HIV/AIDS and Homophobia in Jamaica

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Source: The Body - Feb 3

By Bonnie Goldman

Welcome to HIV Frontlines: Global Edition. In this series, we talk to a range of people throughout the world. From China to Ukraine to Rwanda, these inspiring people are doing their part to make a difference in regions of the world where access to HIV treatment and care is only a shadow of what is generally available in the U.S. Through these interviews, we'll get a glimpse of the realities of HIV in some of the world's poorest areas.

Introduction

Bonnie Goldman: With all the news about the terrible earthquake in Haiti, and as we learn more about how awful conditions in Haiti were before the earthquake, it's easy to forget that there are other countries in the Caribbean that are struggling. When one thinks, for instance, of the island of Jamaica, what immediately comes to mind are white-sand beaches, sunny skies and lilting accents. What doesn't come to mind is an extraordinarily violent place with substandard medical care and HIV run rampant. But the reality is that Jamaica has deep underlying problems and HIV is one of them.

Although the HIV rate in the general Jamaican population is estimated at 1.4%, the Jamaican gay community's HIV rate is an astonishing 32%. This appallingly high rate may be somewhat related to a deep and dangerous homophobia, which puts anyone who's gay at grave risk. Gay Jamaican activists have even been murdered. In fact, in 2004, Human Rights Watch released a searing report called "Hated to Death." It examined homophobia, violence and Jamaica's HIV/AIDS epidemic.

To find out more about the current HIV/AIDS situation in Jamaica, I spoke with poet Kwame Dawes who grew up in Jamaica. In 2007, he traveled to Jamaica where he looked at how HIV/AIDS has shaped the lives of so many people. The result was an amazing multimedia reporting project that he helped produce called "Hope: Living and Loving With HIV in Jamaica."

Also joining me is Nancy Mahon, a senior vice president at MAC Cosmetics and executive director of the MAC AIDS Fund, which has provided over $145 million to help people around the world affected by HIV/AIDS. Through the Pulitzer Center on Crisis Reporting, they helped fund Kwame's project. Welcome, Kwame and Nancy. Thank you so much for joining me.

Homophobia in Jamaica

Bonnie Goldman: Kwame, could you talk a little bit about what it is like to be gay in Jamaica and what it is like to be HIV infected?




Kwame Dawes: I should start off by saying that I grew up in Jamaica. Most of my young adult life was spent in Jamaica. I have family in Jamaica, so I'm in Jamaica five, six times a year. Jamaica is not a place that I jump into and then flee out of. Therefore, I grew up knowing many people who are gay. I also continue to have friends in Jamaica who are gay. During this particular project, I interviewed quite a number of people who are gay who are also living with HIV.

Kwame Dawes

There's no question about the challenges that are there. The challenges are on several fronts.

The first one is the way in which the popular culture and music have repeatedly articulated very disturbing ideas about gays and quite violent lyrics and so on. The violence of the lyrics and the acceptance of it by certain segments of the population leave somebody who is gay with a constant sense of anxiety about the way in which they're viewed and they'll be treated if they come out. So it's a kind of living threat.

And there've been so many instances of violence against men who sleep with men.

Yet there's another side of this thing that is worth paying attention to. The gay community has been far more articulate and present, and in many ways, radical in its resistance to the violence that has been perpetrated against them. That presence is part of what I believe to be a cultural shift that is taking place within a very conservative society. There are many gay people who have left Jamaica simply because it was just untenable to continue to live there comfortably and freely.

"There are many gay people who have left Jamaica simply because it was just untenable to continue to live there comfortably and freely."

That complicates issues of how we deal with HIV. If being gay becomes something that one does not want to be attached to, then there's a reluctance for those people to come out of the closet, or to even just come out to be tested for HIV/AIDS. It's a hard community to then reach. That creates tremendous problems. The numbers are disturbing. Almost 30% of men who sleep with men in Jamaica are estimated to have HIV.

