(December 2000) Jean Jones (not her real name) spent most of her childhood and early teens at a home for children. At 15, she got lucky and went to live with relatives. At 16, however, she had a son, discovered that she had HIV, and that her relatives no longer wanted her around.

Jones and her seemingly healthy 5-year-old son now live at the home of a health worker.

"Sometimes, I just cry; I don't eat, and I get sick all the time. I know I'll die sometime soon, but I'm not too worried about myself; it's my son I am concerned about," says Jones, bundled up at the edge of a bed in the health worker's modest home.

Six Times as Many Girls as Boys 15-19 Years Have HIV in Trinidad and Tobago

Jones' HIV/AIDS condition is replicated many times over among the young female population of Trinidad and Tobago. In the age group 15–19 years, six times as many young women as young men have HIV. This is a dramatic turnaround of the numbers over the last five years. It has come about because of certain factors, including early sexual initiation.

A survey was conducted of 676 young adults (10–29 years old) in Tobago in April by the Family Planning Association; the Tobago AIDS Society; the Caribbean Epidemiology Centre, with support from the Dutch Embassy in Trinidad and Tobago; and the German Technical Cooperation Agency in Tobago. The study found that sexual activity starts as early as 10 years old, the average age being 14 years old for boys and girls combined. Thirteen percent of those 10–14 years old had had sex.

The overall young age of sexual initiation as reported by the study reaffirms that young people between the ages of 10 and 24 years are at high risk of acquiring HIV infection, states the report of the survey.

Young Women Have Older Partners

Along with the quantitative findings, focus groups were also conducted. Participants of these groups remarked on the phenomenon of young women having sex with older men, where materialism plays a role. The report points out that older men are usually able to afford more enticements. It notes that the men take advantage of their more favorable financial positions when they seek relationships with young girls. Unfortunately, a consequence of this age differential between males and females in sexual relationships is that the young women are more susceptible to HIV infection.

Incest, a subject that is not talked about or acknowledged, has a heavy impact on girls. Six percent of the young people surveyed — all girls — said they had had sex with a father, stepfather, uncle, or older brother.

Some girls did not see anything wrong with having sex with a member of the family, says Anne-Marie De Gazon-Washington, a youth officer who was part of the team that conducted the survey. "If that is so, you have to consider how that translates into risky, grown-up behavior."

Young Mothers Are Passing the Virus to Their Babies

A key problem that goes along with rising sexual activity and HIV transmission among young people is the increasing number of young women who transfer the virus to their babies. At the Tobago Regional Health Authority hospital in the capital, Scarborough, HIV testing was conducted on the umbilical cords of newborn babies. The infection rate of the babies of mothers in the 14-24 age group was about 3.6 percent — roughly double the rate for older women.

Addressing these potentially infected babies is urgent.

"If something is not done about mother-to-child transmission, we run the risk of realizing the international norm of 30 percent of the babies born to HIV-positive mothers contracting the virus," says the hospital medical director of Tobago, Dr. Maria Dillon-Remy. That would severely affect the 750 babies born in Tobago every year and eventually the 50,000 population of the island, Dr. Dillon-Remy observed.

Dr. Violet Duke of the Ministry of Health in Trinidad says the government has developed a policy that includes voluntary screening for pregnant women. The next stage is to provide treatment for mothers who develop AIDS after having their babies, "otherwise we will have a generation of orphans," notes Duke. The third stage of the policy would be to begin making combination HIV drug therapy available to persons infected with AIDS.

Under the new policy, a pilot study began in August 1999 with voluntary screening of women for HIV. With the assistance of the Medical Research Foundation of Trinidad and Tobago, six women were treated during pregnancy and, along with their babies, they also received treatment during delivery with AZT. Five other babies whose mothers had not received the drug during pregnancy received AZT treatment. Only one of the 11 babies among those women who were treated has developed the virus.

Given the study results, "We hope to soon be able to offer universal screening to all mothers," says Dr. Dillon-Remy, noting that the incentive given to women with HIV that their babies can be spared the virus "has proven to be the most important reason why mothers are taking the test."

Some Teenagers Say the Problem of High-Risk Sexual Behavior Begins at Home

Young people have their own ideas about the reasons for early sexual activity among their peers.

Adana Clarke, 18, says one reason that young people, especially girls, assume high-risk behavior at an early age has to do with the failure of parents to speak with their children about sex, postponing the issue until the young people are all but out of their teenage years.

Referring specifically to girls, she adds that "a lot of young people are not given love and affection in their homes, and when they get out onto the streets and the fellas tell them 'I love you,' they feel wanted. And because they have low self-esteem, they are forced into sexual behavior at an early age."

Charles Smith, just out of high school, says parents employ a double standard that is also contributing to the spread of the virus in Tobago. He notes that while parents caution their girls about "appropriate behavior," they leave their boys "to do as they wish."

Policy Recommendations Include Services for Young People

Policy recommendations coming out of a workshop on the Sexual Health Needs of Youth in Tobago include the establishment of youth empowerment centers where young people can go for lifestyle counseling and adolescent and health services without the stigma of visiting an AIDS clinic for testing.

One policy approach recommended is the reorientation of health services in order to create youth-friendly, youth-specific approaches to sexual and reproductive health. The young people fear for confidentiality in a small society.

One desire of the youths is for the government and the Tobago House of Assembly, the body responsible for the administration of the local affairs of Tobago, to adopt a policy of having an official youth representative in the Assembly to look after the interests of young people.

One important policy recommendation, however, is for sex education to be offered at school as well as at home. Another calls for increasing the self-esteem of young girls, "especially to have girls who are sexually violated by fathers and uncles begin to understand that it is wrong, and to end the culture of silence about sex in our society," says youth officer, Anne-Marie De Gazon-Washington.


Tony Fraser is a freelance writer in Trinidad.