and there is no cure for AIDS. The only way to protect oneself is to not get infected by the virus. Therefore, educational efforts about how to prevent the spread of the disease are the primary focus of the AIDS programs in St. Kitts and Nevis.

The National AIDS Committee, chaired by Permanent Secretary for Health and Women's Affairs Ian Hodge, and the Information, Education and Communication Committee on HIV and AIDS (IEC), chaired by Director of Women's Affairs Rosalyn Hazelle, share the task of carrying out AIDS programmes on St. Kitts. The IEC meets more frequently and implements the efforts, many of which receive international funding from UN AIDS, in addition to government support.

Mavis Huggins, who serves as National AIDS Coordinator, works primarily on education. Huggins spends much of her time out talking to groups about AIDS, other Sexually Transmitted Diseases (STDs) and sexuality. She and other AIDS educators try to balance their message by calling for sexual abstinence and committed, long-term relationships, as well as safer sex. However, recognizing the common sexual practices, Huggins stressed "We should all be practicing safer sex. Each person should be responsible for their sexuality." Safer sex involves the proper use of condoms when engaging in sexual intercourse or oral sex.

There has been some "resistance from churches to promoting the use of condoms among young people," according to Dr. Cavelle Hobson, a doctor of internal medicine who is on the National AIDS Commission. However, "we on the Committee (IEC) are seeing how sexually active our young people are," remarked Dr. Allen-Ferdinand.

During school presentations the educators ask young people to write down their questions. "Young people ask very explicit questions," Huggins reported, expressing surprise at the number of questions related to lesbian sexuality. She and her co-workers believe that while it is perhaps best for young people to abstain from sex until they are older, this is no longer the norm.

Huggins draws on resources from other parts of the Caribbean to create presentations appropriate to different groups--ranging from churches to schools to sports clubs. A video entitled "AIDS is Coming to Your Church" has proven an effective tool for church groups. A video featuring Magic Johnson has been used with sports groups.

Huggins and others involved in the fight against AIDS often feel that they're fighting an uphill battle. "It's overwhelming at times," she recounted. But the life and death nature of providing the information and resources to prevent the spread of other AIDS and STDs keeps these dedicated professionals hard at work.

Confidentiality on a Small Island
AIDS and the Federation

Part II

Printed in The Observer, June 9, 1996

Many people have had unprotected sexual encounters which put them at risk to become infected with HIV or other Sexually-Transmitted Diseases (STDs). This reality makes AIDS testing an important part of preventing the further spread of this deadly disease. Unfortunately, many people are afraid to get tested and in a small country such as ours this problem is compounded.

Dr. Kathleen Allen-Ferdinand, one of the doctors who has taken on the AIDS crisis, strongly promotes testing. She recognizes that many people are afraid to go into the hospital to be tested. They worry about running into a neighbor or co-worker and being suspected of having AIDS.

To make her patients feel more at ease, Dr. Allen-Ferdinand counsels patients about the meaning of the test, draws the blood in her office and codes it before sending it to the lab. This means that the test is identified only with a number outside of her office. Other doctors give clients a blood test request form which they take to the hospital and from that point on, the test is identified only by a number.

Confidentiality is such a big issue because "people still stigmatize those with AIDS," according to National AIDS Coordinator Mavis Huggins. "People want to know who's infected and some even suggest isolating them," she said. Educating people about the real dangers is one of her goals, so that people who are HIV positive or who have AIDS don't have to hide.

Denial is another factor which keeps people from getting tested. "There is still a significant belief that AIDS is primarily a homosexual problem," reported Dr. Allen-Ferdinand. Statistics tell a different story: of the 53 reported cases in St. Kitts & Nevis 16 were contracted through heterosexual contact and only two through homosexual contact (in 33 cases the exposure wasn't clearly defined). In other countries the vast majority of people becoming infected with HIV are also heterosexual.