Bonnie Goldman: Wow. Why do you think that the rate is so high? Is it because there's so much homophobia that gay men don't take care of themselves, or is it that they don't have the information to take care of themselves?

Kwame Dawes: It's a combination of things. The rate is high, because the rate has been high among gay men historically all around the world. We know that. The question is how are we dealing with it and how are they dealing with it as a community.

"The numbers are disturbing. Almost 30% of men who sleep with men in Jamaica are estimated to have HIV."

One of the great things that we've seen in other parts of the world is that the gay community has been outspoken and willing to address within itself and, of course, within the larger community, how to contend with HIV/AIDS, how to practice safe sex, how to ensure that one is tested and so on.

In Jamaica, because of homophobia, there's anxiety about declaring oneself to be gay. If one contracts HIV/AIDS, they're suspected of being gay. That complicates the matter. As one person said in one of the documentaries that [writer/producer] Micah Fink did, he's more worried about being killed by a crowd for being gay than he is about dying of AIDS. So there's a way in which that is complicated.

The other thing to remember is that we are talking about a country that is relatively poor. Many of the people that we are dealing with have issues of poverty and a lack of education, and therefore, issues that relate to the lack of knowledge.

The greatest work that is done in countering HIV/AIDS is within the communities at risk. If you can go into those communities and then work with them to practice behaviors and patterns of protection and then, of course, HIV testing and treatment, you will make progress.

If that community is underground, it is increasingly difficult to reach; therefore, that increases the likelihood of these high HIV rates. 

Bonnie Goldman: Could you explain the realities of the criminalization of homosexuality? Is there a culture of fear? Do people turn in other people? Is it like prostitution in America, which is prevalent and robust and just a few people get arrested now and again? Or do people get arrested all of the time?  

Kwame Dawes: No, no. I should say very quickly that, regarding the criminalization of homosexuality, you're not dealing largely with the state arresting people because they're gay. This is not what is happening. It's on the books. It's on the books in so many countries. It's on the books in the United States of America where there are sodomy laws.

What happens is that, because homosexuality remains criminalized, there is a culture that feels valid in saying that homosexuality is a negative thing, an immoral thing. But there are very few cases -- except cases in which one is trying to persecute somebody on another front and then uses this as the means to persecute them -- that somebody is so-called "turned in" or arrested and so on.

I think a gay person is not worried about being arrested for homosexual practices. The gay person is more worried about not being protected from violence against them by the community because the police may be complicit in the violence that is enacted against them.

So we are not talking about a kind of police state, in which one turns in gay people and so on. That's not what's happening in Jamaica. People who are gay in Jamaica, in many ways, are known to be gay. What they do fear is that in certain volatile situations, or in certain situations of vulnerability, they may be attacked for this.

Nancy Mahon, Esq.

Nancy Mahon: By way of background, over 80 countries worldwide do have anti-sodomy laws. Overturning the anti-sodomy laws would not cure the problem, but certainly these laws create a perception that governments condone anti-gay violence and, as Kwame said, that there would be no recourse if you were to go to the police.

There are many instances where either the police are part of the violence or the police see it and ignore it.

Kwame Dawes: Exactly.

Bonnie Goldman: Are there then no people in jail for being gay?

Kwame Dawes: No, none that I know of. The state is fully aware that doing that would be deeply problematic, but there have been people who have been charged with sodomy. In those instances, it is seen as being used as a part of it. But -- and I could be wrong on this -- I'm almost quite certain that persecution to the full force of the law has not taken place in Jamaica.

"The violence, the murders and so on that are going on are real issues and they're about a culture in which people enact that violence against gay people. Gay people do not feel that they have and have been shown not to have the protection of the police at all times on these issues."

Again, I must reiterate that that is not the fundamental anxiety. The violence, the murders and so on that are going on are real issues and they're about a culture in which people enact that violence against gay people. Gay people do not feel that they have and have been shown not to have the protection of the police at all times on these issues.

Bonnie Goldman: Do we know how many gay people have been killed?

