Hated to Death: Homophobia, Violence and Jamaica’s HIV/AIDS Epidemic

MISSING IMAGE

Material Information

Title:
Hated to Death: Homophobia, Violence and Jamaica’s HIV/AIDS Epidemic
Physical Description:
81p; PDF document
Language:
English
Creator:
Human Rights Watch
Publisher:
Human Rights Watch
Publication Date:

Subjects

Subjects / Keywords:
Caribbean

Notes

Abstract:
This report was presented by Human Rights Watch in November 2004
Funding:
Support for the development of the technical infrastructure and partner training provided by the United States Department of Education TICFIA program.
General Note:
November 2004 Vol. 16, No. 6 (B)

Record Information

Source Institution:
Caribbean IRN
Holding Location:
Caribbean IRN
Rights Management:
All rights reserved by the source institution.
System ID:
AA00000012:00001


This item is only available as the following downloads:


Full Text



Human Rights Watch November 2004 Vol. 16, No. 6 (B)


Hated to Death:

Homophobia, Violence and Jamaica's HIV/AIDS Epidemic


G lossary of K ey T erm s ..................................................................... ............................. 1
A N ote on Jam aican language ............................................ ................................................... 1
I. S U M M A R Y .............................................................................. ...................... ............. ...... 2
II. R E C O M M E N D A T IO N S .............................................. ................................................ 5
T o the Jam aican govern ent........................................... ................................................. 5
Reform the law enforce ent system ............................ .... .............................. 5
Enhance the national effort against HIV/AIDS......................................................... 7
To Donors and International Organizations.......................... ..................................... 8
III. M E T H O D S ...................................................................................... ............................... 8
IV B A C K G R O U N D ......................................................................... ........................... 9
H IV /A ID S in Jam aica ...................................................... ................................................ 9
Homophobia in Jamaica and its role in driving the HIV/AIDS epidemic.................... 11
V. FINDINGS OF HUMAN RIGHTS WATCH'S INVESTIGATION .................... 17
Police abuse ......... ............................ .......... 18
Police abuse based on sexual orientation and gender identity................................... 18
Police abuse of sex w workers .......................................... ........................................ 31
Police interference with access to HIV/AIDS information and health services......32
A buses in the health care system ....................................................................... ......... 36
D iscrim nation by health care providers ............................................ ................. 36
D iscrim nation in health care provision............................................. ................. 39
Inadequate protection of confidential information.................... ....................41
Driving men who have sex with men and people living with HIV/AIDS from
health care services ............................... ............... .... ................................... 44
Fostering dangerous practices and complicating health care provision ................... 49
D enial of access to transportation........................................................... ................. 50
Other abuses by non-state actors: violence in the family and in the community......... 52
Abuses based on sexual orientation and gender identity.................... ............ 52
Abuses against people living with HIV/AIDS ............................................ .................55
VI. GOVERNMENT RESPONSE ................................................................................. 56
Im proving legal and policy protections ........................................ ............................. 57
Educating health personnel ........................................................................................... 58
Efforts to address police abuse and provide HIV/AIDS education to police.............. 59
Institutional mechanisms to address police misconduct........................................... 60
Police training on HIV/AIDS and related human rights issues ............................... 62
VII. REGIONAL EFFORTS TO ADDRESS HIV/AIDS.................... ............. 62










V III. LE G A L STA N D A RD S........................................................... ........................... 66
Freedom from violence................................................................. ............................. 66
The right to privacy and the right to freedom from discrimination............................. 68
Freedom from arbitrary arrest and detention........................................................... 70
Freedom of association and assem bly ........................................ ............................ 71
The right to the highest attainable standard of health.................................................... 72
IX C O N C L U SIO N .................................................................................. .......................... 7 3
A ckn ow ledgm ents .. . ................. .................................................................................................. 74
Appendix ............................................................... 75










Glossary of Key Terms


Bisexual: a person who is attracted to both sexes.
Gay: a synonym for homosexual.
Gender identity: a person's internal, deeply felt sense of being male or female, or
something other than or in between male and female.
Heterosexual: a person attracted primarily to people of the opposite sex.
Homosexual: a person attracted primarily to people of the same sex.
Lesbian: a female attracted primarily to other females.
LGBT: lesbian, gay, bisexual, or transgender; an inclusive term for groups and identities
sometimes also associated together as "sexual minorities."
Men who have sex with men: men who engage in sexual behavior with other men, but
do not necessarily identify as "gay," "homosexual" or "bisexual."
Sexual orientation: the way in which a person's sexual and emotional desires are
directed. The term categorizes according to the sex of the object of desire-that is, it
describes whether a person is attracted primarily toward people of the same or opposite
sex, or to both.
Transgender: One whose inner gender identity differs from the physical characteristics
of his/her body at birth. Female-to-male transgender people were born with female
bodies but have a predominantly male gender identity; male-to-female transgender
people were born with male bodies but have a predominantly female gender identity.
Women who have sex with women: women who engage in sexual behavior with other
women, but do not necessarily identify as "gay," "homosexual," "lesbian" or "bisexual."


A Note on Jamaican language


Many Jamaicans speak "patois" or Jamaican creole in addition to Caribbean Standard
English. The following patois words and phrases appear in this report:
battyman: "Batty" is slang meaning buttocks. Battyman is a pejorative term for men
who have sex with men, as anal sex is seen as the act that defines them.
"battyman fi dead:" gay men should be dead/killed; gay men must die
"battyman mus' dead:" gay men should be dead/killed; gay men must die
chi chi man: derogatory term for a man who has sex with men.
sodomite: derogatory term for woman who has sex with a woman
"man on man fi dead:" gay men should be dead


HUMAN RIGHTS WATCH, VOL. 16, NO. 6 (B)










I. SUMMARY


On June 9, 2004, Brian Williamson, Jamaica's leading gay rights activist, was murdered in
his home, his body mutilated by multiple knife wounds. Within an hour after his body
was discovered, a Human Rights Watch researcher witnessed a crowd gathered outside
the crime scene. A smiling man called out, "Battyman [homosexual] he get killed!"
Many others celebrated Williamson's murder, laughing and calling out, "let's get them
one at a time," "that's what you get for sin," "let's kill all of them." Some sang "boom
bye bye," a line from a popular Jamaican song about killing and burning gay men.


Jamaica's growing HIV/AIDS epidemic is unfolding in the context of widespread
violence and discrimination against people living with and at high risk of HIV/AIDS,
especially men who have sex with men. Myths about HIV/AIDS persist. Many
Jamaicans believe that HIV/AIDS is a disease of homosexuals and sex workers whose
"moral impurity" makes them vulnerable to it, or that HIV is transmitted by casual
contact. Pervasive and virulent homophobia, coupled with fear of the disease, impedes
access to HIV prevention information, condoms, and health care.


Violent acts against men who have sex with men are commonplace in Jamaica. Verbal
and physical violence, ranging from beatings to brutal armed attacks to murder, are
widespread. For many, there is no sanctuary from such abuse. Men who have sex with
men and women who have sex with women reported being driven from their homes and
their towns by neighbors who threatened to kill them if they remained, forcing them to
abandon their possessions and leaving many homeless. The testimony of Vincent G.,
twenty-two, is typical of the accounts documented by Human Rights Watch: "I don't
live anywhere now. ... Some guys in the area threatened me. 'Battyman, you have to
leave. If you don't leave, we'll kill you.""'


Victims of violence are often too scared to appeal to the police for protection. In some
cases the police themselves harass and attack men they perceived to be homosexual.
Police also actively support homophobic violence, fail to investigate complaints of
abuse, and arrest and detain them based on their alleged homosexual conduct. In some
cases, homophobic police violence is a catalyst for violence and serious-sometimes
lethal-abuse by others. On June 18, 2004, a mob chased and reportedly "chopped,
stabbed and stoned to death" a man perceived to be gay in Montego Bay. Several
witnesses told Human Rights Watch that police participated in the abuse that ultimately



1 Human Rights Watch interview with Vincent G., Kingston, June 14, 2004.




HUMAN RIGHTS WATCH, VOL. 16, NO. 6 (B) 2










led to this mob killing, first beating the man with batons and then urging others to beat
him because he was homosexual.


Because HIV/AIDS and homosexuality often are conflated, people living with
HIV/AIDS and organizations providing HIV/AIDS education and services have also
been targeted. Both state and private actors join violent threats against gay men with
threats against HIV/AIDS educators and people living with HIV/AIDS. In July 2004,
for example, the Jamaican Forum of Lesbians, All-Sexuals and Gays J-FLAG) received
an email threatening to gun down "gays and homosexuals" and "clean up" a group that
provided HIV/AIDS education for youth. In a 2003 case, a police officer told a person
living with HIV/AIDS that he must be homosexual and threatened to kill him if he did
not "move [his] AIDS self from here."


Discrimination against people living with HIV/AIDS in Jamaica poses serious barriers
to obtaining necessary medical care. In interviews with people living with HIV/AIDS,
Human Rights Watch found that health workers often mistreated people living with
HIV/AIDS, providing inadequate care and sometimes denying treatment altogether.
Doctors failed to conduct adequate medical examinations of people living with
HIV/AIDS, sometimes refusing even to touch them. And, in some cases, lack of
treatment in the initial stages made it even less likely that people living with HIV/AIDS
would receive health care services at a later date. Visible symptoms heightened the
discrimination they faced, which in turn created further barriers to obtaining treatment.
People suffering from visible HIV-related symptoms were sometimes denied passage on
public and private transportation, making it difficult to obtain any medical care at
facilities beyond walking distance.


People living with HIV/AIDS said that health workers also routinely released
confidential information to other patients and to members of the public, both through
discriminatory practices that signaled patients' HIV status (such as segregating HIV-
positive patients from others) and by affirmative disclosure of such information. Such
actions violate fundamental rights to privacy and also drive people living with HIV away
from services.


Discrimination also spreads HIV/AIDS in Jamaica by discouraging at-risk individuals
from seeking HIV-related information or health care. Men who have sex with men
reported that health workers had refused to treat them at all, made abusive comments to
them, and disclosed their sexual orientation, putting them at risk of homophobic
violence by others. As a result, many men who have sex with men delayed or avoided
seeking health care altogether, especially for health problems that might mark them as


HUMAN RIGHTS WATCH, VOL. 16, NO. 6 (B)










homosexual, such as sexually transmitted diseases. Because the presence of other
sexually transmitted diseases heightens the risk of HIV transmission, such discrimination
may have fatal consequences.


Jamaica is at a critical moment in its efforts to address a burgeoning HIV/AIDS
epidemic. An estimated 1.5 percent of Jamaicans are living with HIV/AIDS, and
HIV/AIDS is on the increase. Jamaica's Ministry of Health has taken steps to combat
discrimination against people living with and at high risk of HIV/AIDS (such as men
who have sex with men and sex workers), which it has recognized as a key factor driving
Jamaica's HIV/AIDS epidemic. Its national HIV/AIDS program has fostered
important relationships with nongovernmental organizations with established links to
marginalized high-risk groups, provided support for their HIV/AIDS work with them,
and looked to them for guidance in developing an effective response to the epidemic. It
also has provided HIV/AIDS training for health personnel addressing stigma and
discrimination.


But other parts ofJamaica's government undermine these important efforts by
condoning or committing serious human rights abuses. Abuses against men who have
sex with men take place in a climate of impunity fostered by Jamaica's sodomy laws and
are promoted at the highest levels of government. Jamaican legal provisions that
criminalize consensual sex between adult men are used to justify the arrest of peer HIV
educators and to deny HIV prevention services to prisoners, among others. High-level
political leaders, including Prime Minister P.J. Patterson and Minister of Health John
Junor, repeatedly refuse to endorse repeal of discriminatory legislation, ignoring not only
international human rights standards but also reports by both the government's national
HIV/AIDS program and its advisory National AIDS Committee on the role of these
laws in driving Jamaica's HIV/AIDS epidemic.


Jamaican health officials acknowledge that Jamaica's sodomy laws make it difficult for
them to work directly with men who have sex with men. As one high-level health
official told Human Rights Watch: "\\ e don't promote direct programs or services to
MSM [men who have sex with men] as a group because the existing laws impede this
work [and] because [of] the high-level of stigma and discrimination, they're not open to
getting services through the public sector." The police, however, actively impede
government-supported peer HIV prevention efforts among men who have sex with men
and also among sex workers. AIDS outreach workers reported that the very possession
of condoms-a key tool in HIV prevention-triggers police harassment, and in some
cases, arrest and criminal charges.


HUMAN RIGHTS WATCH, VOL. 16, NO. 6 (B)










Jamaica's failure to take action to stop human rights abuses committed by state agents,
to take measures to protect against abuses by state and private actors, and to ensure
access to HIV/AIDS information and services to all Jamaicans violate its obligations as a
state party to regional and international human rights treaties.


In 2004, Jamaica launched an ambitious project to provide antiretroviral treatment to
people living with HIV/AIDS and to address underlying human rights violations that are
driving the epidemic. These are promising initiatives. They will be compromised,
however, unless government leaders make a sustained commitment to end
discrimination and abuse against people living with and at high risk of HIV/AIDS. The
government knows that although HIV/AIDS is stigmatized as a "gay disease," in reality,
in Jamaica as in most of the Caribbean, the most common means of transmission is
heterosexual sex. It also knows that if the epidemic in Jamaica continues to accelerate,
all Jamaicans will suffer. This fact should encourage high-level Jamaican government
officials to act quickly and forcefully to eliminate discriminatory laws and abusive
practices that violate basic rights to equality, dignity, privacy, and health and undermine
HIV/AIDS prevention and treatment efforts. This includes speaking out strongly and
acting forcefully against homophobic violence and abusive treatment of homosexual
men and women and of sex workers. If the Jamaican government chooses instead to let
popular prejudices continue to undermine its attempts to establish rights-based
HIV/AIDS policies, the consequences for all Jamaicans will be dire. Thousands of
Jamaicans will be consigned to lives of horrific abuse and thousands will face premature
and preventable death.


II. RECOMMENDATIONS


To the Jamaican government

Reform the law enforcement system

Police Conduct
Ensure that all allegations of excessive force and other human rights abuses by
law enforcement officials against HIV/AIDS workers, sexual minorities, sex
workers, and people living with HIV/AIDS are investigated promptly and
thoroughly by a body independent of those alleged to be responsible and which
has the necessary powers and resources to fully investigate offences by state
agents. Sanction officials who engage in or condone abuse.


HUMAN RIGHTS WATCH, VOL. 16, NO. 6 (B)










Cease and publicly repudiate all violence and harassment by police and other
agents of the state against men who have sex with men, women who have sex
with women, sex workers, and people living with HIV/AIDS.
Train all criminal justice officials in international human rights standards and
nondiscrimination, including issues of sexuality, sexual orientation, and
HIV/AIDS. Ensure that such training is fully integrated into training programs
provided to all ranks, and not treated as an additional class separated from the
full curriculum of training. Ensure that police at all levels are trained on the
fundamentals of HIV transmission and care for people living with HIV/AIDS
and on the importance of the lifesaving efforts of HIV/AIDS outreach workers.


Law Reform
Repeal sections 76, 77, and 79 of the Offences against the Person Act, which
criminalize sex between consenting adult men and are used as justification for
harassment of men who have sex with men and of HIV/AIDS educators
working with them.
Adopt legislation to protect the rights of people living with HIV/AIDS,
including legislation to proscribe discrimination against them.
Repeal section 80 of the Offences against the Person Act and section 4 of the
Towns and Communities Act, which grant broad latitude for arrest and
detention without a warrant or an order from a magistrate, and replace them
with clear, strict limitations on situations in which an arrest without warrant is
permissible, such as when a crime is occurring or about to occur.
Include "sexual orientation and gender identity" and "sex" in the anti-
discrimination clause of the Charter of Rights and Freedoms proposed as
amendments to the Jamaican Constitution.
Invite international scrutiny of protections against torture and ill-treatment by:

Ratifying the Convention against Torture and Other Cruel, Inhuman
and Degrading Treatment or Punishment, the Optional Protocols to the
International Covenant on Civil and Political Rights and to the U.N.
Convention against Torture, and the Inter-American Convention on the
Prevention, Punishment and Eradication of Violence Against Women.
Making the necessary declaration under article 22 of the U.N.
Convention against Torture to enable the U.N. Committee against
Torture to consider complaints submitted to it.
Including information on the treatment of HIV/AIDS workers and
members of high-risk groups (men who have sex with men, sex


HUMAN RIGHTS WATCH, VOL. 16, NO. 6 (B)










workers) in future periodic reports to human rights treaty bodies
established for the International Covenant on Civil and Political Rights
(overdue as of July 11, 2001) and the Convention on the Elimination of
All Forms of Discrimination Against Women.


Enhance the national effort against HIV/AIDS
Ensure that high-level political leaders, including the prime minister and all other
cabinet officials, take a leadership role in campaigns focusing on improving
human rights protections and reducing stigma and discrimination against people
living with and at high risk of HIV/AIDS. National and parish-level
governments should work with the media and nongovernmental organizations
to disseminate this information in a manner that is accessible to people with
limited literacy skills.
Ensure that the national HIV/AIDS program, in consultation with the Ministry
of National Security and the Jamaican Constabulary Force, develops and
implements a formal plan for a budgeted program of monitoring of and regular
public reporting on violence and abuse against marginalized groups at high risk
of HIV/AIDS.
Government officials at all levels should use public events and contacts with the
media to condemn police violence against HIV/AIDS workers; should affirm
international standards relating to equality, including nondiscrimination based on
sexual orientation, gender identity, and HIV status; and should reiterate the
importance of human rights protections for all groups vulnerable to HIV/AIDS,
including men who have sex with men and sex workers. The Ministry of
Health's stated position, articulated in national policy documents, on the
importance of protecting marginalized groups against stigma and discrimination
should be emphasized in public events and media.
Provide training on HIV/AIDS, sexuality, and sexual orientation to all personnel
in health care facilities, including instruction on the right to privacy and
protection of confidential information about HIV status and specific guidance
on how to guard against negligent and intentional disclosure. Ensure that
appropriate and accessible legal remedies are available to individuals whose
privacy has been infringed or who have experienced discrimination or
harassment in the health system based on HIV status.
Establish an effective and independent oversight and complaint mechanism to
ensure the proper implementation of health policies and norms relating to
HIV/AIDS, including protection of confidential and private information.
Investigate and sanction all health personnel who disclose confidential
information without authorization.


HUMAN RIGHTS WATCH, VOL. 16, NO. 6 (B)










To Donors and International Organizations
Condemn the criminalization of consensual homosexual conduct and support
the repeal of sections 76, 77, and 79 as a violation of the prohibition against
discrimination based on sexual orientation and as an impediment to the national
response to the HIV/AIDS epidemic. The repeal of sections 76, 77, and 79 is
consistent with the International Covenant on Civil and Political Rights, the
American Convention on Human Rights, and the United Nations International
Guidelines on HIV/AIDS and Human Rights.
As part of monitoring compliance with the International Covenant on
Economic, Social and Cultural Rights, the U.N. Committee on Economic, Social
and Cultural Rights should report on Jamaica's efforts to ensure provision of
HIV/AIDS information and services on a nondiscriminatory basis and to
guarantee the confidentiality of information about HIV status.
Ensure that monitoring of police harassment of HIV/AIDS outreach workers
and of people suspected of homosexual conduct, and related human rights
abuses are an important and regular part of monitoring programs supporting
police reform and HIV/AIDS efforts in Jamaica. Accelerate surveillance and
monitoring of NGO reports of police violence through the United Nations
supported monitoring system and other means, and ensure widespread public
reporting of data collected on this subject.
Support the development of organizations among members of the lesbian, gay,
bisexual and transgender community, and among sex workers, to strengthen the
capacity of these persons to advocate for the protection of their rights in
institutional fora.
Promote ratification of the Inter-American Convention on the Prevention,
Punishment and Eradication of Violence against Women.


III. METHODS


This report is based on a three-week field visit to Jamaica in June 2004, as well as prior
and subsequent research. Two Human Rights Watch staff members conducted detailed
interviews with more than seventy-five people living with or at high risk of HIV/AIDS,
including sex workers, men who have sex with men (MSM), women who have sex with
women, and people who had been incarcerated in police lockups and prison. These
interviews took place in Kingston, St. Ann, St. James, St. Catherine, and St. Andrew, the


HUMAN RIGHTS WATCH, VOL. 16, NO. 6 (B)










five parishes hardest hit by HIV/AIDS.2 The identities of most of these persons and
certain identifying information have been withheld to protect their privacy and safety.



These persons were identified largely with the assistance of Jamaican nongovernmental
organizations (NGOs) providing services to people living with HIV/AIDS, men who
have sex with men, women who have sex with women, prisoners, and sex workers.
These interviewees may have had greater access to HIV/AIDS services than those
without comparable connections.



Human Rights Watch also interviewed more than fifty representatives of government
agencies, United Nations officials, donor governments, and NGOs specializing in
HIV/AIDS or human rights; academic institutions; and healthcare workers and hospital
administrators. All documents cited in this report are either publicly available or on file
with Human Rights Watch.



IV. BACKGROUND



HIV/AIDS in Jamaica
As of the end 2003, an estimated 22,000 people, or 1.5 percent of the adult population,
were living with HIV/AIDS in Jamaica, the third largest population of people living with
HIV/AIDS in the Caribbean region (after Haiti and the Dominican Republic).3 HIV
prevalence rates are very high among marginalized populations, including men who have
sex with men and sex workers. The epidemic continues to spread in the general
population.4


According to the Jamaican government's national HIV/AIDS program, in Jamaica HIV
is predominantly transmitted through unprotected heterosexual sex and is increasing



2 Jamaica is divided into fourteen parishes, which are sub-national administrative divisions of the government.
3 Joint United Nations Programme on HIV/AIDS (UNAIDS), 2004 Report on the Global AIDS Epidemic: 4th Global Report
(Geneva: UNAIDS, 2004), p. 202.
4 In 1994-1995, 25 percent of sex workers tested in Montego Bay were HIV-positive; in 1996, 9 percent of sex workers
tested in Kingston were HIV-positive. From 1994-1996, HIV prevalence in major urban areas for men who have sex with
men was more than 30 percent. UNAIDS, "Epidemiological Fact Sheets on HIV/AIDS and Sexually Transmitted
Infections: Jamaica," 2004. See also Country Coordinating Mechanism for the Global Fund to Fight AIDS, Tuberculosis
and Malaria, A Proposal to Scale UP HIV/AIDS Treatment, Prevention, and Policy Efforts in Jamaica, May 2003,
http://www.theglobalfund.org/search/docs/3JAMH_661_0_full.pdf (retrieved August 27, 2004), p. 31 (stating that an
estimated 20 percent of men who have sex with men and 25 percent of male and female sex workers were living with
HIV/AIDS).


HUMAN RIGHTS WATCH, VOL. 16, NO. 6 (B)











faster among women than men.5 Ministry of Health statistics attribute 67.8 percent of
AIDS cases to heterosexual sex and 5.4 percent to homosexual and bisexual sex
combined.6 The percentage of HIV cases acquired through male-to-male sexual contact
is probably higher, however. The fact that homosexual sex is illegal, together with the
strong stigma and discrimination attached to homosexual and bisexual behavior, may
keep many men who have sex with men from admitting to having had sex with other
men. The Ministry of Health has acknowledged that the fact that the large majority of
cases of unknown transmission are among men 1.1 r, that rates of male-to-male
transmission are higher than are reported.7


Several thousand Jamaicans are in urgent need of antiretroviral treatment, but as of this
writing only a fraction of them are receiving it.8 Jamaica secured funding in June 2004 to
scale up access to treatment for people living with HIV/AIDS and made a public
commitment to secure the lowest possible prices for antiretroviral drugs for all
Jamaicans who need them.9 However, in making concerted efforts to join the Free
Trade Area of the Americas, Jamaica is subject to pressure by the United States Trade
Representative to agree to trade policies that may undermine access to affordable
antiretroviral medicines.10



5 Jamaica National HIV/STD Prevention and Control Program, "Facts and Figures, HIV/AIDS Epidemic Update
2004," http://www.moh.gov.jm/AIDS%20DATA%20JUNE%202004.pdf (retrieved August 9, 2004).
6 Children comprise 7.7 percent of cases and the remaining 26.8 percent of cases are categorized as "unknown." Ibid.
7 See ibid. (90 percent of cases of unknown transmission are among men); Ministry of Health, "Report of the Behaviour
Change and Communication Task Force," 2001 (noting large percentage of males among cases of unknown
transmission and observing that "If we look at the literature on male sexual behaviour, and in particular the issues of
socially condemned and therefore secretive sexual behaviour that would contribute to non-reporting, we find the
continuum usually conflated as 'MSMs.'") (cited in Patricia Watson, "Coping in the Dark: HIV Prevention among the MSM
Community in Jamaica," The Jamaica Gleaner, May 5, 2002). The Pan-Caribbean Partnership on HIV/AIDS (PANCAP)
has reported a similar situation in the region. PANCAP, "Caribbean Regional Strategic Framework for HIV/AIDS 2002-
2006," March 2002, p. 4.
8 As of June 2004, an estimated 8000 people were in need of antiretroviral therapy, and 500 persons were
receiving it. J. Peter Figueroa, chief, Epidemiology and AIDS, Ministry of Health, "Implementing Access to
HAART in Jamaica," June 2004.
9 First-line antiretroviral (ARV) therapy costs between U.S.$75 (generic) and U.S.$300 (brand name drugs) per month. In
September 2004, the Ministry of Health began providing ARV therapy in the public sector for free or U.S.$8 pursuant to
the Global Fund for AIDS, Tuberculosis and Malaria agreement. The Ministry of Health estimated that it would provide
ARV therapy to 2000 people living with AIDS by late 2006. Global Fund Agreement,
http://www.theglobalfund.org/search/docs/3JAMH_661_238_ga.pdf.
10 Jamaica, as a party to the World Trade Organization (WTO) Agreement on Trade Related Aspects of Intellectual
Property (TRIPS), must ensure a minimum level of intellectual property protection. In 2001, WTO member states agreed
that TRIPS "cannot and should not" prevent countries from taking measures to expand drug access and encouraged
countries to use TRIPS mechanisms "to the full" in meeting their public health objectives. Jamaica is a party to
negotiations to establish a Free Trade Area of the Americas (FTAA), covering thirty-four countries across the Americas
and the Caribbean. The United States Trade Representative is attempting to include provisions in the FTAA that could
inhibit Jamaica's (and other countries') flexibility to encourage generic drug competition and reduce the price of generic
medicines. The negotiations are intended to be completed by end 2004, with the aim of launching the agreement in 2005.
Concerns about Jamaica's domestic legal and policy commitments that conflict with FTAA proposals have slowed down


HUMAN RIGHTS WATCH, VOL. 16, NO. 6 (B)











Since 1987, the Jamaican government has launched several public awareness campaigns
regarding HIV/AIDS, beginning with the theme "AIDS kills." National surveys report
that a high level of knowledge about methods of HIV prevention coexists with belief in
myths about HIV transmission. A 2000 survey reported that while more than 96
percent of Jamaicans could identify two or more ways to prevent HIV, a significant
percentage of those surveyed subscribed to various myths about HIV, including the
belief that HIV could be transmitted by casual contact (such as sharing food) and by
mosquitoes. The survey also showed a dramatic rise in misconceptions about HIV
transmission since 1996.11 Health workers and people living with HIV/AIDS believe
that the initial campaign had a lasting effect on public information about HIV/AIDS,
leaving many with the impression that an HIV diagnosis means that death is imminent.
According to Joanna W., a peer HIV/AIDS educator, "More than 96 percent of our
people have information about HIV but how the information was given-'AIDS kills'-
left a strong impression .... Many people don't understand that HIV can be with them a
long time before they get AIDS."12



Homophobia in Jamaica and its role in driving the HIV/AIDS epidemic
Violence against men who have sex with men, ranging from verbal harassment to
beatings, armed attacks, and murder, is pervasive in Jamaica.13 Physical attacks against
gay men and men perceived to engage in homosexual conduct are often accompanied by
expressions of intent to kill the victim, such as "Battyman fi dead" [gay men must die].14
They are reluctant to appeal to the police for protection, as police routinely deny them
assistance, fail to investigate complaints of homophobic violence, and arrest or detain
men whom they suspect of being gay. In some cases, the police attack them and
promote homophobic violence by others. Women who have sex with women are also



negotiations, however. See Women's Edge Coalition, "The Effects of Trade Liberalization on Jamaica's Poor: an Analysis
of Agriculture and Services," June 2004, pp. 70-75.
11 Hope Enterprises Ltd., "Report of National Knowledge, Attitudes, Behaviour & Practice Survey. Year 2000." Prepared
for the Ministry of Health, Jamaica. 2000.
12 Human Rights Watch interview with Joanna W., Kingston, June 6, 2004.
13 See Robert Carr, "On 'Judgments:' Poverty, Sexuality-Based Violence and Human Rights in 21st Century Jamaica," The
Caribbean Journal of Social Work, vol. 2 (July 2003), pp. 71-87 (finding that working class men who have sex with men
are vulnerable to attack at any time in an atmosphere that sanctions and actively promotes such attacks); see also Cecil
Gutzmore, "Casting the First Stone: Policing of Homo/Sexuality in Jamaican Popular Culture," Interventions, vol. 6, no. 1
(April 2004), pp. 118-134 (arguing that Jamaican homophobia is exceptional for its overt virulence at the expressive level
and arguably encourages documented tendency and practice toward homophobic violence, and that the combination of
disregard for the law, including by police and other state officials, and the high level of violence in the society put working
class men who have sex with men especially at risk).
14 Human Rights Watch interview with Nicholas C., Kingston, June 9, 2004; Human Rights Watch interview with
Dennis M., Montego Bay, June 21, 2004; Human Rights Watch interview with Vincent G., Kingston, June 14,
2004; Human Rights Watch interview with Curtis M., Ocho Rios, June 15, 2004; see also Robert Carr, "On
'Judgments:' Poverty, Sexuality-Based Violence and Human Rights in 21st Century Jamaica."


HUMAN RIGHTS WATCH, VOL. 16, NO. 6 (B)










targets of community violence and police harassment; and, as with men who have sex
with men, their complaints of violence are often ignored by police.


Endemic violence by private actors and by Jamaican police and security forces, and
inadequate state response to it, are problems faced by all Jamaicans.15 Gays and lesbians
are often on the front lines of such violence, however. Jamaica's sodomy laws, which
criminalize consensual sex between adult men, are used to justify arbitrary arrest and
detention, and sometimes torture, of men (and sometimes women) suspected of being
homosexual. Political and cultural factors, including religious intolerance of
homosexuality, Jamaican popular music, and the use of antigay slogans and rhetoric by
political leaders, also promote violence and discrimination based on sexual orientation
and gender identity. While many of these actions are protected under the rights to
freedom of speech and religion, the Jamaican government has failed to confront them as
root causes of widespread violence and discrimination based on sexual orientation and
gender identity.


The church, a powerful social institution in Jamaica, denounces homosexuality as a sin
and Jamaica's Christian pastors preach strongly against it, sometimes justifying their
opposition in cultural, as well as religious, terms. For example, in opposing the
ordination of an openly gay cleric (a position not unique to Jamaican clergy), a Kingston-
based Anglican priest stated that there was "no way that a Jamaican Anglican
contingency could begin to support such a decision," because "Jamaican society is
intolerant of homosexuality and homosexual behavior."16


Jamaican dancehall music, a powerful cultural force in Jamaican society, reflects and
reinforces popular prejudices against lesbians and gay men. Many dancehall musicians
perform songs that glorify brutal violence and killing of men and women who do not






15 See United Nations Special Rapporteur on Extrajuducial, Summary or Arbitrary Executions, "Report of the
Special Rapporteur, Asma Jahangir, submitted Pursuant to Commission on Human Rights Resolution 2003/53.
Addendum. Mission to Jamaica," E/CN.4/2004/7/Add.2, September 26, 2003; Jamaicans for Justice, The
Jamaica Justice Report, 2002; Families Against State Terrorism, "How Many More? Sample of Police Killings
July 1999-May 2004," May 2004; Amnesty International, "'Until Their Voices are Heard.' The West Kingston
Commission of Inquiry," July 2003; International Commission of Jurists, "Attacks on Justice," August 2002, pp.
222-225; Anthony Harriott, Police and Crime Control in Jamaica: Problems of Reforming Ex-Colonial
Constabularies (Kingston, Jamaica: University of the West Indies Press, 2001); Horace Levy, They Cry
'Respect'! Urban Violence and Poverty in Jamaica (Kingston, Jamaica: University of the West Indies Press,
2001).
16 "Kingston priests reject gay bishop. Jamaican society intolerant of homosexuality, says priest," The Jamaica
Observer, October 30, 2003.


HUMAN RIGHTS WATCH, VOL. 16, NO. 6 (B)











conform to stereotypical gender roles, and celebrate their social cleansing from
Jamaica.1


High-level political leaders foster an atmosphere of violence toward men who have sex
with men. During the 2001 elections, for example, the Jamaican Labour Party (the main
opposition party) adopted "Chi Chi Man," which celebrates burning and killing gay men,
as its theme song.18 The ruling People's National Party responded by adopting as its
campaign slogan for the 2002 national elections "Log On to Progress," a reference to a
popular song and dance ("log on") involving kicking or stomping on gay men.19


Homophobic violence and discrimination, and state failure to respond to these abuses,
violate internationally recognized human rights, including rights to privacy,
nondiscrimination, and protection against violence.20 These abuses are also closely
linked to the spread of HIV/AIDS. Sodomy laws, which violate human rights to privacy
and nondiscrimination,21 undermine HIV/AIDS outreach to men who have sex with
men. State failure to protect lesbian, gay, transgender, and bisexual people from violence
and abuse by police and private citizens marginalizes them and inhibits them from
seeking treatment for HIV and other sexually transmitted diseases that increase the risk
of HIV transmission. The association of HIV/AIDS with homosexuality compounds
the marginalization of many people living with HIV/AIDS, who face additional stigma
and abuse through the presumption that they have engaged in illegal sex. It also keeps
those at highest risk of the disease-including people who do not engage in homosexual
sex-from seeking HIV-related information and health services.


17 Elephant Man's "A Nuh Fi Wi Fault," in which he sings that "When yuh hear a Sodomite get raped/but a fi wi
fault/it's wrong/two women gonna hock up inna bed/that's two Sodomites dat fi dead" ["When you hear a lesbian
getting raped/it's not our fault/it's wrong/two women in bed/that's two sodomites who should be dead"], Beenie
Man's "I'm dreaming of a new Jamaica, come to execute all the gays," and Babycham and Bounty Killer's "Bun
a fire pon a kuh pon mister fagoty, ears ah ben up and a wince under agony, poop man fi drown a yawd man
philosophy" ["burn gay men 'til they wince in agony, gay men should drown, that's the yard man's philosophy"]
are typical of the exhortations to kill and maim lesbians and gay men in many popular dancehall songs. For
further discussion of homophobia in Jamaican dancehall and in popular culture, see Cecil Gutzmore, "Casting
the First Stone;" Tara Atluri, "When the Closet is a Region," working paper no. 5, Centre for Gender and
Development Studies, University of the West Indies, 2001; on dancehall and cultural formation, including the
use of homophobia by dancehall artistes, see also Norman C. Stolzoff, Wake the Town and Tell the People:
Dancehall Culture in Jamaica (Durham, N.C.: Duke Univ. Press, 2000).
18 TOK, "Chi Chi Man," on Reggae Gold 2001 (2001) (lyrics cited in Appendix); see Garwin Davis, "Homophobia Remains
High. Gays Remain in Seclusion, Health Officials Worry," The Jamaica Gleaner, July 26, 2001.
19 Elephant Man, "Log On," on LOG ON (2002) (lyrics cited in Appendix).
20 Jamaica has ratified international and regional treaties proscribing these actions, including the International
Covenant on Civil and Political Rights, the International Covenant on Economic, Social and Cultural Rights, the
Convention on the Elimination of All Forms of Discrimination against Women, and the American Convention on
Human Rights. See discussion at pages 66-73 below.
21 Nicholas Toonen v. Australia, Human Rights Committee, 50th Session, Case no. 488/1992, U.N. Doc.
CCPR/C/50/D/488/1992 (April 4, 1994).


HUMAN RIGHTS WATCH, VOL. 16, NO. 6 (B)










The Jamaican Ministry of Health has acknowledged that homophobic violence and
discrimination, and deep stigma associated with homosexuality, are among the factors
driving the epidemic.22 High-level officials from the Ministry of Health's HIV/AIDS
program also recognize that Jamaica's sodomy laws create significant barriers to
government provision of HIV services to men who have sex with men.


Providing HIV education and prevention services to men who have sex with men is
extremely difficult because they are forced to remain invisible due to prejudice and
abuse.23 According to studies conducted by Jamaican and Caribbean regional health
bodies, many Jamaican men who have sex with men lead dual lives and marry, have
girlfriends, and have children while also engaging in same sex relationships.24 Fear of
being identified as homosexual may keep many people from seeking HIV testing and
also from disclosing homosexual conduct as a possible risk factor if they test positive for
HIV.25 The invisibility of men who engage in homosexual conduct makes effective
communication difficult, even among the men themselves. And the lack of information
about their lives, practices, and community to guide public health interventions
compromises an effective response to the epidemic.


In 1997, the mere suggestion that a task force was considering whether condoms should
be issued to inmates and staff as part of HIV/AIDS prevention efforts in prison
prompted a violent rampage and derailed HIV education efforts for years. After then
Commissioner of Corrections John Prescod proposed that condoms be distributed to
prisoners and correctional officers, correctional officers-apparently offended by the
implication that by distributing condoms they, themselves, were also having sex with
men-walked off their jobs. The officers did not return for several days, until they
received an apology from the Commissioner and an agreement that condoms would not



22 See, e.g., Jamaican Ministry of Health, Jamaica HIV/AIDS/STI National Strategic Plan 2002-2006, January 2002, p. 10;
see also Zadie Neufville, "Fear Among Gay Men Said to Fuel HIV/AIDS Cases," Inter Press Service, March 5, 2002;
Garwin Davis, "Homophobia Remains High. Gays Remain in Seclusion, Health Officials Worry," The Jamaica Gleaner,
July 26, 2001.
23 Ibid.; Human Rights Watch interview with Dr. Yitades Gebre, executive director, Ministry of Health Program
Coordination Unit, Kingston, June 23, 2004; Human Rights Watch interview with Dr. Peter Figueroa, chief, Ministry of
Health Epidemiology Unit, Kingston, June 23, 2004.
24 See Caribbean Regional Epidemiology Center, "Homosexual Aspects of the HIV/AIDS Epidemic in the Caribbean: A
Public Health Challenge for Prevention and Control," 2000; Heather Royes, "Jamaican Men and Same-Sex Activities:
Implications for HIV/STD Prevention," 1993. The subject of a Jamaican study of men who have sex with men and
HIV/AIDS explained, "Society demands that a man should have a woman. To be labeled as gay or homosexual is a name
no man likes. So as a result, men resort to play the game with same-sex and opposite sex activities." "Jamaican Men
and Same-Sex Activities," p. 11.
25 See Ministry of Health, "Report of the Behaviour Change and Communication Task Force," 2001 (cited in Patricia
Watson, "Coping in the Dark: HIV Prevention among the MSM Community in Jamaica," The Jamaica Gleaner, May 5,
2002).


HUMAN RIGHTS WATCH, VOL. 16, NO. 6 (B)











be distributed in prisons. Following the walkout by the correctional officers, inmates at
two ofJamaica's largest prisons rioted. Sixteen prisoners were killed and more than fifty
injured, apparently targeted because other prisoners believed that they were
homosexuals.26


The popular misperception that HIV/AIDS is a homosexual disease impedes effective
HIV prevention and poses serious risks for people living with HIV/AIDS. Health
workers and AIDS outreach workers interviewed by Human Rights Watch reported that
people with whom they worked-including hospital staff-did not believe that HIV was
an issue for them personally because they were not homosexuals. A hospital-based
health worker who provided HIV/AIDS prevention information and services to hospital
staff and people in her town told Human Rights Watch, "\\ hen I tell them about HIV,
they say ... that HIV does not concern them, because it is a battyman [homosexual]
disease."27


The conflation of HIV/AIDS with homosexuality exposes people living with
HIV/AIDS and HIV/AIDS educators to the same treatment meted out to men who
have sex with men.28 ASHE Caribbean Performing Arts Foundation, an NGO that
works with youth, includes HIV/AIDS and sexuality education as an important part of
its work. Its work on HIV/AIDS, however, subjected it to threats, as the following note
sent to the Jamaica Forum for Lesbians, All-Sexuals and Gays J-FLAG) in July 2004
illustrates:


The nasty act of homosexuality will not be tolerated here in Jamaica. Let
me say it quick. One notable battyman have died recently we will be
killing more as the days go by. To make it easy for you we will tell you



26 The riots were at the Tower Street Adult Correctional Centre in Kingston (Kingston general penitentiary) and St.
Catherine's District Prison. Harold B., who was incarcerated at St. Catherine's District Prison during the riots, told Human
Rights Watch that both prisoners and warders put his life at risk: "I couldn't walk free in prison because the warders would
point me out [as a gay man] . and prisoners were killing off gay men." Human Rights Watch interview with Harold B.,
Kingston, June 9, 2004. See also Ministry of National Security and Justice, "Report of the Board of Enquiry into
Disturbances at the Tower Street Adult Correctional Center and the St. Catherine Adult Correctional Centre Between 20th
23rd August, 1997," March 9, 1998; Commission on Human Rights, Report of Special Rapporteur on Torture, "Question of
the Human Rights of All Persons Subjected to Any Form of Detention or Imprisonment, in Particular: Torture and Other
Cruel, Inhuman or Degrading Treatment or Punishment," U.N. Doc. E/CN.4/2002/76/Add.1, March 14, 2002, par. 829.;
Amnesty International, "A Summary of Concerns: A Briefing for the Human Rights Committee," October 1997, p. 14.
27 Human Rights Watch interview, St. Ann's Bay, June 16, 2004. A 1993 study of Jamaican men who have sex
with men and HIV/AIDS suggested that older bisexual men did not believe themselves at risk of HIV because
they believed that HIV was a "gay" disease, and they did not identify as gay. Heather Royes, "Jamaican Men
and Same-Sex Activities: Implications for HIV/STD Prevention," 1993, p. 12.
28 Robert Carr, "Stigmas, Gender and Coping: A Study of HIV+ Jamaicans," Race, Gender& Class, vol. 9, no. 1 (2002),
pp. 122-44.


HUMAN RIGHTS WATCH, VOL. 16, NO. 6 (B)











where you can pick them up and who it was that we gunned down. It
will not be robbery just purification. No batty man down here in
Jamaica. .... Fire burn them and them nasty living. JFLAG must crash.
We declare war on all Gays and Homosexual. Ashe dance group needs
a bit of clean up now. We will be killing gays and homosexuals daily
now. War we say.29 (emphasis added)



Lesbians and HIV risk


A woman without a man can be a target of both community disrespect and rape.

Horace Levy, They Cry Respect'! Urban Violence and Poverty in

Jamaica30


Although the risk of female-to-female HIV transmission is generally estimated to be
small,31 many women who have sex with women also have sex with men. Many
Jamaican lesbians face strong pressure to establish relationships with men and to have
children because doing so is a critical part of establishing their identity as adult women.32


Sexual violence against women and girls, a problem of grave proportions in Jamaica, has
been identified by the World Health Organization as an important factor contributing to
increased HIV incidence among women in the region.33 Sexual violence may increase
the risk of HIV and other sexually transmitted diseases for all survivors.34 Forced or


29 E-mail communication from anotherkillerl @hotmail.com to J-Flag, July 14, 2004.
30 (Kingston, Jamaica: University of the West Indies Press, 2001), p. 37.
31 See Helena A. Kwakwa and M.W. Ghobrial, "Female-to-Female Transmission of Human Immunodeficiency Virus,"
Clinical Infectious Diseases, vol. 35, no. 3 (February 2003), pp. 40-41.
32 See Robert Carr, "Stigmas, Gender and Coping: A Study of HIV+ Jamaicans," Race, Gender& Class (2002), vol. 9, no.
1, pp. 122-144 (discussing gender socialization in Jamaica).
33 See Pan American Health Organization, "Gender and HIV/AIDS,"
http://www.paho.org/english/hdp/hdw/GHIVFactSheetl.PDF (retrieved November 3, 2004); see also United Nations
Development Program, "National Reports on the Situation of Gender Violence Against Women: National Report,
Jamaica," March 1999; Nancy Muturi, "Violence and HIV/AIDS in the Caribbean," presentation at the 2003 American
Public Health Association meetings (arguing that high rates of sexual violence contribute to growing HIV/AIDS epidemic in
Caribbean region).
34 Women and girls are physiologically more vulnerable than men and boys to HIV infection during unprotected
heterosexual vaginal sex. Factors that contribute to this increased risk include the larger surface area of the vagina and
cervix, the high concentration of HIV in the semen of an infected man, and the fact that many of the other sexually
transmitted diseases that increase HIV risk are often left untreated (because they are asymptomatic or because health
care is inaccessible). Girls and young women face even greater risk than adult women, because the vagina and cervix of
young women are less mature and are less resistant to HIV and other sexually transmitted infections, such as chlamydia
and gonorrhea, that increase HIV vulnerability; because changes in the reproductive tract during puberty make the tissue
more susceptible to penetration by HIV; and because young women produce less of the vaginal secretions that provide a


HUMAN RIGHTS WATCH, VOL. 16, NO. 6 (B)










coerced sex creates a risk of trauma: when the vagina or anus is dry and force is used,
genital and anal injuries are more likely, increasing the risk of HIV transmission. Forced
oral sex may cause tears in the skin of the mouth, also increasing the risk of
transmission. The presence of other sexually transmitted diseases also heightens HIV
transmission risk.35 Women who are or are perceived to be lesbians are at an even
greater risk of rape, as they may be targeted for sexual violence based on both their
gender and sexual orientation. 36



V. FINDINGS OF HUMAN RIGHTS WATCH'S INVESTIGATION


In Jamaica, state-sponsored homophobia and discrimination against homosexual men
and women, sex workers, and people living with HIV/AIDS, the conflation of
HIV/AIDS with homosexuality and sex work, and the misguided fear that HIV is
transmitted by air or by casual contact are undermining an effective response to
HIV/AIDS. Police not only harass and persecute people suspected of homosexual
conduct, sex workers, and people living with HIV/AIDS. They also interfere with
HIV/AIDS outreach to them. Men who have sex with men and people living with
HIV/AIDS face serious violence and are often forced to abandon their homes and
communities. Many are denied health care; some cannot even seek health services
because they are denied public and private transportation services. And past experiences
of discrimination, coupled with the fear that HIV status or sexual orientation will be
disclosed and publicized, keep many people from seeking health care in the first
instance.












barrier to HIV transmission for older women. See, e.g., Global Campaign for Microbicides, "About Microbicides: Women
and HIV Risk," http://www.global-campaign.org/womenhiv.htm (retrieved August 28, 2003); UNAIDS, "AIDS: Five Years
since ICPD-Emerging Issues and Challenges for Women, Young People, and Infants," Geneva, 1998, p. 11; The
Population Information Program, Center for Communications Programs, The Johns Hopkins University, "Population
Reports: Youth and HIV/AIDS," vol. 23, no. 3, Fall 2001, p. 7 (citing studies).
35 See United States Centers for Disease Control and Prevention, Fact Sheet: Prevention and Treatment of Sexually
Transmitted Diseases as an HIV Prevention Strategy [online], http://www.cdc.gov/hiv/pubs/facts/hivstd.htm (retrieved
October 27, 2003).
36 See discussion in Section V, below; see also Makeda Silvera, "Man Royals and Sodomites: Some Thoughts on the
Invisibility of Afro-Caribbean Lesbians," Feminist Studies, vol. 18, no. 3, Fall 1992, pp. 521-532 (reporting gang rape of
women "suspected" of lesbianism in 1950s Jamaican towns).


