PrEP: time to rethink prevention, effectiveness and ethics?

By Marsha Rosengarten


PrEP: time to rethink prevention, effectiveness and ethics?


One of the more controversial interventions proposed for HIV prevention in those who test HIV antibody negative and perceived to be at risk is pre-exposure prophylaxis (PrEP) – a daily pill comprising one or two antiretroviral drugs manufactured by Gilead Inc.  Besides the mixed results from multi-site randomised controlled trials (RCTs) seeking to establish the efficacy of PrEP (see iPrEX versus Fem-PrEP), concerns have been raised about PrEP’s potential to undermine condom use, its cost implications in locales where treatment provision is still lacking and elsewhere, its potential to cause unwanted drug side-effects as well as possible drug resistance in those it fails to protect.


Nevertheless, continuing new infections and evidence that high adherence produces a strong protective effect are mobilising many public health authorities to devise feasible implementation models.


Most remarkable about the growing interest in PrEP is the exclusion of the social sciences from major forums where this work is taking place.  One such example is a two-day forum held in the UK by IAPAC on the dual topics of treatment as prevention (TasP) and PrEP.  The only non-biomedical speakers listed on the programme were a psychologist (speaking on adherence), a bioethicist, activists and public health officials linked to various national epidemics.


Indeed it won’t come as a surprise to many to know that despite the millions of dollars to support RCTs for PrEP, the Bill and Melinda Gates Foundation have so far declined to support a substantial programme of social research on PrEP.  In fact if we consider the bioethical requirements imposed on the conduct of RCTs for PrEP and other biomedical interventions, there is no ethical requirement for research on the social dimensions of the intervention during or post RCTs. This applies even when RCTs demonstrate candidate efficacy.


The multiple ways in which PrEP will unfold across the epidemic and the absence of social scientific approaches to grapple with this multiplicity is worrying. Without doubt it underscores the need for this particular blog and other forums designed to enliven the social science contribution and increase its visibility. But the absence of social science also raises the question of what sort of social research should be called upon in response to the biomedicalisation of the epidemic.


Although not wanting to diminish what has already been achieved to date by the social and biomedical sciences, it is worth pointing out that much of this work has relied on the presupposition of an ‘HIV prevention user’ who exists prior to and remains largely distinct from the means of prevention or RCT technology.  Always already conceived as independent of the means of prevention, ‘she’ or ‘he’ is assessed according to whether ‘she’ or ‘he’ does or does not utilize prevention. If not, it is because:


i)      She/he is deficient in knowledge or understanding necessary for adopting safe practices.


ii)    She/he is deficient due to asymmetries in power and situated in such a way to be without services that help mitigate against unsafe practices, for example: housing, food, education, safe forms of employment without discrimination.


iii)  She/he is deficient in responsibility causing her or him to be unable to act safely.


Leaving aside any preferences we may have for one or even two of these accounts of ‘the user’, all can be said to assume and, indeed, enact HIV risk as if consisting of ‘stand-alone entities.’ These entities— for example, users, bodies, knowledge, rights, HIV, condoms, drugs, routes of transmission and so on—are imagined as present in a stable form prior to the risk event and ontologically distinct. 


This thinking is especially prevalent in RCT design, sometimes even the explanation for failure. The MIRA trial (Methods for Improving Reproductive Health in Africa) found that women in the candidate arm who were asked to use a diaphragm with a condom in sexual intercourse were less likely to sustain condom use than women in the placebo arm who were recommended to use only condoms.  In other words, the combining of presumed distinct prevention technologies gave rise to women in the candidate arm being more at risk of HIV infection than those in the placebo arm. 


Here the ‘additional’ object (the diaphragm) did not enhance but, instead, diminished the capacity of the more protective object (the condom).[1] In sum, a logic of ‘stand-alone’ entities undermined prevention in the candidate arm, rendered ineffectual the statistical calculations necessary to a worthwhile trial and, it can be argued, raises the question of whether the logic of ‘stand-alone’ entities leads to a practice devoid of satisfactory ethics.


Importantly, the women in the MIRA trial, like many others negotiating the demands of HIV in the midst of complex and sometimes competing social relations, remind us that ‘objects’ such as condoms, diaphragms, pills etc. are not stable and distinct but emerge with heterogeneous effects in their relations with other phenomena.


Ironically, biomedicine also offers a reminder of the dynamic co-affective nature of the epidemic, even if those practicing it fail to fully comprehend their objects in this way: the virus is of consequence when it is with the human body or in a laboratory study, not when it is independent of other phenomena. Similarly antiretroviral drugs are made effective in their use; or through the monitoring of adherence; or through their capacity to induce ‘side effects’ and so on.  They, too, acquire their effect only in relation to other phenomena and, moreover, it is their effect that we are concerned with.


As a guide to how we might extend the social science of prevention, I want to propose a rethinking of prevention as that which is effective because it is ethical.  By hinging effectiveness to ethics, the relational aspects of intervention come into view.  Put simply, if prevention is to take place—in this instance through the uptake of PrEP—it must perform an aligning with the varying interests of those it is intended for and, at the same time, affecting. More specifically, it must weigh in on some affects—most likely those of pleasure although this is complex territory in itself —well over others—such as coercion and homophobia —and do so by appealing in such a way that the effective user is able to emerge as such.[2]


By anticipating ethics as immanent in the affective work of practice it also becomes possible to become sensitized to dynamics that work against prevention. Particularly pertinent here is the manner in which PrEP has emerged. Its controversial nature cannot be disentangled from the technology of the ‘efficacy’ testing RCT and the legitimation of this process by bioethics. The legitimizing of RCTs in their current form where only a delimited set of effects are of concern—those that may incur more risks than benefits within the parameters of the RCT—excludes precisely that which the more everyday use of the candidate may generate.  Here I am thinking in particular of concerns that PrEP may give rise to what is termed ‘risk compensation’ or may alter gender relations in such a way that women take responsibility for prevention as has happened with the contraceptive pill.[3] Crudely put, how has it come to be ethically legitimate to spend millions of dollars on the efficacy testing of a biomedical agent[4] without providing research into how it will affect the epidemic? Or, to turn the gaze on those who would otherwise neglect us and, at the same time, open for consideration the achievement of biomedical prevention more generally:  has bioethics usurped the role of social science as such by granting biomedicine greater license for its activities but less viability for its products?  


