When the first AIDS case was diagnosed in Belize in 1986, the central government there established a National HIV/AIDS Remediation Program within its Ministry of Health (reference). Since that first diagnosis, the virus and its consequential complications, AIDS, have become the fourth leading cause of death throughout the world, following only diabetes, heart disease, and land transportation accidents (International, 2009).
Although the Belizean Ministry of Health’s National HIV/AIDS Remediation Program has remained the country’s largest direct service provider on HIV/AIDS issue, there has been growing national recognition of the need to complement the health related services that it provides with increased measures of prevention (reference), including policy development programs that focus on social mitigation and epidemic reduction, that is indirect and direct interventions in the HIV/AIDS epidemic still raging throughout the Belizean population. Given the high estimated adult prevalence rate of HIV and AIDS within Belize’s relatively small population as compared to the industrialized nations, soon every person there will not only know someone who has the HIV virus but also someone who has died of AIDs.(www.ifrc.org/doxs/appeals/annual 08)
Poverty as Cause
As elsewhere around the world, the greatest driving force of the HIV/AIDS epidemic in Belize is poverty (Inequalities, 2009). According to the Belize Development Trust, roughly thirty-three percent of the Belizean population lives below the poverty line (reference). In fact, HIV and poverty are reinforcing each other throughout Belize. For example, economically marginalized Belizean women are more likely to be infected with the virus than are their male counterparts (Sutherland, 2014), and when they are infected and publicly identified, they are ostracized and often unable to provide even a subsistence livelihood for themselves and their children (reference). Children, too, are often infected, either through childbirth, rape, or intimate contact with infected family members.
Since insurance, pension and worker’s compensation are available only to a very, very small percentage of the population, and any kind of economic relief is minimal, and there is very little, if any, intention or capacity for real economic intervention by the Belizean or any other governmental agency. Thus family support is the primary and sometimes only basis of patient support in Belize. Children are assuming roles as caregivers to chronically ill parents and grandparents, parents to children, wives to husbands, etc.
Unlike in many industrialized nations, however, the HIV/AIDS virus is spreading mainly throughout the heterosexual community of Belize. Lack of knowledge and understanding about the causes of disease in general and HIV/AIDS in particular are greatly responsible for that, alongside culturally driven prejudices and beliefs that worsen the spread and the outcomes of the disease once it is contracted .In particular, the factors of assumptive male physical dominance, socially acceptable gender disparity, and the generally acceptance of sexual and gender-based violence are all contributing substantially to a rapidly increasing rate of prevalence and deaths among women and children, and hence within the general population as well. Public Teachers as Health Care Educators
Because multiple studies in industrialized nations have found that HIV/AIDS education is an important tool for modifying high risk behaviors and preventing the spread of HIV, Belizean officials have been conducting a concerted, annual effort to train Belizean teachers to provide all students with HIV/AIDS education (reference), but such efforts are insufficient to stem the gathering storm that threatens to deluge Belize, its people, and its social and economic well-being.
To augment Belizean teacher training, international volunteer organizations have also been traveling to and throughout Belize in hopes of at least attempting to provide sufficient outreach education to stem the tide of epidemic.(Lohmann, et al., 2009). Unfortunately, despite the wide variety of volunteer organizations who have entered to provide medical care and social education, all of them together do not have sufficient resources to meet the educational needs of the whole country. As a result, many students in Belize, especially in its most rural areas, still have not yet received any formal HIV/AIDS education .
According to the United Nations, “The full realization of all human rights and fundamental freedoms for all is an essential element in the global response to the HIV epidemic, including in areas of prevention, treatment, care and support” (UN, 2011). Yet in Belize, social prejudice and economic-political discrimination of those with HIV/AIDS is neither socially stigmatized nor illegal. Instead, social pressure is exerted against innocents who are unwittingly or consciously infected by HIV positive family members or others.
To better understand the nature of the Belizean HIV/AIDS epidemic and the country’s governmental response to it, especially those of its educators, this study uses the “SPELIT Matrix” to analyze the research and qualitative data identified “social,” “political” and “economic” variables, or aspects, currently affecting the spread and effects of HIV/AIDS through Belize .It also recognizes the validity of Abraham Maslow’s Theory of Human Motivation (1943), higher level needs became salient
when lower level needs, such as safety, survival and physiological demands like hunger, have been at least minimally met. Since all these are factors in Belizean society’s response to those of its members who are infected with HIV/AIDS, and since the key drivers of the social motivation, as Maslow defines it, are individual and group social awareness and personal relationships (Schmider, 2007), this study employee Maslow’s terms and perspectives to aid its analyses.