Nancy Mahon: No, although we might. There's a group called J-FLAG [Jamaica Forum for Lesbians, All-Sexuals and Gays], which we also fund in Jamaica. It offers hotline intervention services for people who are threatened and has been working on an advocacy level to try and reverse the anti-sodomy laws, or what are called "buggery laws."

Bonnie Goldman: Do a lot of people in Jamaica have Internet access?

Kwame Dawes: Yes, the Internet is quite present in Jamaica, so a lot of people do have access, a lot of poor people don't.

Bonnie Goldman: But the Internet must help the gay population in Jamaica feel less isolated and let them know that there's freedom out there. They could also get information about HIV/AIDS via the Internet.

Kwame Dawes: Yes. What I want to reiterate is that ... I know it's difficult to grasp that when you go to a place like Jamaica, you're in a very contemporary world, in which there are classes in society. There are economic levels and people live at different levels of that society. When we speak of violence in Jamaica, it's really important to understand that there's an epidemic of violence in Jamaica, with almost 2,000 people murdered a year in a population of only 2.5 million. There's a serious epidemic of violence. It is in that context that we see the violence against gays. But if we did the percentages on those, they'd be really, really small.

"When we speak of violence in Jamaica, it's really important to understand that there's an epidemic of violence in Jamaica, with almost 2,000 people murdered a year."

In addition, women have tremendous anxiety about violence against them. There's violence from the police against poor people and so on. So there's a larger context of that kind of struggle that people are having.

The violence that is related to homophobia is part of that larger picture. It's really necessary for that to be understood -- to have a broader sense of it. There is a tremendous amount of information out there, but the work is to try and make sure that people are tested and it has to be one on one.

People know about HIV. In the same way that we work with young people who may be heterosexual, until you can work directly with them, until you can work with the sex workers, until you can work with those who work in the tourist industry, and know them, identify them, and talk to them, and take them through the process, and they're willing to do that, then that information doesn't have the kind of impact that it needs to have.

It's not a question of the information not being available. It's a question of having a closer contact and creating a culture within itself that is open to the kind of work that is needed to ensure adherence and protected [sexual] activities.

Nancy Mahon: This issue of violence and HIV is a worldwide problem. In fact, many of the big funders, such as PEPFAR [U.S. President's Emergency Plan for AIDS Relief], are really beginning to look at how we can look at HIV through a violence lens and understand that if people fear for their safety, their ability to engage in any kind of open, honest and equal-playing-field discussion around safer practices is just nonexistent, whether it be women or whether it be people living with HIV.

Kwame Dawes: That's very true.

Bonnie Goldman: To be quite blunt, it sounds like the heart of the problem with HIV/AIDS in Jamaica is the heterosexual male who is perpetrating violence against both women and men who have sex with men [MSM].

Kwame Dawes: There are multiple problems that we're dealing with. The heart of the problem of homophobia and the impact that it has on the lives of gay people are certainly part of a kind of heterosexual, patriarchal notion of sexuality that has its roots in cultures that go way back. In many ways, part of the work has to be to work through those and to get people to think beyond those constrictions and those constraints.

I think when we say that the heart of the problem is the heterosexual male, the truth is that many of the people who I worked with -- and you'll see on the site -- are straight men and they're dying of AIDS.

Their narrative is as tragic. In fact, many of these straight men, who are living with HIV, are not coming out because of an anxiety about being stigmatized as gay.

I don't know if we can do a great job of identifying who is the problem.

Nancy Mahon: I don't know if we can say they're the problem. I think the issue is that they're critical partners.

Just to add to what Kwame is saying, I think behaviorally we put people into certain boxes that actually they don't stay in. In particular, what we're seeing with straight men is that sometimes they are having sex with men. What we refer to as men who have sex with men, as opposed to [men who have] a gay identity.

The other thing is that particularly in the Caribbean, and elsewhere as well, there is such an enormous amount of sex tourism and commercial sex that there's this sort of big mixing pot. It is critical that we include straight men as partners and really better understand what it is about their sense of masculinity, their sense of utility and their sense of being in relationships with people that is causing this amount of violence.