HUMAN RIGHTS WATCH, VOL. 16, NO. 6 (B)










Police abuse


Police abuse based on sexual orientation and gender identity

Verbal and physical abuse and inciting others to violence


On the afternoon of June 18, 2004, a mob chased and reportedly "chopped, stabbed and
stoned to death" a man perceived to be gay in Montego Bay.37 Several witnesses
reported to Human Rights Watch that police participated in the abuse that ultimately led
to this mob killing, first beating the man with batons and then urging others to beat him
because he was homosexual.


Fred L., thirty, described the incident as follows:


Me and another guy were sitting on the beach .. .While we were there,
some little teenager was on the beach swimming, and Victor, the guy
that was killed, was standing looking at the boy. The boy said, "\\ lh are
you looking me like that? You a battyman." Two rastamen38 said,
"Every day they come on the beach to look at men, battyboy them."
Two policemen and a female police officer were there. The two male
officers started to beat the man with batons. I turned to the female
officer and asked, "\\ h ir has he done wrong?" She turned to me and
said, "Everyday me have to warn people about this guy coming on the
beach. I'm going to lock him up." I said, "For what?" She didn't say.
I said to her, "If he did something wrong, lock him up, don't beat him."
[Victor] started to run from the two male officers toward the Old Fort
Craft Market. The two policemen said, "Beat him because him a
battyman."39


The crowd followed the police officers' lead, beating the victim and throwing bottles and
stones at him.40 Joseph W., twenty-six, told Human Rights Watch that he saw police
hitting the victim with a baton and with their fists, and that once persons from the
crowd started beating the victim:


37 Henry Bucknor, "Alleged Gay Man Chopped to Death in MoBay," Western Mirror, vol. 24, no. 72, June 19, 2004, p. 1.
38 "Rastaman" is a term used to refer to men with dreadlocks (a hairstyle in which the hair grows and is left uncombed,
and forms ropelike locks that hang down from the head) and to Rastafarians, a religious group whose members wear their
hair in dreadlocks.
39 Human Rights Watch telephone interview with Fred L., Montego Bay, July 6, 2004.
40 Ibid.; Human Rights Watch interview with Dennis M., Montego Bay, June 21, 2004; Human Rights Watch interview with
Joseph W., New York, June 28, 2004.


HUMAN RIGHTS WATCH, VOL. 16, NO. 6 (B)










the police officers walked off. The crowd got thicker and more persons
started hitting the guy. Then I saw the guy run out of the road into the
town .... Then I woke up the next morning to hear that Victor was
killed about a mile and a half from the beach.41


Police abuse is a fact of life for many men who have sex with men and women who have
sex with women in all of the communities that Human Rights Watch visited in Jamaica.
As in the incident described above, homophobic police violence can be a catalyst for
violence and abuse by others. It is sometimes lethal. Police abuse is also profoundly
destructive because it creates an atmosphere of fear sending a message to other lesbian,
gay, bisexual, and transgender people that they are without any protection from violence.


Dennis M., twenty, lived in Montego Bay. He told Human Rights Watch:


Police always harass me. ... They stop you and hear you talk a bit
feminine [and ] they ask you personal questions like are you top or
bottom and like that.... The last time this happened... two police
came over and said "Battymen mus' dead. You should be under the
ground. You should not be living in Jamaica." Not every police officer
does that. Some police officers say it is not legal so you should curtail
your behavior. But most of them, once they hear you talk feminish they
begin to bitch [verbally abuse] you and a crowd comes around.42


Nicholas C., twenty-nine, was stopped by the police while walking down the street one
evening in April 2004. The police asked him if he was a battyman and searched him.
After finding condoms, lubricant, and gel, they became violent. "They said, 'You a
battyman. Battyman mus' dead. Run before I shoot you."' The police beat Nicholas C.,
hit him with batons, kicked him, and scattered his things on the ground.43


Several gay men reported that police abuse accelerated violence by others. Albert B.,
thirty-three, and his friends had been attacked by Kingston police a few days before
Human Rights Watch met with him in June 2004. The police beat Albert B. and his



41 Human Rights Watch interview with Joseph W., New York, June 28, 2004. Joseph W. was an acquaintance
of Victor Jarrett's. A third witness told Human Rights Watch that he saw the police beating the victim and a
crowd throwing bottles and stones at him as he ran from the police, and heard people shouting that the victim
was gay and should be killed. Human Rights Watch interview with Dennis M., Montego Bay, June 21, 2004.
42 Human Rights Watch interview with Dennis M., Montego Bay, June 21, 2004.
43 Human Rights Watch interview with Nicholas C., Kingston, June 9, 2004.


HUMAN RIGHTS WATCH, VOL. 16, NO. 6 (B)










friends, threw stones at them, called them "battymen," "faggot," and "nasty men" and
drew their guns at them. The police actions drew the attention of other men, who came
and beat them with boards, crying out "battymen."44


Peter T., nineteen, was walking on the street with friends late in the evening of
December 25, 2003. A police car drove by, and the policemen inside yelled, "Battymen,
go home." When Peter T.'s friend told the police to leave them alone, the police
stopped their car, beat the men, then put them in the police car and drove them to
another part of town. As they let the men out of the car, the police yelled, "Battymen,
battymen, beat them," and fired their guns in the air. This attracted the attention of a
crowd of men armed with machetes, who followed the police instruction and beat
them.45


Harold B., thirty-four, reported several incidents of police abuse in 2004, including an
attack by police a few hours before his interview with Human Rights Watch. For
Harold B., the public humiliation by police that incited others to violence was worse
than physical attacks. "The worst thing is when police embarrass you whenever they see
you in a crowd. When I'm walking on the street, the police yell, 'battyboy, you catch
men.' When they do that, people start to look at you and some want to attack you."46


Many of the men who have sex with men interviewed by Human Rights Watch reported
having to flee their homes and communities because of homophobic violence by their
neighbors or other residents of their towns. In some cases, police abuse of men
suspected of homosexual conduct prompted violence by private actors, whose violence
effectively evicted them from their homes.


Until early 2003, Peter T. lived with a group of gay men in a house in Kingston. He said
that the police visited the house frequently, making derogatory comments about
homosexuality and beating the residents. The police presence would attract others, who
would join in the abuse. He told Human Rights Watch:


Police visit there a whole heap of time. . Every time the police come
to the house, others would always show up. The police come there and
start searching and then the next neighbor would come over and start in.


44 Human Rights Watch interview with Albert B., Kingston, June 9, 2004.
45 Human Rights Watch interview with Peter T., Kingston, June 9, 2004. Machetes are common property in Jamaica and
are used for agricultural work, for personal protection at home (in case of break-ins), and as weapons.
46 Human Rights Watch interview with Harold B., Kingston, June 9, 2004.


HUMAN RIGHTS WATCH, VOL. 16, NO. 6 (B)










Police would search in the closet, under the bed. If they see condoms,
they say that we were fucking, we carry AIDS, battymen have AIDS,
man on man fi dead. [gay men should be dead].47


By February 2003, the violence had escalated sufficiently to drive Peter T. and his
housemates away. One afternoon, "people come and say we can't sleep there tonight
because we're going to bomb it down." Peter T. and his housemates fled, leaving
without their belongings.48


Police abuse of gay men extends to men living with HIV/AIDS, whom they assume
must be gay. Paul M., forty, told Human Rights Watch that in 2003, he was with a
friend who had AIDS when the police approached and asked:


"Eh boy, how you look so, w'happen to you?" The person say, "I have
AIDS and I want to take my medication.' Police say, "you must be
battyman. Eh boy, eh boy, move your AIDS self from here. Mind me
turn mi gun pon yuh and kill you. [Watch out because I might turn my
gun on you and kill you.]"49



Arrests, detention, and prosecution
Gay and bisexual men and AIDS service providers told Human Rights Watch that men
who are or perceived to be gay are routinely threatened with arrest, arrested, detained,
and sometimes prosecuted because of their actual or perceived homosexuality or
homosexual conduct. Human Rights Watch also documented cases of police arrest of
women because of homosexual conduct.


Jamaica's sodomy laws criminalize consensual homosexual conduct between adult men,
prohibiting the "abominable crime of bul. I i committed either with mankind or with
any animal" and "gross indecency."50 "Buggery," which generally refers to all acts of



47 Human Rights Watch interview with Peter T., Kingston, June 9, 2004.
48 Ibid.
49 Human Rights Watch interview with Paul M., Kingston, June 6, 2004.
50 Offences against the Person Act, sections 76, 79. Caribbean states in the British Commonwealth inherited similar
penal codes from the British colonial administration, some of which have since been amended or nullified. For example,
Bahamian law proscribes consensual same sex sexual activity between adults in public but not in private. Sexual
Offences and Domestic Violence Act of the Bahamas, section 16(2)(b). Jamaican and Guyanese laws are silent on
lesbianism, while all acts of homosexuality are illegal in Trinidad and Tobago, Barbados and St. Lucia. "Sodomy Laws in
the Carribbean," http://www.sodomylaws.org/world/caribbean.htm (retrieved November 3, 2004). In 2000, Britain issued
an order repealing sodomy laws in its Overseas Territories, which it had to do to meet its own international treaty


HUMAN RIGHTS WATCH, VOL. 16, NO. 6 (B)











anal intercourse and bestiality, is a felony punishable by imprisonment with hard labor
for up to ten years.51 "Gross indecency," generally interpreted to mean any sexual
intimacy between men short of anal intercourse, is a misdemeanor punishable by up to
two years with hard labor.52


Jamaican law provides broad latitude for police to detain individuals on ill-defined
charges, including suspicion of buggery or gross indecency. The Offences against the
Person Act permits a police officer to arrest without warrant any person found "loitering
in any highway, yard, or other place" between 7 p.m. and 6 a.m. the following morning
whom the constable has "good cause to suspect of having committed, or being about to
commit any felony" proscribed by the Act.53 Jamaican police are also empowered to
arrest without warrant and based on charges made by any "credible person" any person
loitering in a public place to solicit another for prostitution.54


It is impossible to say how frequently sodomy laws are enforced against men engaged in
consensual same sex contact in Jamaica, but by some accounts, they are in active use.55
Lawson Williams, a Kingston attorney who has represented men charged under these
statutes, told Human Rights Watch:


I always seem to have a case of a practicing gay man who is in court on
account of his homosexuality. It's either that he and another have been
busted and are jointly charged for [consensual] bu -. i he's been
charged in circumstances where someone has alleged forcible or



obligations under the European Convention on Human Rights and the International Convention on Civil and Political
Rights. This order affected laws in Anguilla, the British Virgin Islands, the Cayman Islands, Montserrat, and the Turks and
Caicos Islands. "U.K. Ends Territories' Sodomy Laws," PlanetOut, December 22, 2000. Prime Minister P.J. Patterson's
opposition to foreign intervention to repeal Jamaican sodomy laws is ironic, as it is not the same-sex behavior, but the
laws that prohibit it, that are the colonial imposition.
51 Ibid., section 76. According to Jamaican lesbian, gay, bisexual and transgender rights advocates, most
buggery prosecutions involve adult men suspected of engaging in consensual anal sex. Jamaica Forum for
Lesbians, AII-Sexuals and Gays, "Parliamentary Submission with Regard to 'An Act to Amend the Constitution
of Jamaica to Provide for a Charter of Rights and for Connected Matters,"
http://www.jflag.org/programmes/parliamentary_sub.htm (retrieved August 24, 2004).
52 Offences against the Person Act, section 79. This provision follows Victorian law on "gross indecency," which was
known as the "blackmailer's charter," because a man could be convicted on the strength of a blackmailer's accusation.
H. Montgomery Hyde, The Other Love: An Historical and Contemporary Survey of Homosexuality in Britain (London:
Heinemann, 1971), p. 136.
53 Offences against the Person Act, section 80.
54 Towns and Communities Act, sections 3(r), 4 (empowering police to arrest without warrant based on charges made by
any "credible person" that certain offences committed within view of charging party).
55 In June 2004, Human Rights Watch requested police statistics on arrests, convictions and charges imposed
under laws proscribing sodomy and prostitution, but as of this writing has not received them.


HUMAN RIGHTS WATCH, VOL. 16, NO. 6 (B)










unwarranted homosexual advances against him, or there is an allegation
that he has had sex with a minor. ... Too many of the charges of sex
with a minor are motivated by the prejudice that gay men are naturally
inclined to have sex with underage boys, and they fail because of a lack
of physical or credible evidence.


Usually, the police indict gay men for .bu, i t-. This is very difficult to
prove in the context of consensual anal sex and there is seldom a
successful prosecution for tbu., i -. The damage is in the terror of the
charge itself. Oftentimes, the defendant pleads guilty to the lesser
offence of gross indecency, to abbreviate the embarrassment. Or if the
defendant is adamant that he will not compromise, very often the charge
is dismissed for lack of evidence. But the damage is in the charge. It is
standing in the dock in the face of judge, police and sometimes other
litigants, where it is known that you are charged as a battyman.56


High-level police officials claimed that sodomy laws seldom were enforced. Clarence
Taylor, assistant commissioner of police in charge of administration, said that sodomy
cases among adults were rare.57 A St. Ann's Bay constable told Human Rights Watch,
"\\ occasionally arrest homosexuals. If they're caught in the act, we charge them with
tbu _, i .-."58 A high-level police officer at a Kingston divisional police headquarters told
Human Rights Watch in June 2004 that it had been "many moons since we have had an
arrest for solicitation, but. i. or gross indecency."59 A high-level police officer at a
second Kingston divisional police headquarters said that he could not recall a case of
bt.l -. -i. and that the last one may have been three or four years before.60


Regardless of how often buggery and gross indecency laws are actually enforced, the
arrests themselves send a message.61 The Jamaican press publishes the names of men
charged with "consensual" buggery and gross indecency, shaming them and putting
them at risk of physical injury.62 And the threat of criminal sanctions for homosexual


56 Human Rights Watch e-mail communication with Lawson Williams, August 10, 2004. "Lawson Williams" is a
pseudonym.
57 Human Rights Watch interview with Clarence Taylor, Kingston, June 18, 2004.
58 Human Rights Watch interview, St. Ann's Bay, June 16, 2004.
59 Human Rights Watch interview with K.K. Knight, senior police superintendent, Kingston, June 18, 2004.
60 Human Rights Watch interview with Newton Ames, superintendent of police, Kingston, June 18, 2004.
61 Human Rights Watch does not oppose punishment for sexual violence or coercion that would fall within the
sodomy law. We urge Jamaica to amend the criminal law so that sexual violence or coercion against and
between men is subject to equal punishment as sexual violence against women.
62 See, e.g.,The Jamaica Observer, January 11, 2003; The Star, January 18, 2000.


HUMAN RIGHTS WATCH, VOL. 16, NO. 6 (B)










conduct is itself powerful. Buggery and gross indecency laws provide a means to harass,
arrest, and in some cases imprison individuals. They also perpetuate social prejudices.


Allen C., twenty-two, said that he was arrested and charged with tbu l. -- after someone
reported to the police having observed him having sex with another man. He was taken
to the police station, where police officers urged him to confess to a charge of t.bu. --i I
while beating him with a stick and chanting "buggery fi dead" [people who commit
but. -. i should be killed]. The police told him that he would be examined by a doctor in
the rape unit to see if he was the receiving partner in anal intercourse. He was placed in
a jail cell, where he was cursed out as a "battyman" by other inmates. When he was
released to the custody of his mother, the police ensured that the abuse would continue:
when Allen C. left the station, they announced the charges to people outside.


Although the incident took place in 1999 (five years prior to his interview with Human
Rights Watch), Allen C. was still suffering its consequences. He told Human Rights
Watch that since this arrest, "The whole community find out [that I'm homosexual.]
People put up a hand like a gun to their head and say, 'battyman fi dead,' and throw
stones at me. I can't complain to police, because they know I am a homosexual and will
turn on me. Most of the time, I just keep to myself and my friends who are
homosexual." He remained worried about being charged again with but.- -. i and
imprisoned. 63


A number of witnesses said that they thought that some element of their outward
behavior, dress, or appearance was the motivation for police to arrest or detain them.
Ryan N., twenty-three, was interrupted by police while talking with friends. "Police
started saying I'm gay because how me talks. Police took me to the station and
threatened to charge me with gross indecency. I asked him, 'What is gross indecency?
Can you define gross indecency?' Police say, 'When two men start to play with their
penis.' I say, 'Was I doing that?' When they realized that I'm not stupid about the law
and started to quote the law to them, the police started threatening to lock me up and
then men could screw me up in prison." Ryan N. was charged with obstructing police
on duty and resisting arrest.64


Several gay men told Human Rights Watch that they had been stopped by police while
in a car with male friends. Harold B. recalled being stopped by police twice in the first
half of 2004, once the week before his interview with Human Rights Watch. "If you're


63 Human Rights Watch interview with Allen C., Kingston, June 8, 2004.
64 Human Rights Watch interview with Ryan N., Kingston, June 9, 2004.


HUMAN RIGHTS WATCH, VOL. 16, NO. 6 (B)










driving with a friend, police stop you and say, 'battyman, what are you doing in the car-
fucking?' Try to argue with them and they'll take you to the station."65 Vincent G. was
present in early 2004 when police approached a car in which two male friends of his
were sitting, arrested them and threatened to charge them with buggery. His friends
were taken to the police station and then released.66 Ryan N. was parked in a car, eating
burgers with several friends when police approached them, told them they had observed
them kissing, and made them get out of the car and show their documents.61


Police also use other laws as a pretext to stop men based on nonconforming gender
identity. Patrick D., twenty-five, told Human Rights Watch about a 2004 incident: "I
was going to a costume party and wearing a dress. The police stop me and tell me to
hold up my head. I do and they see I am a man. I tell them I am entering a costume
party competition. They radio other cars and accuse me of wanting to rob someone.
They let me go, but they come and look and talk and call me 'battyman."'68


Women who have sex with women are also targeted for arrest because of homosexual
conduct. Lillie P., thirty-six, told Human Rights Watch that she was arrested while
parked in a car with her girlfriend on December 31, 2002. "On New Year's Eve, myself
and my girlfriend went to a lovers' spot after a party. There were a lot of other cars
there, but the police approached us." The police called Lillie P. and her girlfriend "dirty
lesbians," threatened to charge the women with indecent and lewd exposure and asked
them for money. When the women refused to offer a bribe, the police arrested them
and took them to the Portmore police station. At the station, the police superintendent
told the women that they were not going be charged, but that their names would be
recorded in a register. "It was scary at first because at this point I was not out to my
parents and I was going to start a job soon and I was afraid that it was going to
jeopardize it. I was concerned for my girlfriend . She works for [a government
ministry] and could suffer problems if they find out she is gay."69


Extortion and theft
Men who have sex with men are easy targets for extortion by both police and private
actors. Discriminatory police practices, fear that their homosexuality might be
publicized, the paucity of available legal assistance, and the possibility of being


65 Human Rights Watch interview with Harold B., Kingston, June 9, 2004.
66 Human Rights Watch interview with Vincent G., Kingston, June 14, 2004.
67 Human Rights Watch interview with Ryan N., Kingston, June 9, 2004.
68 Human Rights Watch interview with Patrick D., Kingston, June 9, 2004.
69 Human Rights Watch interview with Lillie P., Kingston, June 19, 2004.


HUMAN RIGHTS WATCH, VOL. 16, NO. 6 (B)










prosecuted themselves combine to keep men who have sex with men from filing
complaints or seeking redress when they are victims of extortion.


Several gay men told Human Rights Watch that police demanded money from them and
arrested or beat them when they refused to pay. Harold B. recalled being stopped twice
by police in 2004 and accused of having sex with another man. On one occasion,
Harold B. and a friend were arrested and threatened with a charge of buggery after they
refused to pay money to police. They were taken to the police station, where, after being
questioned by the arresting officers' superior, they were ultimately released."


Two days before his interview with Human Rights Watch, police stopped Lawrence O.
and two friends outside a shopping center in New Kingston. According to Lawrence
O., the police yelled "battymen" and told them that they could avoid arrest by paying a
bribe. When no one produced any money, the police started to shout and to beat
Lawrence O. and his friends, attracting the attention of shopping center security guards,
who, hearing the commotion, joined the police in beating the men.1 A Jamaica AIDS
Support outreach worker reported another case in which a gay man who complained to
police that he was being blackmailed had to pay police to keep them from disclosing his
sexual orientation.72


Lawson Williams, a IGngston attorney, represented several men who had been
blackmailed with accusations of buggery or gross indecency by men who had committed
crimes against them. He said that fear of prosecution under bu i i laws and the dire
implications of charges of buggery prevented blackmail victims from even contemplating
seeking the protection of the state.


The sodomy laws are used to silence MSM, to keep them in check.
They allow criminal acts to be committed against MSM with impunity.
People know-thieves, crooks, layabouts-that if they commit a crime
against you, they can play the "battyman card" to silence you. I've seen
this in my cases. And this builds on the perception that gay men are
saps, not only because they're effeminate, but because their vulnerability
is supported by state institutions-police, courts-that don't protect
them.




70 Human Rights Watch interview with Harold B., Kingston, June 9, 2004.
71 Human Rights Watch interview with Lawrence O., Kingston, June 19, 2004.
72 Human Rights Watch interview with Paul M., Kingston, June 6, 2004.


HUMAN RIGHTS WATCH, VOL. 16, NO. 6 (B)










In a 2004 case, for example, a man charged with car theft claimed that he had taken the
car from its owner after having been forced to have anal sex with him. In his statement
to the police, he admitted driving the car away without permission, stating that he had
meant to drive to the police station to report having been buggered but had been too
ashamed to do so. The car owner was subsequently charged with bu.- .i i -. His accuser
never appeared in court to prosecute his complaints, and the bu -.. i charges against the
car owner ultimately were dropped. As of this writing, the car has not been recovered.73


Police failure to provide protection from violence and abuse


We haven't had any reports about violence against homosexuals. Most of the violence
against homosexuals is internal. Ie never have any cases ofgay men being beaten
up. I know that there is a sort of revulsion against homosexuals, lesbians, but
evidence does not substantiate that there is any level of violence perpetrated against
them.
K.K. Knight, senior superintendent of police, Kingston, June 18,
2004


Ifyou make police report, they start by makingyou instead of the victim the person
that is wrong. The police ask, WIhy all of a sudden they -you a battyman?
How do they know you a battyman?' These kinds of questions trivia/ize the
problem.
Adrian S., thirty, Kingston, June 13, 2004


Men who have sex with men and women who have sex with women repeatedly told
Human Rights Watch that they did not bother to report homophobic violence because
they did not believe that police would take any action to address it, especially in cases
where police were the perpetrators. In some cases, attempts to make complaints were
ignored altogether; in others, police investigation efforts inspired little confidence,
fueling concerns that police cared little for the lives and wellbeing of homosexual men
and women.


Joseph W., twenty-six, lived with two male friends in the Kingston area. In December
2002, a policeman came to their house and told them that he had received a report that


73 Human Rights Watch interview with Lawson Williams, Kingston, June 23, 2004 and statements of complainant and
accused to police. A "buggery" defense appears to have been used by a man charged with felonious wounding, who
claimed he stabbed another man after having been forced by him to have sex in the car at knifepoint. John Tavares,
"Buggery, Case Continues June 22," The Jamaica Observer, June 4, 2004.


HUMAN RIGHTS WATCH, VOL. 16, NO. 6 (B)










they were gay. The policeman forced his way past the security gate and onto the veranda
and threatened to kill Joseph and his roommates if they did not leave. Joseph attempted
to lodge a complaint with the police later that day. When he told police that he lived
with two other men, they laughed and said that there was nothing that they could do to
assist him. The following day, Joseph went to the Police Public Complaints Authority,
the independent state authority charged with investigating allegations of police abuse,
which likewise refused to investigate the case or otherwise provide assistance. After the
initial incident, a crowd gathered around the house hurling antigay insults, and the men
were forced to move-both because they feared for their safety and because their
landlord was concerned about possible damage to his property.74


The night before Lawrence O.'s interview with Human Rights Watch, a friend of his was
robbed and stabbed in front of him. The police came to the scene, retrieved the knife,
and left without investigating the incident or assisting the injured man in obtaining
medical care. "The guy [the assailant] told the police that we were battymen. So the
police just left. The police should have done something. [My friend] was cut and he was
bleeding .... They looked at us and said, 'you are all battymen.' Then they took the
knife [from the assailant] and told him to go."75


In Ocho Rios, several gay men said that there was a man in town who frequently
harassed them and other gay men, threatening to kill them, extorting money from them,
and inciting others to commit violent acts against them. Leroy J., thirty-three, said that
in May 2004, when he tried to report this harassment to the police, the police chased
him out of the station and threatened to attack him. "I went to the police to report
these threats. They wouldn't come. They said that we don't have a right to live in our
own country and that they would chop us up and kill us."76


When he met with Human Rights Watch in June 2004, Allen C. said that people often
threw stones and bottles at him when he walked down the street. He had not
complained about this to the police, however, believing that a prior buggery charge had
effectively stripped him of police protection. "Because of the [buggery charge], police
think I'm homosexual. I can't complain about stone throwing, because then they'll turn
on me."77




74 Human Rights Watch interview with Joseph W., Kingston, June 11, 2004.
75 Human Rights Watch interview with Lawrence O., Kingston, June 19, 2004.
76 Human Rights Watch interview with Leroy J., Ocho Rios, June 16, 2004.
77 Human Rights Watch interview with Allen C., Kingston, June 8, 2004.


HUMAN RIGHTS WATCH, VOL. 16, NO. 6 (B)










Edward P., twenty-two, said that: "Sometimes I can't walk in peace. People shout
battyman and all this stuff. They keep saying that I'm a battyman and men will fuck me
and that I can't walk in this neighborhood. And sometimes if I turn they will try to
attack me." He has not registered a complaint with police, however. "To be honest, I
feel scared because police themselves will try to bitch you and even tell you to leave the
police station."'8


Nicholas C. testified that people in the town where he had lived were constantly
threatening to kill him because he was gay, forcing him to move from the town. He also
testified that he had been beaten by police on more than one occasion. When asked
about lodging a complaint about his neighbors or the police, Nicholas replied,
"Complain? No, because I don't know who to complain to. Police [and homophobic
people in town] are the same thing."'9


Albert B. said, "It doesn't make sense to complain because you will not get anything
from them. One time, a guy accused me of being gay and wanted to beat me. The
policemen drove around and asked me if I did it."80 In May 2004, Paul M. and his
housemates were driven out of his house by a group of men armed with machetes. "I
did not complain to the police. When it comes to homosexuals, we have no rights."8s


Some police denied that homophobic violence was a problem in Jamaica. K.K. Knight,
senior superintendent at the Kingston police station charged with investigating Brian
Williamson's murder, told Human Rights Watch: "Most of the violence against
homosexuals is internal. We never have any cases of gay men being beaten up."82
According to Knight, gay men inflict injury on each other in crimes of passion: "Usually
in homosexual cases, you can see some kind of passion by the amount of injury inflicted
and the scars on the body, and the sort of information you get from witnesses."83
Newton Ames, police superintendent at St. Andrew parish south divisional headquarters,
testified that "we have never had any report of community violence against
homosexuals. [Police involvement] is not a thing that people want in these areas.
People stay away from accusing someone of homosexuality or getting involved in it."84



78 Human Rights Watch interview with Edward P., Ocho Rios, June 16, 2004.
79 Human Rights Watch interview with Nicholas C., Kingston, June 9, 2004.
80 Human Rights Watch interview with Nicholas C., Kingston, June 9, 2004.
81 Human Rights Watch interview with Paul M., Kingston, June 6, 2004.
82 Human Rights Watch interview with K.K. Knight, senior superintendent of police, Kingston, June 18, 2004.
83 Ibid.
84 Human Rights Watch interview with Newton Ames, superintendent of police, Kingston, June 18, 2004.


HUMAN RIGHTS WATCH, VOL. 16, NO. 6 (B)











An individual with close links to law enforcement agencies who had experience working
at murder scenes said that:


abuse of gay men is by gay men. From my experience, all gays are killed
the same way. If you go to a crime scene, you can tell if a person is gay
or straight by how they are killed. Gay men, they are more brutally
slain-by a knife, strip them up.85


There is evidence that supports the claim that in many countries, gay, lesbian, bisexual
and transgender people are victims of serious violence, including murder, because of
their sexual orientation and that these murder victims often undergo exceptional
brutality, sometimes called "overkill" (extreme harm beyond that necessary to cause
death).86 But this evidence does not support any conclusion that gay men commit such
savage acts of violence against other gay men. The "overkill" stems from hate. The
misperception that gay men kill each other in brutal crimes of passion is a common
barrier to investigating "gay murders" not only in Jamaica but in many parts of the
world.8"


Percival Buddan, the officer in charge of HIV/AIDS training for the Jamaican police
force, acknowledged that members of the police force shared homophobic attitudes
common in the general community. According to Buddan, "The police force has a
culture. If they know you're homosexual, you'll definitely be discriminated against and
stigmatized."88 However, in some cases, police had helped protect against assault. A St.
Ann's Bay police officer said that he knew of an incident where police had intervened to



85 Human Rights Watch interview, Kingston, June 10, 2004. A newspaper columnist commenting on Brian Williamson's
murder wrote that "based on cursory investigations, all indications are he was murdered by someone 'in-house.' The
police report suggests that he was chopped all over his body. This is fairly consistent with previous murders in Jamaica
involving male homosexuals.'" Mark Wignall, "Those Flamin' Homosexuals," The Daily Observer, June 17, 2004. See
also S. Escoffery, "Letter of the day Outrage! and hypocrisy in dancehall attack," The Jamaica Gleaner, October 6, 2004
(arguing that in Jamaica, "98 per cent, if not all crimes against homosexuals are homosexual on homosexual crimes").
86 See, e.g., "Homocide in Homosexual Victims: A Study of 67 Cases from the Broward County, Florida, Medical
Examiner's Office (1982-1992), with Special Emphasis on 'Overkill,'" The American Journal of Forensic
Medicine and Pathology, vol. 17, no. 1 (March 1996), pp. 65-69 (comparing number and extent of injuries in
homosexual and heterosexual homicide victims and finding that homosexual homicides were more violent);
Douglas Victor Janoff, "Tales from the Turkish Crypt: Ottawa Researcher Explores Homophobia, Violence and
Murder," Capital Xtra!, July 1, 2004 (reviewing studies of serious violence against lesbian, gay and transgender
people).
87 See, e.g., Human Rights Watch and International Gay and Lesbian Human Rights Commission (IGLHRC),
Public Scandals: Sexual Orientation and Criminal Law in Romania (New York: Human Rights Watch and
IGLHRC, 1998), pp. 65-66.
88 Human Rights Watch interview with Percival Buddan, sub-officer in charge, Jamaican Constabulary Force First AID
Center, Kingston, June 18, 2004.


HUMAN RIGHTS WATCH, VOL. 16, NO. 6 (B)










stop people from stoning gay men.89 A few gay men also testified that police had
assisted them in leaving dangerous situations, such as escorting them from their homes
when armed men were threatening them with serious violence.


On June 9, 2004, Brian Williamson, a prominent gay rights activist and one of the very
few people in Jamaica to appear openly in the media as a gay man, was murdered in his
home, his body mutilated by multiple knife wounds. Because of his international
prominence as a gay rights advocate, his middle-class status, and his dual
Canadian/Jamaican nationality, members of the lesbian, gay, bisexual, and transgender
community initially were hopeful that police would take special care in the investigation
of his murder. But police actions from the start raised cause for concern.


Williamson's body was discovered on the floor of his apartment, reportedly with stab
wounds to his neck and body. After the police left the crime scene, Ernest N., thirty-six,
a friend ofWilliamson's, went to the apartment to clean up. He told Human Rights
Watch that the apartment was unlocked and the door open. A few feet from where the
body had lain, Ernest N. found a ratchet knife and an ice pick, both of which had blood
on them.90


A witness told police that he had seen two men at the apartment the morning of the
murder. The police detained one of the men, nicknamed 'Wingee,' and called the
witness to identify the suspect in a lineup. As the witness passed the lockup on his way
to the lineup, inmates called out, "See the battyboy who has come for Wingee. Him fi
dead. [He should be dead.]" At the lineup, nine individuals were presented with towels
on their heads and white cream (apparently toothpaste) on their faces, making them
virtually unrecognizable. According to the witness, "I never saw that guy with anything
on his head or face so I couldn't identify him." The witness also stated that even one of
the police officers at the station told him that he had never seen participants in a lineup
disguised in this way.91


Police abuse of sex workers
Male and female sex workers interviewed by Human Rights Watch reported being
harassed by police, who apparently regarded them as a source of both money and sex.
Because soliciting sex is illegal, police face little risk of censure for these actions. Male
sex workers face the double condemnation of homosexual conduct and prostitution.

89 Human Rights Watch interview, St. Ann's Bay, June 16, 2004.
90 Human Rights Watch interview with Ernest N., Kingston, June 11, 2004.
91 Human Rights Watch interview with Ellis R., Kingston, June 25, 2004.


HUMAN RIGHTS WATCH, VOL. 16, NO. 6 (B)










These abuses may increase HIV risk for sex workers by driving them further
underground and away from potentially lifesaving information on HIV prevention and
other health services.


Male and female sex workers told Human Rights Watch that police extorted sex and
money in exchange for not arresting them. Vincent G.'s experience was typical of the
accounts we heard. "Police ask for sex and they don't pay. Last time I was with a
policeman was about a month ago. Police said I had to give him a blow job. I had to do
this because I didn't want to get charged."92


An outreach worker with Jamaica AIDS Support told Human Rights Watch: "Sex
workers are arrested, but not as often as gay men. Very naughty police will try to get sex
off of the ladies so they won't get locked up. The ladies say it happens often. .. Gay
men selling sex [are treated] worse than females. They [police] beat them up bad. This
happens often."93


A number of sex workers said that they could not report violence or abuse, in part
because they risked abuse by the police if they did so. Jennifer S. told Human Rights
Watch that police beat her and asked her for money and sex, and clients stole money
from her. When asked whether she had ever reported such abuse to the police, she said,
"Complain? I can't do that because they will not listen to us. . 'Come out of the
station. You're nothing but a whoring girl.' This is what police say when we try to
complain."94 Vincent G. said that when one of his clients stole money from him, "I
couldn't complain to the police about it because I am homosexual."95



Police interference with access to HIV/AIDS information and health
services

Jamaican government policy recognizes that the most effective and indeed in some cases
the only possible AIDS educators for members of marginalized groups, such as men
who have sex with men and sex workers, are their peers. 96 But peer educators and
others who reach out to marginalized groups are often held in the same contempt as the



92 Human Rights Watch interview with Vincent G., Kingston, June 14, 2004.
93 Human Rights Watch interview, Kingston, June 6, 2004.
94 Human Rights Watch interview with Jennifer S., Kingston, June 9, 2004.
95 Human Rights Watch interview with Vincent G., Kingston, June 14, 2004.
96 See, e.g., Ministry of Health, "Jamaica HIV/AIDS/STI National Strategic Plan 2002-2006," January 2002; see also Pan-
Caribbean Partnership on HIV/AIDS, "The Caribbean Regional Strategic Framework for HIV/AIDS 2002-2006," March
2002.


HUMAN RIGHTS WATCH, VOL. 16, NO. 6 (B)










individuals with whom they work and subjected to discrimination and violence at the
hands of the government. Human Rights Watch documented numerous cases of police
harassment of HIV/AIDS workers providing services to men who have sex with men
and to male and female sex workers. In some cases, the very possession of condoms-a
key tool in the work of HIV prevention-triggered police harassment of HIV/AIDS
educators and of sex workers.


Men who have sex with men
The Ministry of Health relies on the NGO Jamaica AIDS Support (AS) to provide
HIV/AIDS information and services to men who have sex with men.9" Dr. Yitades
Gebre, executive director ofJamaica's Program Coordination Unit at the Ministry of
Health, acknowledged that the ministry had "identified MSM as a target population, but
we're not reaching them." He explained "because the laws impeded the Ministry of
Health from working with MSM, we give the work to JAS. To date, we don't promote
direct programs or services to MSM as a group because the existing laws impede this
work [and] because [of] the high level of stigma and discrimination, they're not open to
getting services through the public sector."9" The police however, are actively impeding
JAS' government-supported efforts.


A JAS outreach worker told Human Rights Watch that: "police always try to get in the
way of handing out condoms .... Police say, 'how can you be handing out condoms to
battymen .... We do not encourage you to do this work because battymen fi dead. [gay
men should be dead]."'


He recounted two arrests for handing out condoms to MSM:


In May 2003, I was in an area known to be frequented by gay men ... I
was there handing out condoms on the main road. It was me alone, at
about 9:30 in the evening. I was issuing condoms and about five guys
were there and a police car drove up. There were four police in the car.
They asked, "\\ hat are you doing here? You must be battymen." I say
that I am on my job, issuing condoms. They turned to me and said,
"How come you issuing condoms to battymen?" I say it's a part of my


97 Jamaica AIDS Support is an NGO that also provides HIV/AIDS information and services to men and women who sell
sex for money and engage in transactional sex, hearing-impaired individuals, and inmates, ex-convicts and correctional
services staff. This work is funded by the Ministry of Health through the Global Fund and USAID. The Caribbean
Epidemiology Centre (CAREC) and several United States NGOs also support condom distribution work. Jamaica AIDS
Support, "Targeted Intervention," http://www.jamaicaaidssupport.com/services/intervention.htm (retrieved August 1, 2004).
98 Human Rights Watch interview with Dr. Yitades Gebre, Kingston, June 23, 2004.


HUMAN RIGHTS WATCH, VOL. 16, NO. 6 (B)










job. . He turned to me and said he was going to lock me up because I
am not supposed to be issuing condoms to battymen. . Then his
friend said "come and charge the boy for loitering." And then they said
for me to get in the car and they took me to the police station.


When I was in the police station, I was placed in a holding area and I
asked them to call [my supervisor] at my workplace. They didn't give
me the call right away. I was there for about three hours. And every
police comes into the station, the policemen that arrested me would say
to their friends, the other policemen, "the boy handing out condoms to
battymen." Some will talk some abusive things, like "boy, are you gay?
You a battyman too? Battyman fi dead!" Then I asked them again for
the call because I wanted to know if I am going to be charged because I
am here for over three hours now. After a long deliberation, they let me
go. When I was released, they told me, "Go home and stop helping the
battymen. And we hope we don't catch you handing out condoms to
battymen."99


In October 2003, this outreach worker was again arrested and charged with loitering for
handing out condoms to men:


I was out on the main road handing out condoms in an area known to
be a gay area and the police came down and the men began to run. I
stood my ground and I had a condom in my hand and the policemen
asked me what I was doing there and the police asked me if I were a
battyman. I had three boxes of about 100 condoms in my hand ....
They said that they were going to charge me with loitering, but if they
see me in the act they would kill me. And they said that they were going
to charge me for loitering because they knew that I was a battyman
because only a battyman would be handing out condoms to men. ... I
was accused of buying sex and being a battyman and charged with
loitering.100


The outreach worker was called to appear in court twice, but the charges ultimately were
dropped. 101


99 Human Rights Watch interview with [name withheld on request], Kingston, June 18, 2003.
100 Ibid.
101 Ibid.


HUMAN RIGHTS WATCH, VOL. 16, NO. 6 (B)










Sex workers
Jamaica AIDS Support also provided condoms and HIV/AIDS education to male and
female sex workers who operated in the Kingston, Montego Bay, and Ocho Rios areas,
including street sex workers, go-go dancers, and massage parlor workers. A Kingston-
based JAS outreach worker explained: "\\ e have educational sessions with ladies and
men two nights of the week on the road. We hand out condoms and pamphlets and talk
a little about safe sex and what we can do to help them. We also invite them to JAS to
do free HIV testing, have a place to chat."102 He told Human Rights Watch that he had
been stopped by police several times while handing out condoms on the road to sex
workers. Once he was once accused of being a sex worker and detained overnight in
jail.103


Steve Harvey, JAS' coordinator of targeted interventions in Kingston, said that he had
been stopped by police while doing outreach to sex workers several times in 2003 and
2004. On one occasion, the police accused him of illegal soliciting; other times, police
stopped and searched him, his colleagues, and their car. 104


Police crackdowns on sex work-of which there were at least two in Kingston in the
first five months of 2004-hampered HIV/AIDS prevention work by undermining
outreach workers' ability to distribute condoms and to discuss HIV/AIDS and other
health services with sex workers. Harvey told Human Rights Watch:


Sometimes the police decide that they are going to crack down on sex
work, and they do it for two weeks. During that time, the girls are
afraid. Some of them won't come onto the streets, some of them will go
to other places, and some of them are in hiding so when you go down
the streets, you can't see them. It hampers HIV/AIDS prevention
work. We really don't have the time then to talk to the girls.105


Police also threatened sex workers that possession of condoms could be used as
evidence of their illegal activity. Joyce D., forty-one, had been selling sex on the street
since she was a young girl. She told Human Rights Watch that police regularly took
condoms from her, threatening to use them as evidence against her if she refused to


102 Ibid.
103 Ibid.
104 Human Rights Watch interview with Steve Harvey, coordinator of targeted interventions, Jamaica AIDS Support,
Kingston, June 6, 2004.
105 Ibid.


HUMAN RIGHTS WATCH, VOL. 16, NO. 6 (B)










provide them with sex. "Police say, 'hey girl, if you don't give me some pussy, condom
is there for evidence that you're fucking in the street.' . Now they have the handle. I
have the blade. There is nothing that I can do about it. I give them my body."106


Abuses in the health care system
People living with HIV/AIDS and men who have sex with men face numerous human
rights abuses that constitute barriers to obtaining necessary medical care. Among these
are discrimination by health workers who forced them to wait extended periods of time
to be seen, treated them in an abusive or degrading manner, provided inadequate care, or
denied them treatment altogether. Health workers also routinely violated their privacy
by disclosing confidential information about HIV status and sexual orientation.


Human Rights Watch found that the threat of serious violence and discrimination,
compounded by the deep stigma associated with homosexuality, was keeping men who
engaged in homosexual conduct from seeking medical treatment and from existing
prevention services and driving them to engage in unsafe and unprotected sex.
Discrimination and stigma also was driving people living with HIV/AIDS away from
health care and other HIV/AIDS services.


Several people told Human Rights Watch that health care provision to people living with
HIV/AIDS had improved in the last few years, crediting the Ministry of Health and the
efforts of AIDS service organizations like Jamaica AIDS Support (AS) and the Center
for HIV/AIDS Research, Education and Services (CHARES) for these changes.
"Things have changed a lot," said Orchid Gowe-Hunter, a nurse with Jamaica AIDS
Support, "but people still have some bad experiences."10


Discrimination by health care providers

Heath care delayed or denied
Human Rights Watch interviewed several nurses and AIDS service workers who said
that public hospitals and clinics provided inadequate care to people living with
HIV/AIDS, sometimes refusing to treat them. Some acknowledged that the situation
had improved since the start of the epidemic but stressed that the abuses had not abated
altogether.




106 Human Rights Watch interview with Joyce D., Kingston, June 9, 2004.
107 Human Rights Watch interview with Orchid Gowe-Hunter, Montego Bay, June 21, 2004.