These questions and a host of others could become part of a different approach to prevention, effectiveness and ethics. To reiterate, by conceiving of effectiveness as an achievement of ethical design it may be possible to shift the logic of the stand alone as evident in the deficit individual and as exemplified in the MIRA trial   and begin to work with PrEP as a highly relational entity. Working with PrEP means attending to how it emerges, including how it does so through the design of RCTs and, possibly, as part of the everyday relations involved in its uptake.




[1] Rosengarten M, Michael M, Mykhalovskiy E & Imrie J (2008)‘The Challenges of Technological Innovation in HIV’ Lancet Aug 2;372 (9636):357-8.


[2] See for example: Race, K (2009) Pleasure Consuming Medicine: The Queer Politics of Drugs, Duke University Press, Durham & London; Gomart, E. (2004) ‘Surprised by Methadone: In Praise of Drug Substitution Treatment in a French Clinic’, Body & Society, 10 (2–3): 85–110.


[3] Rosengarten, M. & Michael, M. (2009) ‘The performative function of expectations in translating treatment to prevention: the case of HIV pre-exposure prophylaxis or PrEP’ Social Science & Medicine, Volume 69, Issue 7, October: 1049-1055.


[4] Peters A JTP, Micevska-Scharf M, Van Driel FTM, Jansen WHM (2010) ‘Where does public funding for HIV prevention go to? The case of condoms versus microbicides and vaccines’ Globalization and Health 6, 23:1-10

Caribbean States called upon to adopt OAS Resolution

The Coalition of Lesbian, Gay, Bisexual, Transvestite, Transsexual, Transgender and Intersex (LGBTTTI) Latin American and Caribbean organizations (The Coalition) is calling on all Caribbean states to implement the Organisation of American States (OAS) Resolutions on human rights, sexual orientation and gender identity.
During the 42nd General Assembly of the OAS which took place in Cochabamba, Bolivia from 3 - 5 June, 2012 a fifth resolution “Human Rights, Sexual Orientation and Gender Identity” was adopted. 

A result of long term advocacy of the Coalition, the resolution includes all the issues contained in the previous resolutions which call on Member States to introduce measures against discrimination and human rights violations and to implement public policies.

Additionally, the resolution requests that the Inter-American Commission on Human Rights (IACHR) “prepare a study on legislation and provisions in force in the OAS Members States restricting the human rights of individuals by reason of their sexual orientation or gender identity and to prepare based on that study, guidelines aimed at promoting the decriminalization of homosexuality.” 

According to the Coalition “indifference, omission and complicity by many states in cases of discrimination and violence against the LGBTTTI community make those more severe and limit the enjoyment of the basic needs of our communities.” 

The Coalition noted that this situation is even more serious in the case of legislation in 11 Anglophone countries. 

It contends that in the Caribbean:

• 11 countries still criminalise consenting adult same-gender intimacy;

• two countries ban entry of homosexuals;

• one country imposes life sentences for consenting adult same-gender intimacy;

• homophobia contributes to the region having the second highest HIV and AIDS prevalence and incidence rates;

• there are no protections for domestic violence committed against LGBTTTI persons by their intimate partners or their families; and,

• Lesbian and bisexual women and invisible from any government data produced in the Caribbean.

With this in mind the Coalition states that Caribbean countries must adopt the fifth resolution of the 42nd General Assembly of the OAS and condemn all forms of hum rights violations against the LGBTTTI community, as well as take immediate steps to end all forms of discrimination against this vulnerable group.

USAID to launch LGBT Global Development Partnership Initiative

The event seems to have been rescheduled for the fall according to sources.

Few details are publicly available but this is something big.

On Monday, the United States Agency for International Development(USAID) was to hold a gathering at the Ronald Reagan Building in Washington, DC, to celebrate LGBT pride month and to launch their Global LGBT Equality Partnership.

USAID was launched by President John F. Kennedy in 1961 to handle civilian foreign aid. It operates based on guidelines from the U.S. President, the U.S. Secretary of State and the National Security Council and its goal is to provide "economic, development and humanitarian assistance around the world in support of the foreign policy goals of the United States."

The Partnership would make it current USAID policy to make federal foreign aid available to agencies working to strengthen LGBT rights throughout the world although I assume it would limit it to a number of nations that meet certain diplomatic standards and to organizations that have the infrastructure to handle federal grants from the United States.

From the event press announcement:

Eighty-five countries and territories criminalize LGBT behavior, seven countries have a death penalty for same-sex sexual activity, and fewer than 50 countries punish anti-gay discrimination in full or in part. The partnership will enhance LGBT equality through providing a greater voice in civil society and political processes, increased access to services including police and justice systems and improved economic security.


The Partnership will cast a worldwide net but, speaking specifically about Latin America, a lot of the limited funding that LGBT-rights organizations get comes from local and European sources. One of the few exceptions when it comes to U.S. foundations has been the work of the Astraea Lesbian Foundation for Justice which has long recognized the benefit of supporting international LGBT work.

I know from sources that USAID has been laying the groundwork and already granted some awards. Details will have to wait another day.

The initiative follows a presidential directive last year to use U.S. foreign aid money to secure and protect LGBT rights throughout the world and the exemplary work done by the State Department under Secretary of State Hillary Clinton on these same issues.

On a related matter, today the U.S. Department of State released the following pride month message from Hillary in which she addresses several of the Department of State's international achievements.

Non Discrimination

Foreign assistance agencies will work toward a goal of ensuring that USG implementing partners mirror USG non-discrimination practices for both employees and beneficiaries in the implementation of their programs. We issued a hortatory policy on October 11 for non-discrimination on the bases of sexual orientation, gender identity, pregnancy, marital status, parental status, political affiliation. USAID’s policy supports the human rights of all individuals. USAID’s inclusive policy simultaneously ensuring that faith-based implementing partners retain an exemption from the Federal prohibition on employment discrimination on the basis of religion when the organization receives financial assistance from USAID.