HIV/AIDS Treatment in Jamaica

Bonnie Goldman: Can we turn for a minute to HIV/AIDS treatment? What's the treatment situation like in Jamaica right now? Kwame, can you talk to that?

Kwame Dawes: It's a really interesting story. Until 2003, there was limited access to antiretroviral drugs, particularly for those who couldn't afford it. It was very expensive. As a result, the morbidity that came from HIV/AIDS, the deaths that happened were really disturbingly high.

Annesha Taylor

With calm, intelligence and disarming honesty, Annesha Taylor has managed to help change the perception of HIV/AIDS in Jamaica by her bold act of going public with her status. Her words and a video can be found on the Live Hope Love Web site. Photo: Joshua Cogan, Pulitzer Center on Crisis Reporting

A simple example: One of the support groups that serves people living with the disease in Montego Bay told me that prior to 2003, when antiretroviral drugs became more available, they were looking at 18 to 20 deaths a month. After that, they were down to one or two deaths per month, and sometimes, no deaths at all.

I don't know if we can really understand how powerfully moving that statistic is. There are just so many dramatic differences. People who were living very difficult lives, you may see them struggling with stroke after stroke, and then they managed to have access to antiretroviral drugs and their bodies were changed. They could go out to work. Things were completely different.

So something happened then and much of it is owed to agencies like the MAC AIDS Fund and to the U.S. government, even, at the time for making the funds available for antiretroviral drugs to be had, even for free for those people who needed it.
It has made a huge difference that people can get access to antiretroviral drugs. But that's not guaranteed forever. That's one of the big challenges. The hope is that we will continue to make those drugs available in Jamaica.

Nancy Mahon: That is one of the global challenges. South Africa's also guaranteed universal access. The bottom line, as you know, is that when people take HIV drugs, they have to be on them for the rest of their lives. At this point, globally, we have four million people on HIV drugs, and three million of them are being supported by the U.S. government. In Jamaica, we have seen several big donors like the World Bank -- who had been giving money to HIV -- who are now leaving.

The Global Fund [The Global Fund to Fight AIDS, Tuberculosis and Malaria] has actually been giving over a million dollars a year, which we've been participating in, but we have not seen new donors. One of the bigger issues, I think, that we have in the Caribbean, as a region, is that aside from tourism, there is not much industry there.

"As you can imagine, the [Jamaican] tourism industry does not want to publicize the fact that there's a high HIV rate."
As you can imagine, the [Jamaican] tourism industry does not want to publicize the fact that there's a high HIV rate. Also, the tourism industry is not providing services to its employees the way the manufacturing industries in Africa are.

I think we as a global community need to really get behind the Caribbean and not only make sure that Global Fund dollars and other international dollars go there, but also help local businesses understand that this has to do with the health of their communities...


Kwame Dawes: Absolutely.

Nancy Mahon: And their ability to provide workers for tourism.

Bonnie Goldman: Nancy, when you mention all those numbers, the $1 million a year, and groups such as the Global Fund and PEPFAR, is that money paying for the HIV medications that Jamaicans are taking?

Nancy Mahon: Yes.

Basically, at this point, there are some local funds, but it's largely international funds. The other piece that understandably the governments do not want folks to know is that there's just an enormous amount of poverty in the islands. You'll have one side of Jamaica, such as Montego Bay, which is fabulous and terrific, and then you go to Kingston, and the poverty that I saw in Kingston far outweighs the poverty that I saw in South Africa. 

Bonnie Goldman: Could you provide specific details about that?

Nancy Mahon: When you go into the Kingston health clinic, people would have to spend their entire day traveling to be at the health clinic. Then they would wait. The pharmacy would have to close down at 11 o'clock in the morning because there were so many orders.

Basically, anybody who saw a doctor and had a pharmacy-filled prescription after 11 a.m. would have to either not get their medication or would have to travel back to the pharmacy, which often took three or four hours, the next day.