HUMAN RIGHTS WATCH, VOL. 16, NO. 6 (B)










Human Rights Watch learned that some doctors who treated people living with
HIV/AIDS failed to conduct adequate medical exams or even to touch them, and that
clinic staff had refused to register people living with HIV/AIDS for admission. Men
who have sex with men also told Human Rights Watch that they had been denied health
care treatment.


Tonya Clark, a nurse with Jamaica AIDS Support in Kingston, said that a JAS client who
had suffered a head injury had been denied services twice in the week prior to her
interview with Human Rights Watch. In June 2004, Gary T. was beaten and suffered a
head injury. He first went to the police, who referred him to the hospital with a form to
be completed with details of his injury. After Gary T. told the nurse that he had HIV,
she tore the form up and told him to leave. AJAS social worker returned to the hospital
with Gary T., where they again refused to treat him.108


A health worker with years of experience working in the health sector in northern
Jamaica who assisted people living with HIV/AIDS in obtaining medical care said that
based on her experience, physicians at the regional hospital treated HIV-positive patients
differently from other patients and had provided inadequate care to two of her clients in
April and May 2004. In one case, she brought a client to the regional hospital because
he had lesions on his penis and difficulty urinating. The examining physician stated that
the man had HIV, donned gloves, and ignored the health worker's request to examine
the client's genital area, instead focusing on his chest and abdomen and sending him
home without examining the lesions on the penis. The health worker told Human
Rights Watch:


The doctor that came to see him knows me and my work [with people
living with HIV/AIDS] and said at once, "this is a positive person." . .
I said we found him on the road, I think he has some sores on his penis.
The doctor put on gloves, did a chest exam, peeled off that set [of
gloves], did an abdomen exam, peeled off that set... and I was i.- -,
there is something wrong with his penis. You need to look at him. [The
patient] said he has sores on it and hasn't urinated in a while. And he
has this smell coming from his genitals. The doctor wouldn't look at it. .








o08 Human Rights Watch interview with Tonya Clark, Kingston, June 14, 2004.


HUMAN RIGHTS WATCH, VOL. 16, NO. 6 (B)










The man received no treatment for the lesions on his penis that day. The health worker
ultimately secured the assistance of a nurse who worked with an AIDS service
organization to examine him and provide appropriate medication to treat his lesions. 109


Men who have sex with men and health workers reported that public and private health
care providers refused to treat men whom they knew or perceived to be gay and made
abusive comments to them, at times instigating abusive treatment by others. Curtis M.,
twenty-four, told Human Rights Watch that when a friend accompanied him to St.
Ann's Bay Hospital, a nurse made homophobic remarks, and he left without receiving
treatment. "[The nurse] said, 'I wonder which one is the woman and which one is the
man. . We had to leave because the crowd started looking at us and then on the road
they were hurling words at us, 'battymen fi dead.' I felt threatened."110 He did not
receive treatment that day.


When Leroy J., thirty-three, went to a private doctor, he was told "we don't work with
gay people here."111 Craig F., a health worker in northeast Jamaica, said that public
health centers in the region have refused to treat men whom they believed to be
homosexual and that he had heard health workers making abusive comments to gay and
bisexual men. For example, one health worker told a gay man with gonorrhea that he
was "nasty" and asked why he had sex with other men.112


Several people told Human Rights Watch that health workers routinely mistreated
people living with HIV/AIDS, delaying care or impeding access to treatment. When
Eric B., a thirty-year-old man living with HIV/AIDS, sought treatment for a foot injury,
he had to wait until all other patients had been seen, including people who arrived after
him and people with lesser injuries, before he was examined.113 Craig F. told Human
Rights Watch that in May 2004, a health clinic clerk had refused to register a person
living with HIV/AIDS for treatment, stating that she would not look after anyone who
was HIV-positive.114







109 Human Rights Watch interview, Ocho Rios, June 16, 2004.
110 Human Rights Watch interview with Curtis M., Ocho Rios, June 16, 2004.
111 Human Rights Watch interview with Leroy J., Ocho Rios, June 16, 2004.
112 Human Rights Watch interview with Craig F., Ocho Rios, June 16, 2004.
113 Human Rights Watch interview with Eric B., Kingston, June 8, 2004.
114 Human Rights Watch interview with Craig F., Ocho Rios, June 16, 2004.


HUMAN RIGHTS WATCH, VOL. 16, NO. 6 (B)










Discrimination in health care provision


My neighbor, she was ill, she was HIV-positive. [At the they screened her
off. Her food was taken to her in a styrofoam box, and everyone else on the ward
was treated Everybody else had regularplates, and hers was just in a
box .... I went to her because I knew her. Nobody cleaned her, looked after her.
The nurse said, You know what she have?' I saidyes. The nurse said, Then you
have gloves?' I looked after her, gave her a bath. Her mother came and asked, Why
are they treating her like this, like a dog?' No one cared for her. I went every day
with her mum and cleaned her, taught her mother how to care for her.
Tonya Clark, nurse with Jamaica AIDS Support, Kingston, June 14,
2004


Among those encountered by Human Rights Watch, people living with HIV/AIDS who
did receive medical care were separated from other patients and placed at the back of a
ward or behind a screen with their basic needs left unattended. Health workers also
engaged in discriminatory practices that called attention to their HIV status, such as
placing their clothes and linens in conspicuously marked bags, and making sure that
medical equipment did not touch their skin.115


Orchid Gowe-Hunter, a nurse with Jamaica AIDS Support, had worked with people
living with HIV/AIDS in the Kingston, St. Andrews, and St. James parishes for several
years. She told Human Rights Watch that both Kingston Public Hospital (KPH) and
Cornwall Regional hospitals continued to isolate people living with HIV/AIDS in the
ward. At KPH, for example:


they always isolate them in the ward. They have a little corner way to
the back. One day, we went to visit this guy and he was just lying in the
bed alone. He had no sheets on the bed, no proper clothes. .. He was


11 HIV is not spread by casual contact nor by any airborne means of transmission, including sneezing or
spitting. There is therefore no public health justification for segregating people living with HIV/AIDS from other
patients, or in any way isolating their food, laundry or medical equipment for non-invasive procedures solely
because someone has HIV. Such actions threaten to reveal HIV status, and undermine public health efforts by
creating a false sense of protection from the disease, creating harmful stigma, and thus keeping people from
seeking health care and prevention services. See UNAIDS, HIV/AIDS and Human Rights-International
Guidelines, p. 42. International health organizations recommend that workers in settings where the possibility
of occupational HIV transmission does exist, as where there may be exposure to bloody injuries or being stuck
with unsterile syringes, be trained in "universal precautions" (simple measures to protect against HIV and other
blood borne illnesses) and provided with adequate supplies (such as gloves) to take such precautions. World
Health Organization, "Universal Precautions, Including Injection Safety,"
http://www.who.int.hiv/topics/precautions/universal/en/ (retrieved September 16, 2004).


HUMAN RIGHTS WATCH, VOL. 16, NO. 6 (B)










unable to feed himself or take his medication. All of the food, all of the
medication was just left by the bed.116


Gowe-Hunter's account is typical of those documented by Human Rights Watch.


HIV-positive men who have sex with men faced additional barriers. "They perceive,
and rightfully so, that if they divulge who they are and what they do, they may be
shunned," said Deborah ,M iiii,,, .program manager of the Center for HIV/AIDS
Research, Education and Services. In one case, for example, when an HIV-positive
patient's boyfriend came to visit him, a nurse ran him out of the hospital, telling him that
she did not want any of their "nastiness" there. 117 Joseph W., twenty-six, told Human
Rights Watch that when he visited a friend at Kingston Public Hospital in December
2003:


the nurses and the ancillary workers were laughing and .. i: I-, "which
one of them is the man, which is the woman?" Partly because of his
sexuality and because he was [HIV] positive he was not given the kind
of treatment he should have gotten. He wasn't able to help himself.
They wouldn't change his sheets . They would leave his food there.
Myself and all my friends had to go help him eat.118


Patrick D., twenty-five, found his HIV-positive friend lying in soiled diapers, and
changed them while a nurse called out, "Battyman, you shit up yourself. You shitty
shitty."119


Health care workers at public and private hospitals in Kingston parish told Human
Rights Watch that patients at their institutions were treated the same as others, but noted
that their clothes and linens were placed in specially marked bags and laundered
separately; doctors and nurses used gloves when attending to them; and that when taking
the blood pressure of a person living with HIV/AIDS, they put a "precautionary
barrier" between the person's arm and the cuff. One health worker explained that "if a
patient knows another person is HIV-positive, he won't use the same blood pressure
cuff."120


116 Human Rights Watch interview with Orchid Gowe-Hunter, Montego Bay, June 21, 2004.
117 Human Rights Watch interview with Deborah Manning, director, CHARES, Kingston, June 14, 2004.
118 Human Rights Watch interview with Joseph W., Kingston, June 11, 2004.
119 Human Rights Watch interview with Patrick D., Kingston, June 9, 2004.
120 Comments made at workshop to discuss quality of care for HIV-positive patients, Kingston, June 7, 2004.


HUMAN RIGHTS WATCH, VOL. 16, NO. 6 (B)











Several health workers said that HIV-positive patients posed a danger to health care
workers because they had a tendency to be angry and aggressive and would try to
intentionally infect others with HIV.121 A health worker at a private facility offered this
example of such dangerous behavior: "I had a patient who said he contracted HIV and
it's not his fault, he's not going down with it. He threatened to spit on a nurse."122 A
nurse at a Kingston public hospital acknowledged that she and her coworkers treated
patients differently from other patients. She said that they were concerned about
contracting the virus from patients who were often "deliberately demanding," in part
because they "really hopelessly wanted you to get HIV too."123


In the view of some health workers, the fear that HIV-positive patients would spread the
disease to health care workers and others-whether intentionally or otherwise-justified
segregating patients living with HIV in the hospital as well as in the larger community.
At a workshop to discuss quality of care for patients with HIV, one health worker,
summarizing the views of a small group discussion, said that people living with HIV
"should be isolated to prevent this epidemic from being spread to the rest of society."124
A spokesperson for a second small group added that "some persons [with HIV] are
isolated for their own protection," while others because they "are more i- -_.e i--. They
want to bite you, spit on other patients."125



Inadequate protection of confidential information


That word, confidentiality. I'm so afraid of that word because in most instances it
don't mean
Lena B., twenty-nine, Montego Bay, June 22, 2004


Human Rights Watch found that some health workers failed to preserve the
confidentiality of patients' HIV status. By singling HIV-positive patients out for
disparate treatment absent medical justification, they risked divulging confidential
information about their HIV status. In some cases, health care workers disclosed
confidential information about HIV status without patient authorization. Some health
care workers also disclosed private information about sexual orientation.



121 Ibid.
122 Ibid.
123 Ibid.
124 Ibid.
125 Ibid.


HUMAN RIGHTS WATCH, VOL. 16, NO. 6 (B)










The failure to preserve confidential information about HIV status and sexual orientation
violates the right to privacy protected by the ICCPR and the American Convention on
Human Rights.126 Such actions also threaten other rights. As described above, people
living with HIV/AIDS and men who have sex with men may be denied health care or
subjected to violence and stigma when state and private actors discover their sexual
orientation or that they are HIV-positive.


Lena B., twenty-nine, was hospitalized for the last four months of her pregnancy at the
regional medical center. Doctors and nurses there repeatedly chastised her in front of
other staff and patients about having continued to have sex while living with HIV. A
doctor who knew that she had worked as an HIV/AIDS educator told her that she
"should have known better" not to have sex when she had HIV and chided her for
proving a poor example for others. One of the nurses instructed the ward assistant not
to serve Lena on plates that other patients might use; when that nurse was on duty, Lena
had to use disposable dishware.


At the end of Lena's pregnancy, two doctors discussed the decision to give her an
emergency caesarean section in the middle of the ward, "in front of a lot of people."
The first doctor explained, "I'm going to do the C-section [caesarean section] because
you want to push the child out of your vagina, and you know you have the disease
running around in the vagina and you want to put the child more at risk than he is
already at."127 A second doctor added, "I want to take you on a tour up to the top
where all the AIDS babies and children are and show the misery that you people cause
to come on the land. Because I agree that you should not be having sex, much less
getting pregnant."128


Hospital staff signaled Lena B.'s HIV status to her mother-in-law through their
treatment of her newborn son and comments they made. When Lena B.'s mother-in-
law came to see her new grandchild, she found the baby by the nurse's station, still
unwashed, and asked to help clean it.


126 ICCPR, 999 U.N.T.S. 171, entered into force March 23, 1976, art. 17; American Convention on Human Rights, entered
into force July 18, 1978, art. 11. Jamaican law provides that physicians, nurses and midwives may be subject to
sanctions for failure to protect confidential patient information. See The Medical Act, section 11; The Nurses and
Midwives Act, section 11.
127 Caesarean section delivery has been shown to reduce the risk of mother-to-child HIV transmission. It may
not be appropriate in resource-constrained settings because of limited availability, cost and risk of
complications. World Health Organization, HIVin Pregnancy: A Review, WHO/CHS/RHR/99.15,
UNAIDS/99.35E (Geneva: UNAIDS, 1999), pp. 9, 25. Insistence on caesarean sections may also present a
substantial ethical problem if women are not properly briefed about both the risks and the advantages
associated with undergoing caesarean sections.
128 Human Rights Watch interview with Lena B., Montego Bay, June 22, 2004.


HUMAN RIGHTS WATCH, VOL. 16, NO. 6 (B)












The nurse said, "you come in off the street with germs wanting to take
care of the child and want to finish killing him off because he has
everything going bad for him already?" ... The nurse clean up the child
and she still have him over behind the nurse's station. .. My mother-in-
law says, "I'm going to take him over to the mother to breastfeed." The
nurse said, "Breastfeed what? Mothers like those not even supposed to
have children much less to breastfeed with the type of sickness they
have."


At this point, Lena B.'s mother-in-law asked whether she had AIDS. Lena B. lived with
her in-laws and extended family. She said that since returning home after her HIV status
was disclosed, her family members have tried to kill her on at least three occasions.
Lena had no money to pay for shelter elsewhere, and stayed with her children in a locked
room at the house to protect them.129


The hospital neglected to attend properly to Lena B.'s surgical wounds from her c-
section and they became infected. Lena B. said that based on her experiences, she would
no longer seek treatment for herself in the public health system. There was a
comprehensive health clinic within walking distance of Lena's home. Lena B. said that
she would not take her children there, nor pick up infant formula and groceries provided
to mothers who are living with HIV, because health workers there chastised her and
other women for having gotten pregnant while living with HIV, and publicly disclosed
their status to other patients and members of the public without their authorization. As
a result, Lena B.'s children were also effectively denied health care and other benefits to
which they are entitled.130


Hospital staff providing ancillary services (such as porters, ward assistants, cooks) often
knew patients' HIV status and sometimes disclosed it to family and community
members. A laundry attendant at a Kingston area private hospital said that the head
nurse pointed out a person with HIV to her because his clothes had to be washed
separately.131 A peer educator in St. Andrews and St. Catherine's parishes told Human
Rights Watch: "Sometime the ward assistant knows, sometime the cook know, and I
don't see why they should know. And they talk a lot. .. They go back to their area


129 Lena B. said that in the first few months of 2004, she had been threatened at home several times: her
drinking water had been poisoned; an armed man had come to her house and warned her that he had been
hired by her family to kill her; and she had found materials used in obeah (witchcraft) outside her room. Ibid.
130 Human Rights Watch interview with Lena B., Montego Bay, June 22, 2004.
131 Comments made at workshop to discuss quality of care for HIV-positive patients, Kingston, June 7, 2004.


HUMAN RIGHTS WATCH, VOL. 16, NO. 6 (B)










and they say that Mary Jane is at the hospital, she's HIV-positive. So all of that person's
confidentiality is out." In one case, for example, a patient with HIV recognized a warder
from her area.


She said she had a family member who did not know that she was sick
in the hospital and she did not want the family member to know. The
warder told her family member that this person was HIV-positive and
was in the hospital. .. [The person] did not go back to her community
because she was afraid that she would not be treated nice.132


In some hospitals, porters may learn patients' status because they have access to patient
records. Glenn C., thirty-nine, aJAS volunteer, said that "\\ hen patients go into a ward,
files are given to the porter and they discuss it and they say, 'this is another C13 [the
hospital code for HIV/AIDS]. This is a homosexual.'" He remembered visiting a
person living with HIV/AIDS at a Kingston-area hospital in 2003. 'I asked the porter
where he was. The porter said, 'The battyman. The one with AIDS' [and then] told me
where he was."133


Men who have sex with men and AIDS service workers told Human Rights Watch that
hospital staff also disclosed information about people's sexual orientation. Craig F., a
health worker who worked with men who have sex with men, said that after his client
disclosed his sexual orientation to a contact investigator, "the same day, persons in the
health center knew that he was gay. I heard them talking. 'That man is a battyman.'
They mentioned his name. There was a lot of talk that he is gay and fire burn and him fi
dead."134


Driving men who have sex with men and people living with HIV/AIDS from
health care services
Abusive treatment in the health care system and state failure to protect men who have
sex with men from homophobic violence keep people from seeking health services,
especially for conditions that might mark them as homosexual. Several gay and bisexual
men told us they delayed or avoided seeking treatment for sexually transmitted
infections because they had received poor health care when they were known or
perceived to be gay; feared mistreatment because they were gay; and were concerned that



132 Human Rights Watch interview, Kingston, June 6, 2004.
133 Human Rights Watch interview with Glenn C., Kingston, June 13, 2004.
134 Human Rights Watch interview with Craig F., Ocho Rios, June 16, 2004.


HUMAN RIGHTS WATCH, VOL. 16, NO. 6 (B)










health workers would publicly disclose their sexual orientation, thus risking their safety.
Since the presence of other sexually transmitted diseases heightens the risk of HIV
transmission, the failure to seek care promptly in such cases may have fatal
consequences.135


Craig F., a health worker in northeast Jamaica, estimated that 90 percent of men who
engage in homosexual conduct with whom he had worked had told him that they would
not seek treatment for sexually transmitted diseases in the public health system because
they feared that confidentiality was not maintained.136 Harold B., thirty-four, told
Human Rights Watch that health workers mistreated men who have sex with men:
"\\ 'hl you go to a clinic and they know you are gay, they scorn you."137


A JAS health worker said that the stigma attached to being gay and fear of discrimination
put gay and bisexual men at risk of HIV, both because they did not get relevant HIV
prevention information in the first instance, and because they delayed seeking care for
sexually transmitted diseases that they feared might mark them as gay. He said that
many men who have sex with men "don't know that safer sex goes beyond using a
condom .... They don't use a lubricant and the condom breaks." And many were
reluctant to get tested for sexually transmitted diseases and did not know that the
presence of other sexually transmitted diseases could increase the risk of HIV
transmission.138


Using a water-soluble lubricant helps prevent condom breakage and is recommended for
anal intercourse. Many men who have sex with men will not buy lubricant, however,
because its purchase is equivalent to announcing one's sexual orientation.139 And, as in
the case of Nicholas C. (described above), men who have sex with men who carry
lubricant may be subject to police violence.140


Adrian S., thirty, told Human Rights Watch that he did not feel safe asking his doctor
about gay health issues, especially concerns related to anal or oral sex.


135 See United States Centers for Disease Control and Prevention, Fact Sheet: Prevention and Treatment of Sexually
Transmitted Diseases as an HIV Prevention Strategy [online], http://www.cdc.gov/hiv/pubs/facts/hivstd.htm (retrieved
October 27, 2003).
136 Human Rights Watch interview with Craig F., Ocho Rios, June 16, 2004.
137 Human Rights Watch interview with Harold B., Kingston, June 9, 2004.
138 Human Rights Watch interview, Kingston, June 11, 2004.
139 Human Rights Watch interview with Martin B., Kingston, June 14, 2004; Human Rights Watch interview with Adrian S.,
Kingston, June 13, 2004.
140 See testimony of Nicholas C., p. 19, above.


HUMAN RIGHTS WATCH, VOL. 16, NO. 6 (B)












There was one concern I had with regards to feeling something different
after anal sex with someone, and I just had to not talk about it and
watch it and use my own way of approaching it. There was one instance
when I had anal sex with someone that was very endowed. That meant
that there was some stretching and some tissues torn. I wanted to find
out if I was okay, but I couldn't say anything to anyone and all I could
do is pay extra attention to hygiene and use topical solutions that were
safe.141


Edward P., twenty-two, testified:


One time, I caught gonorrhea. I was so scared of it, to go to the doctor.
At first I said, this will go away. I started to see it getting yellow, and it
started to run [from my penis], then it started to turn green, so I put a
diaper there because it was running really hard and painful. . Some of
my friends won't go to doctors. They don't want the word spread
around, and they say what they don't know won't hurt them.142


When asked where he sought medical treatment, James P., twenty-six, said, "You come
[to Jamaica AIDS Support] if you have something on your bottom," because when gay
men sought treatment elsewhere, health workers pointed out to others that they were
gay. "I think that this keeps gay men from getting treatment. Some of them will keep
from getting treatment until it stinks [until the discharge from an infection has begun to
smell]. [They say] 'I've got gonorrhea and I'm scared to go to the doctor."143 Tonya
Clark, aJAS nurse, said:


Most of the gay men that I talk to don't even want to go to the hospital
at all. They come to me one-on-one and say can you get this for me, can
you get this medicine. Sometimes ordinary medicines, nothing to do
with HIV. But they are afraid to go to a doctor or hospital even with a
common cold or flu because they will ask them questions or call them
names.144



141 Human Rights Watch interview with Adrian S., Kingston, June 13, 2004.
142 Human Rights Watch interview with Edward P., Ocho Rios, June 16, 2004.
143 Human Rights Watch interview with James P., Kingston, June 8, 2004.
144 Human Rights Watch interview with Tonya Clark, Kingston, June 14, 2004.


HUMAN RIGHTS WATCH, VOL. 16, NO. 6 (B)










Curtis M., twenty-four, explained:


I try to keep myself healthy because if you go to the hospital, they won't
take care of you. If you got a bruise on your anus, that would make it
worse. To be honest, if anything should happen to me, I am not going
to the public hospital. I would buy over-the-counter medication or
speak to my friends. I know that I am at risk but just to keep myself
safe I cannot go to the hospital. Because if something should happen to
me, I cannot go to the police because they will not help me.145


Homophobic police actions interfered with HIV/AIDS information and other
prevention services by driving gay and bisexual men from places where they might safely
receive services. JAS held support group meetings for gay and bisexual men to address a
range of issues, including HIV/AIDS, sexuality, violence and discrimination, and
spirituality and family life.146 JAS' targeted interventions coordinator acknowledged that
men who engage in homosexual sex were difficult to reach, noting that "some people
won't come to JAS."147 Some men told Human Rights Watch that they had been
accosted by police when leavingJAS support group meetings, which may explain some
of the reluctance to come to JAS' offices for services.


Joseph W. said that after they left a support group meeting in 2001, he and his friends
were approached by police who asked them, "\\ih Ir are you doing? What kind of
meeting are you coming from? All you look like battymen.' They threatened to arrest us
because we always have to keep up with our 'nastiness."'148 Harold B., thirty-four,
testified he and his friends had been assaulted by police in June 2004, around the corner
from where they had just attended a support group meeting.149


A JAS outreach worker told Human Rights Watch that men who have sex with men
would find a safe place to hang out, but police would come and beat them, undermining
JAS' outreach work. In May 2004, he was working in a Kingston area that JAS outreach
workers had identified as a gay hangout when the police approached. "The police came
and said, 'Battymen leave the area. Don't contaminate the area. Don't come back here.'



145 Human Rights Watch interview with Craig R., Ocho Rios, June 16, 2004.
146 Human Rights Watch interview with Steve Harvey, coordinator of targeted interventions, Jamaica AIDS Support,
Kingston, June 6, 2004.
147 Ibid.
148 Human Rights Watch interview with Joseph W., Kingston, June 11, 2004.
149 Human Rights Watch interview with Harold B., Kingston, June 9, 2004.


HUMAN RIGHTS WATCH, VOL. 16, NO. 6 (B)










One [of the men] ran and broke his foot. . We were so frightened . that we just
drove away."150


The Jamaica Forum for Lesbians, All-Sexuals and Gays (J-FLAG) would be a natural
place to convene men who have sex with men and women who have sex with women to
discuss HIV/AIDS-related issues. J-FLAG's office, however, is not a safe space, as its
own website acknowledges: "Although we provide services and network island-wide,
our office is located in Kingston, Jamaica's Capital and largest city. Due to the potential
for violent retribution, we cannot publish the exact location. We do receive mail at Box
1152, Kingston 8."151


Human Rights Watch also received numerous reports from people living with
HIV/AIDS that they avoided seeking health care at both public and private facilities
because of the abusive treatment they had received and the public disclosure of their
HIV status. As described above, after doctors and nurses at the regional hospital and
local health clinic chastised Lena B. for having sex while she was living with HIV,
disclosed her status to family members who have since tried to kill her, and neglected to
attend to her wounds after delivering her baby by caesarean section, she decided that she
would no longer seek treatment in the public health system for herself, or in the local
clinic for her children. 152


Pam B., forty-three, overheard a nurse from the local health clinic telling someone from
her town that she had AIDS. Public hospitals in Kingston and Portland parishes had
isolated her with other HIV-positive patients, failed to provide her hospital gowns and
linens, and made her wait much longer than other patients for care. Although
unemployed (she lost her job after her employer learned she had AIDS), she avoided
seeking care in health clinics and hospitals in her area "because of the stigma." She also
said that she knew other people living with HIV/AIDS who were afraid to go to the
clinic because clinic staff gossiped about their HIV status.153


John B., forty-nine, told Human Rights Watch:





150 Human Rights Watch interview, June 6, 2004.
151 Jamaica Forum for Lesbians, All-Sexuals and Gays website, http://www.jflag.org/misc/contact.htm (retrieved August
27, 2004).
152 Human Rights Watch interview with Lena B., Montego Bay, June 22, 2004.
153 Human Rights Watch interview with Pam B., Kingston, June 8, 2004.


HUMAN RIGHTS WATCH, VOL. 16, NO. 6 (B)










I don't go to the hospital any more because of bad experiences there.
There was one experience but it stands out in my mind and I would
never go back there .... The nurse said that I had to draw up my shirt
so she could take my blood pressure. She looked through my docket,
saw the referral from Jamaica AIDS Support and that I was HIV-
positive, and told me to roll down my shirt and she took my pressure
from there [on top of the shirt].154


When Human Rights Watch met Patrick D., twenty-five, he was concerned that his
health was failing and that "some day soon" he would have to go to the health clinic.
He was avoiding doing so, however. "I'm afraid to go to the clinic because there's a
special mark on my docket. The porter sees it and says, 'that boy's HIV-positive."'155


Eric B., thirty, pulled his own teeth because he had heard that people living with
HIV/AIDS had been treated poorly by the dentist in his local health care center. He
told Human Rights Watch:


I didn't go there because on the whole, a lot of people go there and have
a bad experience. I just took some pliers and pulled out the teeth
myself. I've heard that the dentist there treats people badly, so I avoided
going. I suffered for six months with a bad tooth because I avoided
care.156


Fostering dangerous practices and complicating health care provision
Under conditions of surveillance by their families and communities, Jamaican gay,
lesbian, bisexual, and transgender people find little privacy for their sexual lives at home.
As discussed below, many face serious violence and become homeless after being driven
from their homes and their towns because of their sexual orientation or gender identity.
Men who have sex with men also risk violence for carrying condoms and lubricant-
both needed for practicing safer sex. The lack of private space to have sex, the threat of
violence based on sexual orientation and for even carrying condoms, and the lack of
recourse to police protection makes it difficult for many gay, lesbian, bisexual, and
transgender people to take precautions to protect against HIV/AIDS. Sex workers
suffer from many of the same threats, and face similar problems in taking measures to
protect against HIV/AIDS.

154 Human Rights Watch interview with John B., June 21, 2004.
155 Human Rights Watch interview with Patrick D., Kingston, June 9, 2004.
156 Human Rights Watch interview with Eric B., Kingston, June 8, 2004.


HUMAN RIGHTS WATCH, VOL. 16, NO. 6 (B)










Homelessness carries additional health risks and complicates the provision of even
routine medical care.157 Exposure to harsh weather conditions, poor nutrition, and the
stress of living in disordered and unsafe conditions compound health problems for
people living with HIV/AIDS.


Albert B., thirty-three, had been homeless since 2001, when he fled his town after his
close gay friend was murdered, and he was told that he was next. He told Human Rights
Watch that most of the time, he had sex outside, in open land or in the bushes. "Gay
people tend to use those places because they can't carry on at home. . But you have
to look out, in case you have to run."158


Denial of access to transportation
People known or perceived to be living with HIV are denied access to public and private
transportation, relegating many to lives isolated from important sources of social
support and undermining their capacity to obtain even basic medical care. Men who are
known or perceived to be gay are likewise denied passage on public and private
transportation, sometimes leaving them vulnerable to attack, and are routinely attacked
on public buses because of conduct or appearance perceived as homosexual.


People with HIV/AIDS may be prone to skin infections on large parts of their bodies.
Several people with HIV/AIDS told Human Rights Watch that when they suffered
visible skin infections, people in their communities would shun them, perhaps because
they feared that the skin infections-or HIV more generally-were contagious.


Angela M., forty-one, lived in a remote village, about one hour's drive from the regional
hospital and several miles from the nearest clinic. She was homebound: no public
transportation would carry her, and the only private car that would drive her was
prohibitively expensive. She told Human Rights Watch that since developing the skin
rash, "All the taxi men, they know, they say they won't carry me. ... At the bus stop,
nobody will stand beside me. I come near, people run away." When she tries to flag a
taxi by her house:


no taxi stops. People tell them that my hair falls off and I run full of
sores and I run bloody water, and nobody wants to carry me. ... I


157 See, e.g., Institute of Medicine, Homelessness, Health, and Human Needs (Washington, D.C.: National Academy
Press, 1988), chapter 4.
158 Human Rights Watch interview with Albert B., Kingston, June 9, 2004.


HUMAN RIGHTS WATCH, VOL. 16, NO. 6 (B)










need to go to the doctor, to the hospital and I don't have money to pay
a private man to get me there. To get to [the hospital], I would have to
pay a private man 3000 [Jamaican] dollars [U.S.$50] both ways. A road
taxi would cost 170 dollars one way [U.S. $2.85], 170 dollars [U.S.$2.85]
to come back.159


Lacking funds for transportation, Angela M. was unable to obtain medical treatment.


John B., a forty-nine-year-old man living with HIV/AIDS, said that taxi drivers
sometimes increased fares for people whom they suspected had HIV. He said that on
one occasion, he had a chest infection and was coughing and short of breath. He told
Human Rights Watch that as he was exiting the taxi, the driver commented, "you have
pneumonia; you have AIDS," and charged him double the usual fare.160


Adrian S., thirty, told Human Rights Watch that as a man perceived as effeminate, he
faced constant verbal and physical abuse and had been denied transportation in public
buses and taxis on many occasions. He said that: "I would be denied passage [on public
buses] because someone would say I was gay. I would have to seek transportation
elsewhere." Nor would taxis pick him up once they heard that he was gay. And
boarding a bus would not guarantee safe passage. Thomas said that he had been
assaulted by a conductress, a bus driver, and by passengers while riding the bus.161


Fabian Thomas, coordinator ofJAS' Montego Bay office, told Human Rights Watch
that he had been contacted by a man who had been attacked and thrown off a public bus
after falling asleep on another passenger's shoulder. According to Thomas, when other
passengers noticed the man's head resting on his male neighbor's shoulder, they cried
out 'battyman,"' threw him off the bus, beat him, stabbed him and left him by the side
of the road.162









159 Human Rights Watch interview with Angela M., June 15, 2004. In June 2004, 1 Jamaican dollar was equivalent to U.S.
$0.015.
160 Human Rights Watch interview with John B., June 21, 2004.
161 Human Rights Watch interview with Adrian S., Kingston, June 13, 2004. A conductor collects fares on public buses. A
conductress is a female bus conductor.
162 Human Rights Watch interview with Fabian Thomas, Montego Bay, June 22, 2004.


HUMAN RIGHTS WATCH, VOL. 16, NO. 6 (B)










Other abuses by non-state actors: violence in the family and in the
community
People living with HIV/AIDS, men who have sex with men, and women who have sex
with women are subject to violence, discrimination, and other forms of abuse by private
actors based on their HIV status and their sexual orientation. State authorities have an
obligation to respond, both to offer redress for violations and punish the offenders, but
also to prevent these violations in the first instance.


Abuses based on sexual orientation and gender identity


Because gay in Jamaica, it's hard for us to live anywhere. Those that can ... they
can rent an apartment and not be molested. But we cannot ... it. Some might
attempt to rent a little house. But within days, or it doesn't last for a month, they
have to run away, leave that they have.
-Aaron H., thirty-eight, Kingston, June 13, 2004


Men who have sex with men and women who have sex with women are routinely
subjected to verbal and physical harassment, in many cases violently evicted from their
homes and driven from their towns.


On the morning of June 24, 2004, a group of armed men forced their way into a
Kingston home, beating up six occupants while shouting homophobic threats.163 The
dancehall musician Buju Banton (Mark Anthony Myrie) is alleged to have been one of
the assailants, reportedly denouncing the occupants for being homosexual and kicking
one man in his mouth and beating him with a board. At least two of the men were
beaten seriously enough to require medical treatment. All nine residents of the house
were forced to abandon their home and possessions that same day, warned by the
attackers that they would be killed if they returned.164 Four of the men returned the
following evening with a police escort to find that their home had been ransacked,
thousands of dollars stolen, and valuable property (including a new refrigerator and
electronic equipment) destroyed.165 All of the men abandoned the residence and the


163 Human Rights Watch interviews with Charles R., Kingston, June 24 and 25, 2004 and statement of Charles
R. to police. Banton composed and performed "Boom Bye Bye," a song that celebrates the killing and burning
of gay men.
164 Human Rights Watch interviews with Charles R., Kingston, June 24 and 25, 2004; Human Rights Watch interviews
with Ricardo P., Kingston, June 24 and 25, 2004; Human Rights Watch interviews with Robert E., Kingston, June 24 and
25, 2004.
165 A Human Rights Watch researcher accompanied the victims to the residence and observed the condition of the home
and the victims' property.


HUMAN RIGHTS WATCH, VOL. 16, NO. 6 (B)










neighborhood, fearful that they would be killed if they return; since the intrusion, at least
one has received death threats.


Charles R., forty-two, Robert E., eighteen, and Ricardo P., twenty, three of the
occupants, described the attack. Charles R. told Human Rights Watch that about a
dozen men armed with machetes, guns, and knives had come to his front door around
10 a.m. on June 24, one of them pointing a gun at him, threatening to shoot him if he
did not let them in. After Charles R.'s landlord ordered him to open the door, the men
stepped in the house and ordered the occupants outside. The assailants told Charles R.
and the others that they were battymen and could not live there, and threatened to shoot
them and burn the house if they remained.166 Charles R. was kicked in the face and
beaten on his back, arm, and leg with a machete and a metal rod by at least three
assailants.167


Robert E. told Human Rights Watch that he was attacked by at least four men, who
chased him from the house, hurling insults and stones, threatening him with a knife, and
accusing him of being the "battyman ringleader." Robert E. ran into the street and
tripped and fell into a gully, seriously injuring his foot.168 Ricardo P. told Human Rights
Watch that he was beaten with a metal rod, forced to take off his shoes, and told to run
from the house.169


Human Rights Watch documented violent evictions in several towns in Jamaica, many of
which occurred either immediately preceding or during the three weeks that we were in
Jamaica. A Kingston man said:


Right now, I'm not living in my house because people thought I was
gay .... About two weeks ago, I got a call at work that there were
twenty-five men surrounding the house because they understood we
were gay and wanted us to leave because they didn't want any gay men
in the area. [I was told] that the men had machetes. I didn't go home
for two days because I was scared.




166 Human Rights Watch interview with Charles R., Kingston, June 24, 2004.
167 Ibid.
168 Human Rights Watch interview with Robert E., Kingston, June 24, 2004. The physician who examined his foot told
Human Rights Watch that Robert E.'s heelbone was broken and he risked further serious injury if he did not take good
care of it.
169 Human Rights Watch interview with Ricardo P., Kingston, June 24, 2004.


HUMAN RIGHTS WATCH, VOL. 16, NO. 6 (B)










When he returned to the house to retrieve some of his things, he noticed several men
outside. "I heard the men say, 'oh the battymen, they move.' I was scared, because they
all had machetes in their hands. In this house, all gay men lived there. Now no one
sleeps there.""17


Daniel S., nineteen, had lived on his own in Montego Bay since he was threatened by
neighbors that they would kill him and chop him up because they had heard he had sex
with men. He told Human Rights Watch, "I am unable to visit my family in the day. If
I want to visit them, it would have to be in the midnight hours."171 Vincent G., twenty-
two, stated, "I don't live anywhere now." He had been homeless since 2003, after he
was forced to leave his mother's house and his town when he was threatened by men in
the area who told him, "battyman, you have to leave. If you don't leave, we'll kill
you."172


Human Rights Watch interviewed Sebastian L., twenty-seven, a few days after he and his
friends had been attacked outside Sebastian L.'s apartment. He said that he was afraid
that the assailants might return. "So I am looking to move now, because I am afraid for
my life.""13


Women who have sex with women reported that they were subjected to constant threats
of sexual violence, in some cases serious enough to force them to leave their homes and
their neighborhoods. Several women who have sex with women told Human Rights
Watch that the message they were given was clear: that they could be "cured" of their
homosexuality by having sex with a man.


Phoebe S., forty-nine, owned a home in St. Thomas parish, where she lived alone for
five years. Men in her community called her "sodomite," pressured her to have sex with
them, and spied on her while she was bathing. She told Human Rights Watch: "Men try
to get friendly. They say, 'you're living alone for so long. You need some sex."' She
said that she had decided to sell her house "because some of the men know I'm gay and
want to rape me." She could not discern, however, whether she was continuously
targeted for sexual violence because she was a woman or because she was a lesbian. She





170 Human Rights Watch interview with Paul M., Kingston, June 6, 2004.
171 Human Rights Watch interview with Daniel S., Montego Bay, June 21, 2004.
172 Human Rights Watch interview with Vincent G., Kingston, June 14, 2004.
173 Human Rights Watch interview with Sebastian L., Ocho Rios, June 15, 2004.


HUMAN RIGHTS WATCH, VOL. 16, NO. 6 (B)










told Human Rights Watch: "I have been raped three times. Sometimes I wonder if it is
because I refuse to be with a man."174


Cynthia S., twenty-seven, said that a lesbian friend of hers had to move out of her
neighborhood because she faced constant verbal and physical harassment by men who
knew that she was a lesbian. "They would say, 'Hey girl, don't you know you are
supposed to take cock,' and put their hands on her when she passed by."175 Ryan N.
was with two lesbian friends in a local park when a man approached the women and
said, "I want to give you a good fuck and you will leave women and start with men."176


Homosexual men and women also face violence and abuse by their own family
members. After Edward P.'s mother found out that he was gay, she threatened to
poison him, which she was encouraged to do by others in their town. Edward P. told
Human Rights Watch: "\ I mother said she wanted to poison me .... I could go for
days after days starving myself. I won't eat her cooking. Yes, I actually believe she
might. People went to her and said, 'after all, he is her son.""' When Lillie P.'s mother
found out that she was lesbian, she threw her out of the family home, leaving her
without a place to live.1 8


Abuses against people living with HIV/AIDS


My mother said she would kill me .. -,.if stayed in the house.
-Ray B., eighteen, Kingston, June 8, 2004


Abuses based on sexual orientation reflect and reinforce abuses against people living
with HIV/AIDS. Health workers, AIDS outreach workers, and people living with
HIV/AIDS told Human Rights Watch that they faced abuse by family and community
members who feared that they could contract HIV/AIDS through casual contact with
them and who associated the disease with homosexuality and prostitution. Several
people living with HIV/AIDS said that they had been thrown out of their family homes
or evicted from private housing when their HIV status became known. Others kept
their HIV status secret for fear that disclosure would subject them to violence.


174 Human Rights Watch interview with Phoebe S. Kingston, June 14, 2004.
175 Human Rights Watch interview with Cynthia S., Kingston, June 8, 2004.
176 Human Rights Watch interview with Ryan N., Kingston, June 9, 2004.
177 Human Rights Watch interview with Edward P., Ocho Rios, June 16, 2004.
178 Human Rights Watch interview with Lillie P., Kingston, June 19, 2004.


HUMAN RIGHTS WATCH, VOL. 16, NO. 6 (B)










After Ray B., eighteen, told his mother that he was HIV-positive, she threatened to
poison him. He could not return home because his mother was afraid that she would
catch HIV from him. Ray told Human Rights Watch: "-\ mother is afraid that if I
touch the gate, she will catch AIDS."179 When aJAS outreach worker heard someone
telling a person living with HIV/AIDS that "AIDS smoke" from his burning rubbish
would affect him and his children, the outreach worker tried to explain that the virus was
not transmitted through the air. His efforts were unsuccessful, however. "People
started to murmur [gossip]. They said they didn't care, this guy had to leave. And he
had to move out of the community."180


Neither age nor disability affords protection from abuse. Tonya Clark, aJAS nurse, told
Human Rights Watch that the previous week, she had heard from an elderly woman
living with HIV/AIDS whose son made her sleep on the porch and fed her from a pan,
like a dog. "Her son tells everyone in the community she has AIDS. They reject her,
except for one neighbor, who gives her food-but she can't let anyone in the
neighborhood see her giving her food."181 Leonard S., a thirty-year-old disabled man
living with HIV, lived with his family. His mother, who knew that he was gay, told him
that if he contracted HIV, she would abandon him at the hospital. He feared worse. He
told Human Rights Watch that if his family or neighbors found out that he was HIV-
positive, he would flee because they would beat or kill him.182


VI. GOVERNMENT RESPONSE


Jamaica acknowledges in its official policy documents the role that homophobia plays in
driving the country's HIV/AIDS epidemic, and lists as a key priority the development of
legislation and policy to protect the human rights of people living with and affected by
HIV/AIDS.183 Despite these stated commitments, there exist few policy or legal
protections for people living with HIV/AIDS or people whose marginalized status puts
them at high risk of infection. The vast majority of people living with HIV/AIDS
remain without access to lifesaving antiretroviral medicines. While some ministries (such
as the Ministry of Education) have drafted national AIDS policies, the lack of
institutional commitment and intersectoral coordination among them hampers the


179 Human Rights Watch interview with Ray B., Kingston, June 8, 2004.
180 Human Rights Watch interview, Kingston, June 6, 2004.
181 Human Rights Watch interview with Tonya Clark, Kingston, June 14, 2004.
182 Human Rights Watch interview with Leonard S. Kingston, June 11, 2004.
183 See, e.g., Ministry of Health, "Jamaica HIV/AIDS/STI National Strategic Plan 2002-2006," January 2002, pp. 10-12
(identifying "discrimination and stigmatization around HIV/AIDS especially homosexuality" as among the factors driving
the epidemic, and policy, advocacy, legal and human rights as a top priority area in its HIV/AIDS plan).


HUMAN RIGHTS WATCH, VOL. 16, NO. 6 (B)










government's response to the epidemic. And the lack of high-level political
commitment to addressing homophobic violence further weakens efforts to fight
HIV/AIDS.



Improving legal and policy protections
In 2001, the National AIDS Committee (NAC), a government-organized NGO
established in 1988 to advise the Ministry of Health on policy issues, drafted a report
reviewing legal, ethical, and human rights issues for people living with HIV/AIDS.184
The report identified a number of weaknesses within existing legislation and
recommended changes to address them. These included drafting comprehensive
antidiscrimination legislation, strengthening legal protections for confidential
information, and repealing the sodomy laws.185


The Office of the Attorney General reviewed the NAC report and in 2002 rejected its
main recommendations, insisting that there be a national AIDS policy before any
legislation was adopted. As of this writing, the national policy document has not yet
been completed.186 High-level officials at the National HIV/AIDS Control Programme,
consistent with the NAC report and Ministry of Health policy documents, have
advocated for the need to repeal discriminatory laws because they impede HIV
prevention efforts and drive vulnerable groups from HIV services. Minister of Health
John Junor repeatedly has rejected these appeals, however.187 And in July 2004, Prime
Minister P.J. Patterson reportedly announced that his government would not be forced
by foreigners to repeal Jamaica's sodomy laws, apparently ignoring government and
NAC reports on their role in driving Jamaica's HIV/AIDS epidemic.188


The U.N. Guidelines on HIV/AIDS and Human Rights specifically recommend that
"an independent agency should be established to redress breaches of confidentiality."189


184 The Minister of Health established the National AIDS Committee (NAC) in 1988 to coordinate a national
multi-sectoral response to HIV/AIDS. It has more than one hundred members, including representatives from
public and private sector organizations and NGOs. http://www.nacjamaica.com/about_nac/index.htm (retrieved
September 16, 2004).
185 See National AIDS Committee, "HIV/AIDS Legal, Ethical and Human Rights Issues in Jamaica,"
http://www.nacjamaica.com/subcom/legal_ethical/index.htm (retrieved April 19, 2004).
186 A draft National AIDS Policy is expected to be circulated for review in the fourth quarter of 2004. Human Rights Watch
telephone interview with Ruth Jankee, executive director, National AIDS Committee, Kingston, September 7, 2004.
187 Human Rights Watch interview with Dr. Peter Figueroa, chief, Ministry of Health Epidemiology Unit, Kingston, June 23,
2004; see also Zadie Neufville, "Fear Among Gay Men Said to Fuel HIV/AIDS Cases," Inter Press Service, March 5, 2002
(reporting that Minister Junor said that while the government is "committed to preventing the spread of the disease," it had
no intention of changing the laws).
188 "PM Says Gov't Will Not Change Anti-Homosexual Laws," Jamaica Observer, July 2, 2004.
189 U.N., HIV/AIDS and Human Rights: International Guidelines, para. 30(c).


