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Advances in Social Sciences Research Journal – Vol. 8, No. 10
Publication Date: October 25, 2021
DOI:10.14738/assrj.810.10953. Hem-Lee-Forsyth, S., & Thomas, R. (2021). Caribbean Faith-Based Organisations: Friend or Foe in the fight against the feminisation
of HIV and AIDS in the Anglophone Caribbean. Advances in Social Sciences Research Journal, 8(10). 9-16.
Services for Science and Education – United Kingdom
Caribbean Faith-Based Organisations: Friend or Foe in the fight
against the feminisation of HIV and AIDS in the Anglophone
Caribbean
Shivaughn Hem-Lee-Forsyth, PhD, MPH
Department of Public Health and Preventive Medicine
St. George's University, Grenada
Renee Thomas, MPH
Department of Public Health and Preventive Medicine
St. George's University, Grenada
ABSTRACT
The feminisation of HIV and AIDS has become a worldwide phenomenon, and the
Caribbean region has not been fortunate enough to be excluded. Caribbean females
had 3-4 times higher infection rates than males up to a decade ago. Studies that
focus on the contributing psychosocial factors to HIV risk in the Caribbean are
limited. This narrative review showcases pivotal work which addresses the
reciprocally connected responsibilities of patriarchy and religious practices and
how they feed into the desolate reality of Anglophone Caribbean women. The
relationship between these cultural issues in the Caribbean, using an
anthropological lens, sets a platform for an investigation into HIV and AIDS. This
paper seeks to encourage further research centred on the religious elements, which
influence heterosexual relationships, and how these relationships are predisposed
to potential HIV and AIDS risk. The ultimate goal of this study is to provide English- speaking Caribbean faith-based organisations, public health officials and
policymakers a public stage to consider further policy implications for the
staggering and disproportionate rates of HIV and AIDS between women and men.
Keywords: Anglophone Caribbean women, faith-based organisations, patriarchy,
feminisation of HIV and AIDS, heterosexual relationships
INTRODUCTION
HIV and AIDS is an ongoing public health concern in the Caribbean community, with the second- highest HIV prevalence after Sub-Saharan Africa (Avert, 2020). Globally, there are almost equal
infection rates among women and men. In Caribbean nation-states, like other countries,
however, more women, as opposed to men, are particularly vulnerable to this epidemic: women
account for approximately 53% of all reported HIV cases (UNAIDS, 2020). Currently, women,
including transgender women, contract HIV disproportionally compared to the rates of men,
and the gap continues to increase among certain groups (Avert, 2020). For example, in Trinidad
and Tobago, HIV and AIDS rates are five times higher for girls than boys ages 15-19 (Pan
American Health Organization (2011). These trends have initiated united cooperation between
local and regional health and gender agencies to reverse the spread of this feminised disease
within Caribbean territories.
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Advances in Social Sciences Research Journal (ASSRJ) Vol. 8, Issue 10, October-2021
Services for Science and Education – United Kingdom
METHODOLOGY
A comprehensive narrative review was conducted to identify research articles that explored
the Feminization of the HIV and AIDS epidemic and the contributing role of Faith-Based
Organisations in dealing with this infectious disease challenge in the Caribbean. The literature
search also included current rates and trends of disease transmission according to gender
within the Caribbean region. For this study, women were defined as cisgender and did not
include women in the transgender community. This review included the analysis of peer- reviewed articles and official reports from international and regional public health agencies.
Library databases were the primary tool used for the literature search. The World Health
Organization, The Joint United Nations Programme on HIV/AIDS, The Pan American Health
Organization and The United Nations Women Entity for Gender Equality and the Empowerment
of Women websites were also used to access fact sheets and other pertinent data on HIV and
AIDS.
Collection of the literature was done using the following search terms: “Faith-Based
Organisations and HIV and AIDS,” “HIV and AIDS in the Caribbean,” “Women and HIV and AIDS,”
and “Religion and HIV and AIDS.” All articles were evaluated for their relevance and
applicability to the themes that were to be explored. A total of twenty-three (23) data sources
were used for this literature review. Most of the articles selected were published within the last
twenty years. An exception was made to include an article outside the specified period since
the covered information is still relevant today. The findings were categorised into four different
themes, which underscored the importance of addressing the Feminization of HIV and AIDS in
the Caribbean and the role of religious organisations in ameliorating the situation.
