ORANJESTAD - New research in the Caribbean islands shows how the HIV taboo is perpetuating this epidemic.
In Aruba, people test themselves too late, do not come to their doctor's appointment or collect their medicines too late, says internist-infectiologist Bert Rodenburg of the Aruban hospital HOH.
The consequences of late testing are major. More than half receive an HIV diagnosis years after the original infection. As a result, many people are not tested for HIV until they are already seriously ill and have AIDS.
Almost half of these patients only start testing when they have symptoms, according to the study in which four years of data were collected by the hospitals of Aruba, Bonaire and Curaçao.
“You should rather have people do routine checks or start testing after sexual contact with someone who is known or thought to have HIV,” Rodenburg explains. Even with multiple sexual partners, it is important to test for HIV regularly.
'Enormous stigma and shame'
In Aruba, two-thirds of HIV diagnoses occur among men who have sex with men. That is comparable to the Netherlands. But unlike in the Netherlands, the 'enormous stigma and shame' in Aruba is a major problem for combating the HIV epidemic, Rodenburg concludes.
“I have patients who do not want to be called by name at the outpatient clinic. The waiting room is very small. Then there is a good chance that someone will recognize that person and almost all patients do.”
Discriminatory law
Arubans with HIV are discriminated against in all kinds of ways, which means that the taboo remains. Rodenburg gives examples of problems with buying a house because you cannot take out life insurance anywhere. Or dismissal after a positive HIV test, where the employer claims that it is due to dysfunction but was still very happy with the employee before the test result.
“These are all experiences that people with HIV have and ensure that people do not dare to talk openly about their HIV status,” Rodenburg explains.
The infectiologist says that there is even legislation that discriminates and thus contributes to maintaining the HIV epidemic: Seven percent of HIV patients in Aruba are people without legal residence papers. This group will not be reimbursed for the costs of an HIV test and treatment.
There is now a bill to change this.
'LHBTI+ emancipation helps reduce stigma'
Rodenburg also advocates for LGBTI+ emancipation in the fight against the HIV epidemic. This emancipation must precede HIV awareness campaigns.
According to him, “there is no point in educating society about HIV if they do not first accept that there are other types of relationships than just heterosexual relationships.”
“We don't have same-sex marriage in Aruba yet. That should be step one.”
HIV infections on the islands
Hospitals on Aruba, Bonaire and Curaçao, assisted by University Medical Center Utrecht, have conducted research into the HIV population on the three islands for the first time.
HIV infections are about 3 to 5 times more common on the ABC islands than in the Netherlands.
More than 1300 people are currently being treated for HIV on the islands. In Aruba that is 392, Curaçao has 900 and Bonaire 60.
The exact number of people infected with HIV on the three islands is not known because there are no demographic figures about the risk groups.