Protection

USAID/OFDA promotes non-discrimination among disaster-affected populations as a core component of protection by recognizing LGBT individuals for their distinct needs among vulnerable groups within an affected population. USAID/OFDA has issued an Annual Program Statement (APS) for sexual and gender based violence, in humanitarian assistance settings, that includes sexual orientation and gender identity, in the areas for which organizations may submit proposals.

USAID has included LGBT concerns in our discussions regarding our programs in the following regions:
LAC (Colombia, Honduras, Jamaica)
AFR (Uganda, Mali, Malawi)
Asia (Pakistan through the film “Bol”)
E&E (Macedonia)


Through email conversations, meetings with civil society activists, and reading cable traffic, we are aware of LGBT concerns in the following USAID-presence countries:
Africa (Zimbabwe, Nigeria, Ghana, Uganda, Namibia, Malawi)
Asia (India, Nepal)
E&E (Russia)
LAC (Haiti, Jamaica, Honduras, Colombia, Nicaragua, regionally through a conference in St. Lucia through ARC International)

Give Gays Minimum Human Rights Now, Urges US

Deputy Assistant Secretary of State Daniel Baer.

Andrew Wildes, Gleaner Writer

WASHINGTON:

A NEWLY established United States foreign policy is demanding that lesbians, gays, bisexuals and transsexuals in countries such as Jamaica be afforded a certain minimum standard of human rights.

Deputy Assistant Secretary of State Daniel Baer, who has responsibility for lesbian, gay, bisexual and transsexual (LGBT) rights, told The Gleaner that the policy is intended to ensure people are not discriminated against because of their sexual orientation.

Baer said the US Department of State will not leave it up to the Jamaican society to decide at its own pace if and when it will acknowledge the basic human rights of homosexuals.

"No! They shouldn't," the deputy assistant secretary of state responded when asked whether individual nations should be left to decide for themselves on LGBT rights.

NEED TO ACT NOW

"They shouldn't be left to decide on their own, the same way they shouldn't be left to decide on their own whether women should be beaten up or imprisoned for being women or whether somebody of a particular religious group ought to be beaten up or imprisoned for being part of that religious group."

The US is, in effect, advocating a global minimum standard. Baer expects that the nitty-gritty issues "will be determined ideally through democratic governance and through citizenship participation".

"There are certain minimum standards that all societies are meant to protect for each person and people shouldn't be thrown in jail or killed for who they are," he added.

At the same time, the deputy assistant secretary of state says LGBT rights are no longer a bottom draw, back door issue for the Department of State.

"There was some engagement before Secretary Clinton, but certainly Secretary Clinton has made it institutionally front and centre," said Baer.

MISUNDERSTOOD COMMENTS

Two years ago, Clinton sent a cable to all US ambassadors across the world saying, in Baer's words, "I want you to engage on these issues the same way you do on the rights of people with disabilities, or women, or religious or ethnic minorities - this is part of our human-rights policy."

Baer took pains to note that Clinton's speech on the subject seven months ago was misunderstood. On International Human Rights Day, Clinton argued that the human rights of LGBT people are no different from the human rights of any other individual.

"There has been a misunderstanding ... that in that speech she also articulated that there was some sort of new conditionally possibility with US assistance based on this," Baer said.

He continued: "What she said was that we would use our assistance policies to help further these human-rights objectives ... . What she was getting at was an affirmative ticking ... . That means paying attention when you are designing a programme and making sure you are being fully inclusive, that populations that are at risk, that are marginalised in societies are included and are at the table. That's an affirmative policy goal that is part of our assistance."

Exodus Official Resigns over Antigay Junket in Jamaica

Exodus International board member Dennis Jernigan has resigned after Truth Wins Out reported Wednesday night that he had breached the organization’s commitment against efforts to criminalize gay people.

Here’s the Exodus announcement. We’ll comment further shortly.

Orlando, Fla. — Exodus International, the oldest and largest Christian ministry dealing with homosexuality, released a new policy statement on the criminalization of homosexuality. While the ministry has long held this perspective, they felt compelled to release a written statement in light of Exodus Board Vice Chairman, Dennis Jernigan’s, comments to the media in Kingston, Jamaica. Exodus board member, Don Schmierer, experienced a similar collision with the media on a trip to Uganda in 2009.

“Dennis Jernigan recently traveled to Jamaica to share his testimony and lead worship at a number of venues,” said Alan Chambers, President of Exodus. “While there he was thrust into a media firestorm and asked to comment on President Obama’s threat to issue sanctions against Jamaica for their laws concerning the criminalization of homosexuality.

“Dennis shared his belief that President Obama is deceived about homosexual behavior and the biblical morality of it. Dennis assured me he is not for the criminalization of homosexuality, and he will release his own statement on this matter. However, Jernigan offered this immediate response ”:

“I believe my heart and intent were misconstrued and therefore, may have harmed Exodus’ mission of ministering to those struggling with same-sex attraction (SSA). To that end, as of this moment, I step down as Vice Chairman of Exodus.”

Here is an excerpt of the Exodus policy statement, also supported by its Board of Directors.

We will not support any legislation that deprives others of life and dignity based on their sexual orientation or the expression of such within the confines of a consensual adult relationship. Finally, we stand with the LGBT community both in spirit, and when necessary, legally and physically, when violence rears it’s head in Uganda, Jamaica or anywhere else in the world.

Chambers is working with the Exodus International Board and staff to craft strong statements, policies and procedures that will ensure their position on life-impacting issues such as this one.

“It is our resolution that unfortunate incidents like this do not happen again in the future,” said Chambers. “As president of Exodus International I take full responsibility for any board member, staff member or ministry affiliate’s ignorance of global issues, especially as they travel. I will make it a priority to keep all who are professionally affiliated with Exodus apprised of the nations where legislative initiatives or laws clearly violate our policy opposing criminalization of homosexuality. We will also craft a policy for our ministry that prohibits our involvement with groups and nations that violate our policies.”

'I Want To Marry My Gay Partner' - St James-Based Lesbian Says Marrying Her Lover Would Be A Dream Come True

Adrian Frater, News Editor

(photo selected randomly)

Western Bureau Gleaner:

Buoyed by the recent lesbian nuptial re-enactment in Silver Sands, Trelawny, one member of a local same-sex couple has declared that she wants to get married in Jamaica.