WOMEN AND HIV RISK
Despite the continued recognition of women's alarming HIV and AIDS case numbers, with their
concomitant high-risk sexual practices, the perceived HIV risk can be best described as low to
moderate. This low perception of women's HIV risk can be attributed to multiple determinants,
including generational knowledge, traditional practices, and misconceptions regarding safe sex
behaviours (Charlery, 2005). Primarily, these cultural beliefs are responsible for driving unsafe
sexual behaviours, which threaten many women's physical and mental health. Because of this
disconcerting truth, attending to HIV and AIDS within the Caribbean is vital by targeting female
groups with the worst health outcomes. This public health matter will require a multi-sectoral
approach to reduce the incidence of HIV among Caribbean women. The religious community
plays a prominent role in Caribbean society and can be a chief ally in pursuing greater HIV
awareness and well-being among the female fellowship.
Faith-based values and beliefs are at the heart of Caribbean culture, and they play an integral
role in the ways people relate one to the other. Religious dogma also influences the attitudes
and behaviours which govern these human interactions. Sometimes, these religious doctrines
are viewed as a purposive extension and perpetuation of patriarchy: a means of advocating and
maintaining social control. Soares (2005, p. 67) elucidates, "This ideology of male dominance,
which underlies society's oppression of and discrimination against women, is often encouraged
by social and cultural institutions such as the church." Socio-cultural perspectives as they relate
to religious cosmology are therefore linked to gender inequity.
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Hem-Lee-Forsyth, S., & Thomas, R. (2021). Caribbean Faith-Based Organisations: Friend or Foe in the fight against the feminisation of HIV and AIDS
in the Anglophone Caribbean. Advances in Social Sciences Research Journal, 8(10). 9-16.
URL: http://dx.doi.org/10.14738/assrj.810.10953
As part of the societal norms, gender disparities have become a driving force, integral to the
feminisation of HIV and AIDS. To mitigate this harmful outcome, "Acknowledgement must be
made of Caribbean gender politics and its obliteration of true female agency. The negative
repercussions of cultural indoctrination on all women within a patriarchal system must also be
given prominence" (Hem-Lee-Forsyth, 2019, p. 22). All persons are entitled to what Soares
(2005, p. 67) describes as "gender justice." [This is where] "the same rights, freedoms,
opportunities, recognition, and respect for all women and men regardless of their position in
society, race and colour identity, religious persuasion, ethnic origin, and sexual orientation"
[are given]. Opportunities should be awarded to everyone in a utopian world, especially those
traditionally dispossessed and disadvantaged by their life's circumstances. Does religion,
therefore, provide this space for espousing "gender justice," or does it epitomise and propagate
gender injustice?
THE ROLE OF RELIGION
Religions practised in the Caribbean such as Christianity, Hinduism, Islam, and Rastafarianism
all have clearly defined positions on the gender issues raised in this discourse. Collectively,
these religions add to the complexity of the problem involving HIV and AIDS and women. For
this discussion, allusion will be principally made to Christianity as it is the most pervasive
religion. The Holy Bible, in Isaiah 61:1, preaches that people should live their lives following the
example of Jesus Christ, whose coming was "to proclaim liberty to the captives and to heal the
broken-hearted." These "captives" and "the broken-hearted" refer to the oppressed in the
society, such as women, gay men, sex workers and the poor, all of whom are at high risk of HIV.
Therefore, it seems logical that Christians should devote themselves to eradicating injustices
meted out to these groups. Isaiah presents God's message, "I love justice and hate oppression,"
while another prophet warns that "injustice is unrighteous and sinful" (Soares, 2005, p. 68). On
this premise, religious leaders should cry out against abhorrent acts of inequalities and
discrimination against disenfranchised communities, and in this case, vulnerable and
victimised women. The revered God is the epitome of love and would therefore want justice for
all. The conflict lies in reconciling what the Holy Bible says and what the church preaches.
