BELIZE CITY, Wed. June 8, 2016–Belize saw HIV-related deaths peak in 2015 at 110, with young productive males being the hardest hit by the disease. Behind those numbers is a phenomenon that has seemingly been driving the HIV epidemic in Belize, with the highest concentration of cases being in the Belize District area. That is evidenced by an unusually high rate of HIV infection in men who have sex with men (MSM)—homosexuals and bisexuals—and a good portion of those men are also having sex with women, while keeping their homosexual relations “on the down low.” Furthermore, some of those men were forced into their first encounter—and some continue to be forced even as adults.
In fact, a comprehensive report to look at the prevalence of HIV among at-risk groups in Belize found that “…the prevalence of HIV found in MSM in Belize was the highest reported after the Multicenter Study in Central America (EMC) in the Central American region.”
Clandestine sexual relations frequently occur without the use of protection, and sometimes under the influence of drugs and alcohol.
A report titled, Central American Behavioral Surveillance Survey (BSS) of HIV/STI Prevalence and Risk Behavior in Most-at-risk Populations in Belize, published in June 2014, unveils the situation of at-risk females who exchange sex for money, and men who have sex with men (homosexuals); and people living with HIV.
Some take the risk to earn money. According to the surveillance report, two-thirds of female sex workers reported having a monthly income higher than the minimum salary, established at BZ$720. Meanwhile, 65% of men who were having sex with other men for money said they received between BZ$101 and BZ$300, although the median payment received for sex was BZ$135 per encounter.
Roughly 65% of MSM—more than half of whom had studied at the tertiary and/or university levels—identified themselves as homosexual; 2.9% were married or in a partnership with a woman and 19.1% were married or in partnership with a man.
Additionally, 32% (44 out of 136) of those who identified their sexual identity said they are bisexual and 29% said they are transgender, transvestite or transsexual.
The most striking finding was an HIV prevalence rate of 13.9% among men who have sex with men. That group was also found to have a prevalence rate of 28% for herpes simplex type 2, virus. The HIV prevalence rate among MSM in Belize is higher than the 10.8% reported in San Salvador, the 9.8% reported in Masaya, Nicaragua, and the 9.7% in San Pedro Sula, Honduras, where similar populations reside.
“The high proportion of bisexuality can be due to the high discrimination that exists in the country towards the MSM community and the taboo that the practice of anal sex represents,” the report said.
The report added that, “From an epidemiological perspective, when the HIV epidemic is concentrated in the population of homosexual and bisexual men, these could represent a key population in the transmission of HIV infection toward the general population.”
The risk of contracting HIV could also be worsened by the fact that some MSM get initiated at a very young age—more than 6 in 10 before the age of 18.
According to the BSS report, the median age at which MSM first began to have sex with other men was reported at 16. About 21% of participants reported that they had their first sexual encounter with a man before they were 15, and another 40% said that they had their first encounter between the ages of 15 and 17.
Overall, 31.9% of the MSM respondents said that they had been forced at some point: 8.1% said their first encounter was forced and 9.6% said that they were raped by other men within the 12 months prior to the study.
The majority of men who report having sex with men have also had sex with women, and a high percentage had relations with women during the 12 months prior to the study.
“Sexual relations with men as well as women, is characteristic of MSM in Belize,” the report said. “More than half reported having had sex with women at some point in their lifetime. A high proportion also reported having sex with women in the last 12 months (approximately 40.0%).”
The survey sampled 1,000 adults, ages 18 and over, including 300 sex workers and 300 men who have sex with men in the Belize, Cayo, Orange Walk and Stann Creek Districts—the four districts where most of the HIV cases are usually recorded.
The results suggested that “the HIV epidemic in Belize could be concentrated among the MSM population…” They also revealed that over 9 in 10 of the respondents said that their last sexual encounter was with a male.
Those include female sex workers, who were found to have a much lower HIV prevalence rate, at 1.0%, but sexually transmitted infections (STIs) were found to be far more prevalent. For example, the survey found 50% prevalence for herpes simplex virus type 2, and a prevalence of nearly 20% for chlamydia and trichomonas.
Nearly half of the female sex workers were not 15 yet at the time of their first encounter; and nearly half had undergone an abortion at least once in their lifetime.
“Even though the prevalence of HIV was not higher than 1%, this does not indicate that there is not a problem of HIV transmission among sex workers… Results indicated increased vulnerability, high prevalence of STIs, low use of condoms, low adequate knowledge on HIV transmission, high consumption of alcohol and sexual abuse, among others,” the report said.
The HIV prevalence rate among female sex workers in Belize is higher than in other Central American cities: next door in Honduras, in the city of Tegucigalpa, it was found to be 5.5%; in San Salvador 5.7%; and in Managua 1.8%.
Drug use also complicates matters, and evidently lowers the chance of condom use, thereby increasing the chances that HIV will be spread through sexual contact. The survey found that 1 in 3 MSM respondents mentioned having used drugs in the 12 months preceding the survey: marijuana, cocaine, crack and ecstasy.
“Regarding the use of drugs, this survey found that close to one third of men and 13% of women had consumed drugs within the prior 12 months… This is the highest proportion found in this population in comparison to those reported in other Central American surveys,” the report said.
“The proportions of alcohol consumption and use of drugs in Belize are higher than those found in El Salvador and Nicaragua,” the report said.
Furthermore, less than 57% knew about preventing HIV transmission.
We wondered what interventions have been put in place since the publication of the 2014 report. Director of Health Services, Dr. Marvin Manzanero, who was a part of the technical team which undertook the study, told Amandala today that the Ministry of Health is scaling up testing in men, in general. In order to bridge the knowledge divide, he said, they are also targeting men with an information campaign.
Furthermore, said Manzanero, they are moving this year towards immediate treatment for everybody, as soon as they are diagnosed with HIV.