Montego Bay-based lesbian model Adrienne Simpsontold The Sunday Gleaner she would love to have even a token marriage to her partner.

Simpson, whose modelling career has taken her into countries that embrace same-sex unions, says she is eyeing this token marriage and will not allow the Jamaican law to be a "shackle" to her plans.

"I am in a relationship with someone who is giving me love, kindness and all the support I need," said Simpson.

"I have been with men and none of them has shown me the love and respect I am now getting," added Simpson.

Despite her pronouncement, Simpson admits that sometimes her conscience bothers her.

"I know it is not accepted in Jamaica but this is someone I want to spend the rest of my life with," said Simpson.

"Sometimes my Christian upbringing chips in and my thoughts waver, but deep down this is the life I want."

'Token weddings' common

According to Simpson, same-sex 'token weddings' are becoming quite common in Jamaica without attracting much fanfare and publicity.

"This is something that is happening regularly in Jamaica these days. I know several persons who have done it and are living happily. In many instances, these lovers operate similarly to the traditional husband and wife … one goes out to work and the other stays home and does domestic duties," added Simpson.

In the case of the Silver Sands mock nuptials, the 'bride' and 'bride', Jamaica-born Nicole Dennis-Benn and her American partner Dr Emma Benn, reportedly got married in New York, where such unions are legal, and merely came to Jamaica, where there is general intolerance to gays, to re-enact what had taken place overseas.

But many persons, including prominent church leaders, have condemned the recent mock nuptials at Silver Sands as an assault on the Christian way of life and saying they are not prepared to allow gay marriages locally.

"This is something that is not pleasing to the Church as it goes against our teaching, which sees marriage as a union between a man and a woman," said Canon Justin Nembhard, the head of the St James Parish Church in Montego Bay.

"It is illegal … in Jamaica. Marriage is not a union between any two people; it must be between a man and a woman," said Nembhard. "This kind of thing is not the norm and is not something you would expect to see in a Christian country."

Not allowed in Jamaica

Like Nembhard, prominent Montego Bay-based lawyer Nathan Robb has noted that regardless of how close the event at Silver Sands mirrors real nuptials, based on the Jamaican law, no marriage officer could legally perform such a wedding.

Robb also dismissed the notion that a marriage officer from a jurisdiction where same-sex marriage is allowed could come to Jamaica and perform such a ceremony legally.

"That individual (overseas marriage officer) would have to obey the Jamaican law once he comes into our jurisdiction," said Robb. "Once it is taking place in Jamaica, the Jamaican law must be observed and the Jamaican law is clear on marriage … there is no ambiguity."

Legal minds have also noted that Simpson and her partner could never get legally married in Jamaica as Section 18(2) of the new Charter of Rights of the Jamaican Constitution defines marriage as a "union of one man and one woman".

Name changed on request

Lesbian couple forced to move from gated community

So as we continue to trod the sometimes difficult roads of living in Jamaica as same gender loving folks more openly now comes this not unusual case where a same gender loving couple in a gated apartment complex found themselves the brunt of taunts which turned to physical threats in an upscale neighborhood leading to their hasty departure for their own safety. Normally more comfortable members of the community would have been spared the innuendos and threats normally meted out to lgbt people from the lower socio economic strata of society and given our classist/elitist nature in Jamaica generally and the insulation of sorts created by just where one lives it was surprising to hear this episode as reported by one of the victims involved.


She wanted to let persons know that she experienced lesbophobia first hand and that it does not matter where one lives the hate will follow if it wants to, a fact that some activists and influentials have been pointing out but some persons are of a different opinion and so there is a kind of complacency in certain upper middle income lgbt groups. The women who recently rented the flat in upper St. Andrew and are working professionals were pleased they had a home to quietly live away from the hustle and bustle of noisy streets, prying eyes and some privacy in a secured gated setting with a security detail at a button's pressing to summon them. Both had also gone through some rejection from their own families as they made known their decision to cohabit and have a long term relationship, this did not sit well with members of their families but they persisted non the less, now this.


Their new neighbours, mostly males with occasional female visitors who moved in some two months after the ladies settled in their comfi flat however had a different idea of living in an apartment complex, the SGL female couple began to notice the previously absent prying eyes phenomenon, the very thing they were trying to escape, whispers as they alight from their car in the evenings after coming in from work or at early mornings if the ladies had a night on the town. The series of peepings as it were and whispers persisted for some time and even other neighbours began to warn the ladies to be careful after what was alleged to be a spirited conversation by the prying men with their women one late evening after the girls left for a private function. Concerns were expressed to the strata management of the property by the ladies by phone who promised that they would look into the issue, this they did by calling in the main male tenant of the apartment, he was warned of overcrowding his flat with other persons who were not named as cohabitants upon signing the rent agreement where he was warned he was in breach. The engagement by the strata manager with the annoying male tenant about his harboring persons and annoying other neighbours seemed to be the reason for himself and his cronies to turn up the heat on the same gender loving females accusing them of being informants or informers in colourful Jamaican parlance where the ladies saw verbal attacks and the man and his friends almost staking out the ladies as they arrive or depart the complex. He complaine bitterly that the ladies should not have said anything about his visitors etc.


But it was a faithful Sunday morning in April as the ladies arrived home from a weekend out when they were approached threateningly by associates of the man who accused them of being lesbians and the usual ugly anti gay descriptions and threatened the more aggressive of the two ladies accusing her additionally of taking away women from men. The commotion awoke other residents who tried to intervene and demanded the non resident friends of the annoying man to leave the property, the security detail was eventually summoned and the police was also called by a concerned resident. Both units arrived and the non residents numbering five were escorted off the property in a car, the shaken women were thankfully consoled by the other residents while a heated argument persisted with members of the security detail and the prying male resident who hurled expletives at them and at the women continuing to name them as informants and lesbians. He also accused the detail as supporting slackness and that maybe they are gay too, he continued that this was not America and no sodomy will be tolerated.


Things cooled eventually but the women wasted no time in seeking a new flat and moved two days after the incident occurred and a tense calm that followed. I have since learnt that the man has been given notice to quit as a petition letter was sent by the other residents who complained to the strata manger of his disturbance and the disappointment of losing the quiet ladies due to him and his friends behaviour.