The machismo culture (masculinity) and marianismo culture (femininity) in the Caribbean
aligns with Christian values and influences women's exposure and vulnerability to HIV and
AIDS. Marianismo (derived from the Virgin Mary) portrays the ideal woman as modest, pure,
dependent, weak, acquiescent, vulnerable, and abstinent until marriage. In this sense,
"femininity" implies that a woman must be innocent and self-sacrificing, placing the needs and
desires of her husband before herself (Pan American Health Organization, 2011). Gupta (2002)
and PAHO (2002), as cited in Hem-Lee-Forsyth (2019), explained that marianismo requires
"good" females to be Virgin Mary-like, and to possess less information on matters related to sex,
as more knowledge might be indicative of promiscuous activities or extramarital relations.
Christianity, which can act as a conduit of machismo, teaches that the man is the head of the
home and the wife must submit to him. According to 1 Corinthians 11:3: "Christ is supreme
over every man; the husband is supreme over his wife."
The everyday living of "good" Christians often reflects this philosophy of male dominion over
the subservient woman as part of the divine design. In cases of infidelity, domestic violence, and
any abuse in the marriage, where men are the primary perpetrators, these acts are often
described as "their [women's] cross to bear;" spouses are encouraged to forgive and work
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Hem-Lee-Forsyth, S., & Thomas, R. (2021). Caribbean Faith-Based Organisations: Friend or Foe in the fight against the feminisation of HIV and AIDS
in the Anglophone Caribbean. Advances in Social Sciences Research Journal, 8(10). 9-16.
URL: http://dx.doi.org/10.14738/assrj.810.10953
social justice, discussions in this modern era on gender, sexual health and safe sex continue to
be taboo- often deemed irreconcilable with most Christian beliefs. Nonetheless, the struggle for
advocacy around these serious issues should be pursued. In a study, Cotton, Puchalski, Sherman
et al. (2006) emphasised that religion could be a great source of solace for individuals living
with HIV. Within the study, most individuals belonged to a religious community; they credited
their faith-based organisation to boost their self-esteem and optimism towards their future
lives (Cotton et al., 2006). Although this study was conducted in the United States, lessons can
be easily extrapolated in the Caribbean context, of which there is a dire need for redress.
It is undeniable that followers are impressed by religious influences on societal values and
norms in everyday living. In Matthew 25:35–36, the Holy Bible stresses the importance of
helping those individuals in need. To fulfil that obligation, religious organisations and their
affiliates participate in service activities centred around serving underprivileged and
dispossessed community members. However, as expounded previously, this practice does not
transcend affairs related to gender and sexual health. In Gomez & Alexis-Thomas (2010), the
unfortunate actuality that came to the fore in that study is the Herculean task of obtaining buy- in from religious leaders to embark on health campaigns targeting sexual health matters.
The unswerving heterosexual thrust of marianismo and Christianity can be linked to the
feminisation of HIV and AIDS in the Caribbean. At such an inopportune moment in history, the
insistence on heteronormality, and the blatant denial and rejection of same-sex sexual
orientation, provide a thriving environment for stigmatisation of lesbian and bisexual women.
According to PAHO (2011), this makes it difficult for women who have sex with women to
access sexual health information and services, including appropriate barrier methods used for
safer sex. This resolute and myopic position on human sexuality within religion-based
organisations presents an obvious quandary in striking a balance between the need to assist
the public through sexual health education and doing it in such a way sans compromise of
integrity regarding religious beliefs.
PERSPECTIVES FROM THE RELIGIOUS COMMUNITIES
The religious community's dilemma is being the champion for social justice and being the
defenders of their faith. The Holy Bible says, "Do not be unequally yoked with unbelievers. For
what partnership has righteousness with lawlessness; sin is lawlessness" (In 2 Corinthians
6:14). For members of the Christian public, this passage suggests avoiding any association with
unrighteous practices. While Christianity typically has a mission of service, education, and
social justice, its followers are also required to uphold their faith without compromising the
teachings of the Holy Bible.
