Belize's Battle Against Aids: Understanding The Spread And Impact

Belize has the highest HIV prevalence in Central America and is one of the worst-affected countries in the region. The transmission of the virus is accelerated by poverty, inadequate use of condoms, and cultural beliefs that encourage men to have multiple sexual partners. The adult HIV prevalence in the general population is approximately 1.8%, rising to 13% in high-risk groups. Heterosexual intercourse without protection is the primary route of HIV transmission among Belizean women, and men who have sex with men account for two-thirds of new HIV infections.

Cultural beliefs and gender inequity

Belize is still working towards achieving gender equality, and this inequality has impacted the spread of AIDS in the country. Gender inequity makes it difficult for women to negotiate condom use, increasing their risk of contracting HIV. As of 2018, 7.8% of women aged 15-49 reported experiencing physical and/or sexual violence by an intimate partner in the previous 12 months. Furthermore, 33.5% of women aged 20-24 were married or in a union before the age of 18, and the adolescent birth rate remains high at 58.2 per 1,000 women aged 15-19 as of 2019. These statistics highlight the gender inequality and power imbalances that exist in Belize, which can contribute to the spread of AIDS.

In addition, there is a lack of legal recognition and protection for the LGBTIQ community in Belize. While the Supreme Court overturned colonial-era "buggery" laws and ruled that the Constitution protects people from discrimination based on sexual orientation, same-sex relationships are not legally recognized. The Immigration Act also classifies "any prostitute or homosexual" as a "prohibited immigrant." This lack of legal protection contributes to the targeting and harassment of LGBTIQ individuals by police and the public. As a result, transgender people are particularly vulnerable.

To combat the spread of AIDS, it is crucial to address these cultural beliefs and gender inequities. This includes promoting gender equality, challenging cultural norms that encourage risky sexual behaviour, and advocating for the human rights of women and the LGBTIQ community.

Stigma and discrimination

The fear of contracting HIV/AIDS is a major factor contributing to stigma and discrimination against PLWHA in Belize. This fear is driven by a lack of knowledge about HIV/AIDS and its transmission, as well as cultural beliefs and misconceptions. For example, cultural beliefs that encourage men to engage in multiple sexual relationships can accelerate the transmission of HIV. The association of HIV infection with perceived moral and religious misconduct, such as sexual promiscuity, homosexuality, and drug use, also contributes to stigmatizing attitudes.

Mother-to-child transmission

To achieve this accomplishment, Belize implemented several measures over the past two decades. Since the early 2000s, the country's healthcare services have been following the Pan American Health Organization's (PAHO) Plan of Action for the Prevention and Control of HIV and Sexually Transmitted Infections. This initiative improved access to prenatal HIV and syphilis testing, ensuring that every pregnant woman is screened two to three times during pregnancy, at delivery, and 18 months postpartum.

The success of Belize's efforts relied on effective treatments for pregnant women who tested positive. For syphilis, health professionals administered penicillin injections for three consecutive weeks. HIV-positive mothers received daily antiretrovirals along with prenatal vitamins. Nurses also conducted follow-up home visits to verify treatment completion and identify potential complications.

Belize's collaboration with PAHO enhanced the research capabilities and capacity of its healthcare services. This enabled more pregnant women to be tested earlier and more accurately. The percentage of women attending health clinics in their first trimester increased to 90%, allowing for timely and effective administration of preventative treatments. Additionally, healthcare providers encouraged partners of mothers who tested positive to get tested as well, fostering community awareness and ensuring more individuals know their HIV status.

The elimination of mother-to-child transmission of HIV and syphilis in Belize is a remarkable achievement, ensuring a new generation free from these diseases. It also represents an opportunity to strengthen the country's healthcare system and sustain this elimination. Belize's success serves as an inspiration and catalyst for other countries working towards the same goal, with a shared vision of a generation free of AIDS.

Inadequate condom use

The National AIDS Commission of Belize aims to provide updated information on HIV and work towards ending the epidemic by 2030. They have implemented a condom social marketing strategy among high-risk groups for HIV infection. Additionally, various civil society organizations, such as PASMO and BFLA, use mass media to promote condom use and safe sexual practices, especially among young people. Despite these efforts, inadequate condom use remains a concern.

Belize faces challenges in implementing effective HIV/AIDS prevention and care programs. These challenges include a growing heterosexual epidemic, increasing mother-to-child transmission rates, and gender inequity, which makes it difficult for women to negotiate condom use. Stigma and discrimination against people with HIV/AIDS, as well as misconceptions about how the disease spreads, also hinder prevention efforts.

To address these issues, the U.S. Agency for International Development (USAID) supports HIV/AIDS programs in Belize through its Central American Regional HIV/AIDS Program. The program enhances the capabilities of Central American organizations to provide HIV/AIDS prevention services, including promoting condom use and safe sexual practices.

Furthermore, the Belize Ministry of Health implements public education initiatives, such as the "Get Tested Today Campaign," to encourage HIV testing and raise awareness about prevention methods, including condom use. Despite these efforts, inadequate condom use continues to contribute to the spread of AIDS in Belize, highlighting the need for continued focus on education, prevention, and addressing the underlying social and cultural factors that influence sexual behavior in the country.

Lack of HIV testing

A lack of HIV testing is a significant factor in the spread of AIDS in Belize. Belize has the highest HIV prevalence in Central America and the third highest in the Caribbean, with the virus being the third leading cause of death in the country. Despite this, only a little over a quarter of the general population reported having had an HIV test and knowing the result.

There are several barriers to HIV testing in Belize, including stigmatization, lack of confidentiality, and discrimination. These factors deter people from getting tested, particularly those from high-risk groups such as men who have sex with men and sex workers. Additionally, inadequate resources, including a lack of trained staff, testing supplies, and private spaces for testing, further hinder testing initiatives.

The Belize Ministry of Health provides guidelines for HIV treatment and universal publicly funded treatment. However, there are no specific guidelines on HIV testing, creating a disparity between the need for testing and the implementation of testing programs.

To address this issue, the development of an accident and emergency (A&E) department HIV testing program in Belize City has been proposed. Key stakeholders, including patients, physicians, nurses, and administrators, have provided input on the recommended program components and potential facilitators and barriers to testing in emergency care.

Patients emphasized the importance of respectful, confidential relationships with A&E staff and preferred to have all A&E patients tested for HIV. In contrast, other stakeholder groups preferred testing specific patient groups, particularly those with signs and symptoms of infection and members of high-risk groups.

Confidentiality and privacy were also highlighted as crucial factors in HIV testing by all stakeholder groups. This includes private spaces for testing, obtaining consent, delivering test results, and counseling.

Furthermore, specific training for staff conducting HIV testing was deemed necessary by most stakeholders. The input from these key stakeholders will inform the development of uniform HIV screening programs and protocols, which can help increase early HIV diagnosis, linkage to care, and treatment in Belize.

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