Good to see some tolerance coming from the other neigbours and who took action to have the man removed, also I am happy the ladies managed to remove themselves from that situation as quickly as they could, sadly we do have issues like this happening although we often do not have them publicized to show that not only homeless or persons from supposed downtown who are beaten or abused. 


Thanks to the ladies for sharing this and bringing some reality to our situation here. 


Be vigilant, be safe.


Peace and tolerance


H

Lesbian couple celebrate their marriage locally .........

The original Gleaner headline read Lesbians Legally Wed but well not quite as you will realise when you read this Gleaner article, the couple actually did the real deal in New York then came to Jamaica to have their local relatives and friends see them as is done by many Jamaican same gender loving couples who have green cards and can afford to do so. I attended a similar set up some months ago after the male couple made their vows in New York as well, this is nothing new per say but have a read of the piece:

Nicole Dennis-Benn (left) and Dr Emma Benn jump the broom during their re-enacted wedding ceremony at Silver Sands in Duncans Trelawny on May 26. Looking on are close friends and family of the couple. - Contributed

An American couple who tied the knot on Jamaican shores last month has documented their experience getting married in a country whose laws have long been antagonistic to same-sex unions.

But, what took place at Silver Sands in Duncans, Trelawny, was just a re-enactment of the actual wedding which took place in Brooklyn, New York weeks earlier.

"All the paperwork was done here (in the United States). We know Jamaican laws do not support gay marriage, so we had all the legal matters settled before we came to Jamaica," Nicole Dennis-Benn, who made sure her name in the marriage was made clear, told The Gleanerfrom the US yesterday.

Dennis-Benn, who grew up in Jamaica, said she wanted to share the experience with her family and friends who could not make it to the US for the actual wedding.

The couple's loved ones were all open to the wedding, except for both their mothers who did not show up.

"Our mothers accepted the relationship, but they said they could not deal with the wedding part of it," Dennis-Benn said.

Their story, which captured the couple's "blissful" moment on the Jamaican north coast two Saturdays ago, has been documented under the heading 'Revolutionary Love by Nicole Y. Dennis-Benn' on her Internet blog.

The article gave a flattering description of the scenery at the venue where Nicole Dennis and her partner, Dr Emma Benn, a US native, dared the unthinkable on Jamaican shores.

Dennis-Benn, 30, grew up in Vineyard Town and left Jamaica for college after completing her studies at a prominent high school in Kingston. It was during her final years in high school that she acknowledged herself as a lesbian.

"I found out in fourth form. When I was coming out, I wondered, 'What the hell?' because I know I couldn't stay in Jamaica and be who I wanted to. I felt I was the only lesbian in Jamaica at the time and I grew up in a Christian home. I knew that most Jamaicans were Christian," she said.

But, despite what some might think, it was not homophobia that mostly fuelled her desire to move to the US, she told The Gleaner.

Classism issues

"It was for a lot of things, but mainly because of the classism. I grew up in Vineyard Town and when I went to (high school), I experienced real classism."

She left Jamaica for studies at Cornell University in New York City. Dennis-Benn, who has her master's degree in creative writing, met Benn while working at Columbia University. The two tied the knot on April 6 before coming to Jamaica to relive the moment a little over a month later.

In her blog, the career writer recalled the moment before the couple dared the unthinkable on Jamaican shores.

"My partner joins me in the water and for the next hour, we swim and mingled with our guests who have also been baked and rejuvenated by the sun. 'You ready?' my partner whispers, swimming up behind me to encircle her arms around my waist. 'Yeah, I'm ready.' We smile at each other, aware in that moment that we're about to do something big, bigger than us.

The Jamaican native shared that it was her partner who helped her rekindle her love affair with the island after living a refugee life for many years."In my vows, I mentioned that because of my partner, I fell in love with my country again. For a long time, I ran away from Jamaica, seeking refuge in the freedom that America offered. However, when I met Emma, she was adamant about visiting Jamaica," Dennis-Benn said in her blog. 'Why not?' she asked when I turned her down a few times. I couldn't tell her then how much I was hurt by the culture, stifled by the seemingly robust structures of colonialism.

"However, when Emma and I finally returned to the island for our first visit as a couple in 2010, something felt different. At the time, I couldn't place what it was. There were no words to describe it since my brain had not yet processed it. I felt beautiful, stronger, empowered."

She said her acceptance of self was part of the reason she decided to have her wedding in Jamaica. However, her decision was strongly criticised by friends in America who claimed to know about Jamaica's anti-gay culture.

"My friends began to question my sanity once I told them that I'll be getting married in Jamaica, a country known internationally for its blatant homophobia. 'Weh di backside yuh mean yuh getting married in Jamaica?'" she further recalled in the blog.

"I had to reassure them that everything would be fine, simultaneously trying to convince myself too. I would constantly ask myself if I'm doing the right thing," she wrote.

No venue

With that decision out of the way, it now became an uphill task for the couple to find a venue in Jamaica that would be accommodating to their lifestyle.

"My partner and I took turns calling resorts in Kingston, the south coast, and the north coast ... . We clutched the receiver with sweaty palms as we prepared to come out as lesbians over and over again. 'Yes, hello, we would like to inquire about hosting our wedding at your hotel. What's the estimated cost for space? Great! Just one more thing you need to know ... my partner is a woman. Yes, that's what I said. A woman. Oh. OK. Uh-huh. I understand. Thanks for your time'," read the blog.

Next stop was at Villa where the two ended up saying "I do".

"I felt like I'd emerged from a dark tunnel, greeted by her radiating light. My father walked me down the aisle while my partner walked down the aisle with her aunt. We walked together as a couple paired with the most significant people in our lives to Whitney Houston's My Love is Your Love, she said of her experience.

To read Nicole Dennis-Benn's blog log on 

Group braces for costly fight against gays ......... Church must be passionate in fight against homosexuality, says pastor

A group opposing homosexuality in Jamaica is adamant that it will not let up on its stance against the gay agenda and is prepared for a costly battle in order to prevent the erosion of family life and the ultimate destruction of the nation.

The group — the Jamaica Coalition for a Healthy Society (JCHS) — comprises individuals and institutions that act as watchdogs for the physical, emotional, spiritual and mental health of the society.