Upon visiting one of the schools of Belize and talking to its teachers, it became evident that there are significant social stigmas and negative social outcomes for students and parents who are diagnosed with HIV, regardless of whether or not the virus has yet to be pathologically expressed at AIDS. That discrimination can originate anywhere — among other students, other parents, administrators, or teachers. Of course excessive fear of infection is one source of that behavior, because more well educated Belizean population believe or feel that their “safety,” in Maslowian terms, or that of others, may be threatened by a student whose household has a member with HIV/AIDS. With proper education and precaution, however, their fears are of course untrue.
Conversations with teachers in that school, however, clarified that, unlike here in the US and in other industrialized countries, social discrimination in Belize against those with HIV/AIDS is not prohibited by Belizean law, despite the fact that it has been strongly discouraged worldwide by human rights organizations, especially the United Nations (UN, 2011). Much more work needs to be done among government officials and educators in Belize if the HIV/AIDS epidemic is to be alleviated. The stigmatization of children with HIV who attend school and of, for example, buying vegetables from a person living with HIV, not only perpetuate poverty and suffering but a society driven by fear and exclusion that cannot raise sufficient human capital or funds to fight its nationwide epidemic.
Furthermore, since the beginning of the HIV/AIDS epidemic, teachers and others reported that HIV/AIDS has been associated with negative religious beliefs including moral failings and sinful behaviors. Researchers have identified religious assumptions and prejudices as causal factors that initiate the process of stigmatization toward HIV/AIDS infected population. (Marcos Reyes, Neslon, Varas, Miluska, and Martinez, 2015). It is clearly observable in Belize, and elsewhere, that HIV/AIDS disturbs the social life and continuity of a community and causes uncertainty, fear, and blame. Moreover, the Belizean government’s response to HIV/AIDS has remained one of the few, worldwide, that has been led by a multi-sectoral governing body that demonstrates national policy and national vision of HIV/AIDS as a social challenge as well as a health challenge (UNAIDS, 2013).
From early on, national governments have often denied the existence of AIDS/HIV, dismissed its potential harm, or moved far too slowly to offer supplementary health services to people with AIDS .Much of what has played out in national and global responses to the HIV/AIDS is shaped by political factors, yet little analysis has been done to dissect political dynamics and motivations (UNRISD, 2005). Much of the responses to HIV/AIDS have been shaped by the public health approach spearheaded largely by the medical community .In Belize, however, the Ministry of Health has mandated that educators be on the front lines of what is also a medical, economic, and political emergency. To date, no thorough, well-funded study has been conducted to confirm or question the government’s policies, administration, recommended methods, or the outcomes of those.
It is not that critical and empirical approaches are inappropriate in the struggle, but that they have not invited, welcomed, or funded, and that no studies have included a thorough consideration of how power relations, inequities among socioeconomic groups, or competition and inequities among nations are influencing the progress in the fight again HIV/AIDS. In fact, social factors and changes that have magnified the spread and impacts of HIV/AIDS, as well as socioeconomics and political changes that could have at least somewhat controlled the epidemic have been largely ignored (UNRISD, 2005)
The most significant factors that appear to determine or drive governmental responses to the global HIV/AIDS pandemic are the infrastructures of individual national and international political economies. Various decision makers and stakeholders — corporate, political, and social — assess what they expect to gain or lose by speaking out or taking a real, substantive action on HIV/AIDS issues and then act according to their own, immediate best interests (UNRISD, 2013).
In addition, racial-ethnic assumptions and issues, as well as issues related to sexuality, tribalism, and cultural change are highly politically sensitive. Interest and support for political analysis of those topics, even in the context of the greatest global medical crisis on earth, have not been forthcoming (UNRISD, 2013). Many non-academics have learned too quickly that research on the political economy of AIDS will either go unfunded or will not further their careers.
Moreover, most donor agencies have little interest funding research or analysis of economic or political contributing factors because such studies are politically sensitive, and at least at the top of most national governmental systems, the political will to adequately address the HIV/AIDS epidemic has been relatively weak at highest levels of authority. Moreover, the stigmas associated with assumed sexual behaviors related to HIV/AIDS infections and the negativity of issues like poverty and suffering create little political capital in a country still struggling with providing basic education to its population. Thus, despite its Ministry of Health, avoidance and ignorance of the HIV/AIDS epidemic and its personal and national consequences is generally upheld by the country’s political authorities, whether by commission or omission of discourse and actions.