HUMAN RIGHTS WATCH, VOL. 16, NO. 6 (B)











Professional organizations governing certain health professionals are empowered to
sanction physicians, nurses, and midwives for professional misconduct, including failure
to protect confidential patient information.190 No independent agency exists, however,
to redress breaches of confidentiality by other health workers, such as porters and ward
assistants, who have access to patient dockets and may otherwise discover patients' HIV
status.191



Educating health personnel

Doctors, nurses, and other medical personnel who work with people living with HIV
need training, both about the disease as well as how to ensure human rights protections
for people living with HIV/AIDS, including ensuring confidentiality of HIV-related
information and addressing discrimination. The Jamaican government has
acknowledged that many health care personnel are not adequately trained in HIV/AIDS
care and treatment and has undertaken steps to address this problem. The Ministry of
Health has devoted a major portion of a World Bank loan to strengthening institutional
capacity to respond to HIV/AIDS, including by providing training on AIDS-related
stigma and discrimination for a range of health personnel (including doctors, nurses,
nutritionists, and medical records workers).192 The Ministry has also specifically targeted
individuals working with medical records for training on protecting confidentiality.193
These training sessions are optional, however.194 In addition, the Ministry also has
begun work with domestic and international HIV/AIDS organizations to address
problems with quality of care for people living with HIV/AIDS.195




190 See, e.g., The Medical Act, section 11; The Nurses and Midwives Act, section 11.
191 Patients can lodge complaints with the Ministry of Health within ten days after suffering a breach of confidentiality or
discrimination by health workers. Ministry of Health, "Client Charter," http://www.moh.gov.jm/Standards.htm (retrieved
August 27, 2004)
192 U.S.$4.82 million, or 29 percent of a World Bank loan received for the 2002-2006 period is being used for HIV/AIDS-
related projects, but it is unclear what portion of these funds are going to training. Country Coordinating Mechanism for
the Global Fund to Fight AIDS, Tuberculosis and Malaria, A Proposal to Scale UP HIV/AIDS Treatment, Prevention, and
Policy Efforts in Jamaica, May 2003, http://www.theglobalfund.org/search/docs/3JAMH_661_0_full.pdf (retrieved August
27, 2004), p. 26.
193 Human Rights Watch telephone interview with Kevin Harvey, coordinator of treatment, care and support for people
living with HIV/AIDS, Ministry of Health, Kingston, September 7, 2004.
194 Ibid.
195 In 2004, the Johns Hopkins Program for International Education in Gynecology and Obstetrics (JHPIEGO), a nonprofit
organization affiliated with Johns Hopkins University that receives funding from USAID, and Jamaica AIDS Support
provided training addressing stigma and discrimination against people living with HIV/AIDS and on infectious disease
control to health care workers at Kingston Public Hospital, one of Jamaica's highest-volume hospitals. The National
HIV/AIDS Program at the Ministry of Health provided oversight for this training, which did not address stigma and
discrimination against men who have sex with men or other vulnerable groups. JHPIEGO, "Project Proposal: Building the
HIV/AIDS Capacity of Health Care Providers and Communities in Jamaica," 2004; E-mail communication with Robert
Carr, director, Jamaica AIDS Support, September 7, 2004.


HUMAN RIGHTS WATCH, VOL. 16, NO. 6 (B)










These are laudable initiatives, but the findings of this report make it clear that
considerable room for improvement remains. HIV/AIDS training, including basic
information addressing HIV transmission, must extend to all hospital personnel,
including porters and laundry workers, and it must be mandatory. In addition, sanctions
must be available and imposed for disclosing confidential information about HIV status
and other HIV/AIDS-related discrimination.


In May 2004, Jamaica signed an agreement with the Global Fund to Fight AIDS,
Tuberculosis and Malaria (Global Fund) that should enable it to address some of the
major gaps in its national response. The bulk of the funds is intended to scale up
availability of antiretroviral medications, with the goal of providing access to all
Jamaicans living with HIV/AIDS within five years. The agreement also priorities
efforts to complete and implement policies and a legislative framework to protect the
human rights of people living with and at high risk of HIV/AIDS, including by
"address[ing] the repeal of discriminatory laws and policies that make it difficult to reach
vulnerable high-risk communities (especially MSM, CSWs [commercial sex workers], and
incarcerated populations)."196 The findings of this report underscore the importance of
enacting into law and enforcing human rights protections for vulnerable high-risk
groups, especially men who have sex with men, to ensure the success of its AIDS
treatment program. If the Jamaican government fails to do so, men who have sex with
men will be denied access to AIDS treatment in the same ways that they have long been
denied access to other health care services.



Efforts to address police abuse and provide HIV/AIDS education to
police
It is widely acknowledged that there is a crisis in policing in Jamaica, fueled in part by
police failure to control high rates of violent crime or to be held accountable for crimes
they commit.197 Human rights abuses by the Jamaican police have been documented
and publicized by national and international organizations for over thirty years, and
millions of dollars have been pledged toward efforts to reform police practices and
improve security.198 The Jamaican government has undertaken important efforts to


196 Country Coordinating Mechanism for the Global Fund to Fight AIDS, Tuberculosis and Malaria, A Proposal to Scale UP
HIV/AIDS Treatment, Prevention, and Policy Efforts in Jamaica, May 2003,
http://www.theglobalfund.org/search/docs/3JAMH_661_0_full.pdf (retrieved August 27, 2004), p.25.
197 See Anthony Harriott, Police and Crime Control in Jamaica: Problems of Reforming Ex-Colonial Constabularies
(Kingston, Jamaica: University of the West Indies Press, 2001); Horace Levy, They Cry 'Respect'! Urban Violence and
Poverty in Jamaica (Kingston, Jamaica: University of the West Indies Press, 2001).
198 See, e.g, ibid.; United Nations Special Rapporteur on Extrajuducial, Summary or Arbitrary Executions, "Report of the
Special Rapporteur, Asma Jahangir, submitted Pursuant to Commission on Human Rights Resolution 2003/53.
Addendum. Mission to Jamaica," E/CN.4/2004/7/Add.2, September 26, 2003; Amnesty International, Jamaica: Killings


HUMAN RIGHTS WATCH, VOL. 16, NO. 6 (B)










address these abuses, including by establishing mechanisms to investigate cases of police
misconduct and to train police regarding the proper use of force.199 But serious
problems with police abuse continue.


The Jamaican Constabulary Force JCF) has only recently acknowledged HIV/AIDS as
a workplace issue and drafted policy guidelines to address HIV/AIDS in its workforce.
These draft guidelines do not, however, address police conduct toward marginalized
populations or toward HIV/AIDS outreach workers. Nor has the government
addressed police abuse based on sexual orientation and gender identity, apparently
ignoring cases that have been documented by domestic and international human rights
organizations and by foreign governments.200



Institutional mechanisms to address police misconduct
Complaints of police abuse can be lodged directly with the Jamaican Constabulary
Force, with its Bureau of Special Investigations or with the Complaints Division of the
Office of Professional Responsibility. The Police Public Complaints Authority (PPCA),
an independent body charged with monitoring and supervising civilian complaints of
police misconduct, also is empowered to investigate cases of police misconduct. Once
an investigation has been completed, reports are sent to the Department of Public
Prosecutions for a ruling on whether criminal or disciplinary proceedings, or a coroner's
inquest, should follow.201 Public access to police and independent complaint
mechanisms is limited by lack of knowledge about them, distrust of the legal system, and
fear of reprisals for making complaints against officials.202


The Bureau of Special Investigations, which investigates fatal shootings and other
killings by police, has been criticized for its failure to conform with international
standards in conducting investigations. Failure to investigate incidents promptly or



and Violence by Police: How Many More Victims," pp. 52-54; Amnesty International, "'Until Their Voices are Heard.' The
West Kingston Commission of Inquiry," July 2003; Jamaicans for Justice, The Jamaica Justice Report, 2002; U.S.
Department of State, "Country Reports on Human Rights Practices: Jamaica, 2003," February 25, 2004. International
donors and agencies contributing to justice reform efforts include the Canadian International Development Agency
(CIDA), the World Bank, the Inter-American Development Bank, the U.S. Agency for International Development (USAID),
the European Union (EU) and the United Nations Development Program (UNDP).
199 See Police and Crime Control in Jamaica, pp. 121-182 (discussing reforms).
200 See, e.g., Amnesty International, "A Summary of Concerns: A Briefing for the Human Rights Committee," October
1997, p. 14. U.S. Department of State, "Country Reports on Human Rights Practices: Jamaica, 2003," February 25, 2004;
Robert Carr and Jamaica Forum for Lesbians, AII-Sexuals and Gays, "Testimonies," 2003.
201 Coroner's inquests are conducted before a judge and jury of the Coroner's Court and the court's verdict referred back
to the Director of Public Prosecutions for a decision whether to continue to prosecute or to close the case.
202 See "Report of the Special Rapporteur on Mission to Jamaica," September 26, 2003.


HUMAN RIGHTS WATCH, VOL. 16, NO. 6 (B)










thoroughly, including failure to collect blood and other forensic evidence or to properly
record crime scene information, compromises the chances for successful prosecution.203
The Office of Professional Responsibility, which investigates complaints of police
misconduct that do not involve firearms, has been criticized for its lack of impartiality
and thoroughness.204


The Police Public Complaints Authority has been criticized as "completely ineffectual"
in carrying out its mandate to investigate, supervise, and monitor complaints of police
misconduct.205 Jamaican and international human rights organizations have argued that
the PPCA's lack of independence and transparency and the Authority's failure to make
full use of its powers contribute to the inadequacy of its investigations.206 Justice Lloyd
Ellis, PPCA Chairman, has stated, for example, that he did not consider it appropriate or
possible to hold Jamaica to the same standards as other countries and that he was
generally satisfied with the quality of police investigations.2"0


Little attention has been paid to police interference with HIV/AIDS outreach workers
or other abuses against men who have sex with men and sex workers. When asked
about police conduct toward men who have sex with men and people living with
HIV/AIDS, Justice Ellis said that he "would be surprised if anyone could prove that
police would set up to abuse people who are homosexuals or, as you put it at high risk of
HIV. If that is done, it is done not by police acting qua police but as citizens." 208 Ellis
acknowledged that gay men might be targeted on the community level but ., -. fl, .I that
they bore some responsibility for violence committed against them: "I have no evidence
of police beating anyone for being gay. You have people doing it in the community,
doing it out of necessity. You have it every day. ... It happens in other countries too.
It's not just a problem in Jamaica."209








203 See, e.g., ibid.; Amnesty International, Jamaica: Killings and Violence by Police: How Many More Victims," pp. 52-54;
Jamaicans for Justice, The Jamaica Justice Report, 2002.
204 Ibid.
205 Jamaicans for Justice, Jamaica's Human Rights Situation, 2003, p. 6.
206 Amnesty International, Jamaica: Killings and Violence by Police, p. 55; Jamaicans for Justice, "Jamaica's Human
Rights Situation," 2003, pp. 6-7.
207 Amnesty International, Jamaica: Killings and Violence by Police p. 55.
208 Human Rights Watch interview with Justice Lloyd Ellis, executive director, Police Public Complaints Authority,
Kingston, June 23, 2004.
209 Ibid.


HUMAN RIGHTS WATCH, VOL. 16, NO. 6 (B)










Police training on HIV/AIDS and related human rights issues
Percival Buddan, the officer in charge of HIV/AIDS training for the Jamaican police
force, acknowledged that there was an urgent need for HIV/AIDS education in the
police force to ensure protection against the disease as well as protection against
HIV/AIDS-related discrimination. He told Human Rights Watch: "Until two or three
years ago, police officers were more or less in the dark about HIV/AIDS, how the virus
was contracted, about universal precautions [to protect against HIV transmission]. And
people who have HIV/AIDS may want to keep it secret because of stigma and
discrimination."210 The Jamaican Constabulary Force has published a document
addressing myths and facts about HIV/AIDS and has begun to include HIV/AIDS
education in its training and in optional lectures given in preparation for annual first aid
certification exams. It is clear that these efforts are insufficient, however. Human
Rights Watch interviewed several police officers, including a high-level police officer in
Kingston and constables in St. Ann's Bay, who made comments indicating their
confusion and incomplete knowledge about HIV transmission. In St. Ann's Bay, for
example, police officers told Human Rights Watch that people living with HIV/AIDS
should be confined in isolated areas for treatment, "so they will not be able to
contaminate other people," and that people living with HIV/AIDS were isolated from
other detainees in the police lockup.211


As of this writing, the Jamaican Constabulary Force HIV/AIDS policy has been drafted
but not approved. Percival Buddan told Human Rights Watch that the draft policy did
not address police conduct toward marginalized populations such as men who have sex
with men and sex workers or toward HIV/AIDS outreach workers to these groups.212



VII. REGIONAL EFFORTS TO ADDRESS HIV/AIDS


Regional efforts to address HIV/AIDS-related discrimination and abuses have the
potential to promote domestic policy reform in Jamaica. Regional organizations
providing assistance in drafting rights-respecting laws and policies can provide guidance


210 Human Rights Watch interview with Percival Buddan, sub-officer in charge, Jamaican Constabulary Force
First AID Center, Kingston, June 18, 2004. "Universal precautions" are simple measures taken to reduce the
risk of transmission of HIV and other bloodborne pathogens through exposure to blood or body fluids, including
the use of protective barriers such as gloves for direct contact with blood or body fluids and careful handling and
disposal of needles, waste, and other materials contaminated with blood or body fluids. World Health
Organization, "Universal Precautions, Including Injection Safety,"
http://www.who.int.hiv/topics/precautions/universal/en/ (retrieved September 16, 2004).
211 Human Rights Watch interview, St. Ann's Bay, June 16, 2004.
212 Human Rights Watch interview with Percival Buddan, sub-officer in charge, Jamaican Constabulary Force
First AID Center, Kingston, June 18, 2004 and telephone interview, Kingston, October 26, 2004.


HUMAN RIGHTS WATCH, VOL. 16, NO. 6 (B)











to Jamaica and use their influence to lobby Jamaica to enact such legislation on an urgent
basis. Regional organizations also can lobby for policy changes that national
organizations lack the political or economic resources to support (such as repeal of the
sodomy laws). These efforts may be constrained by the United States, a major donor,
through its imposition of policies that limit the capacity to advocate for the rights of sex
workers.213


The Pan Caribbean Partnership on HIV/AIDS (PANCAP), a coalition of public and
private national, regional, and international organizations, was established in 2001 by the
Caribbean Community (CARICOM) to scale up national and regional responses to
HIV/AIDS among twenty-one Caribbean states and territories. PANCAP's priority
areas of action include ensuring that national legislation and policies incorporate
international human rights protections; providing treatment, care, and support for
people living with HIV/AIDS; and preventing HIV among vulnerable populations,
including men who have sex with men and sex workers.


Since 2002, PANCAP has worked with the Canadian HIV/AIDS Legal Network to
assist national governments in the region in developing law, policy, and ethical
guidelines.214 PANCAP is currently working with seven Caribbean countries to draft
legislation to protect people living with HIV/AIDS against discrimination at work and in
the health care system, and to ensure universal access to treatment for people living with
HIV/AIDS. According to St. Kitts and Nevis Prime Minister Denzil Douglas, who
represents CARICOM on HIV issues, PANCAP also has been discussing condom
distribution in prisons and laws criminalizing sex between men.215


213 U.S. law and policy bars the use of international HIV/AIDs and anti-trafficking funds by organizations that
promote or advocate prostitution as an employment choice or the legalization of prostitution and that do not
have a policy explicitly opposing prostitution. See United States Leadership against HIV/AIDS, Tuberculosis
and Malaria Act of 2003, P.L. 108-25 (2003) (commonly know as the President's Emergency Plan for AIDS
Relief or PEPFAR), section 104A(e); Office of the United States Global AIDS Coordinator, "The President's
Emergency Plan for AIDS Relief. U.S. Five Year Global HIV/AIDS Strategy," February 2004, p. 65; U.S.
Agency for International Development, "Trafficking in Persons: USAID Strategy for Response," February 2003,
p. 4. Peer education projects are often the most effective and only possible AIDS educators for sex workers
and have been acknowledged for their success in providing HIV education and prevention services in many
countries throughout the world. See Kemala Kempadoo and Jo Doezema, Global Sex Workers: Rights,
Resistance, Rebellion (London: Routledge, 1998); Human Rights Watch, "Epidemic of Abuse: Police
Harassment of HIV/AIDS Outreach Workers in India," A Human Rights Watch Report, vol. 14, no. 5(c), July
2002. U.S. funding restrictions undermine support for this important work, and limit advocacy strategies to
ensure safe sex during sex work.
214 Canadian HIV/AIDS Legal Network, PANCAP, CARICOM, "Action Plan and Workshop Reports: Programme on
HIV/AIDS, Law, Ethics and Human Rights," January 2004.
215 Caribbean poised to pass HIV Laws," BBC Caribbean, March 8, 2004. This contradicts current CARICOM model
legislation for sexual offences that endorses criminalization of adult homosexual conduct. See CARICOM Model
Legislation for Sexual Offences, section 15, http://www.caricom.org/archives/sexualoffences.htm (retrieved August 27,
2004).


HUMAN RIGHTS WATCH, VOL. 16, NO. 6 (B)










In October 2003, the Global Fund approved eight CARICOM proposals, including
regional proposals by PANCAP and the Organization of Eastern Caribbean States
(OECS).216 PANCAP's proposal aims to bolster its current law reform efforts by
establishing a regional mechanism to ensure human rights protections for people living
with HIV/AIDS; to coordinate regional and sub-regional HIV/AIDS prevention
efforts; and to address inequities in care, treatment, and support among Caribbean
countries.217 PANCAP regional efforts to ensure human rights protections have the
potential to complement Jamaica's national law and policy reforms.


There have been important regional efforts to establish and coordinate networks of
people living with HIV/AIDS, men who have sex with men, and sex workers. The
Caribbean Regional Network of People living with HIV/AIDS (CRN+) provides
training and technical assistance to people living with HIV/AIDS in twenty-seven
territories and seven national networks in the Caribbean region. CRN+'s position on
the PANCAP steering committee has made it a key partner in regional initiatives,
including with the World Bank and the Caribbean Health Research Council. In July
2004, CRN+ got approval of its own Global Fund proposal, which aims to enhance the
capacity of people living with HIV/AIDS in the region to obtain treatment, care, and
support services, to adhere to new treatment regimes, and to participate in advocacy and
policymaking on the national and regional level.218 This initiative targets people living
with HIV/AIDS and their networks in twelve Caribbean countries, including Jamaica.219
In Jamaica, the United Nations Theme Group on HIV/AIDS is also providing support
and technical assistance for the Jamaican Network of Seropositives (JN+).220


Since 2003, the NGO International HIV/AIDS Alliance has been working in several
Caribbean countries to mobilize support and HIV/AIDS prevention education for men




216 These proposals were from Guyana and Haiti (two each), Belize, Jamaica, the Organization of Eastern
Caribbean States and PANCAP. CARICOM, "Eight CARICOM Proposals Successful at Sixth Meeting of Global
Fund to Fight AIDS, Tuberculosis and Malaria (GFATM)," October 15, 2003.
217 PANCAP, Scaling Up the Regional Response to HIV/AIDS through the Pan Caribbean Partnership on HIV/AIDS. The
OECS proposal focuses on improving access to HIV/AIDS prevention and treatment services in the nine small island
nations that comprise the OECS subregion (Anguilla, Antigua & Barbuda, the British Virgin Islands, Dominica, Grenada,
Montserrat, St. Kitts & Nevis, St. Lucia, and St Vincent and the Grenadines), which share strong economic, social and
cultural links. Country Coordinating Mechanism, Scaling up prevention, care and treatment to combat the HIV/AIDS
pandemic in the organization of Eastern Caribbean States (OECS) Sub-Region.
218 CRN+, Strengthening the Community of PLWHA and those affected by HIV/AIDS in the Caribbean-a Community
Based Initiative, http://www.theglobalfund.org/search/docs/4MANH_767_0_full.pdf (retrieved August 20, 2004).
219 Ibid.
220 Human Rights Watch interview with Bernard Bainvil, Chair, U.N. Theme Group on HIV/AIDS, Jamaica, Kingston, June
10, 2004.


HUMAN RIGHTS WATCH, VOL. 16, NO. 6 (B)










who have sex with men.221 In 2003, Jamaica AIDS Support collaborated with the
Alliance to establish and support community organizations of men who have sex with
men in the eastern Caribbean, and to form a regional network of groups working with
men who have sex with men to provide support to national groups.222 The Latin
American Association for Comprehensive Health and Citizenship, a network of lesbian,
gay, bisexual, and transgender groups in Central and South America, has been working
with groups working with men who have sex with men in the region to develop and
support strategies to force governments to address the needs of men who have sex with
men in national HIV/AIDS programs.223


In some Caribbean countries since the mid-1990s, sex worker organizations have been
providing HIV/AIDS and other health services, and advocating for the protection of
sex workers' rights.224 The Movimiento de Mujeres Unidas, MODEMU (The Movement of
United Women) and the Maxi Linder Association in Suriname have been internationally
recognized for such work and looked to as models for other organizations in the region.


The U.S. government provides significant funding to support HIV/AIDS-related work
in the region, including work targeting sex workers. U.S. law and policy bars the use of
these funds by organizations that do not have a policy explicitly opposing prostitution
and limits the legal advocacy that can be done with these funds. These funding
restrictions limit the extent to which other organizations might emulate the exemplary
work of organizations like MODEMU and the Maxi Linder Association. A health
worker working with sex workers in Jamaica told Human Rights Watch that the
restrictions have impeded the organization's work with sex workers by undermining its
ability to support efforts for sex workers to organize on their own behalf and to join
with regional and international calls for advocacy on behalf of the rights of sex
workers.225 Other NGOs that receive U.S. government funding to work with sex
workers in the region may face similar obstacles.



221 International HIV/AIDS Alliance, Annual Review 2003, pp. 41-42. The Alliance established its Caribbean program in
2003, and targets prevention and care activities for men who have sex with men, sex workers, and people living with
HIV/AIDS.
222 Ibid.; Human Rights Watch e-mail communication with Robert Carr, director, Jamaica AIDS Support, August 19, 2004.
223 Asociacion para la Salud Integral y Ciudadania de America Latina (ASICAL), "Quienes Somos,"
http://www.sidalac.org.mx/asical/asical.html (retrieved August 21, 2004). The International AIDS Alliance and the POLICY
Project have been collaborating with ASICAL in this work. See International AIDS Alliance, Annual Review 2003, p. 41;
The Men's Health in Latin America," February 6, 2003, http://www.policyproject.com/page_whatsNew.cfm?read=30
(retrieved August 21, 2004); POLICY Project, "POLICY/ASICAL Training Promotes Men's Health in Latin America,"
February 6, 2003, http://www.policyproject.com/page_whatsNew.cfm?read=30 (retrieved August 21, 2004).
224 See Kemala Kempadoo and Jo Doezema, Global Sex Workers: Rights, Resistance, Rebellion (London: Routledge,
1998).
225 Human Rights Watch interview, Kingston, June 14, 2004.


HUMAN RIGHTS WATCH, VOL. 16, NO. 6 (B)










VIII. LEGAL STANDARDS


When people in Jamaica are driven from their homes and towns, subjected to relentless
violence with little recourse to police protection, discriminated against in health care
provision, and face public disclosure of confidential and private information because
they are living with HIV/AIDS or based on their sexual orientation or gender identity,
they are not experiencing "Jamaican culture." They are experiencing human rights
violations.


Jamaica has ratified international and regional treaties requiring it to protect human
rights to freedom from violence and arbitrary arrest and detention, freedom of
association and assembly, the highest attainable standard of health, privacy, and
nondiscrimination based on sexual orientation, gender identity, and HIV status. These
treaties include the International Covenant on Civil and Political Rights (ICCPR), the
International Convention on Economic, Social and Cultural Rights (ICESCR), the
Convention on the Elimination of all Forms of Discrimination against Women, and the
American Convention on Human Rights (ACHR).


Laws criminalizing homosexual conduct and abuses based on sexual orientation and
gender identity have been extensively reviewed by United Nations bodies charged with
interpreting these treaties, U.N. special experts on torture, extrajudicial executions, and
health, and bodies established by the U.N. charter for the protection and promotion of
human rights. Jamaica's sodomy laws and many of the practices described in this report
are completely at odds with the conclusions of these bodies, which have roundly
condemned such laws and practices as violations of fundamental human rights to
privacy and nondiscrimination, and for fueling serious human rights abuses against
sexual minorities.


Freedom from violence
The Jamaican Constitution recognizes the right to life as a fundamental right.226 Jamaica
has also ratified international and regional instruments that enshrine this protection,
including the International Covenant on Civil and Political Rights (ICCPR) and the
American Convention on Human Rights.227 By inciting third parties to commit acts of
serious violence against men who have sex with men and failing properly to investigate



226 Jamaican Constitution, article 14.
227 ICCPR, 999 U.N.T.S. 171, entered into force March 23, 1976, article 6; American Convention on Human Rights,
ratified by Jamaica on August 7, 1978, article 4(1).


HUMAN RIGHTS WATCH, VOL. 16, NO. 6 (B)











crimes of violence against them, the Jamaican government is failing in its obligation to
protect the right to life.


The ICCPR and the American Convention require states to prevent torture and other
cruel, inhuman or degrading treatment or punishment, including by private actors.228
These treaties further require state parties to ensure to all persons within their territory
the rights recognized therein.229


When police beat, mistreat, and abuse people on the basis of their HIV status, sexual
orientation, or consensual sexual conduct with members of the same sex, they violate
these basic protections. When police instigate or fail to protect against such violence or
abuse committed by private actors, they also violate these protections. The ICCPR's
prohibition against torture and cruel, inhuman or degrading treatment or punishment
applies "not only to acts that cause physical pain but also to acts that cause mental
suffering to the victim."230


The Convention on the Elimination of All Forms of Discrimination against Women
(CEDAW), to which Jamaica is a party, requires state parties "without delay" to take all
appropriate measures to end gender-based discrimination, including by taking action to
modify rigid stereotyping of the roles of men and women.231 Gender-based violence
may also be considered a form of gender-based discrimination prohibited under
CEDAW.232 The CEDAW Committee recognizes that pervasive sex-based stereotyping
perpetuates social prejudices and contributes to gender-based violence.233 Although the


228 ICCPR, article 7; American Convention, article 5; see also CEDAW General Recommendation 19 ("Under general
international law, States may also be responsible for private acts if they fail to act with due diligence to prevent violations
of rights or to investigate and punish acts of violence, and for providing compensation.").
229 ICCPR, article 2; American Convention, article 1(1).
230 Human Rights Committee, General Comment 20, Article 7 (Forty-fourth session, 1992), Compilation of General
Comments and General Recommendations Adopted by Human Rights Treaty Bodies, U.N. Doc. HRI\GEN\1\Rev.1 at 30
(1994). The Human Rights Committee, the United Nations body charged with monitoring implementation of the ICCPR,
has commented that states should provide special protections for particularly vulnerable persons. The Special
Rapporteur on Torture has identified sexual minorities as a "particularly vulnerable group" with respect to torture in various
contexts, and condemned discriminatory laws and attitudes that subject members of sexual minorities to abuse and
deprive them of means to claim and ensure enforcement of their rights. "Report of the Special Rapporteur on the question
of torture and other cruel, inhuman and degrading treatment or punishment," U.N. General Assembly, U.N. Doc. A/56/156,
July 3, 2001.
231 CEDAW, G.A. Res. 34/180, U.N. Doc. A/34/46, entered into force September 3, 1981, articles 2, 5(a).
232 CEDAW, article 2; United Nations General Assembly, "Declaration on the Elimination of Violence against Women,"
A/RES/48/104, December 20, 1993 (issued on February 23, 1994), article 4; Committee on the Elimination of All Forms
of Discrimination against Women, Violence Against Women. General Recommendation 19 (eleventh session, 1992), U.N.
Document CEDAW/C/1992/L.1/Add.15, para. 11; see also Inter-American Convention on the Prevention, Punishment and
Eradication of Violence against Women," article 4.
233 CEDAW Committee, Violence Against Women, General Recommendation 19, para. 11.


HUMAN RIGHTS WATCH, VOL. 16, NO. 6 (B)










Committee's comments focus on violence against women, the phrase "gender-based
violence" includes violence targeted against both men and women based on their sexual
orientation or gender identity. Thus, men as well as women may be targeted for
discrimination because they fail to conform to stereotypes based on gender or because
they claim a gender identity that fails to conform to societal expectations. The measures
enumerated by the CEDAW Committee to combat gender-based violence include
instituting effective complaints procedures and remedies for survivors of gender-based
violence, and ensuring appropriate medical care, counseling and support services.234
States should adopt these sorts of measures to protect men, as well as women, from
gender-based violence.



The right to privacy and the right to freedom from discrimination

Jamaica's sodomy laws (sections 76, 77, and 79 of the Offences against the Person Act)
are meant, and used, to criminalize consensual sexual conduct between adult males, and
are used to criminalize consensual sexual conduct between adult females. In the 1994
case of Nicholas Toonen v. Austral/a, the U.N. Human Rights Committee, which monitors
compliance with and adjudicates complaints brought under the ICCPR and its Optional
Protocol, held that sodomy laws punishing consensual, adult homosexual conduct
violate the rights to privacy and nondiscrimination guaranteed by the ICCPR.235 The
Committee also noted that criminalization of homosexual practices hampered HIV
prevention "by driving underground many of the people at risk of infection."236 The
Committee has thus urged states to bar discrimination based on sexual orientation.237


Since Toonen, the Human Rights Committee, the Committee on Economic, Social and
Cultural Rights, and the CEDAW Committee have called for the repeal of laws
criminalizing consensual adult homosexual conduct.238 In the case of Trinidad and
Tobago, the Human Rights Committee has urged that it extend the provisions of anti-





234 Ibid., para. 24.
235Nicholas Toonen v. Australia, Human Rights Committee, 50th Session, Case no. 488/1992, U.N. Doc.
CCPR/C/50/D/488/1992 (April 4, 1994).
236 Ibid., para. 8.5.
237 See, e.g., U.N. Human Rights Committee, "Concluding Observations of the Human Rights Committee: Poland," 66th
Session, U.N. Doc. CCPR/C/79/Add.110, p. 23 (urging inclusion of constitutional protections against sexual-orientation-
based discrimination).
238 See Ignacio Saiz, "Bracketing Sexuality: Human Rights and Sexual Orientation-A Decade of Development
and Denial at the U.N.," Health and Human Rights, vol. 7, no. 2, pp. 51-52 and n. 16 (citing decisions in which
HRC has called for repeal in Tanzania and Romania; the CESCR has called for repeal in Cyprus; and CEDAW
has called for repeal in Kyrgystan).


HUMAN RIGHTS WATCH, VOL. 16, NO. 6 (B)










discrimination legislation "to those suffering discrimination on grounds of age, sexual
orientation, pregnancy or infection with HIV/AIDS."239


The U.N. Special Rapporteur on Extrajudicial, Summary, or Arbitrary Executions has
observed that sodomy laws facilitate violence and human rights abuses against sexual
minorities:


The Special Rapporteur further believes that criminalizing matters of
sexual orientation increases the social stigmatization of members of
sexual minorities, which in turn makes them more vulnerable to violence
and human rights abuses, including violations of the right to life.
Because of this stigmatization, violent acts directed against persons
belonging to sexual minorities are also more likely to be committed in a
climate of impunity.240


Human Rights Watch recognizes the freedom of all people to follow their conscience in
deciding whether to support or oppose homosexuality or homosexual behavior.
However, rigid stereotyping of roles for men and women can lead to significant abuse of
people who do not conform to those stereotypes and contribute to gender-based
violence. Jamaica's obligations under international law to protect against gender-based
discrimination require that it take "all appropriate measures" to "modify the social and
cultural patterns of conduct of men and women, with a view to achieving the elimination
of prejudices and customary and all other practices which are based on the idea of the
inferiority or the superiority of either of the sexes or on stereotyped roles for men and
women."241 Moral objections to nonconforming sexual orientation or gender identity
are not an adequate basis to avoid this obligation.


The U.N. Commission on Human Rights, the main political body within the U.N.
system charged with human rights matters, interprets article 26 of the ICCPR, which
prohibits[] any discrimination and guarantees] all persons equal and effective
protection against discrimination on any ground such as race, colour, sex, language,





239 Concluding Observations of the Human Rights Committee: Trinidad and Tobago," U.N. Doc.
CCPR/CO/70/TTO, November 3, 2000, para. 11.
240 "Report of the Special Rapporteur on extrajudicial, summary or arbitrary executions," U.N. Doc. E/CN.4/1999/39,
January 6, 1999, para. 77.
241 CEDAW, article 5(a); see also CEDAW Committee, General Recommendation 19 (noting importance of
rejecting stereotyped roles for men because they contribution to gender-based violence).


HUMAN RIGHTS WATCH, VOL. 16, NO. 6 (B)










religion, political or other opinion, national or social origin, property, birth or other
status" as prohibiting discrimination based on HIV/AIDS.242


The non-binding U.N. International Guidelines on HIV/AIDS and Human Rights
enjoin states to "enact or strengthen anti-discrimination and other protective laws that
protect vulnerable groups, people living with HIV/AIDS and people with disabilities in
the public and private sectors."243 The guidelines advise that the laws cover health care
and access to transportation (among other areas), and note particular areas where
discrimination is likely and merit legal protection, including: (1) protection from
discriminatory acts, including "HIV/AIDS vilification" and vilification of people who
engage in same sex relationships; and (2) protection of confidentiality of medical
information, including HIV status, and other personal information, and the need for
disciplinary and enforcement mechanisms in cases of breaches of confidentiality.244


International law proscribing discrimination extends to discrimination in provision of
transportation based on sexual orientation and HIV/AIDS. The U.N. Human Rights
Committee has found that prohibitions on discrimination place a broad mandate on
states to remedy unequal treatment in all areas of life, finding that article 26 of the
ICCPR "prohibits discrimination in law or in fact in any field regulated or protected by
the public authorities."245 Jamaica is therefore responsible for providing protections
against discrimination in transportation services (buses, taxis) subject to its regulation.



Freedom from arbitrary arrest and detention
The ICCPR and the American Convention protect the right to liberty and security of the
person and prohibit all arbitrary detention.246 The U.N. Working Group on Arbitrary
Detention has affirmed that the detention of people solely on the basis of their sexual



242 ICCPR, article 26; Commission on Human Rights, "The Protection of Human Rights in the Context of Human
Immunodeficiency Virus (HIV) and Acquired Immune Deficiency Syndrome (AIDS)," Resolution 1995/44, adopted without
a vote, March 3, 1995.
243 U.N., HIV/AIDS and Human Rights International Guidelines, Guideline 5.
244 Ibid., paras. 30(a), (d), (h). The U.N. Guidelines specifically recommend that "an independent agency should be
established to address breaches of confidentiality," and that "provision should be made for professional bodies to
discipline cases of breaches of confidentiality as professional misconduct." Ibid., para. 30(c).
245 Human Rights Committee, General Comment 18: Nondiscrimination, 37th Session, 1989, U.N. Doc. HRI/GEN/1/Rev.1,
p. 26.
246 ICCPR, articles 9(1) and 9(3); American Convention, article 7. The U.N. Human Rights Committee, in its authoritative
interpretation of the article 9 right to liberty and security, states that article 9(1) is "applicable to all deprivations of liberty,
whether in criminal cases or in other cases such as, for example, mental illness, vagrancy, drug addiction, educational
purposes, immigration control, etc." U.N. Human Rights Committee, General Comment 8: Right to liberty and security of
persons (Art. 9), Sixteenth session, 30/06/82


HUMAN RIGHTS WATCH, VOL. 16, NO. 6 (B)










orientation violates fundamental human rights.247 The ICCPR further provides an
enforceable right to compensation for victims of unlawful arrest or detention.248 The
protections of the ICCPR and the American Convention are violated when state agents
arrest or detain people on the basis of their sexual orientation, their consensual sexual
conduct with others of the same sex, or their association with homosexual men and
women and with sex workers.



Freedom of association and assembly
The ICCPR and the American Convention protect the rights of assembly and to
freedom of association with others.249 States violate these rights when police harass,
arrest and otherwise abuse men who have sex with men, women who have sex with
women, sex workers, and peer educators attempting to provide HIV/AIDS education
and services to them. States also violate these rights when they promulgate laws that
impede efforts by such people to organize to assert and defend their rights or hinder
others from doing so on their behalf. In this respect, Jamaica's sodomy laws violate the
rights to freedom of association and assembly.


Jamaica's failure to protect the rights of groups like the Jamaica Forum for Lesbians, All-
Sexuals and Gays to safely convene has consequences for their ability to exercise other
rights, as the U.N. has recognized. The U.N. General Assembly's Declaration on
Human Rights Defenders has called attention to the role of the freedoms of association
and assembly in the defense of all human rights.250 Indeed, the Special Representative of
the U.N. Secretary General on Human Rights Defenders has called attention to the
"greater risks... faced by defenders of the rights of certain groups as their work
challenges social structures, traditional practices and interpretations of religious precepts
that may have been used over long periods of time to condone and justify violation of
the human rights of members of such groups. Of special importance will be... human
rights groups and those who are active on issues of sexuality, especially sexual
orientation."251




247 U.N. Working Group on Arbitrary Detention, "Opinion no. 7/2002 (Egypt)", at 7 and 14-15.
248 ICCPR, article 9(5); see also American Convention, article 10 (providing right to compensation where sentenced by a
final judgment through miscarriage of justice).
249 ICCPR, articles 21, 22(1); American Convention, articles 16, 17; see also Universal Declaration of Human
Rights, article 20.
250 U.N. Declaration on the Rights and Responsibilities of Individuals, Groups, and Organs of Society to Promote and
Protect Universally Recognized Human Rights and Fundamental Freedoms (U.N. General Assembly Resolution
53/144, March 8, 1999), article 5.
251 "Report of the Special Representative to the Secretary General on human rights defenders," U.N. Doc.
E/CN.4/2001/94, para. 89(g).


HUMAN RIGHTS WATCH, VOL. 16, NO. 6 (B)











The right to the highest attainable standard of health
International law recognizes the human right to obtain life-saving health services without
fear of punishment or discrimination. The International Covenant on Economic, Social
and Cultural Rights (ICESCR) guarantees the right to the highest attainable standard of
health without discrimination based on certain prohibited grounds (including sexual
orientation and HIV status) and requires governments to take all necessary steps for the
"prevention, treatment and control of epidemic . diseases.252 The Committee on
Economic, Social and Cultural Rights has interpreted article 12 to require state parties to
ensure access to information and services necessary for physical and mental health
without discrimination based on HIV status and sexual orientation.253 According to the
CESCR, article 12 of the ICESCR also requires states to take affirmative steps to
promote health, including ensuring that third parties do not limit access to health-related
information and services and refrain from conduct that limits people's capacity to
protect their health.254


Laws and policies that "are likely to result in ... unnecessary morbidity and preventable
mortality" constitute specific violations of the right to health.255 Police interference with
HIV prevention efforts and discriminatory access to health facilities and services are a
blatant interference with the right to the highest attainable standard of health. Jamaica's
failure to ensure that government and private actors do not interfere with the ability of
men who have sex with men and women who have sex with women to receive health
information and services and to protect confidential information about HIV status also
violates the right to the highest attainable standard of health.256


Access to complete and accurate information about condoms and HIV/AIDS is
recognized by article 19 of the ICCPR, which guarantees the "freedom to seek, receive



252 ICESCR, U.N. Doc. A/6316 (1966), articles 2(2), 12(1), 12(2)(c). Article 10 of the Additional Protocol to the
American Convention on Human Rights in the Area of Economic, Social and Cultural Rights protects the right to
health. Although Jamaica has not acceded to this convention, it does codify prevailing Organization of
American States (OAS) standards. Jamaica's obligations under the American Convention require it to take
measures toward progressive realization of such standards. See American Convention, article 26 (obligating
state parties to adopt measures toward progressive realization of rights implicit in economic, social, educational,
scientific and cultural standards set forth in the OAS Charter).
253 Committee on Economic, Social and Cultural Rights, General Comment 14: The Right to the Highest Attainable
Standard of Health, August 11, 2000, paras. 12, 18, 19, 30, 50, 54.
254 Ibid., paras. 33, 50.
255 Ibid., para. 50.
256 General Comment 14, paras. 12, 16 and n. 8; see also Human Rights Watch, Ignorance Only: HIV/AIDS,
Human Rights and Federally Funded Abstinence-Only Programs in the United States. Texas: A Case Study,
vol. 15, no. 5(g), September 2002, pp. 41-42.


HUMAN RIGHTS WATCH, VOL. 16, NO. 6 (B)










and impart information of all kinds."257 Parties to the ICCPR are obliged not only to
refrain from censoring information, but to take active measures to give effect to this
right.258 The Committee on Economic, Social and Cultural Rights similarly stated that
"information accessibility" is an essential element of the human right to health, noting
that "education and access to information concerning the main health problems in the
community, including methods of preventing and controlling them" are of "comparable
priority" to the core obligations of the ICESCR.259


Access to HIV prevention services saves lives. Access to health care prevents people
living with HIV/AIDS from unnecessary suffering and early death. The right to life is
recognized by all major human rights treaties and, as interpreted by the U.N. Human
Rights Committee, requires governments to take "positive measures" to increase life
expectancy.260 These should include taking adequate steps to provide accessible
information and services for HIV prevention, and ensuring access to medical treatment
for people living with HIV/AIDS.



IX. CONCLUSION


Jamaica is at a crossroads in its efforts to address its growing HIV/AIDS epidemic. The
epidemic is spreading among the general population, and HIV/AIDS is on the increase.
The Jamaican government-namely, the Ministry of Health's national HIV/AIDS
program-has acknowledged that human rights abuses against marginalized populations
at risk of HIV and against people living with HIV/AIDS are important factors driving
the epidemic. Its national HIV/AIDS strategy has at its core protection of human rights
and fundamental freedoms of people living with and at high risk of HIV/AIDS. And
since 2002, the Jamaican government has received significant resources to put its
national HIV/AIDS strategy into action, including by developing a legal framework to
ensure human rights protections.






257 ICCPR, article 19(2).
258 See ICCPR, article 2(2), providing that "each State Party to the present Covenant undertakes to take the necessary
steps, in accordance with its constitutional processes and with the provisions of the present Covenant, to adopt such laws
or other measures as may be necessary to give effect to the rights recognized in the present Covenant." State
responsibility to give effect to the right to information is further elaborated in S. Coliver, ed., The Right to Know: Human
Rights and access to reproductive health information (Article 19 and University of Pennsylvania Press, 1995), pp. 45-47.
259 Committee on Economic, Social and Cultural Rights (CESCR), The right to the highest attainable standard of health,
para. 44(d).
260 Human Rights Committee (HRC), The right to life: HRC General comment 6 (16th Sess., 1982), para. 5.


HUMAN RIGHTS WATCH, VOL. 16, NO. 6 (B)










But absent political leadership to end state-sponsored violence and discrimination
against men who have sex with men, sex workers, and people living with HIV/AIDS
and against peer educators working with them, Jamaica could miss an opportunity to
reverse the course of its epidemic. Government leaders must act quickly and forcefully
to combat widely-held prejudices that interfere with HIV/AIDS policy and undermine
Jamaicans' human right to health. The Jamaican government must also join forces with
regional efforts to reform discriminatory laws and policies that create the conditions in
which the epidemic flourishes. If Jamaica fails to take such steps, its investment in
fighting AIDS will be wasted. The cost will be immeasurable, and for many Jamaicans,
the consequences will prove fatal.


Acknowledgments


This report was written by Rebecca Schleifer, based on research conducted by Rebecca
Schleifer of the HIV/AIDS and Human Rights Program and Scott Long of the Lesbian,
Gay, Bisexual, and Transgender Rights Program at Human Rights Watch. It was
reviewed by Joanne Csete, director of the HIV/AIDS Program; Scott Long, director,
Lesbian, Gay, Bisexual, and Transgender Rights Program; Marianne Mollmann,
Americas researcher for the Women's Rights Division; Daniel Wilkinson, researcher
with the Americas Division; Dinah PoKempner, general counsel; and Widney Brown,
deputy program director of Human Rights Watch. Production assistance was provided
by Jennifer Nagle, Andrea Holley, Veronica Matushaj, and Fitzroy Hepkins.


A number of experts and nongovernmental organizations in Jamaica and elsewhere
assisted with this research. Human Rights Watch gratefully acknowledges the Jamaica
Forum of Lesbians, All-Sexuals and Gays and Jamaica AIDS Support for their invaluable
assistance and courageous work.


We extend sincere thanks to everyone who shared their experiences with us and made
this report possible, and regret that we cannot mention of all them by name.


HUMAN RIGHTS WATCH, VOL. 16, NO. 6 (B)











Appendix

Dancehall Songs Referred to in the Report


Boom Bye Bye261 by Buju Banton


Werl iz in chobl
Enitaim Buju Banton com
Battybwoy git op ahn ron
A gonshat, mi hed bak
Hie mi tel im nou, kruu, iz laik ...