Vice-president of the Jamaica Association of Evangelicals Reverend Peter Garth, who is closely aligned to the Coalition, said he has already called on the evangelical community to set aside funding for this uphill struggle.

"I have been saying to the evangelical community that our ministers are going to be dragged in and out of the courts and we had better begin now to set things aside," Garth told the weekly Jamaica Observer Monday Exchange of reporters and editors at the newspaper's head office in Kingston yesterday.

Adding that this will be a costly affair, Garth said the evangelical community must be prepared to pick up the slack.

"It is going to be costly to deal with it and the Church must be prepared to deal with that, which is why we are saying we are going to need funds because they (the gay community) have the funding," he said.

According to Garth, homosexuality is a threat to family life and an issue which he will continue to speak against, regardless of the consequence.

"We are not going to let down or to give up. I am not afraid. I am not afraid to lose my visa; take it away. I am not afraid to lose my life; take it away, but I hold on to my sovereign position and when I speak, one of the things which is amazing to JFLAG (Jamaica Forum of Lesbians All Sexuals and Gays) and others is that I am not quoting biblical scriptures," he said.

Garth said he examines the homosexual issue from a moral, biblical, medical and social point of view.

"I take off my religious hat and put on my psychology training hat where I deal with these matters because I am not only going to be pushing scriptures," he said.

Garth said the Church has to be passionate in its fight against homosexuality when it examines the proclamation of the homosexual manifesto which was entered into the US Congressional Record on February 15, 1987, and which reads in part: "We shall sodomise your sons, emblems of your feeble masculinity, of your shallow dreams and vulgar lies. We shall seduce them in your schools, in your dormitories, in your gymnasiums, in your locker rooms, in your sports arenas, in your seminaries, in your youth groups, in your movie theatre bathrooms, in your army bunkhouses, in your truck stops, in your all-male clubs, in your houses of Congress, wherever men are with men together.

"Your sons shall become our minions and do our bidding. They will be recast in our image. They will come to crave and adore us.... All laws banning homosexual activity will be revoked. Instead, legislation shall be passed which engenders love between men.

"All homosexuals must stand together as brothers; we must be united artistically, philosophically, socially, politically, and financially. We will triumph only when we present a common face to the vicious heterosexual enemy.

"If you dare to cry faggot, fairy, queer, at us, we will stab you in your cowardly hearts and defile your dead, puny bodies."

According to Garth, the gay community has been instructed to talk about gays as loudly as possible and to portray them as victims, not as aggressive challengers and to make them look good and the people opposed to them look bad.

As such, Garth said the Church is trying to influence others to look at the structure which provides value for our nation.

A former member of the gay community, Rev Dennis Jernigan, said that community has all the creative, financial and intellectual power.

According to Jernigan, an American citizen, the gay community gives more than the 10 per cent tithe that Christians give to the church, as they are very adamant about their agenda.

"If I was still in that group and was still a part of that agenda, of course I would take that as my battle cry and I would do everything in my power to bring it to pass," he said.

Meanwhile, Dr Wayne West, founding member of JCHS, said the intention of this Christian think tank is to present research findings to the society to come up with solutions in the public arena.

"People are asking for you to justify your position, not simply to say that this is how it should be, so we thought it important to form a group of persons who would be willing to do some of the legwork and come up with solutions which we plan to put in the public domain for debate and consideration," he said.

The Coalition, he said, will be putting differing worldviews to Jamaicans for them to decide what will inform the laws.

One such view, he explained, is that everything is permissible and the only real important value is autonomy of the individual to do whatever they wish to and tolerance of the community to allow them to do it.

Laws, he argued, would have to be changed to recognise and facilitate the consideration that human beings have no control over their actions as these would be determined solely by chemical reactions. As such, to hold people accountable for what they do would be unfair, and there would be no such thing as morality.

"If at the end of the day Jamaicans feel they will define marriage as between any number of persons of any gender, and throw in Rover or a pig or horse or two... this is what this country is facing, and same-sex marriage and the rights for people to have sex as they choose are really the leaves of a very big tree and we need to expose that tree to the people of the country," he said.

Read more: http://www.jamaicaobserver.com/news/Group-braces-for-costly-fight-against-gays_11518361#ixzz1viRYXnIS 

also see: 

Monday Exchange: Same sex marriage

Anti-gay couple barred - England stops Jamaican-born Christians from fostering 16th child

This is very old news of course but I guess like everywhere else the Jamaica Observer is catching the sensationalism to sell papers and seeing the issue of buggery and gay marriage are hot off the lips of most these days following Obama's personal support of gay marriage which does not necessarily means it will be law in all the states of pushed at the federal level. The Observer however wrote:

JOHNS... gays have more rights than Christians (Photo: Garfield Robinson)

A Jamaican-born British couple say they have been told they can’t foster a 16th child in their Derby County home, because as Christians they don’t believe homosexuality is right.

Owen and Eunice Johns, who are back home in Jamaica, are preparing to take the matter before the European Court of Justice with the support of a coalition of Christian groups who are firmly opposed to the gay and lesbian lifestyle.

“These people (gays) have more rights than Christians. We have been called retarded homophobics because we want to stand up for the truth,” Eunice Johns, a retired nurse who hails from Trelawny, said in an interview with the Jamaica Observer yesterday.

Johns appeared at joint press conference with the Jamaica Coalition for a Healthy Society, the Jamaica Association of Evangelicals and the Roman Catholic Family to highlight what they suggested was a “secular agenda” in the fight against HIV/AIDS epidemic.

The group, which consists of several influential Christian leaders, reaffirmed their objections to the lifestyle practised by gays and lesbians.

The Johns have been foster parents to 15 Jamaican children since they started taking children into their home in England in 1992. All went well, they said, until they went back to the Derby City Council to foster a 16th child in 2006.

“They started asking about my Christianity and I told them I was a Christian, I go to church on a Sunday. I told them I was a Bible-believing Christian,” Eunice said.

She was asked: “What if a child of five came to you one day from school and told you that they were homosexual?” To this she responded: “I would care for that child, I would give them love and attention and all that’s required.”

Her response, however, did not find favour with the social worker and when Eunice ventured to ask what her response should have been, she was told: “You would have to tell this child that it is alright to be homosexual.”