Dr. Allen-Ferdinand would like to see other doctors provide testing in their offices, though she acknowledges that this is more clostly than sending patients to the hospital. A system is needed which assures people that their confidentiality will be preserved, otherwise people will die unnecessarily.

She told the sad story of a "23 year-old patient, who later died of AIDS." Allen-Ferdinand asked him if there was anyone in his family who they could talk with about his illness. His brother came in soon afterwards and the doctor felt that the three of them had a good talk. The next day she saw her patient out on the street begging. His brother had kicked him out of the house.

Dr. Clavelle Hobson, who tends to see AIDS patients after they have become quite ill, has noticed that some families have become more supportive, visiting their sick relatives. Dr. Allen-Ferdinand has also seen more positive family response recently, but pointed out that there's still a long way to go.

The problem of people with AIDS being abandoned by family and friends has led to discussions of establishing a hospice for people who are terminally ill. Such a facility would help not only people with AIDS, but others in need of such care. Funding for a feasibility study for this project has been approved by UN AIDS.

This is only one of a number of projects which is in the planning stage. Fortunately for all of us, there are those in our community who are working hard to educate us about how to live safe and healthy lives in the age of AIDS.

Education to Stop the Spread of AIDS

Part III

Printed in The Observer, June 23, 1996

Education is the primary tool being used to combat the spread of AIDS. With that in mind, upcoming plans of the National AIDS Committee concentrate on getting information to more people, in ways which are more effective. The second national "Knowledge, Attitudes, Practices and Beliefs Study" is currently underway to help the Committee assess the general public's knowledge of these issues.

National AIDS Coordinator Mavis Huggins reported that their two year work plan has been approved by UN AIDS and funds should be forthcoming. Early indications are that a funding request to the French Mission has also been favorably received.

This money would be used for workshops to prepare professionals to counsel those who are HIV positive, other patients with sexually-transmitted diseases and people with AIDS and their families. Peer counseling workshops on sexuality in secondary schools and workshops for doctors are also being planned.

Training seminars with the police force on both St. Kitts and Nevis have recently been conducted. Ongoing educational programs for young people will continue. One hopeful sign acording to Huggins, is that "other groups are now expressing an interest in doing AIDS related programs." One such effort is the staging of the Trinidadian play "One of Our Sons is Missing" by the National Players, scheduled for July 20-21 and 26-28 at Basseterre High School.

The St. Kitts Teachers' Union (SKTU) will continue their teacher training efforts with a workshop scheduled for July. Randy Taylor of the SKTU and Olvis Dyer of the Nevis Teachers' Union attended an International Conference on "School Health and HIV/AIDS Prevention" last summer in Zimbabwe. Resources from that conference are being shared with other teachers.

A counseling hotline is another service which the Committee would like to see established. Such a hotline would handle a variety of crisis calls, as well as providing information about HIV and AIDS. The feasibility of establishing a hospice for terminally ill people, including those dying of AIDS, is being studied. Similar facilities are currently operating in Jamaica and the Bahamas.

Another important service provided by the National AIDS Committee involves "contact tracing." If someone tests HIV positive, anyone with whom they have had sexual contact should be notified, receive counseling and be encouraged to undergo an HIV test. The Committee can help make those contacts as well as providing the necessary information and counseling.

Getting the drugs to help people trying to live with AIDS is another problem according to Dr. Cavelle Hobson who treats AIDS patients at the JN France Hospital. AZT, the most common drug used to fight the virus in the United States, is much too expensive for most patients here. "Buying the drugs to treat the secondary infections involved with AIDS is also a problem," she explained.

Dr. Kathleen Allen-Ferdinand, an active member of the National AIDS Commission, believes that finding better ways to empower women, particularly young women, to "say no" to sexual advances is vital. She recounted a conversation with a young woman who said, "I told him, not without a condom and he did it anyway." The woman added that "no, it wasn't rape." Many women describe difficulties in getting their partners to use condoms. She responds to them with the question, "Do you love him enough to die for him?"