For conservative Christians, in particular, participating in sexual health education presents a
potential threat to their beliefs, teachings, and perspectives. According to a study conducted in
Jamaica, there are faith-based initiatives to tackle the HIV and AIDS crisis in the country;
however, these initiatives are not well-documented. Nevertheless, Christian establishments
give support dedicated to sexual health education through their HIV and AIDS ministries. These
services come in the form of psychosocial and family life counselling, health fairs, and
seminars/workshops. While stigma and discrimination towards risky sexual behaviours are
still prevalent in the Caribbean, these religious bodies respond to the loud cry to the cause by
making provisions for disenfranchised groups within their communities (Muturi, 2008).
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Hem-Lee-Forsyth, S., & Thomas, R. (2021). Caribbean Faith-Based Organisations: Friend or Foe in the fight against the feminisation of HIV and AIDS
in the Anglophone Caribbean. Advances in Social Sciences Research Journal, 8(10). 9-16.
URL: http://dx.doi.org/10.14738/assrj.810.10953
undertaking can indeed exist. With this combined stakeholder engagement, there will be
positive outcomes when grabbling with the feminisation of HIV and AIDS.
CONCLUSION
Internationally, as The Joint United Nations Programme on HIV/AIDS [UNAIDS] and critical
patrons strive to end the HIV and AIDS epidemic by 2030 aggressively, it is also of utmost
importance to consider the feminisation of HIV and AIDS. In the Caribbean community,
religious groups are significant partners and influencers; in this regard, their power of influence
on the cultural practices of their people is second to none. Notably, Caribbean societies are
matriarchal- women often lead households; furthermore, females play pivotal roles within the
religious community. With prominent female leadership engagement within religious
institutions, strategically, women are positioned to challenge gender norms and advocate for
gender equality; this affirmative action will lead to an emphatic win: a reduction in the
feminisation of HIV and AIDS.
According to the Kaiser Family Foundation Global Health Policy, approximately 50% of people
living with HIV in the Caribbean have suppressed viral loads, below the global average of 59%
(Kaiser Family Foundation, 2021). This statistic indicates that Caribbean islands lag behind the
rest of the world in guaranteeing equitable access to medication for blood viral load reduction
in HIV patients. At this juncture, further scrutiny into discrepancies of viral load within the
Caribbean compared to the rest of the world and viral load differences among genders is
warranted.
This article mainly draws on resources from countries outside of the Caribbean region for
comparisons and recommendations. There are limited regional analyses that focus on religion's
role in the fight against the feminisation of HIV and AIDS. Findings and recommendations on
men who have sex with men and transgender women, both associated with the feminisation of
HIV and AIDS in the Caribbean, have not been included in this manuscript. Considering both
identities in the discussion on HIV and AIDS within religious organisations for future studies
must be considered. Indisputably, apart from religious communities, there are many other
communities providing opportunities for scholars to explore other pertinent and
interconnected areas of HIV research to concentrate on the ongoing HIV epidemic.
Anthropological factors, and their influence on HIV and AIDS, need to be a focal point of the
exploration if there is any hope of reversing the feminisation of HIV and AIDS in Caribbean
nations.
References
Austin S. & Harris, G. (2011). Addressing Health Disparities: The Role of an African American
Health Ministry Committee. Social Work in Public Health, 26(1), 123-135.
Cotton, S., Puchalski C.M., Sherman, S. N. et al. (2006). Spirituality and religion in patients with HIV/AIDS. Journal
of general internal medicine, 21(5), S5-13. https://doi.org/10.1111/j.1525-1497.2006.00642.x
Francis, C., & Lewis-Agard, N. (2020). Faith Based Efforts in the Caribbean to Combat Discrimination Based on
Sexual Orientation and Gender Identity. Arcus Foundation. Retrieved from
https://www.arcusfoundation.org/wp-content/uploads/2020/06/Arcus-Faith-Based-Efforts-in-the-Caribbean- to-Combat-Discrimination-Based-on-Sexual-Orientation-and-Gender-Identity-1.pdf