Failing to convince Eunice to change her mind on the matter, the social worker said she would have to raise the issue with her manager. Two weeks later the manager came to see her.

“She said to us: ‘Well, Mr and Mrs Johns, we were told that you said you could not tell a child it is alright to be homosexual, and in this day and age you would have to because so many children are not sure where they are and a lot of them are confused. So many people are confused these days, because they weren’t told that their sexuality and what they are feeling is right’.”

She said she and her husband were then taken before a panel of 12 persons at the Council where they were asked to explain their views on homosexuality. Two weeks after that, they got a letter thanking them for withdrawing their application to foster children. The couple were shocked, because they had made no such request. However, they decided not to contest the Council on the matter.

“After they said, ‘thank you for withdrawing’, we said ‘that’s alright, we would leave it, no skin off our nose, perhaps we shouldn’t foster’,” she recalled.

But just a few weeks later, they learnt of another couple whose foster child was taken away because they refused to tell them that homosexuality was right, she added.

After the passage of The Equality Act (Sexual Orientation) Regulations of 2007, Johns said they began hearing of Christians who were being prosecuted for denouncing the gay lifestyle. Several Christian children’s homes had been closed, Christian pastors were being abused, and several Christian business owners were forced to close because they decided to affirm their belief. Christian marriage counsellors were also coming under increased pressure because of their refusal to marry same-sex couples, she claimed.

The Johns’ case eventually attracted the attention of the Christian Concern for Our Nation, a religious lobby group in London. Their solicitors took the matter before the Nottingham Crown Court in 2009. Following months of court appearances by the Johns, their lawyers, representatives of the Derby City Council, and civil rights group, the High Court, in a landmark ruling in 2010, noted that laws protecting gays from discrimination superceded the couple’s religious belief.

“The judge did not say we could not foster children, but the judge was saying England is no longer a Christian country, it’s now a secular country. He made it quite clear that we have got to adhere to what is being set out,” said Eunice, who came back to Jamaica five months ago with her husband.

Their solicitors are now preparing to take the matter before the European Court of Justice, Johns said, adding that Jamaica was in a good position to refute what she believed was a hidden agenda by the Lesbian, Gay, Bi-sexual and Transgender community.

“I notice the word that they are using here while trying to push this thing through is tolerance. We are Christians, so we should be tolerant. But it only takes that first door and it’s like a domino effect, all of the other doors are going to be opened,” she said.

Read more:

also see a previous entry on a radio interview they did late 2011

Shirley Richards & The Jamaican UK Foster Parents (The Johns) on Love 101 FM ............. on buggery

Anal Fixation (Tell Me Pastor)

After a long hiatus as you may have noticed my readers and the shouting matches on national radio on Obama's support for gay marriage rights in the United States comes this convenient letter to the Tell Me Pastor of the Star News. With threats to Miss Portia Simpson Miller from supporters and non supporters alike that if she attempts to review the buggery law the PNP may loose support all kinds of antigay drama come flying out of the woodwork.

Have a read of this latest letter to Pastor Dumas and see if it makes sense bearing in mind that anal sex is criminalized in Jamaica whether committed on a man or a woman but the matter of privacy ought to be considered.

Here is the letter and pastor's response

Dear Pastor,

I am 35 years and a Christian. I got married to a man I knew in Jamaica, but he migrated to the United States. We were only acquainted with each other before he went to live in America. He came back to Jamaica and visited me at my workplace. He said somebody told him where I was working. He took my number and, the evening of that very day, called and invited me out. We went to Port Royal and had fish. He told me he was always admiring me when he was living in Jamaica. He also told me that he had got married to an American woman but they broke up. He said that she was too demanding. He was living in New York but had moved and went to another State.

got another girl pregnant

He asked me if I had a boyfriend. I told him no. My boyfriend and I had broken up a year before and I had taken a break from men. I broke up with my boyfriend at the time because he got another girl pregnant.

This man took me out every night because when I met him he only had three days before returning to America. He asked me to have sex with him, but I told him no because I did not know him well enough. We kissed, but that was all. He went back to America and called me two, three times a day. Sometimes at work I had to turn off my phone to do my work. He came back to Jamaica last year and begged me for sex. He brought me a very expensive watch. I had sex with him twice during that visit.

We got married last December. On my wedding night, he tried to have sex with me in my bottom and I strongly objected. He tried to fight me to do it and I told him that I would kill him. We made up.

Pastor, I am now living with him in America and he always wants anal sex. When I am asleep, he is trying to do so. He says everybody is doing it. I told him I am going to leave him if he doesn't stop. He says that is what he likes. I am not working. I am here because I have a visa.

Pastor, please give me your advice. Many nights I have to be sleeping in the couch because I am afraid to go on the bed.

L.S.

 

Dear L.S.,

This man is not going to stop harassing you to for anal sex. He has declared that is what he likes. He tried to coax you into it and you objected. He has not succeeded. He tried to force you and it hasn't worked. He does not respect the position you have taken and is making a big mistake by believing he has a right to have sex with you anyhow he pleases.

I suggest you ask him whether he would go with you to see a therapist. If he objects and continues to demand anal sex, you should seriously consider seeing a lawyer for advice.

Pastor

Layered Stigma among Health Facility and Social Services Staff toward Most-at-Risk Populations in Jamaica

This report was prepared by independent consultants Audrey Brown, MSc, DLSHTM, Althea
Bailey, MPH, and Quaine Palmer, MEd; and by Kara Tureski, MPH, Susan J. Rogers, PhD, Anya Cushnie, MIH, and Abidemi Adelaja, MPH from C-Change/FHI 360.

This publication is made possible by the generous support of the American people through the United States Agency for International Development (USAID) and the U.S. President's Emergency Plan for AIDS Relief (PEPFAR) under the terms of Agreement No. GPO-A-00-07-00004-00. The contents are the responsibility of the C-Change project, managed by FHI 360, and do not necessarily reflect the views of USAID or the United States Government.

