Otisha gone large on BBC

By Emma Joseph

BBC World Service

I first met Otisha, a tall Afro-Guyanese transvestite prostitute in 2003 when I reported on HIV and Aids in Guyana and Barbados.Back then, the Caribbean had the second highest rate of infection in the world.

The prevalence among female sex workers in Guyana was 27% and 21% for men who have sex with men.

Five years later, Otisha is still a commercial sex worker and business is booming for him.
"I go with lots of clients," said Otisha, who has himself managed to avoid contracting HIV.

When I last visited, men were paying extra money to have unprotected sex.

"You do have some men who pay that type of money to have sex but I'm not going to have unprotected sex," said Otisha.

Raising awareness

Government support for HIV and Aids sufferers has improved dramatically in Guyana in the past five years.

"They are promoting more Aids programmes on national television and promoting the use of condoms," said Otisha.

Since the World Bank came on board in 2004 and after President George W Bush's Aids initiative, more money has been made available to promote awareness and education.
Dr Shanti Singh, who heads the country's national Aids programme, feels that this has had an impact on the number of cases.

"In 2003/2004 our prevalence was approximately 2.4%. At the end of 2006 we conducted another survey, so we estimate in Guyana, right now our prevalence is about 1.55%," said Dr Singh.

The infection rate among female sex workers has also dropped significantly in recent years.
"There has been a lot of work going on to educate the general public - mass media campaigns, a lot of print media and education material," added Dr Singh

Getting support

According to the National Aids Programme, about 5,000 people are now in a free treatment and care programme.

I visited a clinic where I met a young policewoman who had contracted HIV from her husband.

"I thought I was going to die, I shut down my bank account and I made wills concerning my children," she said.

When she first came to the clinic, she had lost all hope but the support she received changed her mind.

"I want to live, so that's why I dress and look fancy and you can't even tell that I have HIV," she said.

However, one of the biggest obstacles for the Guyanese government is how to stop further infections.

HIV is still the leading cause of death among people between the ages of 20 and 49, and the infection rate among commercial sex workers and men who have sex with men remains extremely high.

Isabella, an 18-year-old orphan, had to prostitute herself to put a roof over her head.
She has been having regular unprotected sex since started working a year ago.

"I don't know how to use a condom," said Isabella.

She has never been tested and estimates that she has had unprotected sex with around 50 men.

Multiple partners

Barbados is renowned for being socially conservative and religious but when it comes to sex, it is a different matter.

"In the Caribbean the infection rate is 1.2% and here in Barbados it's around 1.8%," said Dr Carol Jacobs, who is the head of the National Aids Commission.

"We are relatively high but unless we can cut the number of new cases, we still have a big challenge on our hands," she said.

Woman between the ages of 15 and 29 have the highest infection rates, as a result of having multiple partners as well as anal sex.

"We are just embarking on our five-year strategic plan, paying a lot of emphasis to treatment and prevention, with behaviour change and communication in particular," said Dr Jacobs.

"It is about men in particular having multiple partners and I think the young women think if you can do it, so can we," said Dr Jacobs.
Education

The National Aids Commission has just launched what it calls a "Champions Programme," where they are getting artists and musicians to promote the safe sex message to young people.

However, many of the people engaging in risky sexual behaviour are the parents themselves.
Corey Lane, from the Aids commission, feels that adults think young people do not have sex.
"A lot of teachers don't feel comfortable talking to these children about sex, they feel that they are too young to know about it," said Mr Lane.

"We have proven in surveys that primary school children are engaging in sex as early as nine. However, the good news is that we have been able to reduce HIV/Aids mortality by over 70%."
According to Mr Lane, Barbados has also been able to reduce the incidence of new cases as every major public place now offers testing.

Five years ago, when I reported on HIV and Aids in the Caribbean, the big issue was stigma and discrimination

Now, I've seen how the quality of life for people living with the disease in Guyana and Barbados has improved dramatically.

People are living longer and huge strides have been made in terms of treatment and care in less than a decade.

Sadly one thing that hasn't changed is the infection rate, which is only surpassed by the far higher figures in sub-Saharan Africa.