Chorus:
Boom, bai bai, iina battybwoy hed
Ruud buai no promuot no naasi man
Dem hafi ded
Boom, bai bai, iina battybwoy hed
Ruud buai no promuot no naasi man
Dem hafi ded.


Tuu man ichop ahn a robop
Ahn a lie dong iina bed
Ogop uan aneda ahn a fiilop leg
Sen fi di matic ahn di Uzi instead
Shuut dem, no come ef wi shuut dem.


No waahn Jaki, gi dem Paal instead
Dem no waahn di swiitnis bitwiin di leg


Gial ben dong bakwie ahn aksep di peg
Ahn efi riili at
Yu nuo shi still naa go fled.


Som man still no waahn di panti tried
Pior batty bizniz dem lov
Mi se human iz di grietes ting
Gad eva put pan di lan


World is in trouble
Anytime Buju Banton comes
Faggots get up and run
A gunshot, yikes
Hear me tell him now, crew, it's like ...


Boom, bye bye, in a f _ .r's head
Rude boys don't promote nasty men
They have to die
Boom, bye bye, in a f _.r's head
Rude boys don't promote nasty men
They have to die.


Two men hitch up and are rubbing up
And are laying down in bed
Hug up one another and feeling up legs
Send for the automatic and the Uzi instead
Shoot them, don't come if we shoot them.


Don't wantJackie, give them Paul instead
They don't want the sweetness between the
legs
Girl bend down backwards and accept the peg
And if it really hurts
You know she still won't flee.


Some men still don't want the panty raid
Only bottom business they love
I say woman is the greatest thing
God ever put on the land


261 Gun shot sounds


HUMAN RIGHTS WATCH, VOL. 16, NO. 6 (B)











Buju lovin dem fram hed dong to fut batam.


Bot som man a ter roun
We dem get dat fram?
Piita iz nat fa Janit, Piita iz faJan
Suuzet iz nat fa Paal, Suuzet is fa An
We di bomboclaat dem gat dat fram?


ler com di DJ niem Buju Banton
Com fi schrietn yu taak
Kaa mi se dis iz nat a baagin
Mi se dis iz nat a diil
Gai com nier wi den him skin mos piil
Bon im op bad laik a uol taia will.


Aal di Niuu Yaak kruu dem no promuot battyman

Jomp ahn daans, unu push op unu an
Aal di Bruklin gial dem no promuot battyman
Jomp ahn buogl ah wain yu batam
Kianiedian gial dem no laik battyman
Efyu a no uan, yu hafi push up yu an.


Buju loving them from head down to feet.


But some men are turning around
Where do they get that from?
Peter is not for Janet, Peter is for John
Suzette is not for Paul, Suzette is for Ann
Where the fuck do they get that from?


Here comes the DJ named Buju Banton
Come to straighten your talk
Because I say this is not a bargain
I say this is not a deal
Guy comes near us then his skin must peel262
Bum him up bad like an old tyre wheel.


All the New York crew don't promote faggots

Jump and dance, everyone put up your hands
All the Brooklyn girls don't promote faggots
Jump and ... .1 .- and gyrate your bottom
Canadian girls don't like faggots
If you are not one, you have to put up your
hand.


Chi Chi Man [Gay Man], by TOK


My Crew (My Crew) my dogs (my dogs)


Set rules (Set rules) set laws (set laws)


We represent for di lords of yards


A gal alone a feel up my balls


My crew (my people) my dogs (my
people)
Set rules (Set rules) set laws (set
laws)
We represent all the area dons [gang
leaders]
Only girls are allowed to feel up my
balls


Chorus:


262 In Jamaica, pouring acid on an individual is a common revenge tactic
263 A type of dance


HUMAN RIGHTS WATCH, VOL. 16, NO. 6 (B)











From dem a par inna chi chi man car


Blaze di fire mek we bun dem! (Bun dem!)


From dem a drink inna chi chi man bar
Blaze di fire mek we dun dem! (Dun dem!)




So mi go so, do yuh see weh I see?


i _ when your doing that
Nuff a dem a freak dem a carry all dem dutty act


Thug nigga wanna bees nuff a dem a lick it back


It dem bring it to we, hold on nuff coppa a shot


Coppa shot rise up every calico go rat tat tat


Rat tat tat every chi chi man dem haffi get flat
die
Get flat, mi and my niggas ago mek a pack


Chi chi man fi dead and dat's a fact.


So mi go so la la la la la la la la la la la
Nah go mek nuh chi chi man walk right a so


From a bwoy a deep we ago dun dem right now


Leff him whole family dem a blow wow
I see it from far mi and dem nah go par


A nuff a dem bwoy weh a smoke man cigar


Mi and dem could never inna one bar


Dem bwoy deh flex too bizarre.


Once they get together in a gay
men's car
Blaze the fire, let's bum them! (Bum
them!)
Once they drink in a gay bar
Blaze the fire, let's bum them! (Kill
them!)


I'm looking on, do you see what I
see?
S_ when you are doing that
Lots of them are freaks, they bring
all their dirty acts
Thug nigga wannabees -lots of
them take it (in the arse)
If they bring it to us, hold on lots of
bullets are going to fly
Bullets fly, take up every calico (gun)
and shoot rat-tat-tat
Rat-tat-tat every gay man will have to


Die, me and my niggas will make a
pact
Gay men must die and that's a fact.


We are not part of us la la la la
Not going to let any gay men walk
here
Once a man takes cock we are going
to kill them right now
Leave his whole family to cry
I see it from far, I am not going to
mix with them
There are lots of those guys that
suck cock
Me and them could never stay in the
same bar
Those boys are just too weird.


HUMAN RIGHTS WATCH, VOL. 16, NO. 6 (B)











Log On264 by Elephant Man


Lag aan, ahn step pan chi chi man
Tep pan im laik a uol claat
Daans wi a daans ahn a bon out aal friiki man
A daans wi a daans ahn a krosh out aal bingi man
Du di waak, mek mi si di lait ahn di tuoch dem faas.



Chorus:
Lag aan, ahn tep pan chi chi man
Lag aan, fram yu nuo se yu no iki man


Lag aan, ahn tep pan chi chi man
Daans wi a daans ahn a bon out aa' friiki man.


Bout baas? A huu da breda cuda a taak?


Gimi paas, yu no si a dis ya daans di piipl dem want?


Tep pan im laik a uol cleat
A daans wi a daans ahn a crosh out dem ...
Bon blaas yu skiear yu cia bos di niu daans


Du di waak, mek mi si di lait ahn di tuoch dem faas


Jerimi, com elp mi du di bran niu daans.




Aa rait now, yu no si dem buai ya tek man fi fuul?


Kiaahn tek dem tu yu daansn skuul.
Gad a mi bakativ, miuzik a mi tuul
Aal rait ya nou
Yu no si di huol a di tapa265 dem a dwiit?


Log on, and step on queer men
Step on him like an old cloth
We're dancing to bum out all freaky men
We're dancing to crush out all queer men
Do the walk, show me your lighter and torch
fast.



Log on, and step on queer men
Log on, once you know you're not an ickie
man
Log on, and step on queer men
We're dancing to bum out all freaky men.


What boss? Who could that brother be talking
about?
Excuse me, don't you see it's this dance the
people want?
Step on him like an old cloth
We're dancing to crush them out
Bum, blast, you're scared, you can do the new
dance
Do the walk, show me your lighter and torch
fast
Jeremy, come help me do the brand new
dance.


All right now, don't you see these guys take us
for fools?
You can't take them to your dancing school
God is my support, music is my tool
All right here now
Don't you see all the top people doing it?


264 A dance with foot motion as if squashing a cockroach the lyrics boast about crushing gay men.
265 Shortened form of tapanaaris, a term indicating persons of wealth, prestige


HUMAN RIGHTS WATCH, VOL. 16, NO. 6 (B)











Fiuucha a aax Elifant ow mi dwiit
Put owt yu rait an ahn put owt yu rait flit


Lag aan, ahn ron di chriit.
Aa rait, siit? Chi chi man kiaahn stap da wan
ya fram dwiit



Wiek op, iina di rang bed yu a sliip
Yu no si di gial dem kanchrak yu a briich?


Fiuucha ron im dong, di buai fi get biit


Kiaahn paas Spanish Tong pahn Prinsis Chriit
Bier rat-a-tat di shata dem wud ahn a biit
Jerimi, ton op di miuuzik ina di chriit
Dis ya niuu daans a ron di plies.


The future is asking Elephant how I do it
Put out your right hands and put out your
right feet
Log on, and run the street.
All right, see it? Queers can't stop this one
from doing it



Wake up, in the wrong bed you are sleeping
Don't you see the girls' contract you are
breaching?
In future run him down, the boy should be
beaten
Can't go by Spanish Town on Princess Street
Only rat-a-tat the shooters would and beating
Jeremy, turn up the music in the street
This new dance is running the place.


HUMAN RIGHTS WATCH, VOL. 16, NO. 6 (B)




Full Text

PAGE 1

Human Rights Watch November 2004 Vol. 16, No. 6 (B) Hated to Death: Homophobia, Violence and Jamaica’s HIV/AIDS Epidemic Glossary of Key Terms.......................................................................................................... ......1 A Note on Jamaican language.................................................................................................... .1 I. SUMMARY.................................................................................................................... ...........2 II. RECOMMENDATIONS....................................................................................................5 To the Jamaican government..................................................................................................5 Reform the law enforcement system.................................................................................5 Enhance the national effort against HIV/AIDS.............................................................7 To Donors and International Organizations........................................................................8 III. METHODS.................................................................................................................. .........8 IV. BACKGROUND................................................................................................................ .9 HIV/AIDS in Jamaica............................................................................................................ .9 Homophobia in Jamaica and its role in driving the HIV/AIDS epidemic....................11 V. FINDINGS OF HUMAN RIGHTS WATCH’S INVESTIGATION......................17 Police abuse................................................................................................................... ..........18 Police abuse based on sexual orientation and gender identity.....................................18 Police abuse of sex workers..............................................................................................31 Police interference with access to HIV/AIDS information and health services......32 Abuses in the health care system..........................................................................................36 Discrimination by health care providers.........................................................................36 Discrimination in health care provision..........................................................................39 Inadequate protection of confidential information.......................................................41 Driving men who have sex with men and people living with HIV/AIDS from health care services........................................................................................................... ..44 Fostering dangerous practices and complicating health care provision.....................49 Denial of access to transportation........................................................................................50 Other abuses by non-state actors: vio lence in the family and in the community.........52 Abuses based on sexual orientation and gender identity..............................................52 Abuses against people living with HIV/AIDS..............................................................55 VI. GOVERNMENT RESPONSE.......................................................................................56 Improving legal and policy protections...............................................................................57 Educating health personnel...................................................................................................58 Efforts to address police abuse and provide HIV/AIDS education to police..............59 Institutional mechanisms to address police misconduct..............................................60 Police training on HIV/AIDS and related human rights issues.................................62 VII. REGIONAL EFFORTS TO ADDRESS HIV/AIDS...............................................62

PAGE 2

VIII. LEGAL STANDARDS..................................................................................................66 Freedom from violence.......................................................................................................... 66 The right to privacy and the right to freedom from discrimination...............................68 Freedom from arbitrary arrest and detention.....................................................................70 Freedom of association and assembly.................................................................................71 The right to the highest attainable standard of health.......................................................72 IX. CONCLUSION................................................................................................................ ..73 Acknowledgments................................................................................................................ .......74 Appendix....................................................................................................................... ...............75

PAGE 3

1 HUMAN RIGHTS WATCH, VOL. 16, NO. 6 (B) Glossary of Key Terms Bisexual: a person who is attracted to both sexes. Gay: a synonym for homosexual. Gender identity: a person’s internal, deeply felt sense of being male or female, or something other than or in between male and female. Heterosexual: a person attracted primarily to people of the opposite sex. Homosexual: a person attracted primarily to people of the same sex. Lesbian: a female attracted primarily to other females. LGBT: lesbian, gay, bisexual, or transgender; an inclusive term for groups and identities sometimes also associated together as "sexual minorities." Men who have sex with men: men who engage in sexual behavior with other men, but do not necessarily identify as "gay," “homosexual” or "bisexual." Sexual orientation: the way in which a person's sexual and emotional desires are directed. The term categorizes according to the sex of the object of desire—that is, it describes whether a person is attracted primarily toward people of the same or opposite sex, or to both. Transgender: One whose inner gender identity differs from the physical characteristics of his/her body at birth. Female-to-male transgender people were born with female bodies but have a predominantly male gender identity; male-to-female transgender people were born with male bodies but have a predominantly female gender identity. Women who have sex with women: women who engage in sexual behavior with other women, but do not necessarily identify as “gay,” “homosexual,” “lesbian” or “bisexual.” A Note on Jamaican language Many Jamaicans speak “patois” or Jamaican creole in addition to Caribbean Standard English. The following patois words and phrases appear in this report: battyman: “Batty” is slang meaning buttocks. Battyman is a pejorative term for men who have sex with men, as anal sex is seen as the act that defines them. “battyman fi dead:” gay men should be dead/killed; gay men must die “battyman mus’ dead:” gay men should be dead/killed; gay men must die chi chi man : derogatory term for a man who has sex with men. sodomite: derogatory term for woman who has sex with a woman “man on man fi dead:” gay men should be dead

PAGE 4

HUMAN RIGHTS WATCH, VOL. 16, NO. 6 (B) 2 I. SUMMARY On June 9, 2004, Brian Williamson, Jamaica’s leading gay rights activist, was murdered in his home, his body mutilated by multiple knife wounds. Within an hour after his body was discovered, a Human Rights Watch researcher witnessed a crowd gathered outside the crime scene. A smiling man called out, “Battyman [homosexual] he get killed!” Many others celebrated Williamson’s murder, laughing and calling out, “let’s get them one at a time,” “that’s what you get for sin,” “let’s kill all of them.” Some sang “boom bye bye,” a line from a popular Jamaican song about killing and burning gay men. Jamaica’s growing HIV/AIDS epidemic is unfolding in the context of widespread violence and discrimination against people living with and at high risk of HIV/AIDS, especially men who have sex with men. Myths about HIV/AIDS persist. Many Jamaicans believe that HIV/AIDS is a disease of homosexuals and sex workers whose “moral impurity” makes them vulnerable to it, or that HIV is transmitted by casual contact. Pervasive and virulent homophobia, coupled with fear of the disease, impedes access to HIV prevention information, condoms, and health care. Violent acts against men who have sex with men are commonplace in Jamaica. Verbal and physical violence, ranging from beatings to brutal armed attacks to murder, are widespread. For many, there is no sanctuary from such abuse. Men who have sex with men and women who have sex with women reported being driven from their homes and their towns by neighbors who threatened to kill them if they remained, forcing them to abandon their possessions and leaving many homeless. The testimony of Vincent G., twenty-two, is typical of the accounts documented by Human Rights Watch: “I don’t live anywhere now. . Some guys in the area threatened me. ‘Battyman, you have to leave. If you don’t leave, we’ll kill you.’”1 Victims of violence are often too scared to appeal to the police for protection. In some cases the police themselves harass and attack men they perceived to be homosexual. Police also actively support homophobic violence, fail to investigate complaints of abuse, and arrest and detain them based on their alleged homosexual conduct. In some cases, homophobic police violence is a catalyst for violence and serious—sometimes lethal—abuse by others. On June 18, 2004, a mob chased and reportedly “chopped, stabbed and stoned to death” a man perceived to be gay in Montego Bay. Several witnesses told Human Rights Watch that police participated in the abuse that ultimately 1 Human Rights Watch interview with Vincent G., Kingston, June 14, 2004.

PAGE 5

3 HUMAN RIGHTS WATCH, VOL. 16, NO. 6 (B) led to this mob killing, first beating the man with batons and then urging others to beat him because he was homosexual. Because HIV/AIDS and homosexuality often are conflated, people living with HIV/AIDS and organizations providing HIV/AIDS education and services have also been targeted. Both state and private actors join violent threats against gay men with threats against HIV/AIDS educators and people living with HIV/AIDS. In July 2004, for example, the Jamaican Forum of Lesbians, All-Sexuals and Gays (J-FLAG) received an email threatening to gun down “gays and homosexuals” and “clean up” a group that provided HIV/AIDS education for youth. In a 2003 case, a police officer told a person living with HIV/AIDS that he must be homosexual and threatened to kill him if he did not “move [his] AIDS self from here.” Discrimination against people living with HIV/AIDS in Jamaica poses serious barriers to obtaining necessary medical care. In interviews with people living with HIV/AIDS, Human Rights Watch found that health workers often mistreated people living with HIV/AIDS, providing inadequate care and sometimes denying treatment altogether. Doctors failed to conduct adequate medical examinations of people living with HIV/AIDS, sometimes refusing even to touch them. And, in some cases, lack of treatment in the initial stages made it even less likely that people living with HIV/AIDS would receive health care services at a later date. Visible symptoms heightened the discrimination they faced, which in turn created further barriers to obtaining treatment. People suffering from visible HIV-related symptoms were sometimes denied passage on public and private transportation, making it difficult to obtain any medical care at facilities beyond walking distance. People living with HIV/AIDS said that health workers also routinely released confidential information to other patients and to members of the public, both through discriminatory practices that signaled patients’ HIV status (such as segregating HIVpositive patients from others) and by affirma tive disclosure of such information. Such actions violate fundamental rights to privacy and also drive people living with HIV away from services. Discrimination also spreads HIV/AIDS in Jamaica by discouraging at-risk individuals from seeking HIV-related information or health care. Men who have sex with men reported that health workers had refused to treat them at all, made abusive comments to them, and disclosed their sexual orientation, putting them at risk of homophobic violence by others. As a result, many men who have sex with men delayed or avoided seeking health care altogether, especially for health problems that might mark them as

PAGE 6

HUMAN RIGHTS WATCH, VOL. 16, NO. 6 (B) 4 homosexual, such as sexually transmitted diseases. Because the presence of other sexually transmitted diseases heightens the risk of HIV transmission, such discrimination may have fatal consequences. Jamaica is at a critical moment in its efforts to address a burgeoning HIV/AIDS epidemic. An estimated 1.5 percent of Jamaicans are living with HIV/AIDS, and HIV/AIDS is on the increase. Jamaica’s Ministry of Health has taken steps to combat discrimination against people living with and at high risk of HIV/AIDS (such as men who have sex with men and sex workers), which it has recognized as a key factor driving Jamaica’s HIV/AIDS epidemic. Its national HIV/AIDS program has fostered important relationships with nongovernmental organizations with established links to marginalized high-risk groups, provided support for their HIV/AIDS work with them, and looked to them for guidance in developing an effective response to the epidemic. It also has provided HIV/AIDS training for health personnel addressing stigma and discrimination. But other parts of Jamaica’s government undermine these important efforts by condoning or committing serious human rights abuses. Abuses against men who have sex with men take place in a climate of impunity fostered by Jamaica’s sodomy laws and are promoted at the highest levels of government. Jamaican legal provisions that criminalize consensual sex between adult men are used to justify the arrest of peer HIV educators and to deny HIV prevention services to prisoners, among others. High-level political leaders, including Prime Minister P.J. Patterson and Minister of Health John Junor, repeatedly refuse to endorse repeal of discriminatory legislation, ignoring not only international human rights standards but also reports by both the government’s national HIV/AIDS program and its advisory National AIDS Committee on the role of these laws in driving Jamaica’s HIV/AIDS epidemic. Jamaican health officials acknowledge that Jamaica’s sodomy laws make it difficult for them to work directly with men who have sex with men. As one high-level health official told Human Rights Watch: “We don’t promote direct programs or services to MSM [men who have sex with men] as a group because the existing laws impede this work [and] because [of] the high-level of stigma and discrimination, they’re not open to getting services through the public sector.” The police, however, actively impede government-supported peer HIV prevention efforts among men who have sex with men and also among sex workers. AIDS outreach workers reported that the very possession of condoms—a key tool in HIV prevention—triggers police harassment, and in some cases, arrest and criminal charges.

PAGE 7

5 HUMAN RIGHTS WATCH, VOL. 16, NO. 6 (B) Jamaica’s failure to take action to stop human rights abuses committed by state agents, to take measures to protect against abuses by state and private actors, and to ensure access to HIV/AIDS information and services to all Jamaicans violate its obligations as a state party to regional and international human rights treaties. In 2004, Jamaica launched an ambitious project to provide antiretroviral treatment to people living with HIV/AIDS and to address underlying human rights violations that are driving the epidemic. These are promising initiatives. They will be compromised, however, unless government leaders make a sustained commitment to end discrimination and abuse against people living with and at high risk of HIV/AIDS. The government knows that although HIV/AIDS is stigmatized as a “gay disease,” in reality, in Jamaica as in most of the Caribbean, the most common means of transmission is heterosexual sex. It also knows that if the epidemic in Jamaica continues to accelerate, all Jamaicans will suffer. This fact should encourage high-level Jamaican government officials to act quickly and forcefully to eliminate discriminatory laws and abusive practices that violate basic rights to equality, dignity, privacy, and health and undermine HIV/AIDS prevention and treatment efforts. This includes speaking out strongly and acting forcefully against homophobic violence and abusive treatment of homosexual men and women and of sex workers. If the Jamaican government chooses instead to let popular prejudices continue to undermine its attempts to establish rights-based HIV/AIDS policies, the consequences for all Jamaicans will be dire. Thousands of Jamaicans will be consigned to lives of horrific abuse and thousands will face premature and preventable death. II. RECOMMENDATIONS To the Jamaican government Reform the law enforcement system Police Conduct € Ensure that all allegations of excessive force and other human rights abuses by law enforcement officials against HIV/AIDS workers, sexual minorities, sex workers, and people living with HIV/AIDS are investigated promptly and thoroughly by a body independent of those alleged to be responsible and which has the necessary powers and resources to fully investigate offences by state agents. Sanction officials who engage in or condone abuse.

PAGE 8

HUMAN RIGHTS WATCH, VOL. 16, NO. 6 (B) 6 € Cease and publicly repudiate all violence and harassment by police and other agents of the state against men who have sex with men, women who have sex with women, sex workers, and people living with HIV/AIDS. € Train all criminal justice officials in international human rights standards and nondiscrimination, including issues of sexuality, sexual orientation, and HIV/AIDS. Ensure that such training is fully integrated into training programs provided to all ranks, and not treated as an additional class separated from the full curriculum of training. Ensure that police at all levels are trained on the fundamentals of HIV transmission and care for people living with HIV/AIDS and on the importance of the lifesaving efforts of HIV/AIDS outreach workers. Law Reform € Repeal sections 76, 77, and 79 of the Offences against the Person Act, which criminalize sex between consenting adult men and are used as justification for harassment of men who have sex with men and of HIV/AIDS educators working with them. € Adopt legislation to protect the rights of people living with HIV/AIDS, including legislation to proscribe discrimination against them. € Repeal section 80 of the Offences against the Person Act and section 4 of the Towns and Communities Act, which grant broad latitude for arrest and detention without a warrant or an order from a magistrate, and replace them with clear, strict limitations on situations in which an arrest without warrant is permissible, such as when a crime is occurring or about to occur. € Include “sexual orientation and gender identity” and “sex” in the antidiscrimination clause of the Charter of Rights and Freedoms proposed as amendments to the Jamaican Constitution. € Invite international scrutiny of protections against torture and ill-treatment by: € Ratifying the Convention against Torture and Other Cruel, Inhuman and Degrading Treatment or Punishment, the Optional Protocols to the International Covenant on Civil and Political Rights and to the U.N. Convention against Torture, and the Inter-American Convention on the Prevention, Punishment and Eradication of Violence Against Women. € Making the necessary declaration under article 22 of the U.N. Convention against Torture to enable the U.N. Committee against Torture to consider complaints submitted to it. € Including information on the treatment of HIV/AIDS workers and members of high-risk groups (men who have sex with men, sex

PAGE 9

7 HUMAN RIGHTS WATCH, VOL. 16, NO. 6 (B) workers) in future periodic reports to human rights treaty bodies established for the International Covenant on Civil and Political Rights (overdue as of July 11, 2001) and the Convention on the Elimination of All Forms of Discrimination Against Women. Enhance the national effort against HIV/AIDS € Ensure that high-level political leaders, inclu ding the prime minister and all other cabinet officials, take a leadership role in campaigns focusing on improving human rights protections and reducing stigma and discrimination against people living with and at high risk of HIV/AIDS. National and parish-level governments should work with the media and nongovernmental organizations to disseminate this information in a manner that is accessible to people with limited literacy skills. € Ensure that the national HIV/AIDS progr am, in consultation with the Ministry of National Security and the Jamaican Constabulary Force, develops and implements a formal plan for a budgeted program of monitoring of and regular public reporting on violence and abuse against marginalized groups at high risk of HIV/AIDS. € Government officials at all levels should use public events and contacts with the media to condemn police violence against HIV/AIDS workers; should affirm international standards relating to equality, including nondiscrimination based on sexual orientation, gender identity, and HIV status; and should reiterate the importance of human rights protections for all groups vulnerable to HIV/AIDS, including men who have sex with men and sex workers. The Ministry of Health’s stated position, articulated in national policy documents, on the importance of protecting marginalized groups against stigma and discrimination should be emphasized in public events and media. € Provide training on HIV/AIDS, sexuality, and sexual orientation to all personnel in health care facilities, including instruction on the right to privacy and protection of confidential information about HIV status and specific guidance on how to guard against negligent and intentional disclosure. Ensure that appropriate and accessible legal remedies are available to individuals whose privacy has been infringed or who have experienced discrimination or harassment in the health system based on HIV status. € Establish an effective and independent oversight and complaint mechanism to ensure the proper implementation of health policies and norms relating to HIV/AIDS, including protection of confidential and private information. Investigate and sanction all health personnel who disclose confidential information without authorization.

PAGE 10

HUMAN RIGHTS WATCH, VOL. 16, NO. 6 (B) 8 To Donors and International Organizations € Condemn the criminalization of consensual homosexual conduct and support the repeal of sections 76, 77, and 79 as a violation of the prohibition against discrimination based on sexual orientation and as an impediment to the national response to the HIV/AIDS epidemic. The repeal of sections 76, 77, and 79 is consistent with the International Covenant on Civil and Political Rights, the American Convention on Human Rights, and the United Nations International Guidelines on HIV/AIDS and Human Rights. € As part of monitoring compliance with the International Covenant on Economic, Social and Cultural Rights, the U.N. Committee on Economic, Social and Cultural Rights should report on Jamaica’s efforts to ensure provision of HIV/AIDS information and services on a nondiscriminatory basis and to guarantee the confidentiality of information about HIV status. € Ensure that monitoring of police harassment of HIV/AIDS outreach workers and of people suspected of homosexual conduct, and related human rights abuses are an important and regular part of monitoring programs supporting police reform and HIV/AIDS efforts in Jamaica. Accelerate surveillance and monitoring of NGO reports of police violence through the United Nations supported monitoring system and other means, and ensure widespread public reporting of data collected on this subject. € Support the development of organizations among members of the lesbian, gay, bisexual and transgender community, and among sex workers, to strengthen the capacity of these persons to advocate for the protection of their rights in institutional fora. € Promote ratification of the Inter-American Convention on the Prevention, Punishment and Eradication of Violence against Women. III. METHODS This report is based on a three-week field visit to Jamaica in June 2004, as well as prior and subsequent research. Two Human Rights Watch staff members conducted detailed interviews with more than seventy-five people living with or at high risk of HIV/AIDS, including sex workers, men who have sex with men (MSM), women who have sex with women, and people who had been incarcerated in police lockups and prison. These interviews took place in Kingston, St. Ann, St. James, St. Catherine, and St. Andrew, the

PAGE 11

9 HUMAN RIGHTS WATCH, VOL. 16, NO. 6 (B) five parishes hardest hit by HIV/AIDS.2 The identities of most of these persons and certain identifying information have been withheld to protect their privacy and safety. These persons were identified largely with the assistance of Jamaican nongovernmental organizations (NGOs) providing services to people living with HIV/AIDS, men who have sex with men, women who have sex with women, prisoners, and sex workers. These interviewees may have had greater access to HIV/AIDS services than those without comparable connections. Human Rights Watch also interviewed more than fifty representatives of government agencies, United Nations officials, donor governments, and NGOs specializing in HIV/AIDS or human rights; academic institutions; and healthcare workers and hospital administrators. All documents cited in this report are either publicly available or on file with Human Rights Watch. IV. BACKGROUND HIV/AIDS in Jamaica As of the end 2003, an estimated 22,000 people, or 1.5 percent of the adult population, were living with HIV/AIDS in Jamaica, the third largest population of people living with HIV/AIDS in the Caribbean region (after Haiti and the Dominican Republic).3 HIV prevalence rates are very high among marginalized populations, including men who have sex with men and sex workers. The epidemic continues to spread in the general population.4 According to the Jamaican government’s national HIV/AIDS program, in Jamaica HIV is predominantly transmitted through unprotected heterosexual sex and is increasing 2 Jamaica is divided into fourteen parishes, which are s ub-national administrative divisions of the government. 3 Joint United Nations Programme on HIV/AIDS (UNAIDS), 2004 Report on the Global AIDS Epidemic: 4th Global Report (Geneva: UNAIDS, 2004), p. 202. 4 In 1994-1995, 25 percent of sex workers tested in Montego Bay were HIV-positive; in 1996, 9 percent of sex workers tested in Kingston were HIV-positive. From 1994-1996, HIV prevalence in major urban areas for men who have sex with men was more than 30 percent. UNAIDS, “Epidemiologica l Fact Sheets on HIV/AIDS and Sexually Transmitted Infections: Jamaica,” 2004. See also Country Coordinating Me chanism for the Global Fund to Fight AIDS, Tuberculosis and Malaria, A Proposal to Scale UP HIV/AIDS Treatment, Prevention, and Policy Efforts in Jamaica, May 2003, http://www.theglobalfund.org/search/docs/3JAMH_661_0_full.pdf (retrieved August 27, 2004), p. 31 (stating that an estimated 20 percent of men who have sex with men and 25 pe rcent of male and female sex workers were living with HIV/AIDS).

PAGE 12

HUMAN RIGHTS WATCH, VOL. 16, NO. 6 (B) 10 faster among women than men.5 Ministry of Health statistics attribute 67.8 percent of AIDS cases to heterosexual sex and 5.4 percent to homosexual and bisexual sex combined.6 The percentage of HIV cases acquired through male-to-male sexual contact is probably higher, however. The fact that homosexual sex is illegal, together with the strong stigma and discrimination attached to homosexual and bisexual behavior, may keep many men who have sex with men from admitting to having had sex with other men. The Ministry of Health has acknowledged that the fact that the large majority of cases of unknown transmission are among men suggests that rates of male-to-male transmission are higher than are reported.7 Several thousand Jamaicans are in urgent need of antiretroviral treatment, but as of this writing only a fraction of them are receiving it.8 Jamaica secured funding in June 2004 to scale up access to treatment for people living with HIV/AIDS and made a public commitment to secure the lowest possible prices for antiretroviral drugs for all Jamaicans who need them.9 However, in making concerted efforts to join the Free Trade Area of the Americas, Jamaica is subject to pressure by the United States Trade Representative to agree to trade policies that may undermine access to affordable antiretroviral medicines.10 5 Jamaica National HIV/STD Prevention and Control Progr am, “Facts and Figures, HIV/AIDS Epidemic Update 2004,” http://www.moh.gov.jm/AIDS%20DATA%20J UNE%202004.pdf (retrieved August 9, 2004). 6 Children comprise 7.7 percent of cases and the remaining 26.8 percent of cases are categorized as “unknown.” Ibid. 7 See ibid. (90 percent of cases of unknown transmission are among men); Ministry of Health, “Report of the Behaviour Change and Communication Task Force,” 2001 (noting large percentage of males among cases of unknown transmission and observing that “If we look at the literature on male sexual behaviour, and in particular the issues of socially condemned and therefore secretive sexual behaviour that would contribute to non-reporting, we find the continuum usually conflated as ‘MSMs.’ ”) (cited in Patricia Watson, “Coping in the Dark: HIV Prevention among the MSM Community in Jamaica,” The Jamaica Gleaner, May 5, 2002). The Pan-Caribbean Partnership on HIV/AIDS (PANCAP) has reported a similar situation in the region. PANCAP, “Caribbean Regional Strategic Framework for HIV/AIDS 20022006,” March 2002, p. 4. 8 As of June 2004, an estimated 8000 people were in need of antiretroviral therapy, and 500 persons were receiving it. J. Peter Figueroa, chief, Epidemiology and AIDS, Ministry of Health, “Implementing Access to HAART in Jamaica,” June 2004. 9 First-line antiretroviral (ARV) therapy costs between U.S. $75 (generic) and U.S.$300 (brand name drugs) per month. In September 2004, the Ministry of Health began providing ARV t herapy in the public sector for free or U.S.$8 pursuant to the Global Fund for AIDS, Tuberculosis and Malaria agreement. Th e Ministry of Health estimated that it would provide ARV therapy to 2000 people living with AIDS by late 2006. Global Fund Agreement, http://www.theglobalfund.org/search/docs/3JAMH_661_238_ga.pdf. 10 Jamaica, as a party to the World Trade Organization (W TO) Agreement on Trade Related Aspects of Intellectual Property (TRIPS), must ensure a minimum level of intellectual property protection. In 2001, WTO member states agreed that TRIPS “cannot and should not” pr event countries from taking measur es to expand drug access and encouraged countries to use TRIPS mechanisms “to the full” in meeting their public health objectives. Jamaica is a party to negotiations to establish a Free Trade Area of the Americas (FTAA), covering thirty-four c ountries across the Americas and the Caribbean. The United States Trade Representative is attempting to include provisi ons in the FTAA that could inhibit Jamaica’s (and other countries’) flexibility to enc ourage generic drug competition and reduce the price of generic medicines. The negotiations are intended to be completed by e nd 2004, with the aim of launching the agreement in 2005. Concerns about Jamaica’s domestic legal and policy commitments that conflict with FTAA proposals have slowed down

PAGE 13

11 HUMAN RIGHTS WATCH, VOL. 16, NO. 6 (B) Since 1987, the Jamaican government has launched several public awareness campaigns regarding HIV/AIDS, beginning with the theme “AIDS kills.” National surveys report that a high level of knowledge about methods of HIV prevention coexists with belief in myths about HIV transmission. A 2000 survey reported that while more than 96 percent of Jamaicans could identify two or more ways to prevent HIV, a significant percentage of those surveyed subscribed to various myths about HIV, including the belief that HIV could be transmitted by casual contact (such as sharing food) and by mosquitoes. The survey also showed a dr amatic rise in misconceptions about HIV transmission since 1996.11 Health workers and people living with HIV/AIDS believe that the initial campaign had a lasting effect on public information about HIV/AIDS, leaving many with the impression that an HIV diagnosis means that death is imminent. According to Joanna W., a peer HIV/AIDS educator, “More than 96 percent of our people have information about HIV but how the information was given—‘AIDS kills’— left a strong impression. . Many people don’t understand that HIV can be with them a long time before they get AIDS.”12 Homophobia in Jamaica and its role in driving the HIV/AIDS epidemic Violence against men who have sex with men, ranging from verbal harassment to beatings, armed attacks, and murder, is pervasive in Jamaica.13 Physical attacks against gay men and men perceived to engage in homosexual conduct are often accompanied by expressions of intent to kill the victim, such as “Battyman fi dead” [gay men must die].14 They are reluctant to appeal to the police for protection, as police routinely deny them assistance, fail to investigate complaints of homophobic violence, and arrest or detain men whom they suspect of being gay. In some cases, the police attack them and promote homophobic violence by others. Women who have sex with women are also negotiations, however. See Women’s Edge Coalition, “The Effe cts of Trade Liberalization on Jamaica’s Poor: an Analysis of Agriculture and Services,” June 2004, pp. 70-75. 11 Hope Enterprises Ltd., “Report of National Knowledge, Atti tudes, Behaviour & Practice Survey. Year 2000.” Prepared for the Ministry of Health, Jamaica. 2000. 12 Human Rights Watch interview with Joanna W., Kingston, June 6, 2004. 13 See Robert Carr, “On ‘Judgments:’ Poverty, Sexuality-Based Violence and Human Rights in 21st Century Jamaica,” The Caribbean Journal of Social Work, vol. 2 (July 2003), pp. 71-87 (finding that working class men who have sex with men are vulnerable to attack at any time in an atmosphere that sanctions and actively promotes such attacks); see also Cecil Gutzmore, “Casting the First Stone: Policing of Homo/Sexuality in Jamaican Popular Culture,” Interventions, vol. 6, no. 1 (April 2004), pp. 118-134 (arguing that Jamaican homophobia is exc eptional for its overt virulence at the expressive level and arguably encourages documented tendency and practice to ward homophobic violence, and that the combination of disregard for the law, including by police and other state official s, and the high level of violence in the society put working class men who have sex with men especially at risk). 14 Human Rights Watch interview with Nicholas C., Kingston, June 9, 2004; Human Rights Watch interview with Dennis M., Montego Bay, June 21, 2004; Human Rights Watc h interview with Vincent G., Kingston, June 14, 2004; Human Rights Watch interview with Curtis M., Ocho Rios, June 15, 2004; see also Robert Carr, “On ‘Judgments:’ Poverty, Sexuality-Based Violence and Human Rights in 21st Century Jamaica.”

PAGE 14

HUMAN RIGHTS WATCH, VOL. 16, NO. 6 (B) 12 targets of community violence and police harassm ent; and, as with men who have sex with men, their complaints of violence are often ignored by police. Endemic violence by private actors and by Jamaican police and security forces, and inadequate state response to it, are problems faced by all Jamaicans.15 Gays and lesbians are often on the front lines of such violence, however. Jamaica’s sodomy laws, which criminalize consensual sex between adult men, are used to justify arbitrary arrest and detention, and sometimes torture, of men (and sometimes women) suspected of being homosexual. Political and cultural factors, including religious intolerance of homosexuality, Jamaican popular music, and the use of antigay slogans and rhetoric by political leaders, also promote violence and discrimination based on sexual orientation and gender identity. While many of these actions are protected under the rights to freedom of speech and religion, the Jamaican government has failed to confront them as root causes of widespread violence and discrimination based on sexual orientation and gender identity. The church, a powerful social institution in Jamaica, denounces homosexuality as a sin and Jamaica’s Christian pastors preach strongly against it, sometimes justifying their opposition in cultural, as well as religious, terms. For example, in opposing the ordination of an openly gay cleric (a position not unique to Jamaican clergy), a Kingstonbased Anglican priest stated that there was “no way that a Jamaican Anglican contingency could begin to support such a decision,” because “Jamaican society is intolerant of homosexuality and homosexual behavior.”16 Jamaican dancehall music, a powerful cultural force in Jamaican society, reflects and reinforces popular prejudices against lesbians and gay men. Many dancehall musicians perform songs that glorify brutal violence and killing of men and women who do not 15 See United Nations Special Rapporteur on Extrajuducial, Summary or Arbitrary Executions, “Report of the Special Rapporteur, Asma Jahangir, submitted Pursuant to Commission on Human Rights Resolution 2003/53. Addendum. Mission to Jamaica,” E/CN.4/2004/7/Add.2, September 26, 2003; Jamaicans for Justice, The Jamaica Justice Report, 2002; Families Against State Terrorism, “How Many More? Sample of Police Killings July 1999-May 2004,” May 2004; Amnesty International, “’ Until Their Voices are Heard.’ The West Kingston Commission of Inquiry,” July 2003; International Commi ssion of Jurists, “Attacks on Justice,” August 2002, pp. 222-225; Anthony Harriott, Police and Crime Control in Jamaica: Problems of Reforming Ex-Colonial Constabularies (Kingston, Jamaica: University of t he West Indies Press, 2001); Horace Levy, They Cry ‘Respect’! Urban Violence and Poverty in Jamaica (Kingston, Jamaica: University of the West Indies Press, 2001). 16 “Kingston priests reject gay bishop. Jamaican society intolerant of homosexuality, says priest,” The Jamaica Observer, October 30, 2003.

PAGE 15

13 HUMAN RIGHTS WATCH, VOL. 16, NO. 6 (B) conform to stereotypical gender roles, and celebrate their social cleansing from Jamaica.17 High-level political leaders foster an atmosphere of violence toward men who have sex with men. During the 2001 elections, for example, the Jamaican Labour Party (the main opposition party) adopted “Chi Chi Man,” which celebrates burning and killing gay men, as its theme song.18 The ruling People’s National Party responded by adopting as its campaign slogan for the 2002 national elections “Log On to Progress,” a reference to a popular song and dance (“log on”) involving kicking or stomping on gay men.19 Homophobic violence and discrimination, and state failure to respond to these abuses, violate internationally recognized human rights, including rights to privacy, nondiscrimination, and protection against violence.20 These abuses are also closely linked to the spread of HIV/AIDS. Sodomy laws, which violate human rights to privacy and nondiscrimination,21 undermine HIV/AIDS outreach to men who have sex with men. State failure to protect lesbian, gay, transgender, and bisexual people from violence and abuse by police and private citizens marginalizes them and inhibits them from seeking treatment for HIV and other sexually transmitted diseases that increase the risk of HIV transmission. The association of HIV/AIDS with homosexuality compounds the marginalization of many people living with HIV/AIDS, who face additional stigma and abuse through the presumption that they have engaged in illegal sex. It also keeps those at highest risk of the disease—including people who do not engage in homosexual sex—from seeking HIV-related information and health services. 17 Elephant Man’s “A Nuh Fi Wi Fault,” in which he sings that “When yuh hear a Sodomite get raped/but a fi wi fault/it’s wrong/two women gonna hock up inna bed/that’s tw o Sodomites dat fi dead” [“When you hear a lesbian getting raped/it’s not our fault/it’s wrong/two women in bed/that’s two sodomites who should be dead”], Beenie Man’s “I’m dreaming of a new Jamaica, come to execute all the gays,” and Babycham and Bounty Killer’s “Bun a fire pon a kuh pon mister fagoty, ears ah ben up and a wince under agony, poop man fi drown a yawd man philosophy” [“burn gay men ‘til they wince in agony, gay men should drown, that’s the yard man’s philosophy”] are typical of the exhortations to kill and maim lesb ians and gay men in many popular dancehall songs. For further discussion of homophobia in Jamaican dancehall and in popular culture, see Cecil Gutzmore, “Casting the First Stone;” Tara Atluri, “When the Closet is a Region,” working paper no. 5, Centre for Gender and Development Studies, University of the West Indies 2001; on dancehall and cultural formation, including the use of homophobia by dancehall artist es, see also Norman C. Stolzoff, Wake the Town and Tell the People: Dancehall Culture in Jamaica (Durham, N.C.: Duke Univ. Press, 2000). 18 TOK, “Chi Chi Man,” on Reggae Gold 2001 (2001) (lyrics cited in Appendix); see Garwin Davis, “Homophobia Remains High. Gays Remain in Seclusi on, Health Officials Worry,” The Jamaica Gleaner, July 26, 2001. 19 Elephant Man, “Log On,” on LOG ON (2002) (lyrics cited in Appendix). 20 Jamaica has ratified international and regional treaties proscribing thes e actions, including the International Covenant on Civil and Political Rights, the International Covenant on Economic Social and Cultural Rights, the Convention on the Elimination of All Forms of Disc rimination against Women, and the American Convention on Human Rights. See discussion at pages 66-73 below. 21 Nicholas Toonen v. Australia, Human Rights Committee, 50th Session, Case no. 488/1992, U.N. Doc. CCPR/C/50/D/488/1992 (April 4, 1994).

PAGE 16

HUMAN RIGHTS WATCH, VOL. 16, NO. 6 (B) 14 The Jamaican Ministry of Health has acknowledged that homophobic violence and discrimination, and deep stigma associated with homosexuality, are among the factors driving the epidemic.22 High-level officials from the Ministry of Health’s HIV/AIDS program also recognize that Jamaica’s sodomy laws create significant barriers to government provision of HIV services to men who have sex with men. Providing HIV education and prevention services to men who have sex with men is extremely difficult because they are forced to remain invisible due to prejudice and abuse.23 According to studies conducted by Jamaican and Caribbean regional health bodies, many Jamaican men who have sex with men lead dual lives and marry, have girlfriends, and have children while also engaging in same sex relationships.24 Fear of being identified as homosexual may keep many people from seeking HIV testing and also from disclosing homosexual conduct as a possible risk factor if they test positive for HIV.25 The invisibility of men who engage in homosexual conduct makes effective communication difficult, even among the men themselves. And the lack of information about their lives, practices, and community to guide public health interventions compromises an effective response to the epidemic. In 1997, the mere suggestion that a task force was considering whether condoms should be issued to inmates and staff as part of HIV/AIDS prevention efforts in prison prompted a violent rampage and derailed HIV education efforts for years. After then Commissioner of Corrections John Prescod proposed that condoms be distributed to prisoners and correctional officers, correctional officers—apparently offended by the implication that by distributing condoms they, themselves, were also having sex with men—walked off their jobs. The officers did not return for several days, until they received an apology from the Commissioner and an agreement that condoms would not 22 See, e.g., Jamaican Ministry of Health, Jamaica HIV/AIDS/STI National Strategic Plan 2002-2006, January 2002, p. 10; see also Zadie Neufville, “Fear Among Gay Men Said to Fuel HIV/AIDS Cases,” Inter Press Service, March 5, 2002; Garwin Davis, “Homophobia Remains High. Gays Re main in Seclusion, Health Officials Worry,” The Jamaica Gleaner July 26, 2001. 23 Ibid.; Human Rights Watch interview with Dr. Yitades G ebre, executive director, Ministry of Health Program Coordination Unit, Kingston, June 23, 2004; Human Rights Watc h interview with Dr. Peter Figueroa, chief, Ministry of Health Epidemiology Unit, Kingston, June 23, 2004. 24 See Caribbean Regional Epidemiology C enter, “Homosexual Aspects of the HIV/AIDS Epidemic in the Caribbean: A Public Health Challenge for Prevention and Control,” 2000; Heather Royes, “Jamaican M en and Same-Sex Activities: Implications for HIV/STD Prevention, ” 1993. The subject of a Jamaican study of men who have sex with men and HIV/AIDS explained, “Society demands that a man should have a woman. To be la beled as gay or homosexual is a name no man likes. So as a result, men resort to play the gam e with same-sex and opposite sex activities.” “Jamaican Men and Same-Sex Activities,” p. 11. 25 See Ministry of Health, “Report of the Behaviour C hange and Communication Task Force,” 2001 (cited in Patricia Watson, “Coping in the Dark: HIV Preventi on among the MSM Community in Jamaica,” The Jamaica Gleaner, May 5, 2002).

