WOMEN living with HIV, trapped in relationships and deathly afraid to tell their partners because that disclosure could result in them being killed, are just some of the horrors staffers at Jamaica AIDS Support For Life (JASL) juggle in fighting the spread of the disease.

“We had a client whose partner is a licensed firearm holder and there is no way, under any circumstance, she says she can let him know that she is living with HIV because she fears he will kill her. Definitely, we have heard some horror stories, though not as frequently as we used to; I think part of the issue is the shame, a lot of the women are not going to tell us and so sometimes we will get the stories months in or even years after,” Dr Jennifer Tomlinson, medical director for JASL — the oldest HIV/AIDS response non-governmental organisation (NGO) in the Caribbean — told members of the Jamaica Observer’s editorial team in a recent interview.

“These women are afraid for their lives, some of them are actually afraid for their lives,” Dr Tomlinson said, adding that there have been instances in which a partner will insist on being present during the visit, at which point health practitioners have to devise creative explanations for the client’s visit.

“Others are afraid to come in because they don’t want their partner to know where they are going. I have had a client sit in front of me and her partner is on the phone calling to find out where she is,” Tomlinson said.

The UNAIDS said that in 2023, globally, there were 39.9 million people living with HIV, with 53 per cent of them being women and girls. While 86 per cent of all people living with HIV knew their status in 2023, about 5.4 million people did not know that they were living with HIV.

According to Dr Tomlinson, the all-consuming fear with which these women live has also impacted their mental health.

“Sometimes it’s a matter where we have to even refer clients to psychiatrists because they get so stressed, so distressed, there is so much anxiety [and] there is depression. People come in with suicidal ideation because there is so much fear and they feel so hopeless, they can’t leave the situation,” the JASL medical director said further.

The medical doctor noted that it was also frequently the case that the women choose to remain in the situation because they are “concerned about the welfare of their children” and have no other options for living arrangements.

Describing the situation as “a barrier to care”, the medical doctor said the psychosocial support offered by JASL takes on increased importance.

“They can’t take their medication because they can’t let their partners see that they are taking medication. The fear that they have of their living situation is such a barrier to care that you feel you are not getting anywhere with them in terms of their physical care,” she noted further.

“We have to have the proper psychosocial support, we offer support individually and we offer group support,” Dr Tomlinson said while pointing out that younger women were more “receptive” to JASL’s efforts to “empower them”.

“What we have had to do is we talk to the people who are likely to experience violence about what their rights are and also what provisions are there. So when you have a woman who is afraid to leave because she doesn’t know how her children will eat, we can let her know that there is a Maintenance Act where he can be compelled to maintain the children,” JASL Policy and Advocacy Officer Patrick Lalor said.

He said JASL also partners with other NGOs that provide shelter, while also exposing the women to avenues that allow them to earn.

In the meantime, he pointed out that women who are in relationships with men who are HIV positive are also in a precarious situation because their partners blame shift and refuse to even allow them to negotiate condom use.

“They can’t have sex on their terms and they end up becoming HIV positive as well,” Lalor said.

“At this point the most we can hope for is to get the women to a point where they are safe [and] empowered so that they know what their rights are and physically in optimal health so that they are not at risk of transmitting HIV to their partners because, very often, they have no say in the state of their relationship,” Tomlinson told the Sunday Observer team.

HIV — human immunodeficiency virus — attacks the body’s immune system. Acquired immunodeficiency syndrome (AIDS) occurs at the most advanced stage of infection. HIV targets the body’s white blood cells, weakening the immune system.

A 2013 study funded by the United Nations Development Programme said there are no laws to safeguard the right of persons living with HIV to an adequate standard of living and social protection in the event of unemployment, sickness, or disability, and to protect them and their households from stigmatising, discriminatory, and violent actions.

Jamaica’s 2017 Revised National HIV Policy says HIV and AIDS rank among the top 10 causes of premature death in Jamaica. According to statistics from UNAIDS, 30,000 people are living with HIV in Jamaica, which is equivalent to nine per cent of the HIV population in the Caribbean region.

World AIDS Day is recognised each year on December 1. This year’s theme is ‘Take the Rights Path: My Health, My Right!’