Women's Issues In Guyana

Fatal Nexus: HIV/AIDS and Sexual Violence

Posted in Education,Legislation by wiig on October 21, 2007
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Chronicle – October 21, 2007

“A recent study found that condoms were used in only 3% of reported sexual violence cases in Guyana. Sexual violence carries not only a risk of pregnancy but a particularly high risk of transmission of HIV/AIDS, because of the increased risk of injury and bleeding.”

Stamp it Out: The Ministry of Human Services and Social Security Consultation Paper on Sexual Violence

On Friday, Minister of Human Services and Social Security Ms. Priya Manickchand officially began consultations on her initiative aimed at “strengthening existing protection against sexual violence and reforming the law on sexual offences.”

In the first paragraph of Foreword to the consultation paper, militantly entitled ‘Stamp it Out’ Minister Manickchand states that:

“Sexual violence is the most widespread and unpunished of crimes. It destroys lives, families and communities, holds back our society and economy, and spreads HIV/AIDS and other STDs.”

The nexus between sexual violence and the spread of HIV/AIDS is one which has been established in many societies, within the region and outside of it. In the extreme cases of post-conflict societies, particularly where rape was used as primarily a tool of war, the linkage between mass HIV transmission and sexual violence is clear. The example of the recent conflict in the Democratic Republic of Congo stands out. According to an article in the April 8, 2004 edition of the U.S. magazine, ‘The Nation’, it was estimated that some 60 percent of combatants in the conflict were HIV-positive, while some 30 percent of the women raped during the conflict were infected with the virus.

“And one of the key factors fuelling the epidemic amongst women, and particularly young women, is violence and specifically sexual violence. And it occurred to us that people are vaguely aware, in a general sense, of the contribution of violence to susceptibility or vulnerability to
infection among women…”

Judy Auerbach, Vice-President American Foundation for AIDS Research

In conflict-free societies however, the connection is less obvious, with the linkage established only through dedicated initiatives which necessarily include components of research, analysis, discussion, consensus and then policy formulation.

For example, in 2000, the Canadian government hosted an inter-agency conference convened with the specific purpose of examining the two issues in correlation.

“Over the last three years,” reads the background abstract for the conference, “Health Canada (Canada’s federal department of health) has supported policy and programme development related to HIV and sexual violence through a series of initiatives targeted at counsellors, health care professionals, and women who have experienced sexual violence and are at risk for HIV or living with HIV/AIDS. These initiatives have brought together representatives from government and various non-governmental organizations to work collaboratively in linking HIV and sexual violence.”

According to Minister Manickchand, much of the new measures proposed by the consultation paper are geared towards deterring potential offenders by cleaning up the investigative/judicial side of the equation, wherein there is in a meager 1% conviction rate in rape cases; and reforming the legislative side where much of the current laws on sexual offences are outdated.

But what happens in the cases where legal deterrents fail to work? In the HIV/AIDS and larger social work community in Guyana there is ample anecdotal evidence of deliberate transmission of HIV through sexual violence, specifically rape.

One social work official related to this paper a case she encountered some time ago. A girl in her mid-teens who was raped several times during the course of one day initially tested negative for HIV. The relief felt by those familiar with and connected to the case was short lived however when a subsequent battery of medical tests, in which the HIV-test was only incidental, showed the rape victim was infected with the virus.

One area the Ministry of Human Service’s Consultation paper does not address is with what some jurisdictions referred to as the malicious or deliberate transmission of HIV. According to Minister Manickchand, while this issue was not included in the consultation paper, one of the very first responses she received after distributing ‘Stamp it Out’ was one in which the respondent posited that rapists who are aware of their status and sexually assault their victims without protection should be charged for murder or attempted murder.

This is a problem that is engaging several countries at present. South Africa denies bail to any HIV positive person accused of rape unless there are special circumstances brought to be bear on the case.

According to Minister Manickchand, one foreseeable problem of going in that direction would be that it could infringe on the confidentiality presumed with HIV-testing and counselling in Guyana. An associated problematique arises regarding transmission via consensual sex whereas the transmitting partner is aware of their status and the newly infected partner is not.

There are also other areas of concern, some not as direct. Three years ago, when Minister of Health, Dr. Leslie Ramsammy suggested the decriminalization of homosexual sex as a means of combating the spread of HIV/AIDS, he received vigorous opposition from the local religious community as well as other sections of society.

Societal homophobia, particularly in the Caribbean, has often been associated with the larger issues of sexual violence and the spread of HIV/AIDS. In Jamaica for example, according to a Human Rights Watch report published in 2004, homophobia resulted in many homosexual people, both male and female, leading sexual double-lives due to the fear of violent reaction – often rape in the case of lesbians – to their sexuality being exposed.

In the Ministry of Human Services’ ‘Stamp it Out’ consultation paper, Article S351 which covers ‘Gross indecency of male with male’ will be retained and “will continue to cover consensual activity.”

Sunday Chronicle asked Minister Manickchand about the reason for not using the opportunity to decriminalize consensual adult homosexual sex, particularly since the criminalization of what is legally known as ‘buggery’ has been identified as a stumbling block in the fight against HIV/AIDS.

According to the Minister, this consultation process is by no means an exhaustive one vis a vis the reform of Guyana’s sexual offences legislation. She stated that the decision was taken to touch on aspects of the existing legislation with clear and measurable negative impact, and any legislation dealing with consensual sexual activity was not highlighted for change in what she says is a first phase of consultation and reform.

The very last resort of protecting victims of sexual violence from HIV infection is what is termed Post-Exposure Prophylaxis or PEP. PEP consists of the administering of anti-retroviral (ARV) drugs immediately after potential exposure to the virus.

The two major situations in which PEP is usually warranted are in the health care environment wherein a health care worker is exposed to possible infection; and in cases of sexual assault.

In some countries, PEP practices are codified in law. A new Sexual Offences Bill was passed in South Africa, a country known both for its significant level of HIV prevalence and its high incidence of rape, in April this year: the bill effectively put into law a 2002 Cabinet policy decision providing PEP to victims of sexual assault.

Guyana has a fairly comprehensive PEP regimen as outlined in the Ministry of Health’s ‘National Guidelines for Management of HIV-Infected and HIV-Exposed Adults and Children, August 2006 Revision.’

“The basic ARV regimen for PEP,” the guidelines state “should be available 24 hours a day, including nights and weekends, in all healthcare facilities.”

The document also implies that HIV post-exposure prophylaxis should be administered within seventy-two hours of any reported sexual assault.

According to Minister Manickchand however, recent responses to her ministry’s consultation paper indicate that post-sexual assault PEP regimen is not being strictly followed across the country. Health workers from several health facilities, during a recent consultation with the Ministry of Health, stated that there have been cases of rape where PEP was not readily available.

Hopefully, she told this paper, the situation will be improved. On the possibility of the need for legislation instead of policy to ensure this improvement she had this to say:

“You hope sometimes you don’t have to regulate with a law but if it turns out that you have to, then you have to.”


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