PAGE 17

15 HUMAN RIGHTS WATCH, VOL. 16, NO. 6 (B) be distributed in prisons. Following the walkout by the correctional officers, inmates at two of Jamaica’s largest prisons rioted. Sixteen prisoners were killed and more than fifty injured, apparently targeted because other prisoners believed that they were homosexuals.26 The popular misperception that HIV/AIDS is a homosexual disease impedes effective HIV prevention and poses serious risks for people living with HIV/AIDS. Health workers and AIDS outreach workers interviewed by Human Rights Watch reported that people with whom they worked—including hospital staff—did not believe that HIV was an issue for them persona lly because they were not homosexuals. A hospital-based health worker who provided HIV/AIDS prevention information and services to hospital staff and people in her town told Human Rights Watch, “When I tell them about HIV, they say . that HIV does not concern them, because it is a battyman [homosexual] disease.”27 The conflation of HIV/AIDS with homosexuality exposes people living with HIV/AIDS and HIV/AIDS educators to the same treatment meted out to men who have sex with men.28 ASHE Caribbean Performing Arts Foundation, an NGO that works with youth, includes HIV/AIDS and sexuality education as an important part of its work. Its work on HIV/AIDS, however, subjected it to threats, as the following note sent to the Jamaica Forum for Lesbians, All-Sexuals and Gays (J-FLAG) in July 2004 illustrates: The nasty act of homosexuality will not be tolerated here in Jamaica. Let me say it quick. One notable battyman have died recently we will be killing more as the days go by. To make it easy for you we will tell you 26 The riots were at the Tower Street Adult Correctional Centre in Kingston (Kingston general penitentiary) and St. Catherine’s District Prison. Harold B., who was incarcerated at St. Catherine’s District Prison during the riots, told Human Rights Watch that both prisoners and warders put his life at risk: “I couldn’t walk free in prison because the warders would point me out [as a gay man]. . and prisoners were killing off gay men.” Human Rights Watch interview with Harold B., Kingston, June 9, 2004. See also Minist ry of National Security and Justice, “Report of the Board of Enquiry into Disturbances at the Tower Street Adult Correctional Center and the St. Catherine Adult Correctional Centre Between 20th23rd August, 1997,” March 9, 1998; Commission on Human Rights, Report of Special Rapporteur on Torture, “Question of the Human Rights of All Persons Subjected to Any Form of De tention or Imprisonment, in Particular: Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment,” U.N. Doc. E/CN.4/2002/76/Add.1, March 14, 2002, par. 829.; Amnesty International, “A Summary of Concerns: A Brie fing for the Human Rights Committee,” October 1997, p. 14. 27 Human Rights Watch interview, St. Ann’s Bay, June 16, 2004. A 1993 study of Jamaican men who have sex with men and HIV/AIDS suggested that older bisexual m en did not believe themselves at risk of HIV because they believed that HIV was a “gay” disease, and they di d not identify as gay. Heather Royes, “Jamaican Men and Same-Sex Activities: Implications for HIV/STD Prevention,” 1993, p. 12. 28 Robert Carr, “Stigmas, Gender and Coping: A Study of HIV+ Jamaicans,” Race, Gender & Class, vol. 9, no. 1 (2002), pp. 122-44.

PAGE 18

HUMAN RIGHTS WATCH, VOL. 16, NO. 6 (B) 16 where you can pick them up and who it was that we gunned down. It will not be robbery just purification. No batty man down here in Jamaica. . . Fire burn them and them nasty living. JFLAG must crash. We declare war on all Gays and Homosexual. Ashe dance group needs a bit of clean up now We will be killing gays and homosexuals daily now. War we say .29 (emphasis added) Lesbians and HIV risk A woman without a man can be a target of both community disrespect and rape. — Horace Levy, They Cry ‘Respect’! Urban Violence and Poverty in Jamaica30 Although the risk of female-to-female HIV transmission is generally estimated to be small,31 many women who have sex with women also have sex with men. Many Jamaican lesbians face strong pressure to establish relationships with men and to have children because doing so is a critical part of establishing their identity as adult women.32 Sexual violence against women and girls, a problem of grave proportions in Jamaica, has been identified by the World Health Organization as an important factor contributing to increased HIV incidence among women in the region.33 Sexual violence may increase the risk of HIV and other sexually transmitted diseases for all survivors.34 Forced or 29 E-mail communication from anotherkiller1@ hotmail.com to J-Flag, July 14, 2004. 30 (Kingston, Jamaica: University of the West Indies Press, 2001), p. 37. 31 See Helena A. Kwakwa and M.W. Ghobrial, “Female-to -Female Transmission of Hu man Immunodeficiency Virus,” Clinical Infectious Diseases, vol. 35, no. 3 (February 2003), pp. 40-41. 32 See Robert Carr, “Stigmas, Gender and Coping: A Study of HIV+ Jamaicans,” Race, Gender & Class (2002), vol. 9, no. 1, pp. 122-144 (discussing gender socialization in Jamaica). 33 See Pan American Health Organization, “Gender and HIV/AIDS,” http://www.paho.org/english/hdp/hdw/GHIVFactSheetI.PDF (re trieved November 3, 2004); see also United Nations Development Program, “National Reports on the Situati on of Gender Violence Agai nst Women: National Report, Jamaica,” March 1999; Nancy Muturi, “Violence and HIV/ AIDS in the Caribbean,” presentation at the 2003 American Public Health Association meetings (ar guing that high rates of sexual violence c ontribute to growing HIV/AIDS epidemic in Caribbean region). 34 Women and girls are physiologically more vulnerable than men and boys to HIV infection during unprotected heterosexual vaginal sex. Factors that contribute to this increased risk include the larger surface area of the vagina and cervix, the high concentration of HIV in the semen of an infected man, and the fact that many of the other sexually transmitted diseases that increase HIV risk are often left untreated (because th ey are asymptomatic or because health care is inaccessible). Girls and y oung women face even greater risk than adult women, because the vagina and cervix of young women are less mature and are less resistant to HIV and other sexually transmitted infections, such as chlamydia and gonorrhea, that increase HIV vulnerability; because changes in the reproductive tract duri ng puberty make the tissue more susceptible to penetration by HIV; and because young wo men produce less of the vaginal secretions that provide a

PAGE 19

17 HUMAN RIGHTS WATCH, VOL. 16, NO. 6 (B) coerced sex creates a risk of trauma: when the vagina or anus is dry and force is used, genital and anal injuries are more likely, increasing the risk of HIV transmission. Forced oral sex may cause tears in the skin of the mouth, also increasing the risk of transmission. The presence of other sexually transmitted diseases also heightens HIV transmission risk.35 Women who are or are perceived to be lesbians are at an even greater risk of rape, as they may be targeted for sexual violence based on both their gender and sexual orientation. 36 V. FINDINGS OF HUMAN RIGHTS WATCH’S INVESTIGATION In Jamaica, state-sponsored homophobia and discrimination against homosexual men and women, sex workers, and people living with HIV/AIDS, the conflation of HIV/AIDS with homosexuality and sex work, and the misguided fear that HIV is transmitted by air or by casual contact are undermining an effective response to HIV/AIDS. Police not only harass and persecute people suspected of homosexual conduct, sex workers, and people living with HIV/AIDS. They also interfere with HIV/AIDS outreach to them. Men who have sex with men and people living with HIV/AIDS face serious violence and are often forced to abandon their homes and communities. Many are denied health care; some cannot even seek health services because they are denied public and private transportation services. And past experiences of discrimination, coupled with the fear that HIV status or sexual orientation will be disclosed and publicized, keep many people from seeking health care in the first instance. barrier to HIV transmission for older women. See, e.g ., Global Campaign for Microbici des, “About Microbicides: Women and HIV Risk,” http://www.global-campaign.org/womenhiv.htm (re trieved August 28, 2003); UNAIDS, “AIDS: Five Years since ICPD—Emerging Issues and Cha llenges for Women, Young People, and Infants,” Geneva, 1998, p. 11; The Population Information Program, Center for Communications Programs, The Johns Hopkins University, “Population Reports: Youth and HIV/AIDS,” vol. 23, no. 3, Fall 2001, p. 7 (citing studies). 35 See United States Centers for Disease Control and Prev ention, Fact Sheet: Prevention and Treatment of Sexually Transmitted Diseases as an HIV Preventi on Strategy [online], http://www.cdc.gov/hiv/pubs/facts/hivstd.htm (retrieved October 27, 2003). 36 See discussion in Section V, below; see also Makeda S ilvera, “Man Royals and Sodomites: Some Thoughts on the Invisibility of Afro-Caribbean Lesbians,” Feminist Studies, vol. 18, no. 3, Fall 1992, pp. 521-532 (reporting gang rape of women “suspected” of lesbianism in 1950s Jamaican towns).

PAGE 20

HUMAN RIGHTS WATCH, VOL. 16, NO. 6 (B) 18 Police abuse Police abuse based on sexual or ientation and gender identity Verbal and physical abuse and in citing others to violence On the afternoon of June 18, 2004, a mob chased and reportedly “chopped, stabbed and stoned to death” a man perceived to be gay in Montego Bay.37 Several witnesses reported to Human Rights Watch that police participated in the abuse that ultimately led to this mob killing, first beating the man with batons and then urging others to beat him because he was homosexual. Fred L., thirty, described the incident as follows: Me and another guy were sitting on the beach . .While we were there, some little teenager was on the beach swimming, and Victor, the guy that was killed, was standing looking at the boy. The boy said, "Why are you looking me like that? You a battyman." Two rastamen38 said, "Every day they come on the beach to look at men, battyboy them." Two policemen and a female police officer were there. The two male officers started to beat the man with batons. I turned to the female officer and asked, “What has he done wrong?” She turned to me and said, "Everyday me have to warn people about this guy coming on the beach. I'm going to lock him up.” I said, “For what?” She didn't say. I said to her, “If he did something wrong, lock him up, don't beat him.” [Victor] started to run from the two male officers toward the Old Fort Craft Market. The two policemen said, "Beat him because him a battyman."39 The crowd followed the police officers’ lead, beating the victim and throwing bottles and stones at him.40 Joseph W., twenty-six, told Human Rights Watch that he saw police hitting the victim with a baton and with their fists, and that once persons from the crowd started beating the victim: 37 Henry Bucknor, “Alleged Gay Man Chopped to Death in MoBay,” Western Mirror, vol. 24, no. 72, June 19, 2004, p. 1. 38 “Rastaman” is a term used to refer to men with dreadlo cks (a hairstyle in which the hair grows and is left uncombed, and forms ropelike locks that hang down from the head) and to Rastafarians, a religious group whose members wear their hair in dreadlocks. 39 Human Rights Watch telephone interview with Fred L., Montego Bay, July 6, 2004. 40 Ibid.; Human Rights Watch interview with Dennis M., Mont ego Bay, June 21, 2004; Human Rights Watch interview with Joseph W., New York, June 28, 2004.

PAGE 21

19 HUMAN RIGHTS WATCH, VOL. 16, NO. 6 (B) the police officers walked off. The crowd got thicker and more persons started hitting the guy. Then I saw the guy run out of the road into the town. . Then I woke up the next morning to hear that Victor was killed about a mile and a half from the beach.41 Police abuse is a fact of life for many men who have sex with men and women who have sex with women in all of the communities that Human Rights Watch visited in Jamaica. As in the incident described above, homophobic police violence can be a catalyst for violence and abuse by others. It is sometimes lethal. Police abuse is also profoundly destructive because it creates an atmosphere of fear sending a message to other lesbian, gay, bisexual, and transgender people that they are without any protection from violence. Dennis M., twenty, lived in Montego Bay. He told Human Rights Watch: Police always harass me. . They stop you and hear you talk a bit feminine [and ] they ask you personal questions like are you top or bottom and like that. . The last time this happened . two police came over and said “Battymen mus’ dead. You should be under the ground. You should not be living in Jamaica.” Not every police officer does that. Some police officers say it is not legal so you should curtail your behavior. But most of them, once they hear you talk feminish they begin to bitch [verbally abuse] you and a crowd comes around.42 Nicholas C., twenty-nine, was stopped by the police while walking down the street one evening in April 2004. The police asked him if he was a battyman and searched him. After finding condoms, lubricant, and gel, they became violent. “They said, ‘You a battyman. Battyman mus’ dead. Run before I shoot you.’” The police beat Nicholas C., hit him with batons, kicked him, and scattered his things on the ground.43 Several gay men reported that police abuse accelerated violence by others. Albert B., thirty-three, and his friends had been attacked by Kingston police a few days before Human Rights Watch met with him in June 2004. The police beat Albert B. and his 41 Human Rights Watch interview with Joseph W., New York, June 28, 2004. Joseph W. was an acquaintance of Victor Jarrett’s. A third witness told Human Righ ts Watch that he saw the police beating the victim and a crowd throwing bottles and stones at him as he ran fr om the police, and heard people shouting that the victim was gay and should be killed. Human Rights Watch interview with Dennis M., Montego Bay, June 21, 2004. 42 Human Rights Watch interview with Dennis M., Montego Bay, June 21, 2004. 43 Human Rights Watch interview with Nicholas C., Kingston, June 9, 2004.

PAGE 22

HUMAN RIGHTS WATCH, VOL. 16, NO. 6 (B) 20 friends, threw stones at them, called them “battymen,” “faggot,” and “nasty men” and drew their guns at them. The police actions drew the attention of other men, who came and beat them with boards, crying out “battymen.”44 Peter T., nineteen, was walking on the street with friends late in the evening of December 25, 2003. A police car drove by, and the policemen inside yelled, “Battymen, go home.” When Peter T.’s friend told the police to leave them alone, the police stopped their car, beat the men, then put them in the police car and drove them to another part of town. As they let the men out of the car, the police yelled, “Battymen, battymen, beat them,” and fired their guns in the air. This attracted the attention of a crowd of men armed with machetes, who followed the police instruction and beat them.45 Harold B., thirty-four, reported several incidents of police abuse in 2004, including an attack by police a few hours before his interview with Human Rights Watch. For Harold B., the public humiliation by police that incited others to violence was worse than physical attacks. “The worst thing is when police embarrass you whenever they see you in a crowd. When I’m walking on the street, the police yell, ‘battyboy, you catch men.’ When they do that, people start to look at you and some want to attack you.”46 Many of the men who have sex with men interviewed by Human Rights Watch reported having to flee their homes and communities because of homophobic violence by their neighbors or other residents of their towns. In some cases, police abuse of men suspected of homosexual conduct prompted violence by private actors, whose violence effectively evicted them from their homes. Until early 2003, Peter T. lived with a group of gay men in a house in Kingston. He said that the police visited the house frequently, making derogatory comments about homosexuality and beating the residents. The police presence would attract others, who would join in the abuse. He told Human Rights Watch: Police visit there a whole heap of time. . Every time the police come to the house, others would always show up. The police come there and start searching and then the next neighbor would come over and start in. 44 Human Rights Watch interview with Albert B., Kingston, June 9, 2004. 45 Human Rights Watch interview with Peter T., Kingston, J une 9, 2004. Machetes are common property in Jamaica and are used for agricultural work, for personal protection at home (in case of break-ins), and as weapons. 46 Human Rights Watch interview with Harold B., Kingston, June 9, 2004.

PAGE 23

21 HUMAN RIGHTS WATCH, VOL. 16, NO. 6 (B) Police would search in the closet, under the bed. If they see condoms, they say that we were fucking, we carry AIDS, battymen have AIDS, man on man fi dead. [gay men should be dead].47 By February 2003, the violence had escalated sufficiently to drive Peter T. and his housemates away. One afternoon, “people come and say we can’t sleep there tonight because we’re going to bomb it down.” Peter T. and his housemates fled, leaving without their belongings.48 Police abuse of gay men extends to men living with HIV/AIDS, whom they assume must be gay. Paul M., forty, told Human Rights Watch that in 2003, he was with a friend who had AIDS when the police approached and asked: “Eh boy, how you look so, w’happen to you?” The person say, “I have AIDS and I want to take my medication.’ Police say, “you must be battyman. Eh boy, eh boy, move your AIDS self from here. Mind me turn mi gun pon yuh and kill you. [Watch out because I might turn my gun on you and kill you.]”49 Arrests, detention, and prosecution Gay and bisexual men and AIDS service providers told Human Rights Watch that men who are or perceived to be gay are routinely threatened with arrest, arrested, detained, and sometimes prosecuted because of their actual or perceived homosexuality or homosexual conduct. Human Rights Watch also documented cases of police arrest of women because of homosexual conduct. Jamaica’s sodomy laws criminalize consensual homosexual conduct between adult men, prohibiting the “abominable crime of buggery, committed either with mankind or with any animal” and “gross indecency.”50 “Buggery,” which generally refers to all acts of 47 Human Rights Watch interview with Peter T., Kingston, June 9, 2004. 48 Ibid. 49 Human Rights Watch interview with Paul M., Kingston, June 6, 2004. 50 Offences against the Person Act, secti ons 76, 79. Caribbean states in the British Commonwealth inherited similar penal codes from the British colonial adm inistration, some of which have sinc e been amended or nullified. For example, Bahamian law proscribes consensual same sex sexual activity between adults in public but not in private. Sexual Offences and Domestic Violence Act of the Bahamas, section 16(2)(b). Jamaican and Guyanese laws are silent on lesbianism, while all acts of homosexuality are illegal in Trinidad and Tobago, Barbados and St. Lucia. “Sodomy Laws in the Carribbean,” http://www.sodomylaws.org/world/caribbean.htm (retrieved November 3, 2004). In 2000, Britain issued an order repealing sodomy laws in its Overseas Territories, which it had to do to meet its own international treaty

PAGE 24

HUMAN RIGHTS WATCH, VOL. 16, NO. 6 (B) 22 anal intercourse and bestiality, is a felony punishable by imprisonment with hard labor for up to ten years.51 “Gross indecency,” generally interpreted to mean any sexual intimacy between men short of anal intercourse, is a misdemeanor punishable by up to two years with hard labor.52 Jamaican law provides broad latitude for police to detain individuals on ill-defined charges, including suspicion of buggery or gross indecency. The Offences against the Person Act permits a police officer to arrest without warrant any person found “loitering in any highway, yard, or other place” between 7 p.m. and 6 a.m. the following morning whom the constable has “good cause to sus pect of having committed, or being about to commit any felony” proscribed by the Act.53 Jamaican police are also empowered to arrest without warrant and based on charges made by any “credible person” any person loitering in a public place to solicit another for prostitution.54 It is impossible to say how frequently sodomy laws are enforced against men engaged in consensual same sex contact in Jamaica, but by some accounts, they are in active use.55 Lawson Williams, a Kingston attorney who has represented men charged under these statutes, told Human Rights Watch: I always seem to have a case of a practicing gay man who is in court on account of his homosexuality. It's either that he and another have been busted and are jointly charged for [consensual] buggery, he's been charged in circumstances where so meone has alleged forcible or obligations under the European Convention on Human Rights and the International Convention on Civil and Political Rights. This order affected laws in Anguilla, the British Vi rgin Islands, the Cayman Islands, Montserrat, and the Turks and Caicos Islands. “U.K. Ends Territories’ Sodomy Laws,” PlanetOut, December 22, 2000. Prime Minister P.J. Patterson’s opposition to foreign intervention to repeal Jamaican sodomy laws is ironic, as it is not the same-sex behavior, but the laws that prohibit it, that are the colonial imposition. 51 Ibid., section 76. According to Jamaican lesbian, gay, bisexual and transgende r rights advocates, most buggery prosecutions involve adult m en suspected of engaging in consensual anal sex. Jamaica Forum for Lesbians, All-Sexuals and Gays, “Parliamentary Submissi on with Regard to ‘An Act to Amend the Constitution of Jamaica to Provide for a Charter of Rights and for Connected Matters,” http://www.jflag.org/programmes/parliamentary_sub.htm (retrieved August 24, 2004). 52 Offences against the Person Act, secti on 79. This provision follows Victor ian law on “gross indecency,” which was known as the “blackmailer’s charter,” bec ause a man could be convicted on the streng th of a blackmailer’s accusation. H. Montgomery Hyde, The Other Love: An Historical and Contempora ry Survey of Homosexuality in Britain (London: Heinemann, 1971), p. 136. 53 Offences against the Person Act, section 80. 54 Towns and Communities Act, sections 3 (r), 4 (empowering police to arrest without warrant based on charges made by any “credible person” that ce rtain offences committed within view of charging party). 55 In June 2004, Human Rights Watch requested police st atistics on arrests, conv ictions and charges imposed under laws proscribing sodomy and prostitution, but as of this writing has not received them.

PAGE 25

23 HUMAN RIGHTS WATCH, VOL. 16, NO. 6 (B) unwarranted homosexual advances against him, or there is an allegation that he has had sex with a minor. . Too many of the charges of sex with a minor are motivated by the prejudice that gay men are naturally inclined to have sex with underage boys, and they fail because of a lack of physical or credible evidence. Usually, the police indict gay men for bugger y. This is very difficult to prove in the context of consensual anal sex and there is seldom a successful prosecution for buggery. The damage is in the terror of the charge itself. Oftentimes, the defendant pleads guilty to the lesser offence of gross indecency, to abbreviate the embarrassment. Or if the defendant is adamant that he will not compromise, very often the charge is dismissed for lack of evidence. But the damage is in the charge. It is standing in the dock in the face of judge, police and sometimes other litigants, where it is known that you are charged as a battyman.56 High-level police officials claimed that sodomy laws seldom were enforced. Clarence Taylor, assistant commissioner of police in charge of administration, said that sodomy cases among adults were rare.57 A St. Ann’s Bay constable told Human Rights Watch, “We occasionally arrest homosexuals. If they’re caught in the act, we charge them with buggery.”58 A high-level police officer at a Kingston divisional police headquarters told Human Rights Watch in June 2004 that it had been “many moons since we have had an arrest for solicitation, buggery, or gross indecency.”59 A high-level police officer at a second Kingston divisional police headquarters said that he could not recall a case of buggery, and that the last one may have been three or four years before.60 Regardless of how often buggery and gross indecency laws are actually enforced, the arrests themselves send a message.61 The Jamaican press publishes the names of men charged with “consensual” buggery and gross indecency, shaming them and putting them at risk of physical injury.62 And the threat of criminal sanctions for homosexual 56 Human Rights Watch e-mail communication with Lawson Williams, August 10, 2004. “Lawson Williams” is a pseudonym. 57 Human Rights Watch interview with Clarence Taylor, Kingston, June 18, 2004. 58 Human Rights Watch interview, St. Ann’s Bay, June 16, 2004. 59 Human Rights Watch interview with K.K. Knight, senior police superintendent, Kingston, June 18, 2004. 60 Human Rights Watch interview with Newton Ames, s uperintendent of police, Kingston, June 18, 2004. 61 Human Rights Watch does not oppose punishment for sexual violence or coercion that would fall within the sodomy law. We urge Jamaica to amend the criminal law so that sexual viol ence or coercion against and between men is subject to equal punishment as sexual violence against women. 62 See, e.g., The Jamaica Observer January 11, 2003; The Star January 18, 2000.

PAGE 26

HUMAN RIGHTS WATCH, VOL. 16, NO. 6 (B) 24 conduct is itself powerful. Buggery and gross indecency laws provide a means to harass, arrest, and in some cases imprison individuals. They also perpetuate social prejudices. Allen C., twenty-two, said that he was arrested and charged with buggery after someone reported to the police having observed him having sex with another man. He was taken to the police station, where police officers urged him to confess to a charge of buggery while beating him with a stick and chanting “buggery fi dead” [people who commit buggery should be killed]. The police told him that he would be examined by a doctor in the rape unit to see if he was the receiving partner in anal intercourse. He was placed in a jail cell, where he was cursed out as a “battyman” by other inmates. When he was released to the custody of his mother, the police ensured that the abuse would continue: when Allen C. left the station, they announced the charges to people outside. Although the incident took place in 1999 (five years prior to his interview with Human Rights Watch), Allen C. was still suffering its consequences. He told Human Rights Watch that since this arrest, “The whole commun ity find out [that I’m homosexual.] People put up a hand like a gun to their head and say, ‘battyman fi dead,’ and throw stones at me. I can’t complain to police, because they know I am a homosexual and will turn on me. Most of the time, I just keep to myself and my friends who are homosexual.” He remained worried about being charged again with buggery and imprisoned. 63 A number of witnesses said that they thought that some element of their outward behavior, dress, or appearance was the motivation for police to arrest or detain them. Ryan N., twenty-three, was interrupted by police while talking with friends. “Police started saying I’m gay because how me talks. Police took me to the station and threatened to charge me with gross indecency. I asked him, ‘What is gross indecency? Can you define gross indecency?’ Police say, ‘When two men start to play with their penis.’ I say, ‘Was I doing that?’ When they realized that I’m not stupid about the law and started to quote the law to them, the police started threatening to lock me up and then men could screw me up in prison.” Ryan N. was charged with obstructing police on duty and resisting arrest.64 Several gay men told Human Rights Watch that they had been stopped by police while in a car with male friends. Harold B. recalled being stopped by police twice in the first half of 2004, once the week before his interview with Human Rights Watch. “If you’re 63 Human Rights Watch interview with Allen C., Kingston, June 8, 2004. 64 Human Rights Watch interview with Ryan N., Kingston, June 9, 2004.

PAGE 27

25 HUMAN RIGHTS WATCH, VOL. 16, NO. 6 (B) driving with a friend, police stop you and say, ‘battyman, what are you doing in the car— fucking?’ Try to argue with them and they’ll take you to the station.”65 Vincent G. was present in early 2004 when police approached a car in which two male friends of his were sitting, arrested them and threatened to charge them with buggery. His friends were taken to the police station and then released.66 Ryan N. was parked in a car, eating burgers with several friends when police approached them, told them they had observed them kissing, and made them get out of the car and show their documents.67 Police also use other laws as a pretext to stop men based on nonconforming gender identity. Patrick D., twenty-five, told Human Rights Watch about a 2004 incident: “I was going to a costume party and wearing a dress. The police stop me and tell me to hold up my head. I do and they see I am a man. I tell them I am entering a costume party competition. They radio other cars and accuse me of wanting to rob someone. They let me go, but they come and look and talk and call me ‘battyman.’” 68 Women who have sex with women are also targeted for arrest because of homosexual conduct. Lillie P., thirty-six, told Human Rights Watch that she was arrested while parked in a car with her girlfriend on December 31, 2002. “On New Year’s Eve, myself and my girlfriend went to a lovers’ spot after a party. There were a lot of other cars there, but the police approached us.” The police called Lillie P. and her girlfriend “dirty lesbians,” threatened to charge the women with indecent and lewd exposure and asked them for money. When the women refused to offer a bribe, the police arrested them and took them to the Portmore police station. At the station, the police superintendent told the women that they were not going be charged, but that their names would be recorded in a register. “It was scary at first because at this point I was not out to my parents and I was going to start a job soon and I was afraid that it was going to jeopardize it. I was concerned for my girlfriend . She works for [a government ministry] and could suffer problems if they find out she is gay.”69 Extortion and theft Men who have sex with men are easy targets for extortion by both police and private actors. Discriminatory police practices, fear that their homosexuality might be publicized, the paucity of available legal assistance, and the possibility of being 65 Human Rights Watch interview with Harold B., Kingston, June 9, 2004. 66 Human Rights Watch interview with Vincent G., Kingston, June 14, 2004. 67 Human Rights Watch interview with Ryan N., Kingston, June 9, 2004. 68 Human Rights Watch interview with Patrick D., Kingston, June 9, 2004. 69 Human Rights Watch interview with Lillie P., Kingston, June 19, 2004.

PAGE 28

HUMAN RIGHTS WATCH, VOL. 16, NO. 6 (B) 26 prosecuted themselves combine to keep men who have sex with men from filing complaints or seeking redress when they are victims of extortion. Several gay men told Human Rights Watch that police demanded money from them and arrested or beat them when they refused to pay. Harold B. recalled being stopped twice by police in 2004 and accused of having sex with another man. On one occasion, Harold B. and a friend were arrested and threatened with a charge of buggery after they refused to pay money to police. They were taken to the police station, where, after being questioned by the arresting officers’ superior, they were ultimately released.70 Two days before his interview with Human Rights Watch, police stopped Lawrence O. and two friends outside a shopping center in New Kingston. According to Lawrence O., the police yelled “battymen” and told them that they could avoid arrest by paying a bribe. When no one produced any money, the police started to shout and to beat Lawrence O. and his friends, attracting the attention of shopping center security guards, who, hearing the commotion, joined the police in beating the men.71 A Jamaica AIDS Support outreach worker reported another case in which a gay man who complained to police that he was being blackmailed had to pay police to keep them from disclosing his sexual orientation.72 Lawson Williams, a Kingston attorney, represented several men who had been blackmailed with accusations of buggery or gross indecency by men who had committed crimes against them. He said that fear of prosecution under buggery laws and the dire implications of charges of buggery prevented blackmail victims from even contemplating seeking the protection of the state. The sodomy laws are used to silence MSM, to keep them in check. They allow criminal acts to be committed against MSM with impunity. People know—thieves, crooks, layabouts—that if they commit a crime against you, they can play the “battyman card” to silence you. I’ve seen this in my cases. And this builds on the perception that gay men are saps, not only because they’re effeminate, but because their vulnerability is supported by state institutions—police, courts—that don’t protect them. 70 Human Rights Watch interview with Harold B., Kingston, June 9, 2004. 71 Human Rights Watch interview with Lawrence O., Kingston, June 19, 2004. 72 Human Rights Watch interview with Paul M., Kingston, June 6, 2004.

PAGE 29

27 HUMAN RIGHTS WATCH, VOL. 16, NO. 6 (B) In a 2004 case, for example, a man charged with car theft claimed that he had taken the car from its owner after having been forced to have anal sex with him. In his statement to the police, he admitted driving the car away without permission, stating that he had meant to drive to the police station to report having been buggered but had been too ashamed to do so. The car owner was subsequently charged with buggery. His accuser never appeared in court to prosecute his complaints, and the buggery charges against the car owner ultimately were dropped. As of this writing, the car has not been recovered.73 Police failure to provide prot ection from violence and abuse We haven’t had any reports about violence against homosexuals. Most of the violence against homosexuals is internal. We never have any cases of gay men being beaten up. I know that there is a sort of revulsion against homosexuals, lesbians, but evidence does not substantiate that there is any level of violence perpetrated against them. — K.K. Knight, senior superintendent of police, Kingston, June 18, 2004 If you make a police report, they start by making you instead of the victim the person that is wrong. The police ask, ‘Why all of a sudden they calling you a battyman? How do they know you a battyman?’ These kinds of questions trivialize the problem. — Adrian S., thirty, Kingston, June 13, 2004 Men who have sex with men and women who have sex with women repeatedly told Human Rights Watch that they did not bother to report homophobic violence because they did not believe that police would take any action to address it, especially in cases where police were the perpetrators. In some cases, attempts to make complaints were ignored altogether; in others, police investigation efforts inspired little confidence, fueling concerns that police cared little for the lives and wellbeing of homosexual men and women. Joseph W., twenty-six, lived with two male friends in the Kingston area. In December 2002, a policeman came to their house and told them that he had received a report that 73 Human Rights Watch interview with Lawson Williams, Ki ngston, June 23, 2004 and statements of complainant and accused to police. A “buggery” defense appears to have been used by a man charged with felonious wounding, who claimed he stabbed another man after having been forced by him to have sex in the car at knifepoint. John Tavares, “Buggery, Case Continues June 22,” The Jamaica Observer, June 4, 2004.

PAGE 30

HUMAN RIGHTS WATCH, VOL. 16, NO. 6 (B) 28 they were gay. The policeman forced his way past the security gate and onto the veranda and threatened to kill Joseph and his roommates if they did not leave. Joseph attempted to lodge a complaint with the police later that day. When he told police that he lived with two other men, they laughed and said that there was nothing that they could do to assist him. The following day, Joseph went to the Police Public Complaints Authority, the independent state authority charged with investigating allegations of police abuse, which likewise refused to investigate the case or otherwise provide assistance. After the initial incident, a crowd gathered around the house hurling antigay insults, and the men were forced to move—both because they feared for their safety and because their landlord was concerned about possible damage to his property.74 The night before Lawrence O.’s interview with Human Rights Watch, a friend of his was robbed and stabbed in front of him. The police came to the scene, retrieved the knife, and left without investigating the incident or assisting the injured man in obtaining medical care. “The guy [the assailant] told the police that we were battymen. So the police just left. The police should have done something. [My friend] was cut and he was bleeding. . They looked at us and said, ‘you are all battymen.’ Then they took the knife [from the assailant] and told him to go.”75 In Ocho Rios, several gay men said that there was a man in town who frequently harassed them and other gay men, threatening to kill them, extorting money from them, and inciting others to commit violent acts against them. Leroy J., thirty-three, said that in May 2004, when he tried to report this harassment to the police, the police chased him out of the station and threatened to attack him. “I went to the police to report these threats. They wouldn’t come. They said that we don’t have a right to live in our own country and that they would chop us up and kill us.”76 When he met with Human Rights Watch in June 2004, Allen C. said that people often threw stones and bottles at him when he walked down the street. He had not complained about this to the police, however, believing that a prior buggery charge had effectively stripped him of police protection. “Because of the [buggery charge], police think I’m homosexual. I can’t complain about stone throwing, because then they’ll turn on me.”77 74 Human Rights Watch interview with Joseph W., Kingston, June 11, 2004. 75 Human Rights Watch interview with Lawrence O., Kingston, June 19, 2004. 76 Human Rights Watch interview with Leroy J., Ocho Rios, June 16, 2004. 77 Human Rights Watch interview with Allen C., Kingston, June 8, 2004.

PAGE 31

29 HUMAN RIGHTS WATCH, VOL. 16, NO. 6 (B) Edward P., twenty-two, said that: “Sometimes I can’t walk in peace. People shout battyman and all this stuff. They keep saying that I’m a battyman and men will fuck me and that I can’t walk in this neighborhood. And sometimes if I turn they will try to attack me.” He has not registered a complaint with police, however. “To be honest, I feel scared because police themselves will try to bitch you and even tell you to leave the police station.”78 Nicholas C. testified that people in the town where he had lived were constantly threatening to kill him because he was gay, forcing him to move from the town. He also testified that he had been beaten by police on more than one occasion. When asked about lodging a complaint about his neighbors or the police, Nicholas replied, “Complain? No, because I don’t know who to complain to. Police [and homophobic people in town] are the same thing.”79 Albert B. said, “It doesn’t make sense to complain because you will not get anything from them. One time, a guy accused me of being gay and wanted to beat me. The policemen drove around and asked me if I did it.”80 In May 2004, Paul M. and his housemates were driven out of his house by a group of men armed with machetes. “I did not complain to the police. When it comes to homosexuals, we have no rights.”81 Some police denied that homophobic violence was a problem in Jamaica. K.K. Knight, senior superintendent at the Kingston police station charged with investigating Brian Williamson’s murder, told Human Rights Wa tch: “Most of the violence against homosexuals is internal. We never have any cases of gay men being beaten up.”82 According to Knight, gay men inflict injury on each other in crimes of passion: “Usually in homosexual cases, you can see some kind of passion by the amount of injury inflicted and the scars on the body, and the sort of information you get from witnesses.”83 Newton Ames, police superintendent at St. Andrew parish south divisional headquarters, testified that “we have never had any report of community violence against homosexuals. [Police involvement] is not a thing that people want in these areas. People stay away from accusing someone of homosexuality or getting involved in it.”84 78 Human Rights Watch interview with Edward P., Ocho Rios, June 16, 2004. 79 Human Rights Watch interview with Nicholas C., Kingston, June 9, 2004. 80 Human Rights Watch interview with Nicholas C., Kingston, June 9, 2004. 81 Human Rights Watch interview with Paul M., Kingston, June 6, 2004. 82 Human Rights Watch interview with K.K. Knight, seni or superintendent of police, Kingston, June 18, 2004. 83 Ibid. 84 Human Rights Watch interview with Newton Ames, s uperintendent of police, Kingston, June 18, 2004.

PAGE 32

HUMAN RIGHTS WATCH, VOL. 16, NO. 6 (B) 30 An individual with close links to law enforcement agencies who had experience working at murder scenes said that: abuse of gay men is by gay men. From my experience, all gays are killed the same way. If you go to a crime scene, you can tell if a person is gay or straight by how they are killed. Gay men, they are more brutally slain—by a knife, strip them up.85 There is evidence that supports the claim that in many countries, gay, lesbian, bisexual and transgender people are victims of ser ious violence, including murder, because of their sexual orientation and that these murd er victims often undergo exceptional brutality, sometimes called “overkill” (extreme harm beyond that necessary to cause death).86 But this evidence does not support any conclusion that gay men commit such savage acts of violence against other gay men. The “overkill” stems from hate. The misperception that gay men kill each other in brutal crimes of passion is a common barrier to investigating “gay murders” not only in Jamaica but in many parts of the world.87 Percival Buddan, the officer in charge of HIV/AIDS training for the Jamaican police force, acknowledged that members of the police force shared homophobic attitudes common in the general community. According to Buddan, “The police force has a culture. If they know you’re homosexual, you’ll definitely be discriminated against and stigmatized.”88 However, in some cases, police had helped protect against assault. A St. Ann’s Bay police officer said that he knew of an incident where police had intervened to 85 Human Rights Watch interview, Kingston, June 10, 2004. A newspaper columnist commenting on Brian Williamson’s murder wrote that “based on cursory investigations, all i ndications are he was murdered by someone ‘in-house.’ The police report suggests that he was chopped all over his body. This is fairly consistent with previous murders in Jamaica involving male homosexuals.’” Mark Wignall, “Those Flamin’ Homosexuals,” The Daily Observer, June 17, 2004. See also S. Escoffery, “Letter of the day – Outrage! and hypocrisy in dancehall attack,” The Jamaica Gleaner October 6, 2004 (arguing that in Jamaica, “98 per cent, if not all crimes against homosexuals are homosex ual on homosexual crimes”). 86 See, e.g., “Homocide in Homosexual Victims: A Study of 67 Cases from the Broward County, Florida, Medical Examiner’s Office (1982-1992), with Special Emphasis on ’Overkill,’” The American Journal of Forensic Medicine and Pathology, vol. 17, no. 1 (March 1996), pp. 65-69 (comparing number and extent of injuries in homosexual and heterosexual homicide vi ctims and finding that homosexual homicides were more violent); Douglas Victor Janoff, “Tales from the Turkish Crypt: Ottawa Researc her Explores Homophobia, Violence and Murder,” Capital Xtra!, July 1, 2004 (reviewing studies of serious violence against lesbian, gay and transgender people). 87 See, e.g., Human Rights Watch and Internationa l Gay and Lesbian Human Rights Commission (IGLHRC), Public Scandals: Sexual Orientatio n and Criminal Law in Romania (New York: Human Rights Watch and IGLHRC, 1998), pp. 65-66. 88 Human Rights Watch interview with Percival Buddan, subofficer in charge, Jamaican Constabulary Force First AID Center, Kingston, June 18, 2004.

PAGE 33

31 HUMAN RIGHTS WATCH, VOL. 16, NO. 6 (B) stop people from stoning gay men.89 A few gay men also testified that police had assisted them in leaving dangerous situations, such as escorting them from their homes when armed men were threatening them with serious violence. On June 9, 2004, Brian Williamson, a prominent gay rights activist and one of the very few people in Jamaica to appear openly in the media as a gay man, was murdered in his home, his body mutilated by multiple knife wounds. Because of his international prominence as a gay rights advocate, his middle-class status, and his dual Canadian/Jamaican nationality, members of the lesbian, gay, bisexual, and transgender community initially were hopeful that police would take special care in the investigation of his murder. But police actions from the start raised cause for concern. Williamson’s body was discovered on the floor of his apartment, reportedly with stab wounds to his neck and body. After the police left the crime scene, Ernest N., thirty-six, a friend of Williamson’s, went to the apartment to clean up. He told Human Rights Watch that the apartment was unlocked and the door open. A few feet from where the body had lain, Ernest N. found a ratchet knife and an ice pick, both of which had blood on them.90 A witness told police that he had seen two men at the apartment the morning of the murder. The police detained one of the m en, nicknamed ‘Wingee,’ and called the witness to identify the suspect in a lineup. As the witness passed the lockup on his way to the lineup, inmates called out, “See the battyboy who has come for Wingee. Him fi dead. [He should be dead.]” At the lineup, nine individuals were presented with towels on their heads and white cream (apparently toothpaste) on their faces, making them virtually unrecognizable. According to the witness, “I never saw that guy with anything on his head or face so I couldn’t identify him.” The witness also stated that even one of the police officers at the station told him that he had never seen participants in a lineup disguised in this way.91 Police abuse of sex workers Male and female sex workers interviewed by Human Rights Watch reported being harassed by police, who apparently regarded them as a source of both money and sex. Because soliciting sex is illegal, police face little risk of censure for these actions. Male sex workers face the double condemnation of homosexual conduct and prostitution. 89 Human Rights Watch interview, St. Ann’s Bay, June 16, 2004. 90 Human Rights Watch interview with Ernest N., Kingston, June 11, 2004. 91 Human Rights Watch interview with Ellis R., Kingston, June 25, 2004.

PAGE 34

HUMAN RIGHTS WATCH, VOL. 16, NO. 6 (B) 32 These abuses may increase HIV risk for sex workers by driving them further underground and away from potentially lifesaving information on HIV prevention and other health services. Male and female sex workers told Human Rights Watch that police extorted sex and money in exchange for not arresting them. Vincent G.’s experience was typical of the accounts we heard. “Police ask for sex and they don’t pay. Last time I was with a policeman was about a month ago. Police said I had to give him a blow job. I had to do this because I didn’t want to get charged.”92 An outreach worker with Jamaica AIDS Support told Human Rights Watch: “Sex workers are arrested, but not as often as gay men. Very naughty police will try to get sex off of the ladies so they won’t get locked up. The ladies say it happens often. . Gay men selling sex [are treated] worse than females. They [police] beat them up bad. This happens often.”93 A number of sex workers said that they could not report violence or abuse, in part because they risked abuse by the police if they did so. Jennifer S. told Human Rights Watch that police beat her and asked her for money and sex, and clients stole money from her. When asked whether she had ever reported such abuse to the police, she said, “Complain? I can’t do that because they will not listen to us. . ‘Come out of the station. You’re nothing but a whoring girl.’ This is what police say when we try to complain.”94 Vincent G. said that when one of his clients stole money from him, “I couldn’t complain to the police about it because I am homosexual.”95 Police interference with access to HIV/AIDS information and health services Jamaican government policy recognizes that the most effective and indeed in some cases the only possible AIDS educators for members of marginalized groups, such as men who have sex with men and sex workers, are their peers. 96 But peer educators and others who reach out to marginalized groups are often held in the same contempt as the 92 Human Rights Watch interview with Vincent G., Kingston, June 14, 2004. 93 Human Rights Watch interview, Kingston, June 6, 2004. 94 Human Rights Watch interview with Jennifer S., Kingston, June 9, 2004. 95 Human Rights Watch interview with Vincent G., Kingston, June 14, 2004. 96 See, e.g., Ministry of Health, “Jamaica HIV/AIDS/STI National Strategic Plan 2002-2006,” January 2002; see also PanCaribbean Partnership on HIV/AIDS, “The Caribbean Regional Strategic Framework for HIV/AIDS 2002-2006,” March 2002.