There's very little health care infrastructure. The larger debate around HIV focuses a great deal on the fact that you can't just focus on HIV. You need to look at the health system overall and the health system in Jamaica is very impoverished.

Then the issue is how do you treat a chronic terminal illness on top of that and on top of diabetes, sickle cell anemia, heart disease and all the other issues people are facing.

Bonnie Goldman: So Jamaica doesn't have a Paul Farmer who's out there with great energy and ideas?

Nancy Mahon: No.

Kwame Dawes: Some people have that kind of money, but that's not where they're putting it.

Nancy Mahon: Actually, we are funding the Clinton Global Initiative to work in a similar situation, but it has not attracted nearly the number of dollars that Haiti has.

Bonnie Goldman: It's ironic, because Jamaica's much more on people's minds, in terms of a tourist destination.

Nancy Mahon: I don't think it's ironic. I think it's purposeful. I think it's been to the Jamaican people's disadvantage that it's largely a tourism place.

Bonnie Goldman: Yes, but don't you think that if it becomes known that Jamaica is such a mess in terms of HIV, homophobia and the shocking poverty, then fewer tourists will go there and then Jamaica will lose money.

Nancy Mahon: Right. So the trick is to create enough pressure on the governments and the international community to basically equip folks with as much HIV information and as much prevention materials as we can, and to give them the best care we can.

Bonnie Goldman: Is there any work being done to convince the Jamaican government to change practices, to be more involved in HIV and to change its feelings about homosexuality?

Kwame Dawes: I think there's a lot of work going on. I should say that in my experience, the work that is being done by the ministry of health in trying to raise awareness and to do things on HIV/AIDS has been quite positive. I think increasingly many of these governments that we're talking about are governments that are struggling with tremendous debts, working with the IMF [International Monetary Fund].

Therefore, there's this big challenge of how do we balance all of this and how do we make this work. But at the same time, there are leaders in the Jamaican government who have spoken in very disturbing and, I would say, unfortunate ways and homophobic ways that are not very helpful in that situation.

Now, organizations like J-FLAG and many of the support groups that exist in Jamaica are constantly in dialogue with the government and trying to lobby and see change done. The extent to which that has made a difference is clear. It has made some difference, as you'd hear if you spoke to the J-FLAG folks, but there's still a long way to go.

Part of the long way to go is that a politician simply claims that, "I'm getting pressure from my constituents who say that if I say it's OK for somebody to be gay, then they'll vote me out." This is their argument. They put the blame on the society.

Of course what we say to them is that, "You need to take some leadership here, and that will help to change those views or those attitudes."

There is a conversation going on, and that conversation is really important. But at the same time, as much as you might have this conversation and this dialogue, there are people living and dying with this disease and they desperately need the treatment. Many of them get the treatment, but they're too hungry to take the medication.

Many of the people I know living with the disease who are on medication have only found work with the health ministry. That has helped them to look after their families and so on. The ministry of health has given them work to do. They've been doing tremendous work in awareness and so on.

But not everybody has had that benefit. There are those real issues that have to do with poverty and that have to do with access to basic nutrition and basic living that come with the horror of poverty that we see around the world. Those things too need to be addressed.

Bonnie Goldman: Do you know what percentage of HIV-infected people in Jamaica who need HIV treatment are getting it? Nancy, do you know that?

Nancy Mahon: You have to define the word "need."

Bonnie Goldman: Let's say need treatment according to WHO [World Health Organization] guidelines.

Nancy Mahon: Basically, there are two different issues. One is how available HIV testing is. Then at what point do you intervene? My understanding is that it's on the lower level compared to other countries.

Kwame Dawes: But I should say that one of the positive developments that has happened in Jamaica, in terms of treatment and testing, is that up until a year ago at least -- and I think it continues to be that way -- any woman giving birth in any of the medical facilities in Jamaica is tested for HIV. Much of the statistics that we get about HIV rates comes through that source.

That gives us a good sense of what is happening. In many cases, since the advent of antiretroviral drugs, many of the children who are born to mothers who have been tested -- we have been able to save them from having HIV by putting the mothers on medication. And that has made a huge difference.