According to the Heritage Foundations “2016 Report of Economic Freedom,” Belize’s record in economic freedom and opportunity has “stagnated” over recent years: “The government’s record on structural reform is uneven, and lingering policy weaknesses in many parts of the economy constrain more dynamic growth. Despite some streamlining of the process for setting up a business and completing regulatory requirements, such challenges as poor enforcement of the commercial code and lack of transparency often deter entrepreneurial activity.” So, although Belize’s policy of “limited” central government might appear on the surface to permit individuals to engage uninterrupted in economic growth, issues like inefficient fiscal policies, bureaucratic red tape, criminality, and backdoor deals all seem to be limiting Belize’s opportunities for economic growth, and hence for the possibility of devoting more funds to HIV/AIDS education or treatment. (Heritage, 2016)
Belize’s national HIV/AIDS response policy remains heavily dependent on external funding. Domestic public expenditure has financed only twenty-nine percent of total expenditure. Thus, Belize’s fight against HIV/AIDS remains highly vulnerable to adverse effects of cuts in external funding. (Global Fund, 2014) The federal government of the United States has been the single largest external donor for HIV/AIDS relief, including that to Belize. The Global Fund was the second largest external donor funding 31 percent of foreign funds. (Global Fund, 2014)
Belize’s Ministry of Health and the Ministry of Education should join in an effort to provide Belizean teachers with more teaching opportunities and materials with which to teach students and parents about HIV/AIDS, effectively, multiple times a year, as well as to coordinate their efforts more carefully with those of volunteer organizations. Budget restraints aside, however, the current lesson planning and methods to addressing the issues involved have not yet been sufficiently studied to determine their effectiveness; nor are educators empowered to try multiple methods and approaches or work alongside other social service professionals and international medical and health-education volunteers.
Belize’s educators must be much more well-prepared if they are to take down HIV/AIDS. To do make a real difference in the spread of such an infectious and insidious disease, teachers must not only have a much more than adequate knowledge of the biology and sociology of the virus, its transmission, symptoms, and prevention of transmission, but they must also gain a very high comfort level with the discussion of topics generally viewed in Belize as deeply personal if not socially unacceptable. Topics such as responsible sexuality, the short and long-term physical, emotional, sexual, and mental medical and social effects of HIV/AIDS on the individual and the family, the related issues of the unacceptability of spousal, child, and elder abuse, as well as how to field and direct the social information that their students and parents may provide regarding the spread of infection among their family members, neighborhoods, and large communities — all must be areas of considerable strength and acumen for Belizean teachers if the Ministry of Health expects its countries classroom teachers to bear the psychological, social, and medical weight of a nationwide plague.
There is still a great deal of work to be done to control the spread of HIV/AIDS in Belize, including and perhaps especially an increased sense of responsibility and stewardship by the central government of Belize over its people, their lives, livelihoods, medical health, and suffering. There should be greater involvement of vulnerable and suffering populations in politics and of key economic and political leaders in the fight against HIV/AIDS there. Legal barriers to providing support for the population with HIV should be removed, and government should take a visible stance in support of elimination of this disease, including providing more than cursory attempts at education and the allocation of more economic and human resources to the fight, rather than just depend on international funding and the global economy.
.Inequalities fueling HIV pandemic. (2009) International Federation of Red Cross and Red Crescent. ifrc.org. 1 July 2016.
Heritage Foundation. 2016 Index of Economic Freedom: Belize.http://www.heritage.org/index/country/belize. 7 July 2016.
Global Fund (2014). Global Aids Country Progress Report. globalfund.org. 1 July 2016.
International Journal of Infectious Diseases,13: 2227-e235. 6 July 2016.
UN General Assembly (2011). Political Declaration on HIV/AIDS: Intensifying our efforts to eliminate HIV/AIDS, adopted by the UN General Assembly 10 June 2011. HIV/AIDS and human rights. United Nations Human Rights Office of the High Commissioner. http://www.ohchr.org/EN/Issues/HIV/Pages/HIVIndex.aspx. 6 July 2016.
UNRISD (2005). United National Research Institute for Social Development. unaids.org. 1 July 2016.
UNRISD (2013). United National Research Institute for Social Development. unaids.org. 1 July 2016.