PAGE 35

33 HUMAN RIGHTS WATCH, VOL. 16, NO. 6 (B) individuals with whom they work and subjected to discrimination and violence at the hands of the government. Human Rights Watch documented numerous cases of police harassment of HIV/AIDS workers providing services to men who have sex with men and to male and female sex workers. In some cases, the very possession of condoms—a key tool in the work of HIV prevention—triggered police harassment of HIV/AIDS educators and of sex workers. Men who have sex with men The Ministry of Health relies on the NGO Jamaica AIDS Support (JAS) to provide HIV/AIDS information and services to men who have sex with men.97 Dr. Yitades Gebre, executive director of Jamaica’s Program Coordination Unit at the Ministry of Health, acknowledged that the ministry had “identified MSM as a target population, but we’re not reaching them.” He explained “because the laws impeded the Ministry of Health from working with MSM, we give the work to JAS. To date, we don’t promote direct programs or services to MSM as a group because the existing laws impede this work [and] because [of] the high level of stigma and discrimination, they’re not open to getting services through the public sector.”98 The police however, are actively impeding JAS’ government-supported efforts. A JAS outreach worker told Human Rights Watch that: “police always try to get in the way of handing out condoms. . Police say, ‘how can you be handing out condoms to battymen. . We do not encourage you to do this work because battymen fi dead. [gay men should be dead].’” He recounted two arrests for handing out condoms to MSM: In May 2003, I was in an area known to be frequented by gay men . I was there handing out condoms on the main road. It was me alone, at about 9:30 in the evening. I was issuing condoms and about five guys were there and a police car drove up. There were four police in the car. They asked, “What are you doing here? You must be battymen.” I say that I am on my job, issuing condoms. They turned to me and said, “How come you issuing condoms to battymen?” I say it’s a part of my 97 Jamaica AIDS Support is an NGO that also provides HI V/AIDS information and services to men and women who sell sex for money and engage in transactional sex, hearing-impai red individuals, and inmates, ex-convicts and correctional services staff. This work is funded by the Ministry of Health through the Global Fund and USAID. The Caribbean Epidemiology Centre (CAREC) and several United States NGOs also support condom dist ribution work. Jamaica AIDS Support, “Targeted Intervention,” http://www.j amaicaaidssupport.com/services/intervent ion.htm (retrieved August 1, 2004). 98 Human Rights Watch interview with Dr. Yitades Gebre, Kingston, June 23, 2004.

PAGE 36

HUMAN RIGHTS WATCH, VOL. 16, NO. 6 (B) 34 job. . He turned to me and said he was going to lock me up because I am not supposed to be issuing condoms to battymen. . Then his friend said “come and charge the boy for loitering.” And then they said for me to get in the car and they took me to the police station. When I was in the police station, I was placed in a holding area and I asked them to call [my supervisor] at my workplace. They didn’t give me the call right away. I was there for about three hours. And every police comes into the station, the policemen that arrested me would say to their friends, the other policemen, “the boy handing out condoms to battymen.” Some will talk some abusive things, like “boy, are you gay? You a battyman too? Battyman fi dead!” Then I asked them again for the call because I wanted to know if I am going to be charged because I am here for over three hours now. After a long deliberation, they let me go. When I was released, they told me, “Go home and stop helping the battymen. And we hope we don’t catch you handing out condoms to battymen.”99 In October 2003, this outreach worker was again arrested and charged with loitering for handing out condoms to men: I was out on the main road handing out condoms in an area known to be a gay area and the police came down and the men began to run. I stood my ground and I had a condom in my hand and the policemen asked me what I was doing there and the police asked me if I were a battyman. I had three boxes of about 100 condoms in my hand. . They said that they were going to charge me with loitering, but if they see me in the act they would kill me. And they said that they were going to charge me for loitering because they knew that I was a battyman because only a battyman would be handing out condoms to men. . I was accused of buying sex and being a battyman and charged with loitering.100 The outreach worker was called to appear in court twice, but the charges ultimately were dropped. 101 99 Human Rights Watch interview with [name withheld on request], Kingston, June 18, 2003. 100 Ibid. 101 Ibid.

PAGE 37

35 HUMAN RIGHTS WATCH, VOL. 16, NO. 6 (B) Sex workers Jamaica AIDS Support also provided condoms and HIV/AIDS education to male and female sex workers who operated in the Kingston, Montego Bay, and Ocho Rios areas, including street sex workers, go-go dancers, and massage parlor workers. A Kingstonbased JAS outreach worker explained: “We have educational sessions with ladies and men two nights of the week on the road. We hand out condoms and pamphlets and talk a little about safe sex and what we can do to help them. We also invite them to JAS to do free HIV testing, have a place to chat.”102 He told Human Rights Watch that he had been stopped by police several times while handing out condoms on the road to sex workers. Once he was once accused of being a sex worker and detained overnight in jail.103 Steve Harvey, JAS’ coordinator of targeted interventions in Kingston, said that he had been stopped by police while doing outreach to sex workers several times in 2003 and 2004. On one occasion, the police accused him of illegal soliciting; other times, police stopped and searched him, his colleagues, and their car. 104 Police crackdowns on sex work—of which there were at least two in Kingston in the first five months of 2004—hampered HIV/AIDS prevention work by undermining outreach workers’ ability to distribute condoms and to discuss HIV/AIDS and other health services with sex workers. Harvey told Human Rights Watch: Sometimes the police decide that they are going to crack down on sex work, and they do it for two weeks. During that time, the girls are afraid. Some of them won’t come onto the streets, some of them will go to other places, and some of them are in hiding so when you go down the streets, you can’t see them. It hampers HIV/AIDS prevention work. We really don’t have the time then to talk to the girls.105 Police also threatened sex workers that possession of condoms could be used as evidence of their illegal activity. Joyce D., forty-one, had been selling sex on the street since she was a young girl. She told Human Rights Watch that police regularly took condoms from her, threatening to use them as evidence against her if she refused to 102 Ibid. 103 Ibid. 104 Human Rights Watch interview with Steve Harvey, coor dinator of targeted interventions, Jamaica AIDS Support, Kingston, June 6, 2004. 105 Ibid.

PAGE 38

HUMAN RIGHTS WATCH, VOL. 16, NO. 6 (B) 36 provide them with sex. “Police say, ‘hey girl, if you don’t give me some pussy, condom is there for evidence that you’re fucking in the street.’ . Now they have the handle. I have the blade. There is nothing that I can do about it. I give them my body.”106 Abuses in the health care system People living with HIV/AIDS and men who have sex with men face numerous human rights abuses that constitute barriers to obtaining necessary medical care. Among these are discrimination by health workers who forced them to wait extended periods of time to be seen, treated them in an abusive or degrading manner, provided inadequate care, or denied them treatment altogether. Health workers also routinely violated their privacy by disclosing confidential information about HIV status and sexual orientation. Human Rights Watch found that the threat of serious violence and discrimination, compounded by the deep stigma associated with homosexuality, was keeping men who engaged in homosexual conduct from seeking medical treatment and from existing prevention services and driving them to engage in unsafe and unprotected sex. Discrimination and stigma also was driving people living with HIV/AIDS away from health care and other HIV/AIDS services. Several people told Human Rights Watch that health care provision to people living with HIV/AIDS had improved in the last few years, crediting the Ministry of Health and the efforts of AIDS service organizations like Jamaica AIDS Support (JAS) and the Center for HIV/AIDS Research, Education and Services (CHARES) for these changes. “Things have changed a lot,” said Orchid Gowe-Hunter, a nurse with Jamaica AIDS Support, “but people still have some bad experiences.”107 Discrimination by health care providers Heath care delayed or denied Human Rights Watch interviewed several nurses and AIDS service workers who said that public hospitals and clinics provided inadequate care to people living with HIV/AIDS, sometimes refusing to treat them. Some acknowledged that the situation had improved since the start of the epidemic but stressed that the abuses had not abated altogether. 106 Human Rights Watch interview with Joyce D., Kingston, June 9, 2004. 107 Human Rights Watch interview with Orchid Gowe-Hunter, Montego Bay, June 21, 2004.

PAGE 39

37 HUMAN RIGHTS WATCH, VOL. 16, NO. 6 (B) Human Rights Watch learned that some doctors who treated people living with HIV/AIDS failed to conduct adequate medical exams or even to touch them, and that clinic staff had refused to register people living with HIV/AIDS for admission. Men who have sex with men also told Human Rights Watch that they had been denied health care treatment. Tonya Clark, a nurse with Jamaica AIDS Support in Kingston, said that a JAS client who had suffered a head injury had been denied services twice in the week prior to her interview with Human Rights Watch. In June 2004, Gary T. was beaten and suffered a head injury. He first went to the police, who referred him to the hospital with a form to be completed with details of his injury. After Gary T. told the nurse that he had HIV, she tore the form up and told him to leave. A JAS social worker returned to the hospital with Gary T., where they again refused to treat him.108 A health worker with years of experience working in the health sector in northern Jamaica who assisted people living with HIV/AIDS in obtaining medical care said that based on her experience, physicians at the regional hospital treated HIV-positive patients differently from other patients and had provided inadequate care to two of her clients in April and May 2004. In one case, she brought a client to the regional hospital because he had lesions on his penis and difficulty urinating. The examining physician stated that the man had HIV, donned gloves, and ignored the health worker’s request to examine the client’s genital area, instead focusing on his chest and abdomen and sending him home without examining the lesions on the penis. The health worker told Human Rights Watch: The doctor that came to see him knows me and my work [with people living with HIV/AIDS] and said at once, “this is a positive person.” . I said we found him on the road, I think he has some sores on his penis. The doctor put on gloves, did a chest exam, peeled off that set [of gloves], did an abdomen exam, peeled off that set . and I was saying, there is something wrong with his penis. You need to look at him. [The patient] said he has sores on it and hasn’t urinated in a while. And he has this smell coming from his genitals. The doctor wouldn’t look at it. . 108 Human Rights Watch interview with Tonya Clark, Kingston, June 14, 2004.

PAGE 40

HUMAN RIGHTS WATCH, VOL. 16, NO. 6 (B) 38 The man received no treatment for the lesions on his penis that day. The health worker ultimately secured the assistance of a nurse who worked with an AIDS service organization to examine him and provide appropriate medication to treat his lesions. 109 Men who have sex with men and health workers reported that public and private health care providers refused to treat men whom they knew or perceived to be gay and made abusive comments to them, at times instigating abusive treatment by others. Curtis M., twenty-four, told Human Rights Watch that when a friend accompanied him to St. Ann’s Bay Hospital, a nurse made homophobic remarks, and he left without receiving treatment. “[The nurse] said, ‘I wonder which one is the woman and which one is the man. . We had to leave because the crowd started looking at us and then on the road they were hurling words at us, ‘battymen fi dead.’ I felt threatened.”110 He did not receive treatment that day. When Leroy J., thirty-three, went to a private doctor, he was told “we don’t work with gay people here.”111 Craig F., a health worker in northeast Jamaica, said that public health centers in the region have refused to treat men whom they believed to be homosexual and that he had heard health workers making abusive comments to gay and bisexual men. For example, one health worker told a gay man with gonorrhea that he was “nasty” and asked why he had sex with other men.112 Several people told Human Rights Watch that health workers routinely mistreated people living with HIV/AIDS, delaying care or impeding access to treatment. When Eric B., a thirty-year-old man living with HIV/AIDS, sought treatment for a foot injury, he had to wait until all other patients had been seen, including people who arrived after him and people with lesser injuries, before he was examined.113 Craig F. told Human Rights Watch that in May 2004, a health clinic clerk had refused to register a person living with HIV/AIDS for treatment, stating that she would not look after anyone who was HIV-positive.114 109 Human Rights Watch intervie w, Ocho Rios, June 16, 2004. 110 Human Rights Watch interview with Curtis M., Ocho Rios, June 16, 2004. 111 Human Rights Watch interview with Leroy J., Ocho Rios, June 16, 2004. 112 Human Rights Watch interview with Craig F., Ocho Rios, June 16, 2004. 113 Human Rights Watch interview with Eric B., Kingston, June 8, 2004. 114 Human Rights Watch interview with Craig F., Ocho Rios, June 16, 2004.

PAGE 41

39 HUMAN RIGHTS WATCH, VOL. 16, NO. 6 (B) Discrimination in health care provision My neighbor, she was ill, she was HIV-positive. [At the hospital], they screened her off. Her food was taken to her in a styrofoam box, and everyone else on the ward was treated differently. Everybody else had regular plates, and hers was just in a box. . I went to her because I knew her. Nobody cleaned her, looked after her. The nurse said, ‘You know what she have?’ I said yes. The nurse said, ‘Then you have gloves?’ I looked after her, gave her a bath. Her mother came and asked, ‘Why are they treating her like this, like a dog?’ No one cared for her. I went every day with her mum and cleaned her, taught her mother how to care for her. — Tonya Clark, nurse with Jamaica AIDS Support, Kingston, June 14, 2004 Among those encountered by Human Rights Watch, people living with HIV/AIDS who did receive medical care were separated from other patients and placed at the back of a ward or behind a screen with their basic needs left unattended. Health workers also engaged in discriminatory practices that called attention to their HIV status, such as placing their clothes and linens in conspicuously marked bags, and making sure that medical equipment did not touch their skin.115 Orchid Gowe-Hunter, a nurse with Jamaica AIDS Support, had worked with people living with HIV/AIDS in the Kingston, St. Andrews, and St. James parishes for several years. She told Human Rights Watch that both Kingston Public Hospital (KPH) and Cornwall Regional hospitals continued to isolate people living with HIV/AIDS in the ward. At KPH, for example: they always isolate them in the ward. They have a little corner way to the back. One day, we went to visit this guy and he was just lying in the bed alone. He had no sheets on the bed, no proper clothes. . He was 115 HIV is not spread by casual contact nor by an y airborne means of transmi ssion, including sneezing or spitting. There is therefore no public health justificat ion for segregating people living with HIV/AIDS from other patients, or in any way isolating t heir food, laundry or medical equipment for non-invasive procedures solely because someone has HIV. Such actions threaten to re veal HIV status, and undermine public health efforts by creating a false sense of protection from the disease, creating harmful stigma, and thus keeping people from seeking health care and prevent ion services. See UNAIDS, HIV/AIDS and Human Rights-International Guidelines p. 42. International health organizations recomm end that workers in settings where the possibility of occupational HIV transmission does exis t, as where there may be exposure to bloody injuries or being stuck with unsterile syringes, be trained in “universal precautions” (simple measures to pr otect against HIV and other blood borne illnesses) and provided with adequate supplies (suc h as gloves) to take such precautions. World Health Organization, “Universal Prec autions, Including Injection Safety,” http://www.who.int.hiv/topics/precautions/universal /en/ (retrieved September 16, 2004).

PAGE 42

HUMAN RIGHTS WATCH, VOL. 16, NO. 6 (B) 40 unable to feed himself or take his medication. All of the food, all of the medication was just left by the bed.116 Gowe-Hunter’s account is typical of those documented by Human Rights Watch. HIV-positive men who have sex with men faced additional barriers. “They perceive, and rightfully so, that if they divulge who they are and what they do, they may be shunned,” said Deborah Manning, program manager of the Center for HIV/AIDS Research, Education and Services. In one case, for example, when an HIV-positive patient’s boyfriend came to visit him, a nurse ran him out of the hospital, telling him that she did not want any of their “nastiness” there. 117 Joseph W., twenty-six, told Human Rights Watch that when he visited a friend at Kingston Public Hospital in December 2003: the nurses and the ancillary workers were laughing and saying, “which one of them is the man, which is the woman?” Partly because of his sexuality and because he was [HIV] positive he was not given the kind of treatment he should have gotten. He wasn’t able to help himself. They wouldn’t change his sheets . They would leave his food there. Myself and all my friends had to go help him eat.118 Patrick D., twenty-five, found his HIV-positive friend lying in soiled diapers, and changed them while a nurse called out, “Battyman, you shit up yourself. You shitty shitty.”119 Health care workers at public and private hospitals in Kingston parish told Human Rights Watch that patients at their institutions were treated the same as others, but noted that their clothes and linens were placed in specially marked bags and laundered separately; doctors and nurses used gloves when attending to them; and that when taking the blood pressure of a person living with HIV/AIDS, they put a “precautionary barrier” between the person’s arm and the cuff. One health worker explained that “if a patient knows another person is HIV-positive, he won’t use the same blood pressure cuff.”120 116 Human Rights Watch interview with Orchid Gowe-Hunter, Montego Bay, June 21, 2004. 117 Human Rights Watch interview with Deborah Ma nning, director, CHARES, Kingston, June 14, 2004. 118 Human Rights Watch interview with Joseph W., Kingston, June 11, 2004. 119 Human Rights Watch interview with Patrick D., Kingston, June 9, 2004. 120 Comments made at workshop to discuss quality of care for HIV-positive patients, Kingston, June 7, 2004.

PAGE 43

41 HUMAN RIGHTS WATCH, VOL. 16, NO. 6 (B) Several health workers said that HIV-positive patients posed a danger to health care workers because they had a tendency to be angry and aggressive and would try to intentionally infect others with HIV.121 A health worker at a private facility offered this example of such dangerous behavior: “I had a patient who said he contracted HIV and it’s not his fault, he’s not going down wi th it. He threatened to spit on a nurse.”122 A nurse at a Kingston public hospital acknowled ged that she and her coworkers treated patients differently from other patients. She said that they were concerned about contracting the virus from patients who were often “deliberately demanding,” in part because they “really hopelessly wanted you to get HIV too.”123 In the view of some health workers, the fear that HIV-positive patients would spread the disease to health care workers and others—whether intentionally or otherwise—justified segregating patients living with HIV in the hospital as well as in the larger community. At a workshop to discuss quality of care for patients with HIV, one health worker, summarizing the views of a small group discussion, said that people living with HIV “should be isolated to prevent this epidemic from being spread to the rest of society.”124 A spokesperson for a second small group added that “some persons [with HIV] are isolated for their own protection,” while others because they “are more aggressive. They want to bite you, spit on other patients.”125 Inadequate protection of c onfidential information That word, confidentiality. I’m so afraid of that word because in most instances it don’t mean anything. — Lena B., twenty-nine, Montego Bay, June 22, 2004 Human Rights Watch found that some health workers failed to preserve the confidentiality of patients’ HIV status. By singling HIV-positive patients out for disparate treatment absent medical justification, they risked divulging confidential information about their HIV status. In some cases, health care workers disclosed confidential information about HIV status without patient authorization. Some health care workers also disclosed private information about sexual orientation. 121 Ibid. 122 Ibid. 123 Ibid. 124 Ibid. 125 Ibid.

PAGE 44

HUMAN RIGHTS WATCH, VOL. 16, NO. 6 (B) 42 The failure to preserve confidential information about HIV status and sexual orientation violates the right to privacy protected by the ICCPR and the American Convention on Human Rights.126 Such actions also threaten other rights. As described above, people living with HIV/AIDS and men who have sex with men may be denied health care or subjected to violence and stigma when state and private actors discover their sexual orientation or that they are HIV-positive. Lena B., twenty-nine, was hospitalized for the last four months of her pregnancy at the regional medical center. Doctors and nurses there repeatedly chastised her in front of other staff and patients about having continued to have sex while living with HIV. A doctor who knew that she had worked as an HIV/AIDS educator told her that she “should have known better” not to have sex when she had HIV and chided her for proving a poor example for others. One of the nurses instructed the ward assistant not to serve Lena on plates that other patients might use; when that nurse was on duty, Lena had to use disposable dishware. At the end of Lena’s pregnancy, two doctors discussed the decision to give her an emergency caesarean section in the middle of the ward, “in front of a lot of people.” The first doctor explained, “I’m going to do the C-section [caesarean section] because you want to push the child out of your vagina, and you know you have the disease running around in the vagina and you want to put the child more at risk than he is already at.”127 A second doctor added, “I want to take you on a tour up to the top where all the AIDS babies and children are and show the misery that you people cause to come on the land. Because I agree that you should not be having sex, much less getting pregnant.”128 Hospital staff signaled Lena B.’s HIV status to her mother-in-law through their treatment of her newborn son and comments they made. When Lena B.’s mother-inlaw came to see her new grandchild, she found the baby by the nurse’s station, still unwashed, and asked to help clean it. 126 ICCPR, 999 U.N.T.S. 171, entered into force March 23, 1976, art. 17; American Convention on Human Rights, entered into force July 18, 1978, art. 11. Jamaican law provides that physicians, nurses and mi dwives may be subject to sanctions for failure to protect confi dential patient information. See The Medical Act, section 11; The Nurses and Midwives Act, section 11. 127 Caesarean section delivery has been shown to reduce t he risk of mother-to-child HIV transmission. It may not be appropriate in resource-constrained settings because of limited availability, cost and risk of complications. World Health Organization, HIV in Pregnancy: A Review, WHO/CHS/RHR/99.15, UNAIDS/99.35E (Geneva: UNAIDS, 1999), pp. 9, 25. In sistence on caesarean sections may also present a substantial ethical problem if women are not pr operly briefed about both the risks and the advantages associated with undergoing caesarean sections. 128 Human Rights Watch interview with Lena B., Montego Bay, June 22, 2004.

PAGE 45

43 HUMAN RIGHTS WATCH, VOL. 16, NO. 6 (B) The nurse said, “you come in off the street with germs wanting to take care of the child and want to finish killing him off because he has everything going bad for him already?” . The nurse clean up the child and she still have him over behind the nurse’s station. . My mother-inlaw says, “I’m going to take him over to the mother to breastfeed.” The nurse said, “Breastfeed what? Mo thers like those not even supposed to have children much less to breastfeed with the type of sickness they have.” At this point, Lena B.’s mother-in-law asked whether she had AIDS. Lena B. lived with her in-laws and extended family. She said that since returning home after her HIV status was disclosed, her family members have tried to kill her on at least three occasions. Lena had no money to pay for shelter elsewhere, and stayed with her children in a locked room at the house to protect them.129 The hospital neglected to attend properly to Lena B.’s surgical wounds from her csection and they became infected. Lena B. said that based on her experiences, she would no longer seek treatment for herself in the public health system. There was a comprehensive health clinic within walking distance of Lena’s home. Lena B. said that she would not take her children there, nor pick up infant formula and groceries provided to mothers who are living with HIV, because health workers there chastised her and other women for having gotten pregnant while living with HIV, and publicly disclosed their status to other patients and members of the public without their authorization. As a result, Lena B.’s children were also effectively denied health care and other benefits to which they are entitled.130 Hospital staff providing ancillary services (such as porters, ward assistants, cooks) often knew patients’ HIV status and sometimes disclosed it to family and community members. A laundry attendant at a Kingston area private hospital said that the head nurse pointed out a person with HIV to her because his clothes had to be washed separately.131 A peer educator in St. Andrews and St. Catherine’s parishes told Human Rights Watch: “Sometime the ward assistant knows, sometime the cook know, and I don’t see why they should know. And they talk a lot. . They go back to their area 129 Lena B. said that in the first few months of 2004, she had been threatened at home several times: her drinking water had been poisoned; an armed man had come to her house and warned her that he had been hired by her family to kill her; and she had found materi als used in obeah (witchcraft) outside her room. Ibid. 130 Human Rights Watch interview with Lena B., Montego Bay, June 22, 2004. 131 Comments made at workshop to discuss quality of care for HIV-positive patients, Kingston, June 7, 2004.

PAGE 46

HUMAN RIGHTS WATCH, VOL. 16, NO. 6 (B) 44 and they say that Mary Jane is at the hospital, she’s HIV-positive. So all of that person’s confidentiality is out.” In one case, for example, a patient with HIV recognized a warder from her area. She said she had a family member who did not know that she was sick in the hospital and she did not want the family member to know. The warder told her family member that this person was HIV-positive and was in the hospital. . [The person] did not go back to her community because she was afraid that she would not be treated nice.132 In some hospitals, porters may learn patients’ status because they have access to patient records. Glenn C., thirty-nine, a JAS volunteer, said that “When patients go into a ward, files are given to the porter and they discuss it and they say, ‘this is another C13 [the hospital code for HIV/AIDS]. This is a homosexual.”’ He remembered visiting a person living with HIV/AIDS at a Kingston-area hospital in 2003. ‘I asked the porter where he was. The porter said, ‘The battyman. The one with AIDS’ [and then] told me where he was.”133 Men who have sex with men and AIDS service workers told Human Rights Watch that hospital staff also disclosed information about people’s sexual orientation. Craig F., a health worker who worked with men who have sex with men, said that after his client disclosed his sexual orientation to a contact investigator, “the same day, persons in the health center knew that he was gay. I heard them talking. ‘That man is a battyman.’ They mentioned his name. There was a lot of talk that he is gay and fire burn and him fi dead.”134 Driving men who have sex with men and people living with HIV/AIDS from health care services Abusive treatment in the health care system and state failure to protect men who have sex with men from homophobic violence keep people from seeking health services, especially for conditions that might mark them as homosexual. Several gay and bisexual men told us they delayed or avoided seeking treatment for sexually transmitted infections because they had received poor health care when they were known or perceived to be gay; feared mistreatment because they were gay; and were concerned that 132 Human Rights Watch interview, Kingston, June 6, 2004. 133 Human Rights Watch interview with Glenn C., Kingston, June 13, 2004. 134 Human Rights Watch interview with Craig F., Ocho Rios, June 16, 2004.

PAGE 47

45 HUMAN RIGHTS WATCH, VOL. 16, NO. 6 (B) health workers would publicly disclose their sexual orientation, thus risking their safety. Since the presence of other sexually transmitted diseases heightens the risk of HIV transmission, the failure to seek care promptly in such cases may have fatal consequences.135 Craig F., a health worker in northeast Jamaica, estimated that 90 percent of men who engage in homosexual conduct with whom he had worked had told him that they would not seek treatment for sexually transmitted diseases in the public health system because they feared that confidentiality was not maintained.136 Harold B., thirty-four, told Human Rights Watch that health workers mistreated men who have sex with men: “When you go to a clinic and they know you are gay, they scorn you.”137 A JAS health worker said that the stigma attached to being gay and fear of discrimination put gay and bisexual men at risk of HIV, both because they did not get relevant HIV prevention information in the first instance, and because they delayed seeking care for sexually transmitted diseases that they feared might mark them as gay. He said that many men who have sex with men “don’t know that safer sex goes beyond using a condom. . They don’t use a lubricant and the condom breaks.” And many were reluctant to get tested for sexually transmitted diseases and did not know that the presence of other sexually transmitted diseases could increase the risk of HIV transmission.138 Using a water-soluble lubricant helps prevent condom breakage and is recommended for anal intercourse. Many men who have sex with men will not buy lubricant, however, because its purchase is equivalent to announcing one’s sexual orientation.139 And, as in the case of Nicholas C. (described above), men who have sex with men who carry lubricant may be subject to police violence.140 Adrian S., thirty, told Human Rights Watch that he did not feel safe asking his doctor about gay health issues, especially concerns related to anal or oral sex. 135 See United States Centers for Disease Control and Prev ention, Fact Sheet: Prevention and Treatment of Sexually Transmitted Diseases as an HIV Preventi on Strategy [online], http://www.cdc.gov/hiv/pubs/facts/hivstd.htm (retrieved October 27, 2003). 136 Human Rights Watch interview with Craig F., Ocho Rios, June 16, 2004. 137 Human Rights Watch interview with Harold B., Kingston, June 9, 2004. 138 Human Rights Watch interview, Kingston, June 11, 2004. 139 Human Rights Watch interview with Martin B., Kingston, June 14, 2004; Human Rights Watch interview with Adrian S., Kingston, June 13, 2004. 140 See testimony of Nicholas C., p. 19, above.

PAGE 48

HUMAN RIGHTS WATCH, VOL. 16, NO. 6 (B) 46 There was one concern I had with regards to feeling something different after anal sex with someone, and I just had to not talk about it and watch it and use my own way of approaching it. There was one instance when I had anal sex with someone that was very endowed. That meant that there was some stretching and some tissues torn. I wanted to find out if I was okay, but I couldn’t say anything to anyone and all I could do is pay extra attention to hygiene and use topical solutions that were safe.141 Edward P., twenty-two, testified: One time, I caught gonorrhea. I was so scared of it, to go to the doctor. At first I said, this will go away. I started to see it getting yellow, and it started to run [from my penis], then it started to turn green, so I put a diaper there because it was running really hard and painful. . Some of my friends won’t go to doctors. They don’t want the word spread around, and they say what they don’t know won’t hurt them.142 When asked where he sought medical treatment, James P., twenty-six, said, “You come [to Jamaica AIDS Support] if you have something on your bottom,” because when gay men sought treatment elsewhere, health workers pointed out to others that they were gay. “I think that this keeps gay men from getting treatment. Some of them will keep from getting treatment until it stinks [until the discharge from an infection has begun to smell]. [They say] ‘I’ve got gonorrhea and I’m scared to go to the doctor.”143 Tonya Clark, a JAS nurse, said: Most of the gay men that I talk to don’t even want to go to the hospital at all. They come to me one-on-one and say can you get this for me, can you get this medicine. Sometimes ordinary medicines, nothing to do with HIV. But they are afraid to go to a doctor or hospital even with a common cold or flu because they will ask them questions or call them names.144 141 Human Rights Watch interview with Adrian S., Kingston, June 13, 2004. 142 Human Rights Watch interview with Edward P., Ocho Rios, June 16, 2004. 143 Human Rights Watch interview with James P., Kingston, June 8, 2004. 144 Human Rights Watch interview with To nya Clark, Kingston, June 14, 2004.

PAGE 49

47 HUMAN RIGHTS WATCH, VOL. 16, NO. 6 (B) Curtis M., twenty-four, explained: I try to keep myself healthy because if you go to the hospital, they won’t take care of you. If you got a bruise on your anus, that would make it worse. To be honest, if anything should happen to me, I am not going to the public hospital. I would buy over-the-counter medication or speak to my friends. I know that I am at risk but just to keep myself safe I cannot go to the hospital. Because if something should happen to me, I cannot go to the police because they will not help me.145 Homophobic police actions interfered with HIV/AIDS information and other prevention services by driving gay and bisexual men from places where they might safely receive services. JAS held support group meetings for gay and bisexual men to address a range of issues, including HIV/AIDS, sexua lity, violence and discrimination, and spirituality and family life.146 JAS’ targeted interventions coordinator acknowledged that men who engage in homosexual sex were difficult to reach, noting that “some people won’t come to JAS.”147 Some men told Human Rights Watch that they had been accosted by police when leaving JAS support group meetings, which may explain some of the reluctance to come to JAS’ offices for services. Joseph W. said that after they left a support group meeting in 2001, he and his friends were approached by police who asked them, “‘What are you doing? What kind of meeting are you coming from? All you look like battymen.’ They threatened to arrest us because we always have to keep up with our ‘nastiness.’”148 Harold B., thirty-four, testified he and his friends had been assaulted by police in June 2004, around the corner from where they had just attended a support group meeting.149 A JAS outreach worker told Human Rights Watch that men who have sex with men would find a safe place to hang out, but police would come and beat them, undermining JAS’ outreach work. In May 2004, he was working in a Kingston area that JAS outreach workers had identified as a gay hangout when the police approached. “The police came and said, ‘Battymen leave the area. Don’t contaminate the area. Don’t come back here.’ 145 Human Rights Watch interview with Craig R., Ocho Rios, June 16, 2004. 146 Human Rights Watch interview with Steve Harvey, coor dinator of targeted interventions, Jamaica AIDS Support, Kingston, June 6, 2004. 147 Ibid. 148 Human Rights Watch interview with Joseph W., Kingston, June 11, 2004. 149 Human Rights Watch interview with Harold B., Kingston, June 9, 2004.

PAGE 50

HUMAN RIGHTS WATCH, VOL. 16, NO. 6 (B) 48 One [of the men] ran and broke his foot. . We were so frightened . that we just drove away.”150 The Jamaica Forum for Lesbians, All-Sexuals and Gays (J-FLAG) would be a natural place to convene men who have sex with men and women who have sex with women to discuss HIV/AIDS-related issues. J-FLAG’s office, however, is not a safe space, as its own website acknowledges: “Although we provide services and network island-wide, our office is located in Kingston, Jamaica's Capital and largest city. Due to the potential for violent retribution, we cannot publish the exact location. We do receive mail at Box 1152, Kingston 8.”151 Human Rights Watch also received numerous reports from people living with HIV/AIDS that they avoided seeking health care at both public and private facilities because of the abusive treatment they had received and the public disclosure of their HIV status. As described above, after doctors and nurses at the regional hospital and local health clinic chastised Lena B. for having sex while she was living with HIV, disclosed her status to family members who have since tried to kill her, and neglected to attend to her wounds after delivering her baby by caesarean section, she decided that she would no longer seek treatment in the public health system for herself, or in the local clinic for her children. 152 Pam B., forty-three, overheard a nurse from the local health clinic telling someone from her town that she had AIDS. Public hospitals in Kingston and Portland parishes had isolated her with other HIV-positive patients, failed to provide her hospital gowns and linens, and made her wait much longer than other patients for care. Although unemployed (she lost her job after her employer learned she had AIDS), she avoided seeking care in health clinics and hospitals in her area “because of the stigma.” She also said that she knew other people living with HIV/AIDS who were afraid to go to the clinic because clinic staff gossiped about their HIV status.153 John B., forty-nine, told Human Rights Watch: 150 Human Rights Watch interview, June 6, 2004. 151 Jamaica Forum for Lesbians, All-Sex uals and Gays website, http://www.jflag. org/misc/contact.htm (retrieved August 27, 2004). 152 Human Rights Watch interview with Lena B., Montego Bay, June 22, 2004. 153 Human Rights Watch interview with Pam B., Kingston, June 8, 2004.

PAGE 51

49 HUMAN RIGHTS WATCH, VOL. 16, NO. 6 (B) I don’t go to the hospital any more because of bad experiences there. There was one experience but it stands out in my mind and I would never go back there. . The nurse said that I had to draw up my shirt so she could take my blood pressure. She looked through my docket, saw the referral from Jamaica AIDS Support and that I was HIVpositive, and told me to roll down my shirt and she took my pressure from there [on top of the shirt].154 When Human Rights Watch met Patrick D., twenty-five, he was concerned that his health was failing and that “some day soon” he would have to go to the health clinic. He was avoiding doing so, however. “I’m afraid to go to the clinic because there’s a special mark on my docket. The porter sees it and says, ‘that boy’s HIV-positive.’”155 Eric B., thirty, pulled his own teeth because he had heard that people living with HIV/AIDS had been treated poorly by the dentist in his local health care center. He told Human Rights Watch: I didn’t go there because on the whole, a lot of people go there and have a bad experience. I just took some pliers and pulled out the teeth myself. I’ve heard that the dentist there treats people badly, so I avoided going. I suffered for six months with a bad tooth because I avoided care.156 Fostering dangerous practices and comp licating health care provision Under conditions of surveillance by their fa milies and communities, Jamaican gay, lesbian, bisexual, and transgender people find little privacy for their sexual lives at home. As discussed below, many face serious violence an d become homeless after being driven from their homes and their towns because of their sexual orientation or gender identity. Men who have sex with men also risk violence for carrying condoms and lubricant— both needed for practicing safer sex. The lack of private space to have sex, the threat of violence based on sexual orientation and for even carrying condoms, and the lack of recourse to police protection makes it difficult for many gay, lesbian, bisexual, and transgender people to take precautions to protect against HIV/AIDS. Sex workers suffer from many of the same threats, and face similar problems in taking measures to protect against HIV/AIDS. 154 Human Rights Watch interview with John B., June 21, 2004. 155 Human Rights Watch interview with Patrick D., Kingston, June 9, 2004. 156 Human Rights Watch interview with Eric B., Kingston, June 8, 2004.

PAGE 52

HUMAN RIGHTS WATCH, VOL. 16, NO. 6 (B) 50 Homelessness carries additional health risks and complicates the provision of even routine medical care.157 Exposure to harsh weather conditions, poor nutrition, and the stress of living in disordered and unsafe conditions compound health problems for people living with HIV/AIDS. Albert B., thirty-three, had been homeless since 2001, when he fled his town after his close gay friend was murdered, and he was told that he was next. He told Human Rights Watch that most of the time, he had sex outside, in open land or in the bushes. “Gay people tend to use those places because they can’t carry on at home. . But you have to look out, in case you have to run.”158 Denial of access to transportation People known or perceived to be living with HIV are denied access to public and private transportation, relegating many to lives isolated from important sources of social support and undermining their capacity to obtain even basic medical care. Men who are known or perceived to be gay are likewise denied passage on public and private transportation, sometimes leaving them vulnerable to attack, and are routinely attacked on public buses because of conduct or appearance perceived as homosexual. People with HIV/AIDS may be prone to skin infections on large parts of their bodies. Several people with HIV/AIDS told Human Rights Watch that when they suffered visible skin infections, people in their communiti es would shun them, perhaps because they feared that the skin infections—or HIV more generally—were contagious. Angela M., forty-one, lived in a remote village, about one hour’s drive from the regional hospital and several miles from the nearest clinic. She was homebound: no public transportation would carry her, and the only private car that would drive her was prohibitively expensive. She told Human Rights Watch that since developing the skin rash, “All the taxi men, they know, they say they won’t carry me. . At the bus stop, nobody will stand beside me. I come near, people run away.” When she tries to flag a taxi by her house: no taxi stops. People tell them that my hair falls off and I run full of sores and I run bloody water, and nobody wants to carry me. . I 157 See, e.g., Institute of Medicine, Homelessness, Health, and Human Needs (Washington, D.C.: National Academy Press, 1988), chapter 4. 158 Human Rights Watch interview with Albert B., Kingston, June 9, 2004.

PAGE 53

51 HUMAN RIGHTS WATCH, VOL. 16, NO. 6 (B) need to go to the doctor, to the hospital and I don’t have money to pay a private man to get me there. To get to [the hospital], I would have to pay a private man 3000 [Jamaican] dollars [U.S.$50] both ways. A road taxi would cost 170 dollars one way [U.S. $2.85], 170 dollars [U.S.$2.85] to come back.159 Lacking funds for transportation, Angela M. was unable to obtain medical treatment. John B., a forty-nine-year-old man living with HIV/AIDS, said that taxi drivers sometimes increased fares for people whom they suspected had HIV. He said that on one occasion, he had a chest infection and was coughing and short of breath. He told Human Rights Watch that as he was exiting the taxi, the driver commented, “you have pneumonia; you have AIDS,” and charged him double the usual fare.160 Adrian S., thirty, told Human Rights Watch that as a man perceived as effeminate, he faced constant verbal and physical abuse and had been denied transportation in public buses and taxis on many occasions. He said that: “I would be denied passage [on public buses] because someone would say I was gay. I would have to seek transportation elsewhere.” Nor would taxis pick him up once they heard that he was gay. And boarding a bus would not guarantee safe passage. Thomas said that he had been assaulted by a conductress, a bus driver, and by passengers while riding the bus.161 Fabian Thomas, coordinator of JAS’ Montego Bay office, told Human Rights Watch that he had been contacted by a man who had been attacked and thrown off a public bus after falling asleep on another passenger’s shoulder. According to Thomas, when other passengers noticed the man’s head resting on his male neighbor’s shoulder, they cried out ‘battyman,’” threw him off the bus, beat him, stabbed him and left him by the side of the road.162 159 Human Rights Watch interview with Angela M., June 15, 2004 In June 2004, 1 Jamaican dollar was equivalent to U.S. $0.015. 160 Human Rights Watch interview with John B., June 21, 2004. 161 Human Rights Watch interview with Adrian S., Kingston, June 13, 2004. A conductor collects fares on public buses. A conductress is a female bus conductor. 162 Human Rights Watch interview with Fabian Thomas, Montego Bay, June 22, 2004.

PAGE 54

HUMAN RIGHTS WATCH, VOL. 16, NO. 6 (B) 52 Other abuses by non-state actors: vi olence in the family and in the community People living with HIV/AIDS, men who have sex with men, and women who have sex with women are subject to violence, discrimination, and other forms of abuse by private actors based on their HIV status and their sexual orientation. State authorities have an obligation to respond, both to offer redress for violations and punish the offenders, but also to prevent these violations in the first instance. Abuses based on sexual ori entation and gender identity Because gay in Jamaica, it’s hard for us to live anywhere. Those that can afford, they can rent an apartment and not be molested. But we cannot afford it. Some might attempt to rent a little house. But within days, or it doesn’t last for a month, they have to run away, leave everything that they have. —Aaron H., thirty-eight, Kingston, June 13, 2004 Men who have sex with men and women who have sex with women are routinely subjected to verbal and physical harassment, in many cases violently evicted from their homes and driven from their towns. On the morning of June 24, 2004, a group of armed men forced their way into a Kingston home, beating up six occupants while shouting homophobic threats.163 The dancehall musician Buju Banton (Mark Anthony Myrie) is alleged to have been one of the assailants, reportedly denouncing the occupants for being homosexual and kicking one man in his mouth and beating him with a board. At least two of the men were beaten seriously enough to require medical treatment. All nine residents of the house were forced to abandon their home and possessions that same day, warned by the attackers that they would be killed if they returned.164 Four of the men returned the following evening with a police escort to find that their home had been ransacked, thousands of dollars stolen, and valuable property (including a new refrigerator and electronic equipment) destroyed.165 All of the men abandoned the residence and the 163 Human Rights Watch interviews with Charles R., Kingston, June 24 and 25, 2004 and statement of Charles R. to police. Banton composed and performed “Boom By e Bye,” a song that celebrates the killing and burning of gay men. 164 Human Rights Watch interviews with Charles R., Kings ton, June 24 and 25, 2004; Human Rights Watch interviews with Ricardo P., Kingston, June 24 and 25, 2004; Human Right s Watch interviews with Robert E., Kingston, June 24 and 25, 2004. 165 A Human Rights Watch researcher accompanied the victim s to the residence and observed the condition of the home and the victims’ property.

PAGE 55

53 HUMAN RIGHTS WATCH, VOL. 16, NO. 6 (B) neighborhood, fearful that they would be killed if they return; since the intrusion, at least one has received death threats. Charles R., forty-two, Robert E., eighteen, and Ricardo P., twenty, three of the occupants, described the attack. Charles R. told Human Rights Watch that about a dozen men armed with machetes, guns, and knives had come to his front door around 10 a.m. on June 24, one of them pointing a gun at him, threatening to shoot him if he did not let them in. After Charles R.’s landlord ordered him to open the door, the men stepped in the house and ordered the occupants outside. The assailants told Charles R. and the others that they were battymen and could not live there, and threatened to shoot them and burn the house if they remained.166 Charles R. was kicked in the face and beaten on his back, arm, and leg with a machete and a metal rod by at least three assailants.167 Robert E. told Human Rights Watch that he was attacked by at least four men, who chased him from the house, hurling insults and stones, threatening him with a knife, and accusing him of being the “battyman ringleader.” Robert E. ran into the street and tripped and fell into a gully, seriously injuring his foot.168 Ricardo P. told Human Rights Watch that he was beaten with a metal rod, forced to take off his shoes, and told to run from the house.169 Human Rights Watch documented violent evictions in several towns in Jamaica, many of which occurred either immediately preceding or during the three weeks that we were in Jamaica. A Kingston man said: Right now, I’m not living in my house because people thought I was gay. . About two weeks ago, I got a call at work that there were twenty-five men surrounding the house because they understood we were gay and wanted us to leave because they didn’t want any gay men in the area. [I was told] that the men had machetes. I didn’t go home for two days because I was scared. 166 Human Rights Watch interview with Charles R., Kingston, June 24, 2004. 167 Ibid. 168 Human Rights Watch interview with Robert E., Kingston, June 24, 2004. The physician who examined his foot told Human Rights Watch that Robert E.’s heelbone was broken and he risked further serious injury if he did not take good care of it. 169 Human Rights Watch interview with Ricardo P., Kingston, June 24, 2004.

PAGE 56

HUMAN RIGHTS WATCH, VOL. 16, NO. 6 (B) 54 When he returned to the house to retrieve some of his things, he noticed several men outside. “I heard the men say, ‘oh the battymen, they move.’ I was scared, because they all had machetes in their hands. In this house, all gay men lived there. Now no one sleeps there.”170 Daniel S., nineteen, had lived on his own in Montego Bay since he was threatened by neighbors that they would kill him and chop him up because they had heard he had sex with men. He told Human Rights Watch, “I am unable to visit my family in the day. If I want to visit them, it would have to be in the midnight hours.”171 Vincent G., twentytwo, stated, “I don’t live anywhere now.” He had been homeless since 2003, after he was forced to leave his mother’s house and his town when he was threatened by men in the area who told him, “battyman, you have to leave. If you don’t leave, we’ll kill you.”172 Human Rights Watch interviewed Sebastian L., twenty-seven, a few days after he and his friends had been attacked outside Sebastian L.’s apartment. He said that he was afraid that the assailants might return. “So I am looking to move now, because I am afraid for my life.”173 Women who have sex with women reported that they were subjected to constant threats of sexual violence, in some cases serious enough to force them to leave their homes and their neighborhoods. Several women who have sex with women told Human Rights Watch that the message they were given was clear: that they could be “cured” of their homosexuality by having sex with a man. Phoebe S., forty-nine, owned a home in St. Thomas parish, where she lived alone for five years. Men in her community called her “sodomite,” pressured her to have sex with them, and spied on her while she was bathing. She told Human Rights Watch: “Men try to get friendly. They say, ‘you’re living alone for so long. You need some sex.’” She said that she had decided to sell her house “because some of the men know I’m gay and want to rape me.” She could not discern, however, whether she was continuously targeted for sexual violence because she was a woman or because she was a lesbian. She 170 Human Rights Watch interview with Paul M., Kingston, June 6, 2004. 171 Human Rights Watch interview with Daniel S., Montego Bay, June 21, 2004. 172 Human Rights Watch interview with Vincent G., Kingston, June 14, 2004. 173 Human Rights Watch interview with Sebastian L., Ocho Rios, June 15, 2004.