Bonnie Goldman: So there are drugs available to treat pregnant women.

Kwame Dawes: If a new mother tests positive in any of the medical facilities, she will get that treatment, yes.
And the child is treated right away. It's a sign of progress. The real progress there is that the drugs are available because there's always been the interest in care at that level. But nothing could be done about it before because of the cost of the drugs.

Bonnie Goldman: In terms of the women testing positive, what's the stigma like?

Kwame Dawes: All you have to do is imagine what would happen to you if you found out you have HIV/AIDS. It's going to change your life in many ways. But for women, the stigma clearly does not extend to the question of homophobia.

I think the culture is changing. Before you'd be even hard-pressed to have somebody treat you. Nurses and doctors would be anxious about treating someone with HIV. I've seen this here in South Carolina too. This is a huge problem. That has changed a great deal through education and through training.

But families can ostracize you if you have the disease. There's sometimes shame associated with the fact that you've contracted the disease. That is only changed by people who are living with the disease who can come up front and say, "I have the disease and I'm saying I have the disease without shame and without fear of saying that."

There have been a number of examples of such individuals. Rosie Stone, a Jamaican woman who was married to one of our great pollsters in Jamaica, a very famous man called Carl Stone who died of the disease. It was a secret when he died of the disease. She finally came out and said, "I have the disease," and she wrote a book about it.

That was really remarkable because here's a middle- to upper-class woman who has come out, and she's worked with young children and she said she has the disease. The realization that it can affect just anybody has made a great difference.

I think that kind of work is important, which is why I think the Live Hope Love Web site has been so important in putting the voices and faces of people with the disease out there to say anybody can be living with HIV. The questions are: How do you live with it? How do you prevent yourself from getting this disease if you don't have it?

About the MAC AIDS Fund

Bonnie Goldman: Nancy, could you tell us how the MAC AIDS Fund got involved in Jamaica?

Nancy Mahon: Sure. We are a global funder of AIDS. We're actually, interestingly, the second largest corporate funder to AIDS worldwide, even though we're a cosmetic company. It's been something that MAC has been committed to since the founding of the company. Internationally, we wanted to focus on the two areas that had the highest HIV rates. Those areas are South Africa and, unbeknownst to many people, the second area is the Caribbean. We feel very strongly that the Caribbean is an area of the world where there's been a lack of focus and lack of funding to help those who really combat the epidemic. 

Bonnie Goldman: What are some of the initiatives that MAC AIDS Fund has been involved with?  

Nancy Mahon: We have funded about $7 million in a wide range of initiatives over the last couple of years. Everything from HIV testing, treatment and care in the Dominican Republic, as well as in Jamaica, to advocacy around some of the issues, including the shame and stigma issues that prevent people from accessing HIV care.

For instance, in Jamaica, we see homophobia, which is keeping people away from HIV testing and driving high-risk sex underground. As a result, men who have sex with men in Jamaica have an HIV rate that is double the amount in the Dominican Republic, where we see less of that.

We've also funded a group called the Pulitzer Center, to bring media and news attention to the Caribbean, and begin to take a look at what the issues are surrounding HIV in the Caribbean. The general state of journalism, unfortunately, as well as the lack of resources in the Caribbean, has meant that there's very little reporting on health issues in the Caribbean, particularly with respect to HIV.

Bonnie Goldman: I noticed that there's a new site called the Glass Closet, which went up a few months ago. Can you tell me a little bit about that initiative?

Nancy Mahon: We funded a portion of it. Basically, the Pulitzer Center, which is a non-profit news organization, created a portal on the Web that combines information on homophobia within the Caribbean and some of the other projects they've been doing. Our funding is HIV specific. Although, in order to really tackle that issue, you have to take on issues around the shame and stigma in homophobia.