Executive Summary

FHI 360’s Communication for Change (C-Change) project, funded by USAID/PEPFAR, in
Jamaica provides technical assistance in social and behavior change communication (SBCC) to
improve the quality and scale of Jamaica’s response to the HIV and AIDS epidemic. In keeping with its mandate of supporting civil society and government partners in developing evidencebased programming and in working to create supportive enabling environments for most-at-risk populations (MARPs), C-Change conducted a study in 2011 on stigma and discrimination (S&D) within health and social services settings toward persons living with HIV (PLHIV), men who have sex with men (MSM), and sex workers (SW).

S&D occurs when someone is devalued as a result of practices, behaviors, diseases or other characteristics with which they are associated (International Center for Research on Women 2012). MSM and SW are among the most heavily stigmatized groups due to their own unique identifications and the socio-cultural hostilities and fears associated with them. The resulting S&D creates an environment that is intimidating and that increases vulnerabilities for infection, abuse, and death among these groups as they relate to accessing crucial prevention and treatment information and services, quality of services received, and treatment, among others. S&D norms within health services often mirror and mutually reinforce wider social norms. Within health care settings, S&D is particularly of concern given its impact on the ability of those stigmatized to receive appropriate and quality prevention services, treatment, and care.

Along with examining the level of S&D in within health facilities and social services environments, the study sought to understand the association between staff training, or the lack thereof, and reported S&D. It also sought to explore the degree to which layered stigma existed.

Layered stigma is HIV–related stigma combined with stigma toward marginalized groups—a scenario MSM and SW frequently experience as they are often assumed to be core transmitters of HIV infection. Prevalence data show that close to a third of the population of MSM and 4.2 percent of SW in Jamaica are HIV–infected (Jamaica National HIV/STI Program 2010), and S&D of MARPs is a major barrier to their access of health and social services that can help mitigate the growing HIV and AIDS epidemic. With these statistics in mind the overall aim of the study was to inform critical SBCC interventions for the health and social services sectors.

The study was conducted in Kingston, Montego Bay, and Ocho Rios. It included three components with separate samples: 165 health services staff in 23 public, private, or NGOowned health facilities identified as either MARP–friendly or a general facility; 63 staff members of 12 social services organizations that provided support services to MARPs; and 450 male and female sex workers located in popular sites/locations (i.e., clubs, streets, massage parlors, the beach, hotels, guest houses, and bars). Modified survey instruments were pretested and used for each of the components with items adapted from previously tested instruments (Nyblade and MacQuarrie 2006; Kelly et al. 1987; Berger, Estwing, and Lashley 2001).

DOWNLOAD FULL STUDY HERE

Churches deliver a holy blow to our neighbours UNIBAM

The United Belize Advocacy Movement (UNIBAM) received a major blow inside the courtroom of Supreme Court Justice Michelle Arana.  UNIBAM is challenging Section Fifty-Three of the criminal code, which bars carnal intercourse against the order of nature. The crime is an indictable matter with the possibility of ten years in prison.  This morning, a ruling was handed down that struck out UNIBAM as an interested party in the case. The attorneys for the Council of Churches submitted that UNIBAM has no locus standing, and therefore asked for their application to be struck out. In January, the Council of Churches’ attorney, Rodwell Williams made the arguments that some expert affidavits were given, contrary to the rules, and without the leave of the court. Outside the Supreme Court another attorney for the Council of Churches, Michel Chebat explained what the ruling means for the interested parties.

Michel Chebat, Attorney for Council of Churches
“The judge handed down her decision today and what she did was she allowed the application by the church interested parties which were twofold. The initial application was to have UNIBAM struck from the case, which was granted and secondly to have the affidavits of the purported experts filed by the claimant for those to be struck out as having not complied with the rules. And so they were both granted. However, the judge has also granted leave for them to re-file in the event they wish to do so.”

Jose Sanchez
“How significant is the fact that the UNIBAM has been struck out? What role does that play in the entire case?”

Michel Chebat
“As I said, I don’t believe it will stop the case from going forward because there is a second claimant. But in terms of—I suspect—in terms of the bigger picture and appearances, I understand UNIBAM is the umbrella organization, so it may or may not be detrimental to them. I am not sure.”

Jose Sanchez
“In terms of your case, where does it go from here? Procedurally, where do you go?”

Michel Chebat
“Our next step is to file our expert witnesses affidavits which will be done within sixty days of today’s date and then we come back to court for a case management at which time the court will set the stage going forward in terms of trial date and so forth.”

Jose Sanchez
“So in essence the victory if there is any is minimal. Would that be correct?”

Michel Chebat
“I would not say minimal. I think the fact that UNIBAM has been removed, may be a significant blow to them and to their financial support because I believe I believe it is through UNIBAM that the financial support is coming for the case. Leave has been granted to all parties to file expert evidence within sixty days.”

Jules Vasquez, 7 News
“Now all your experts except for Mister Henry Lawrence have been accepted. Am I right?”

Michel Chebat
“Yes that is correct; that is correct. All of the affidavits filed on behalf of the Church interested parties have been accepted by the Court except for Mister Lawrence’s.”

In January, attorney for UNIBAM, Lisa Shoman said that it really didn’t matter whether UNIBAM survived as an applicant, because the case would go on. She said, “I rather suspect that at this point, really doesn’t matter how the judge rules and there may very well be an appeal in either case… We’d like to get the matter before the courts; so that we have several options open and we will look at them when that arises.”

Caleb Orozco and UNIBAM issued a press release this evening on the court ruling in Orozco pretrial hearing. In the Caleb Orozco and UNIBAM versus The Attorney General of Belize litigation, the second claimant, UNIBAM was removed. Caleb Orozco, the first claimant, maintains standing under the Constitution of Belize and according to the release “will continue to pursue the case.”  The release went on to say that, “It also provided for reports to be filed by various expert witnesses on behalf of Orozco and various interested parties. It is expected that the matter will proceed to be determined on the merits once those expert reports are filed.” It went on to say that “Section 53 criminalizes consensual sexual activities between adults that amount to ‘carnal intercourse against the order of nature’, including between men and women. This case is focused on consensual sexual activities between adults. It does not seek to ‘decriminalize’ coerced sexual activities or pedophilia.” Orozco and UNIBAM are represented by a team of regional and local lawyers, including lead counsel Christopher Hamel-Smith, Lisa Shoman and Simeon Samson. The regional team comprises of the Faculty of Law UWI Rights Advocacy Project (URAP).