Hope's Hospice By Kwame Dawes This poem, among others, is featured on LiveHopeLove.com, where you can also find more reporting on HIV in Jamaica. For John Mazourca These days, the language of death is a dialect of betrayals; the bodies broken, placid as saints, hobble along the tiled corridors, from room to room. Below the dormitories is a white squat bungalow, a chapel from which the handclaps and choruses rise and reach us like the scent of a more innocent time. I am trying to listen to the plump Palestinian man with his swaying rural middle-class patois, this jovial servant, his eyes watering at the memory of an eleven year old girl brought to die inside the white walls and cheap fabric of this place; her small body fading, her eyes fiercely flaming with light, with hunger for wide open spaces ? decades of discovery. Her mind is still unable to calculate the treachery of rape, to grasp how a man can seek revenge on her tender body; why as he wept when they took him away, she wept, too, like the day she wept when they took her mother's empty body away, the disease leaving her with nothing but bones, thin skin, the scent of chickens. There is refuge, I know, in distraction, the chapel of charms down the hill, the pure sound of my youth, when cleansed by the perpetual blood my sins were never legion enough for despair; when the comfort of the Holy Spirit was green as this sloping escarpment, thick with trees, cool against the soft sunlight; these things she saw before her body could not cope any more; her laughter, her laughter. The plump man brushes the gleam of tears from his cheeks. I think of the simple equations of compassion; I think of songs, the harmonica, the strained harmonies, the bodies of the dying shuffling past, eyes still hoping; the van waiting in the shade to take me from all of this; the long ride through rain and dark to Kingston, to sleep and more sleep. We thank Peepal Tree Press for permission to reprint "Hope's Hospice."

Poetry and HIV/AIDS Advocacy

Bonnie Goldman: Kwame, let's turn to how you got involved. How did a poet get involved in HIV/AIDS advocacy? How did it come to be that you created this beautiful site with poetry and photographs of people living with HIV?

Kwame Dawes: I've always written about HIV/AIDS, as a writer. I remember, in about 1989, I was fascinated, needless to say, by where HIV/AIDS was in the world at that time.

I think it was '88 or '89 when I saw an issue of TIME magazine with a picture of a woman sitting on a suitcase in the middle of this veld in Kenya. The caption said that she was the sole survivor of her village. AIDS had wiped out her entire village. I was riveted and mesmerized by this woman and by this picture.

I eventually wrote a play, and then a series of plays, on HIV/AIDS, particularly in developing countries. I've also written poetry about it. So this was part of my engagement with what I think of the human realities that surround us. But I probably would not have thought to do a project like this one. This is a full-blown journalistic exercise, going and interviewing many people and so on. I was approached by the Pulitzer Center on Crisis Reporting to do the piece. I felt that I would do it because it was about Jamaica, and Jamaica is dear and close to me.

I felt that I would have access to stories that other people would not have. I also felt that it was important for a Jamaican to tell that story because I think too often stories are ignored or stories are not told with a kind of intimacy and knowledge of the space. Sometimes I exploited this, and I wanted to make sure that the story was told honestly but told with a genuine appreciation of the human realities of that country.

To do it became a challenge but also a very exciting opportunity. Working with what I think are the triumphs and tragedies of human life, and finding art in the midst of it is part of my work. I've always been doing that kind of work, whether it's HIV/AIDS, whether it's Jim Crow laws in South Carolina.

Whatever it is I'm going to explore it and try and find the truth in it.

Nancy Mahon: I think if you've seen the piece [Live Hope Love], you'll witness Kwame's ability to put a human face on the epidemic. The poetry, really, is very effective in, I think, both internally educating about HIV and also externally. That's, again, why we funded the Pulitzer Center, because that's the type of work that's not getting out there. The Pulitzer Center, as I understand it, asked who the best storyteller would be here. In terms of Jamaica, the best storyteller is this very gifted poet.

Bonnie Goldman: It's really moving.

Nancy Mahon: As you saw, they brought a photojournalist in who took some really stunning images. It's very profound in terms of the level of desperation, and the level of need.

Bonnie Goldman: When I looked at Live Hope Love, I was shocked at how much death there was in Jamaica in 2007. It was so tragic in many, many areas. Have things changed in the last two years at all? Would it be a more hopeful situation if you went back and did the same thing?

Kwame Dawes: It's an interesting question to ask. On one level, it cannot be more hopeful because the numbers are still what they are. Especially for men who sleep with men, there's just no way I can say it's more hopeful.

What I can say is that I'm in touch with most of the people I interviewed and they're still alive. I'm in touch with those who were working in the field and they are all still working hard in the field.

I've taken this project back to Jamaica. Just in the summer, we did a presentation of it, and we had all the people who did the interviews come out. We had a panel discussion. It was wonderful to see the openness and the willingness to talk about these issues and to see the tremendous concern that is still there. There's more interest and care in Jamaica. It's not a callous attitude. It's something that I connect with and I understand. But there's a tremendous amount of work still to be done.

We're still getting instances and stories of people who have been brutalized because of being gay. People continue to file to leave Jamaica and to have refugee status here in the United States, because of homophobia in Jamaica.

Bonnie Goldman: Is that common? Can a Jamaican get refugee status because of homophobia?

Kwame Dawes: You can and people have. From my understanding, many of the requests on that front [homophobia] have come from Jamaica. Absolutely. I mean the threat of death is not a casual thing. There's still a tremendous amount of legal work that is being done to ensure that America recognizes that in many more instances as cases in point. But the U.S. State Department has recognized that in the past and continues to do so.

Bonnie Goldman: Thank you. Nancy. Before we go, could you share with us what your next steps will be? I noticed there was a presentation and panel at the CUNY [City University of New York] Graduate Center of Journalism at the end of September. Are you doing other kinds of panel discussions? What other initiatives are you planning to do in the next year?

Nancy Mahon: We hosted a panel at the XVII International AIDS Conference in Mexico City. What we're trying to do is get the word out to donors as well as international advocates. So basically, trying to attract talent and dollars to the Caribbean. What we're thinking about doing is hosting another event with the Pulitzer Center with donors, again, to not only advocate funding alternative media, but looking at the issues within the Caribbean around HIV.

These are tough times. The vast majority of us have decreased portfolios. Grants or free money is hard to come by. But we really believe, and I think have shown, through the grant making that we've done, that with a relatively small amount, you can make an enormous difference within the Caribbean, as well as really make the Caribbean part of the international dialogue on HIV. And again, Africa is an extraordinarily important place. We've done an enormous amount of funding in Africa, but it's sort of ironic, as you would say, that because the Caribbean is in our backyard, because people often associate it with beautiful beaches -- and there are in fact beautiful beaches and great resorts -- that this really horrible issue around health care has been overlooked.

If you look historically, many years ago Jamaica had a very tough problem with sickle cell anemia, which was effectively addressed by the local community, with help from the international community. We're trying to use that as a model and would issue a call to action to all of your readers and listeners to go to the Web site of these various groups to get involved, to write letters to the local Jamaican politicians and, if they can, to send dollars. The Clinton Global Foundation is working in the Caribbean and you can always direct dollars towards them. This group, Jamaican PFLAG [J-FLAG], is also doing work there, as is the Pulitzer Center.

So there's lots of good work to do. Every dollar makes a difference.

People's attention and concern makes a big difference. I also want to congratulate both the Pulitzer Center and Kwame for a terrific piece of work. I don't know if we've mentioned it, but it actually won an Emmy for the Web site and the work that has been done. So it's created a lot of attention around an area and an issue that's been ignored.

This transcript has been lightly edited for clarity.

Ways You Can Help

• If you'd like to get involved, contact J-FLAG or the Pulitzer Center. You can also direct donations to Jamaica at the Clinton Global Initiative.
• For more information about Jamaica and homophobia, read this terrifying report: Hated to Death: Homophobia, Violence and Jamaica's HIV/AIDS Epidemic (PDF), from Human Rights Watch.
• Click here to contact Kwame.
• For the MAC AIDS Fund, click here.