PAGE 57

55 HUMAN RIGHTS WATCH, VOL. 16, NO. 6 (B) told Human Rights Watch: “I have been raped three times. Sometimes I wonder if it is because I refuse to be with a man.”174 Cynthia S., twenty-seven, said that a lesbian friend of hers had to move out of her neighborhood because she faced constant verbal and physical harassment by men who knew that she was a lesbian. “They would say, ‘Hey girl, don't you know you are supposed to take cock,’ and put their hands on her when she passed by.”175 Ryan N. was with two lesbian friends in a local park when a man approached the women and said, “I want to give you a good fuck and you will leave women and start with men.”176 Homosexual men and women also face violence and abuse by their own family members. After Edward P.’s mother found out that he was gay, she threatened to poison him, which she was encouraged to do by others in their town. Edward P. told Human Rights Watch: “My mother said she wanted to poison me. . I could go for days after days starving myself. I won’t eat her cooking. Yes, I actually believe she might. People went to her and said, ‘after all, he is her son.’”177 When Lillie P.’s mother found out that she was lesbian, she threw her out of the family home, leaving her without a place to live.178 Abuses against people living with HIV/AIDS My mother said she would kill me herself if I stayed in the house. —Ray B., eighteen, Kingston, June 8, 2004 Abuses based on sexual orientation reflect and reinforce abuses against people living with HIV/AIDS. Health workers, AIDS outreach workers, and people living with HIV/AIDS told Human Rights Watch that they faced abuse by family and community members who feared that they could contract HIV/AIDS through casual contact with them and who associated the disease with homosexuality and prostitution. Several people living with HIV/AIDS said that they had been thrown out of their family homes or evicted from private housing when their HIV status became known. Others kept their HIV status secret for fear that disclosure would subject them to violence. 174 Human Rights Watch interview with Phoebe S. Kingston, June 14, 2004. 175 Human Rights Watch interview with Cynthia S., Kingston, June 8, 2004. 176 Human Rights Watch interview with Ryan N., Kingston, June 9, 2004. 177 Human Rights Watch interview with Edward P., Ocho Rios, June 16, 2004. 178 Human Rights Watch interview with Lillie P., Kingston, June 19, 2004.

PAGE 58

HUMAN RIGHTS WATCH, VOL. 16, NO. 6 (B) 56 After Ray B., eighteen, told his mother that he was HIV-positive, she threatened to poison him. He could not return home because his mother was afraid that she would catch HIV from him. Ray told Human Rights Watch: “My mother is afraid that if I touch the gate, she will catch AIDS.”179 When a JAS outreach worker heard someone telling a person living with HIV/AIDS that “AIDS smoke” from his burning rubbish would affect him and his children, the outrea ch worker tried to explain that the virus was not transmitted through the air. His efforts were unsuccessful, however. “People started to murmur [gossip]. They said they didn’t care, this guy had to leave. And he had to move out of the community.”180 Neither age nor disability affords protection from abuse. Tonya Clark, a JAS nurse, told Human Rights Watch that the previous week, she had heard from an elderly woman living with HIV/AIDS whose son made her sleep on the porch and fed her from a pan, like a dog. “Her son tells everyone in the community she has AIDS. They reject her, except for one neighbor, who gives her food—but she can’t let anyone in the neighborhood see her giving her food.”181 Leonard S., a thirty-year-old disabled man living with HIV, lived with his family. His mother, who knew that he was gay, told him that if he contracted HIV, she would abandon him at the hospital. He feared worse. He told Human Rights Watch that if his family or neighbors found out that he was HIVpositive, he would flee because they would beat or kill him.182 VI. GOVERNMENT RESPONSE Jamaica acknowledges in its official policy documents the role that homophobia plays in driving the country’s HIV/AIDS epidemic, and lists as a key priority the development of legislation and policy to protect the human rights of people living with and affected by HIV/AIDS.183 Despite these stated commitments, there exist few policy or legal protections for people living with HIV/AIDS or people whose marginalized status puts them at high risk of infection. The vast majority of people living with HIV/AIDS remain without access to lifesaving antiretroviral medicines. While some ministries (such as the Ministry of Education) have drafted national AIDS policies, the lack of institutional commitment and intersectoral coordination among them hampers the 179 Human Rights Watch interview with Ray B., Kingston, June 8, 2004. 180 Human Rights Watch interview, Kingston, June 6, 2004. 181 Human Rights Watch interview with To nya Clark, Kingston, June 14, 2004. 182 Human Rights Watch interview with Leonard S. Kingston, June 11, 2004. 183 See, e.g., Ministry of Health, “Jamaica HIV/AIDS/S TI National Strategic Plan 2002-2006,” January 2002, pp. 10-12 (identifying “discrimination and stigmatization around HIV/AIDS especially homosexuality” as among the factors driving the epidemic, and policy, advocacy, l egal and human rights as a top priority area in its HIV/AIDS plan).

PAGE 59

57 HUMAN RIGHTS WATCH, VOL. 16, NO. 6 (B) government’s response to the epidemic. And the lack of high-level political commitment to addressing homophobic violence further weakens efforts to fight HIV/AIDS. Improving legal and policy protections In 2001, the National AIDS Committee (NAC), a government-organized NGO established in 1988 to advise the Ministry of Health on policy issues, drafted a report reviewing legal, ethical, and human righ ts issues for people living with HIV/AIDS.184 The report identified a number of weaknesses within existing legislation and recommended changes to address them. These included drafting comprehensive antidiscrimination legislation, strengthening legal protections for confidential information, and repealing the sodomy laws.185 The Office of the Attorney General reviewed the NAC report and in 2002 rejected its main recommendations, insisting that there be a national AIDS policy before any legislation was adopted. As of this writing, the national policy document has not yet been completed.186 High-level officials at the National HIV/AIDS Control Programme, consistent with the NAC report and Ministry of Health policy documents, have advocated for the need to repeal discriminatory laws because they impede HIV prevention efforts and drive vulnerable groups from HIV services. Minister of Health John Junor repeatedly has rejected these appeals, however.187 And in July 2004, Prime Minister P.J. Patterson reportedly announced that his government would not be forced by foreigners to repeal Jamaica’s sodomy laws, apparently ignoring government and NAC reports on their role in driving Jamaica’s HIV/AIDS epidemic.188 The U.N. Guidelines on HIV/AIDS and Human Rights specifically recommend that “an independent agency should be established to redress breaches of confidentiality.”189 184 The Minister of Health established the National AIDS Committee (NAC) in 1988 to coordinate a national multi-sectoral response to HIV/AIDS. It has more t han one hundred members, including representatives from public and private sector organizations and NGOs. h ttp://www.nacjamaica.com/about_nac/index.htm (retrieved September 16, 2004). 185 See National AIDS Committee, “HIV/AIDS Legal, Ethical and Human Rights Issues in Jamaica,” http://www.nacjamaica.com/subcom/legal_ethica l/index.htm (retrieved April 19, 2004). 186 A draft National AIDS Policy is expected to be circulated for review in the fourth quarter of 2004. Human Rights Watch telephone interview with Ruth Jankee, executive director, National AIDS Committee, Kingston, September 7, 2004. 187 Human Rights Watch interview with Dr. Peter Figueroa, chief, Ministry of Health Epidemiology Unit, Kingston, June 23, 2004; see also Zadie Neufville, “Fear Among Gay Men Said to Fuel HIV/AIDS Cases,” Inter Press Service, March 5, 2002 (reporting that Minister Junor said that while the government is “committed to preventing t he spread of the disease,” it had no intention of changing the laws). 188 “PM Says Gov’t Will Not Change Anti-Homosexual Laws,” Jamaica Observer, July 2, 2004. 189 U.N., HIV/AIDS and Human Rights: International Guidelines, para. 30(c).

PAGE 60

HUMAN RIGHTS WATCH, VOL. 16, NO. 6 (B) 58 Professional organizations governing certain health professionals are empowered to sanction physicians, nurses, and midwives for professional misconduct, including failure to protect confidential patient information.190 No independent agency exists, however, to redress breaches of confidentiality by other health workers, such as porters and ward assistants, who have access to patient dockets and may otherwise discover patients’ HIV status.191 Educating health personnel Doctors, nurses, and other medical personnel who work with people living with HIV need training, both about the disease as well as how to ensure human rights protections for people living with HIV/AIDS, including ensuring confidentiality of HIV-related information and addressing discrimination. The Jamaican government has acknowledged that many health care personnel are not adequately trained in HIV/AIDS care and treatment and has undertaken steps to address this problem. The Ministry of Health has devoted a major portion of a World Bank loan to strengthening institutional capacity to respond to HIV/AIDS, including by providing training on AIDS-related stigma and discrimination for a range of health personnel (including doctors, nurses, nutritionists, and medical records workers).192 The Ministry has also specifically targeted individuals working with medical records for training on protecting confidentiality.193 These training sessions are optional, however.194 In addition, the Ministry also has begun work with domestic and international HIV/AIDS organizations to address problems with quality of care for people living with HIV/AIDS.195 190 See, e.g., The Medical Act, section 11; The Nurses and Midwives Act, section 11. 191 Patients can lodge complaints with the Ministry of Health within ten days after suffering a breach of confidentiality or discrimination by health workers. Mini stry of Health, “Client Charter,” http://www.moh.gov.jm/Standards.htm (retrieved August 27, 2004) 192 U.S.$4.82 million, or 29 percent of a World Bank loan received for the 2002-2006 period is being used for HIV/AIDSrelated projects, but it is unclear what portion of these funds are going to traini ng. Country Coordinating Mechanism for the Global Fund to Fight AIDS, Tuberculosis and Malaria, A Proposal to Scale UP HIV/AIDS Treatment, Prevention, and Policy Efforts in Jamaica, May 2003, http://www.theglobalfund.org/search/docs/3JAMH_661_0_full.pdf (retrieved August 27, 2004), p. 26. 193 Human Rights Watch telephone interview with Kevin Harv ey, coordinator of treatment, care and support for people living with HIV/AIDS, Ministry of H ealth, Kingston, September 7, 2004. 194 Ibid. 195 In 2004, the Johns Hopkins Program for International Educ ation in Gynecology and Obstet rics (JHPIEGO), a nonprofit organization affiliated with Johns Hopkins University that receives funding from USAID, and Jamaica AIDS Support provided training addressing stigma and di scrimination against people living with HIV/AIDS and on infectious disease control to health care workers at Kingston Public Hospit al, one of Jamaica’s highest-volu me hospitals. The National HIV/AIDS Program at the Ministry of Health provided ov ersight for this training, which did not address stigma and discrimination against men who have sex with men or other vulnerable groups. JHPIEGO, “Project Proposal: Building the HIV/AIDS Capacity of Health Care Providers and Communi ties in Jamaica,” 2004; E-mail communication with Robert Carr, director, Jamaica AIDS Support, September 7, 2004.

PAGE 61

59 HUMAN RIGHTS WATCH, VOL. 16, NO. 6 (B) These are laudable initiatives, but the findings of this report make it clear that considerable room for improvement remains. HIV/AIDS training, including basic information addressing HIV transmission, must extend to all hospital personnel, including porters and laundry workers, and it must be mandatory. In addition, sanctions must be available and imposed for disclos ing confidential informat ion about HIV status and other HIV/AIDS-related discrimination. In May 2004, Jamaica signed an agreement with the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund) that should enable it to address some of the major gaps in its national response. The bulk of the funds is intended to scale up availability of antiretroviral medications, with the goal of providing access to all Jamaicans living with HIV/AIDS within five years. The agreement also prioritizes efforts to complete and implement policies and a legislative framework to protect the human rights of people living with and at high risk of HIV/AIDS, including by “address[ing] the repeal of discriminatory laws and policies that make it difficult to reach vulnerable high-risk communities (especially MS M, CSWs [commercial sex workers], and incarcerated populations).”196 The findings of this report underscore the importance of enacting into law and enforcing human rights protections for vulnerable high-risk groups, especially men who have sex with men, to ensure the success of its AIDS treatment program. If the Jamaican government fails to do so, men who have sex with men will be denied access to AIDS treatment in the same ways that they have long been denied access to other health care services. Efforts to address police abuse and provide HIV/AIDS education to police It is widely acknowledged that there is a crisis in policing in Jamaica, fueled in part by police failure to control high rates of violent crime or to be held accountable for crimes they commit.197 Human rights abuses by the Jamaican police have been documented and publicized by national and international organizations for over thirty years, and millions of dollars have been pledged toward efforts to reform police practices and improve security.198 The Jamaican government has undertaken important efforts to 196 Country Coordinating Mechanism for the Global Fund to Fight AIDS, Tuberculosis and Malaria, A Proposal to Scale UP HIV/AIDS Treatment, Prevention, and Policy Efforts in Jamaica, May 2003, http://www.theglobalfund.org/search/docs/3JAMH_661_0_full.pdf (retrieved August 27, 2004), p.25. 197 See Anthony Harriott, Police and Crime Control in Jamaica: Problem s of Reforming Ex-Colonial Constabularies (Kingston, Jamaica: University of the West Indies Press, 2001); Horace Levy, They Cry ‘Respect’! Urban Violence and Poverty in Jamaica (Kingston, Jamaica: University of the West Indies Press, 2001). 198 See, e.g, ibid.; United Nations Special Rapporteur on Extraj uducial, Summary or Arbitrary Executions, “Report of the Special Rapporteur, Asma Jahangir, submitted Pursuant to Commission on Human Rights Resolution 2003/53. Addendum. Mission to Jamaica,” E/CN.4/2004/7/Add.2, September 26, 2003; Amnesty International, Jamaica: Killings

PAGE 62

HUMAN RIGHTS WATCH, VOL. 16, NO. 6 (B) 60 address these abuses, including by establ ishing mechanisms to investigate cases of police misconduct and to train police regarding the proper use of force.199 But serious problems with police abuse continue. The Jamaican Constabulary Force (JCF) has only recently acknowledged HIV/AIDS as a workplace issue and drafted policy guidelines to address HIV/AIDS in its workforce. These draft guidelines do not, however, address police conduct toward marginalized populations or toward HIV/AIDS outreach workers. Nor has the government addressed police abuse based on sexual orientation and gender identity, apparently ignoring cases that have been documented by domestic and international human rights organizations and by foreign governments.200 Institutional mechanisms to address police misconduct Complaints of police abuse can be lodged directly with the Jamaican Constabulary Force, with its Bureau of Special Investigations or wit h the Complaints Division of the Office of Professional Responsibility. The Police Public Complaints Authority (PPCA), an independent body charged with monitoring and supervising civilian complaints of police misconduct, also is empowered to investigate cases of police misconduct. Once an investigation has been completed, reports are sent to the Department of Public Prosecutions for a ruling on whether criminal or disciplinary proceedings, or a coroner’s inquest, should follow.201 Public access to police and independent complaint mechanisms is limited by lack of knowledge about them, distrust of the legal system, and fear of reprisals for making complaints against officials.202 The Bureau of Special Investigations, which inv estigates fatal sh ootings and other killings by police, has been criticized for its failure to conform with international standards in conducting investigations. Failure to investigate incidents promptly or and Violence by Police: How Many More Victims,” pp. 52-54; Amnesty International, “’Until Their Voices are Heard.’ The West Kingston Commission of Inquiry,” July 2003; Jamaicans for Justice, The Jamaica Justice Report, 2002; U.S. Department of State, “Country Reports on Human Rights Practi ces: Jamaica, 2003,” February 25, 2004. International donors and agencies contributing to justice reform effo rts include the Canadian International Development Agency (CIDA), the World Bank, the Inter-American Development Bank the U.S. Agency for International Development (USAID), the European Union (EU) and the United Nations Development Program (UNDP). 199 See Police and Crime Control in Jamaica, pp. 121-182 (discussing reforms). 200 See, e.g., Amnesty International, “A Summary of Conc erns: A Briefing for the Human Rights Committee,” October 1997, p. 14. U.S. Department of State, “Country Reports on Human Rights Practices: Jamaica, 2003,” February 25, 2004; Robert Carr and Jamaica Forum for Lesbians, A ll-Sexuals and Gays, “Testimonies,” 2003. 201 Coroner’s inquests are conducted before a judge and jury of the Coroner’s Court and the court’s verdict referred back to the Director of Public Prosecuti ons for a decision whether to continue to prosecute or to close the case. 202 See ”Report of the Special Rapporteur on Mission to Jamaica,” September 26, 2003.

PAGE 63

61 HUMAN RIGHTS WATCH, VOL. 16, NO. 6 (B) thoroughly, including failure to collect blood and other forensic evidence or to properly record crime scene information, compromises the chances for successful prosecution.203 The Office of Professional Responsibility, which investigates complaints of police misconduct that do not involve firearms, has been criticized for its lack of impartiality and thoroughness.204 The Police Public Complaints Authority has been criticized as “completely ineffectual” in carrying out its mandate to investigate, supervise, and monitor complaints of police misconduct.205 Jamaican and international human rights organizations have argued that the PPCA’s lack of independence and transparency and the Authority’s failure to make full use of its powers contribute to the inadequacy of its investigations.206 Justice Lloyd Ellis, PPCA Chairman, has stated, for example, that he did not consider it appropriate or possible to hold Jamaica to the same standards as other countries and that he was generally satisfied with the quality of police investigations.207 Little attention has been paid to police interference with HIV/AIDS outreach workers or other abuses against men who have sex with men and sex workers. When asked about police conduct toward men who have sex with men and people living with HIV/AIDS, Justice Ellis said that he “would be surprised if anyone could prove that police would set up to abuse people who are homosexuals or, as you put it at high risk of HIV. If that is done, it is done not by police acting qua police but as citizens.” 208 Ellis acknowledged that gay men might be targeted on the community level but suggested that they bore some responsibility for violence committed against them: “I have no evidence of police beating anyone for being gay. You have people doing it in the community, doing it out of necessity. You have it every day. . It happens in other countries too. It’s not just a problem in Jamaica.”209 203 See, e.g., ibid.; Amnesty International, Jamaica: Killings and Violence by Police: How Many More Victims,” pp. 52-54; Jamaicans for Justice, The Jamaica Justice Report, 2002. 204 Ibid. 205 Jamaicans for Justice, Jamaica’s Human Rights Situation, 2003, p. 6. 206 Amnesty International, Jamaica: Killings and Violence by Police p. 55; Jamaicans for Justice, “Jamaica’s Human Rights Situation,” 2003, pp. 6-7. 207 Amnesty International, Jamaica: Killings and Violence by Police p. 55. 208 Human Rights Watch interview with Justice Lloyd Ellis, ex ecutive director, Police Public Complaints Authority, Kingston, June 23, 2004. 209 Ibid.

PAGE 64

HUMAN RIGHTS WATCH, VOL. 16, NO. 6 (B) 62 Police training on HIV/AIDS and related human rights issues Percival Buddan, the officer in charge of HIV/AIDS training for the Jamaican police force, acknowledged that there was an urgent need for HIV/AIDS education in the police force to ensure protection against the disease as well as protection against HIV/AIDS-related discrimination. He told Human Rights Watch: “Until two or three years ago, police officers were more or less in the dark about HIV/AIDS, how the virus was contracted, about universal precautions [to protect against HIV transmission]. And people who have HIV/AIDS may want to keep it secret because of stigma and discrimination.”210 The Jamaican Constabulary Force has published a document addressing myths and facts about HIV/AIDS and has begun to include HIV/AIDS education in its training and in optional lectures given in preparation for annual first aid certification exams. It is clear that these efforts are insufficient, however. Human Rights Watch interviewed several police officers, including a high-level police officer in Kingston and constables in St. Ann’s Bay, who made comments indicating their confusion and incomplete knowledge about HIV transmission. In St. Ann’s Bay, for example, police officers told Human Rights Watch that people living with HIV/AIDS should be confined in isolated areas for treatment, “so they will not be able to contaminate other people,” and that people living with HIV/AIDS were isolated from other detainees in the police lockup.211 As of this writing, the Jamaican Constabulary Force HIV/AIDS policy has been drafted but not approved. Percival Buddan told Human Rights Watch that the draft policy did not address police conduct toward marginalized populations such as men who have sex with men and sex workers or toward HIV/AIDS outreach workers to these groups.212 VII. REGIONAL EFFORT S TO ADDRESS HIV/AIDS Regional efforts to address HIV/AIDS-related discrimination and abuses have the potential to promote domestic policy reform in Jamaica. Regional organizations providing assistance in drafting rights-respecting laws and policies can provide guidance 210 Human Rights Watch interview with Percival Buddan, sub-officer in charge, Ja maican Constabulary Force First AID Center, Kingston, June 18, 2004. “Universal precautions” are simp le measures taken to reduce the risk of transmission of HIV and other bloodborne pathogens through exposure to blood or body fluids, including the use of protective barriers such as gloves for direct contact with bl ood or body fluids and careful handling and disposal of needles, waste, and other materials contaminated with blood or body fluids. World Health Organization, “Universal Precauti ons, Including Injection Safety,” http://www.who.int.hiv/topics/precautions/unive rsal/en/ (retrieved September 16, 2004). 211 Human Rights Watch interview, St. Ann’s Bay, June 16, 2004. 212 Human Rights Watch interview with Percival Buddan, sub-officer in charge, Ja maican Constabulary Force First AID Center, Kingston, June 18, 2004 and te lephone interview, Kingston, October 26, 2004.

PAGE 65

63 HUMAN RIGHTS WATCH, VOL. 16, NO. 6 (B) to Jamaica and use their influence to lobby Jamaica to enact such legislation on an urgent basis. Regional organizations also can lobby for policy changes that national organizations lack the political or economic resources to support (such as repeal of the sodomy laws). These efforts may be constrained by the United States, a major donor, through its imposition of policies that limit the capacity to advocate for the rights of sex workers.213 The Pan Caribbean Partnership on HIV/AIDS (PANCAP), a coalition of public and private national, regional, and international organizations, was established in 2001 by the Caribbean Community (CARICOM) to scale up national and regional responses to HIV/AIDS among twenty-one Caribbean states and territories. PANCAP’s priority areas of action include ensuring that national legislation and policies incorporate international human rights protections; providing treatment, care, and support for people living with HIV/AIDS; and preventing HIV among vulnerable populations, including men who have sex with men and sex workers. Since 2002, PANCAP has worked with the Canadian HIV/AIDS Legal Network to assist national governments in the region in developing law, policy, and ethical guidelines.214 PANCAP is currently working with seven Caribbean countries to draft legislation to protect people living with HIV/AIDS against discrimination at work and in the health care system, and to ensure universal access to treatment for people living with HIV/AIDS. According to St. Kitts and Nevis Prime Minister Denzil Douglas, who represents CARICOM on HIV issues, PANCAP also has been discussing condom distribution in prisons and laws criminalizing sex between men.215 213 U.S. law and policy bars the use of international HI V/AIDs and anti-trafficking funds by organizations that promote or advocate prostitution as an employment choice or the legaliz ation of prostitution and that do not have a policy explicitly opposing prostitution. See Un ited States Leadership against HIV/AIDS, Tuberculosis and Malaria Act of 2003, P.L. 108-25 (2003) (commonl y know as the President’s Emergency Plan for AIDS Relief or PEPFAR), section 104A(e); Office of the Un ited States Global AIDS Coordinator, “The President’s Emergency Plan for AIDS Relief. U.S. Five Year Global HIV/AIDS Strategy,” February 2004, p. 65; U.S. Agency for International Development, “Trafficking in Persons: USAID Strategy for Response,” February 2003, p. 4. Peer education projects are often the most effective and only possible AIDS educators for sex workers and have been acknowledged for their success in providing HIV education and prevention services in many countries throughout the world. See Kemala Kempadoo and Jo Doezema, Global Sex Workers: Rights, Resistance, Rebellion (London: Routledge, 1998); Human Rights Wa tch, “Epidemic of Abuse: Police Harassment of HIV/AIDS Outreach Workers in India,” A Human Rights Watch Report, vol. 14, no. 5(c), July 2002. U.S. funding restrictions undermine support for th is important work, and limit advocacy strategies to ensure safe sex during sex work. 214 Canadian HIV/AIDS Legal Network, PANCAP, CARICO M, “Action Plan and Workshop Reports: Programme on HIV/AIDS, Law, Ethics and Human Rights,” January 2004. 215 Caribbean poised to pass HIV Laws,” BBC Caribbean, March 8, 2004. This contradicts current CARICOM model legislation for sexual offences that endorses crimina lization of adult homosexual conduct. See CARICOM Model Legislation for Sexual Offences, secti on 15, http://www.caricom.org/archives/sex ualoffences.htm (retrieved August 27, 2004).

PAGE 66

HUMAN RIGHTS WATCH, VOL. 16, NO. 6 (B) 64 In October 2003, the Global Fund approved eight CARICOM proposals, including regional proposals by PANCAP and the Organization of Eastern Caribbean States (OECS).216 PANCAP’s proposal aims to bolster its current law reform efforts by establishing a regional mechanism to ensure human rights protections for people living with HIV/AIDS; to coordinate regional and sub-regional HIV/AIDS prevention efforts; and to address inequities in care, treatment, and support among Caribbean countries.217 PANCAP regional efforts to ensure human rights protections have the potential to complement Jamaica’s national law and policy reforms. There have been important regional efforts to establish and coordinate networks of people living with HIV/AIDS, men who have sex with men, and sex workers. The Caribbean Regional Network of People living with HIV/AIDS (CRN+) provides training and technical assistance to people living with HIV/AIDS in twenty-seven territories and seven national networks in the Caribbean region. CRN+’s position on the PANCAP steering committee has made it a key partner in regional initiatives, including with the World Bank and the Caribbean Health Research Council. In July 2004, CRN+ got approval of its own Global Fund proposal, which aims to enhance the capacity of people living with HIV/AIDS in the region to obtain treatment, care, and support services, to adhere to new treatment regimes, and to participate in advocacy and policymaking on the national and regional level.218 This initiative targets people living with HIV/AIDS and their networks in twelve Caribbean countries, including Jamaica.219 In Jamaica, the United Nations Theme Group on HIV/AIDS is also providing support and technical assistance for the Jamaican Network of Seropositives (JN+).220 Since 2003, the NGO International HIV/AIDS Alliance has been working in several Caribbean countries to mobilize support and HIV/AIDS prevention education for men 216 These proposals were from Guyana and Haiti (two eac h), Belize, Jamaica, the Organization of Eastern Caribbean States and PANCAP. CARICOM, “Eight CARICO M Proposals Successful at Sixth Meeting of Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM),” October 15, 2003. 217 PANCAP, Scaling Up the Regional Response to HIV/AIDS through the Pan Caribbean Partnership on HIV/AIDS The OECS proposal focuses on improving access to HIV/AIDS pr evention and treatment services in the nine small island nations that comprise the OECS subr egion (Anguilla, Antigua & Barbuda, the Britis h Virgin Islands, Dominica, Grenada, Montserrat, St. Kitts & Nevis, St. Lucia, and St Vincent and the Grenadines), which shar e strong economic, social and cultural links. Country Coordinating Mechanism, Scaling up prevention, care and treatment to combat the HIV/AIDS pandemic in the organization of Eastern Caribbean States (OECS) Sub-Region 218 CRN+, Strengthening the Community of PLWHA and those affe cted by HIV/AIDS in the Caribbean—a Community Based Initiative, http://www.theglobalfund.org/search/docs/4MANH_767_0_full.pdf (retrieved August 20, 2004). 219 Ibid. 220 Human Rights Watch interview with Bernard Bainvil, Chair, U.N. Theme Group on HIV/AIDS, Jamaica, Kingston, June 10, 2004.

PAGE 67

65 HUMAN RIGHTS WATCH, VOL. 16, NO. 6 (B) who have sex with men.221 In 2003, Jamaica AIDS Support collaborated with the Alliance to establish and support community organizations of men who have sex with men in the eastern Caribbean, and to form a regional network of groups working with men who have sex with men to provide support to national groups.222 The Latin American Association for Comprehensive Health and Citizenship, a network of lesbian, gay, bisexual, and transgender groups in Central and South America, has been working with groups working with men who have sex with men in the region to develop and support strategies to force governments to address the needs of men who have sex with men in national HIV/AIDS programs.223 In some Caribbean countries since the mid-1990s, sex worker organizations have been providing HIV/AIDS and other health services, and advocating for the protection of sex workers’ rights.224 The Movimiento de Mujeres Unidas MODEMU (The Movement of United Women) and the Maxi Linder Association in Suriname have been internationally recognized for such work and looked to as models for other organizations in the region. The U.S. government provides significant funding to support HIV/AIDS-related work in the region, including work targeting sex workers. U.S. law and policy bars the use of these funds by organizations that do not have a policy explicitly opposing prostitution and limits the legal advocacy that can be done with these funds. These funding restrictions limit the extent to which other organizations might emulate the exemplary work of organizations like MODEMU and the Maxi Linder Association. A health worker working with sex workers in Jamaica told Human Rights Watch that the restrictions have impeded the organization’s work with sex workers by undermining its ability to support efforts for sex workers to organize on their own behalf and to join with regional and international calls for advocacy on behalf of the rights of sex workers.225 Other NGOs that receive U.S. government funding to work with sex workers in the region may face similar obstacles. 221 International HIV/AIDS Alliance, Annual Review 2003, pp. 41-42. The Alliance established its Caribbean program in 2003, and targets prevention and care activi ties for men who have sex with men, sex workers, and people living with HIV/AIDS. 222 Ibid.; Human Rights Watch e-mail communication with Rober t Carr, director, Jamaica AIDS Support, August 19, 2004. 223 Asociacion para la Salud Integral y Ciudadania de America Latina (ASICAL), “Quienes Somos,” http://www.sidalac.org.mx/asical/asical.ht ml (retrieved August 21, 2004). The Inte rnational AIDS Alliance and the POLICY Project have been collaborating with ASICAL in th is work. See International AIDS Alliance, Annual Review 2003 p. 41; The Men’s Health in Latin America,” February 6, 2 003, http://www.policyproject.com/page_whatsNew.cfm?read=30 (retrieved August 21, 2004); POLICY Project, “POLICY/ASICAL Training Promotes Men’s Health in Latin America,” February 6, 2003, http://www.policyproject.com/pag e_whatsNew.cfm?read=30 (retrieved August 21, 2004). 224 See Kemala Kempadoo and Jo Doezema, Global Sex Workers: Rights, Resistance, Rebellion (London: Routledge, 1998). 225 Human Rights Watch interview, Kingston, June 14, 2004.

PAGE 68

HUMAN RIGHTS WATCH, VOL. 16, NO. 6 (B) 66 VIII. LEGAL STANDARDS When people in Jamaica are driven from their homes and towns, subjected to relentless violence with little recourse to police protection, discriminated against in health care provision, and face public disclosure of confidential and private information because they are living with HIV/AIDS or based on their sexual orientation or gender identity, they are not experiencing “Jamaican culture.” They are experiencing human rights violations. Jamaica has ratified international and regional treaties requiring it to protect human rights to freedom from violence and arbitrary arrest and detention, freedom of association and assembly, the highest attainable standard of health, privacy, and nondiscrimination based on sexual orientation, gender identity, and HIV status. These treaties include the International Covenant on Civil and Political Rights (ICCPR), the International Convention on Economic, Social and Cultural Rights (ICESCR), the Convention on the Elimination of all Forms of Di scrimination against Women, and the American Convention on Human Rights (ACHR). Laws criminalizing homosexual conduct and abuses based on sexual orientation and gender identity have been extensively reviewed by United Nations bodies charged with interpreting these treaties, U.N. special experts on torture, extrajudicial executions, and health, and bodies established by the U.N. charter for the protection and promotion of human rights. Jamaica’s sodomy laws and many of the practices described in this report are completely at odds with the conclusions of these bodies, which have roundly condemned such laws and practices as violations of fundamental human rights to privacy and nondiscrimination, and for fueling serious human rights abuses against sexual minorities. Freedom from violence The Jamaican Constitution recognizes the right to life as a fundamental right.226 Jamaica has also ratified international and regional instruments that enshrine this protection, including the International Covenant on Civil and Political Rights (ICCPR) and the American Convention on Human Rights.227 By inciting third parties to commit acts of serious violence against men who have sex with men and failing properly to investigate 226 Jamaican Constitution, article 14. 227 ICCPR, 999 U.N.T.S. 171, entered into force March 23, 1976, article 6; American Convention on Human Rights, ratified by Jamaica on August 7, 1978, article 4(1).

PAGE 69

67 HUMAN RIGHTS WATCH, VOL. 16, NO. 6 (B) crimes of violence against them, the Jamaican government is failing in its obligation to protect the right to life. The ICCPR and the American Convention require states to prevent torture and other cruel, inhuman or degrading treatment or punishment, including by private actors.228 These treaties further require state partie s to ensure to all persons within their territory the rights recognized therein.229 When police beat, mistreat, and abuse people on the basis of their HIV status, sexual orientation, or consensual sexual conduct with members of the same sex, they violate these basic protections. When police instigate or fail to protect against such violence or abuse committed by private actors, they also violate these protections. The ICCPR’s prohibition against torture and cruel, inhuman or degrading treatment or punishment applies “not only to acts that cause physical pain but also to acts that cause mental suffering to the victim.”230 The Convention on the Elimination of All Fo rms of Discrimination against Women (CEDAW), to which Jamaica is a party, requires state parties “without delay” to take all appropriate measures to end gender-based discrimination, including by taking action to modify rigid stereotyping of the roles of men and women.231 Gender-based violence may also be considered a form of gender-based discrimination prohibited under CEDAW.232 The CEDAW Committee recognizes that pervasive sex-based stereotyping perpetuates social prejudices and contributes to gender-based violence.233 Although the 228 ICCPR, article 7; American Convention, article 5; see also CEDAW General Recommendation 19 (“Under general international law, States may also be responsible for private ac ts if they fail to act with due diligence to prevent violations of rights or to investigate and punish acts of violence, and for providing compensation.”). 229 ICCPR, article 2; American Convention, article 1(1). 230 Human Rights Committee, General Comment 20 Article 7 (Forty-fourth session, 1992), Compilation of General Comments and General Recommendations Adopted by Human Rights Treaty Bodies, U.N. Doc. HRI\GEN\1\Rev.1 at 30 (1994). The Human Rights Committee, the United Nations body charged with monitoring implementation of the ICCPR, has commented that states should provi de special protections for particular ly vulnerable persons. The Special Rapporteur on Torture has identified sexual minorities as a “particularly vulnerable gr oup” with respect to torture in various contexts, and condemned discriminatory laws and attitudes t hat subject members of sexual minorities to abuse and deprive them of means to claim and ensure enf orcement of their rights. “Report of the Special Rapporteur on the question of torture and other cruel, inhuman and degrading treatment or punishment,” U.N. General Assembly, U.N. Doc. A/56/156, July 3, 2001. 231 CEDAW, G.A. Res. 34/180, U.N. Doc. A/34/46, entered into force September 3, 1981, articles 2, 5(a). 232 CEDAW, article 2; United Nations General Assembly, “D eclaration on the Elimination of Violence against Women,” A/RES/48/104, December 20, 1993 (issued on February 23, 1994) article 4; Committee on the Elimination of All Forms of Discrimination against Women, Violence Against Women. General Recommendation 19 (eleventh session, 1992), U.N. Document CEDAW/C/1992/L.1/Add.15, para. 11; see also In ter-American Convention on the Prevention, Punishment and Eradication of Violence agai nst Women,” article 4. 233 CEDAW Committee, Violence Against Women, General Recommendation 19 para. 11.

PAGE 70

HUMAN RIGHTS WATCH, VOL. 16, NO. 6 (B) 68 Committee’s comments focus on violence against women, the phrase “gender-based violence” includes violence targeted against both men and women based on their sexual orientation or gender identity. Thus, men as well as women may be targeted for discrimination because they fail to conform to stereotypes based on gender or because they claim a gender identity that fails to c onform to societal expectations. The measures enumerated by the CEDAW Committee to combat gender-based violence include instituting effective complaints procedures and remedies for survivors of gender-based violence, and ensuring appropriate medical care, counseling and support services.234 States should adopt these sorts of measures to protect men, as well as women, from gender-based violence. The right to privacy and the right to freedom from discrimination Jamaica’s sodomy laws (sections 76, 77, and 79 of the Offences against the Person Act) are meant, and used, to criminalize consensual sexual conduct between adult males, and are used to criminalize consensual sexual conduct between adult females. In the 1994 case of Nicholas Toonen v. Australia, the U.N. Human Rights Committee, which monitors compliance with and adjudicates complaints brought under the ICCPR and its Optional Protocol, held that sodomy laws punishing consensual, adult homosexual conduct violate the rights to privacy and nondiscrimination guaranteed by the ICCPR.235 The Committee also noted that criminalization of homosexual practices hampered HIV prevention “by driving underground many of the people at risk of infection.”236 The Committee has thus urged states to bar discrimination based on sexual orientation.237 Since Toonen the Human Rights Committee, the Committee on Economic, Social and Cultural Rights, and the CEDAW Committee have called for the repeal of laws criminalizing consensual adult homosexual conduct.238 In the case of Trinidad and Tobago, the Human Rights Committee has urged that it extend the provisions of anti234 Ibid., para. 24. 235Nicholas Toonen v. Australia, Human Rights Committee, 50th Session, Case no. 488/1992, U.N. Doc. CCPR/C/50/D/488/1992 (April 4, 1994). 236 Ibid., para. 8.5. 237 See, e.g., U.N. Human Rights Committee, “Concluding Ob servations of the Human Rights Committee: Poland,” 66th Session, U.N. Doc. CCPR/C/79/Add.110, p. 23 (urging inclusi on of constitutional protecti ons against sexual-orientationbased discrimination). 238 See Ignacio Saiz, “Bracketing Sexuality: Human Ri ghts and Sexual Orientation—A Decade of Development and Denial at the U.N.,“ Health and Human Rights, vol. 7, no. 2, pp. 51-52 and n. 16 (citing decisions in which HRC has called for repeal in Tanzania and Romania; t he CESCR has called for repeal in Cyprus; and CEDAW has called for repeal in Kyrgystan).

PAGE 71

69 HUMAN RIGHTS WATCH, VOL. 16, NO. 6 (B) discrimination legislation “to those suffering discrimination on grounds of age, sexual orientation, pregnancy or infection with HIV/AIDS.”239 The U.N. Special Rapporteur on Extrajudicial, Summary, or Arbitrary Executions has observed that sodomy laws facilitate violence and human rights abuses against sexual minorities: The Special Rapporteur further believes that criminalizing matters of sexual orientation increases the social stigmatization of members of sexual minorities, which in turn makes them more vulnerable to violence and human rights abuses, including violations of the right to life. Because of this stigmatization, violent acts directed against persons belonging to sexual minorities are also more likely to be committed in a climate of impunity.240 Human Rights Watch recognizes the freedom of all people to follow their conscience in deciding whether to support or oppose homosexuality or homosexual behavior. However, rigid stereotyping of roles for men and women can lead to significant abuse of people who do not conform to those stereotypes and contribute to gender-based violence. Jamaica’s obligations under international law to protect against gender-based discrimination require that it take “all ap propriate measures” to “modify the social and cultural patterns of conduct of men and women, with a view to achieving the elimination of prejudices and customary and all other practices which are based on the idea of the inferiority or the superiority of either of the sexes or on stereotyped roles for men and women.”241 Moral objections to nonconforming sexual orientation or gender identity are not an adequate basis to avoid this obligation. The U.N. Commission on Human Rights, the main political body within the U.N. system charged with human rights matters, interprets article 26 of the ICCPR, which “prohibit[s] any discrimination and guarantee[s] all persons equal and effective protection against discrimination on any ground such as race, colour, sex, language, 239 Concluding Observations of the Human Ri ghts Committee: Trinidad and Tobago,” U.N. Doc. CCPR/CO/70/TTO, November 3, 2000, para. 11. 240 “Report of the Special Rapporteur on extrajudicial, summary or arbitrary executions,” U.N. Doc. E/CN.4/1999/39, January 6, 1999, para. 77. 241 CEDAW, article 5(a); see also CEDAW Committee, General Recommendation 19 (noting importance of rejecting stereotyped roles for men because th ey contribution to gender-based violence).

PAGE 72

HUMAN RIGHTS WATCH, VOL. 16, NO. 6 (B) 70 religion, political or other opinion, national or social origin, property, birth or other status" as prohibiting discrimination based on HIV/AIDS.242 The non-binding U.N. International Guidelines on HIV/AIDS and Human Rights enjoin states to “enact or strengthen anti-discrimination and other protective laws that protect vulnerable groups, people living with HIV/AIDS and people with disabilities in the public and private sectors.”243 The guidelines advise that the laws cover health care and access to transportation (among other areas), and note particular areas where discrimination is likely and merit legal protection, including: (1) protection from discriminatory acts, including “HIV/AIDS vilification” and vilification of people who engage in same sex relationships; and (2) protection of confidentiality of medical information, including HIV status, and other personal information, and the need for disciplinary and enforcement mechanisms in cases of breaches of confidentiality.244 International law proscribing discrimination extends to discrimination in provision of transportation based on sexual orientation and HIV/AIDS. The U.N. Human Rights Committee has found that prohibitions on discrimination place a broad mandate on states to remedy unequal treatment in all areas of life, finding that article 26 of the ICCPR “prohibits discrimination in law or in fact in any field regulated or protected by the public authorities.”245 Jamaica is therefore responsible for providing protections against discrimination in transportation services (buses, taxis) subject to its regulation. Freedom from arbitrary arrest and detention The ICCPR and the American Convention protect the right to liberty and security of the person and prohibit all arbitrary detention.246 The U.N. Working Group on Arbitrary Detention has affirmed that the detention of people solely on the basis of their sexual 242 ICCPR, article 26; Commission on Human Rights, “The Pr otection of Human Rights in the Context of Human Immunodeficiency Virus (HIV) and Acquir ed Immune Deficiency Syndrome (AIDS),” Resolution 1995/44, adopted without a vote, March 3, 1995. 243 U.N., HIV/AIDS and Human Rights Inte rnational Guidelines, Guideline 5. 244 Ibid., paras. 30(a), (d), (h). The U.N. Guidelines specifically recommend that “an independent agency should be established to address breaches of confidentiality,” and that “provision should be made for professional bodies to discipline cases of breaches of confidentiality as professional misconduct.” Ibid., para. 30(c). 245 Human Rights Committee, General Comment 18: Nondiscrimination 37th Session, 1989, U.N. Doc. HRI/GEN/1/Rev.1, p. 26. 246 ICCPR, articles 9(1) and 9(3); Americ an Convention, article 7. The U.N. Human Rights Committee, in its authoritative interpretation of the article 9 right to liberty and security, stat es that article 9(1) is "applic able to all deprivations of l iberty, whether in criminal cases or in other cases such as, for example, mental ill ness, vagrancy, drug addiction, educational purposes, immigration control, et c." U.N. Human Rights Committee, General Comment 8: Right to liberty and security of persons (Art. 9), Sixteenth session, 30/06/82

PAGE 73

71 HUMAN RIGHTS WATCH, VOL. 16, NO. 6 (B) orientation violates fundamental human rights.247 The ICCPR further provides an enforceable right to compensation for victims of unlawful arrest or detention.248 The protections of the ICCPR and the American Convention are violated when state agents arrest or detain people on the basis of their sexual orientation, their consensual sexual conduct with others of the same sex, or their association with homosexual men and women and with sex workers. Freedom of association and assembly The ICCPR and the American Convention protect the rights of assembly and to freedom of association with others.249 States violate these rights when police harass, arrest and otherwise abuse men who have sex with men, women who have sex with women, sex workers, and peer educators attempting to provide HIV/AIDS education and services to them. States also violate these rights when they promulgate laws that impede efforts by such people to organize to assert and defend their rights or hinder others from doing so on their behalf. In this respect, Jamaica’s sodomy laws violate the rights to freedom of association and assembly. Jamaica’s failure to protect the rights of groups like the Jamaica Forum for Lesbians, AllSexuals and Gays to safely convene has consequences for their ability to exercise other rights, as the U.N. has recognized. The U.N. General Assembly’s Declaration on Human Rights Defenders has called attention to the role of the freedoms of association and assembly in the defense of all human rights.250 Indeed, the Special Representative of the U.N. Secretary General on Human Rights Defenders has called attention to the “greater risks… faced by defenders of the rights of certain groups as their work challenges social structures, traditional practices and interpretations of religious precepts that may have been used over long periods of time to condone and justify violation of the human rights of members of such groups. Of special importance will be… human rights groups and those who are active on issues of sexuality, especially sexual orientation.”251 247 U.N. Working Group on Arbitrary Detention, “Opinion no. 7/2002 (Egypt)”, at 7 and 14-15. 248 ICCPR, article 9(5); see also American Convention, arti cle 10 (providing right to com pensation where sentenced by a final judgment through miscarriage of justice). 249 ICCPR, articles 21, 22(1); American Convention, articl es 16, 17; see also Universal Declaration of Human Rights, article 20. 250 U.N. Declaration on the Rights and Responsibilities of Individuals, Groups, and Organs of Society to Promote and Protect Universally Recognized Human Rights and Fundamental Freedoms (U.N. General Assembly Resolution 53/144, March 8, 1999), article 5. 251 “Report of the Special Representative to the Secretary General on human rights defenders,” U.N. Doc. E/CN.4/2001/94, para. 89(g).

PAGE 74

HUMAN RIGHTS WATCH, VOL. 16, NO. 6 (B) 72 The right to the highest attainable standard of health International law recognizes the human right to obtain life-saving health services without fear of punishment or discrimination. The International Covenant on Economic, Social and Cultural Rights (ICESCR) guarantees the right to the highest attainable standard of health without discrimination based on certain prohibited grounds (including sexual orientation and HIV status) and requires governments to take all necessary steps for the “prevention, treatment and control of epidemic . diseases.252 The Committee on Economic, Social and Cultural Rights has interpreted article 12 to require state parties to ensure access to information and services necessary for physical and mental health without discrimination based on HIV status and sexual orientation.253 According to the CESCR, article 12 of the ICESCR also requires states to take affirmative steps to promote health, including ensuring that third parties do not limit access to health-related information and services and refrain from conduct that limits people’s capacity to protect their health.254 Laws and policies that “are likely to result in . unnecessary morbidity and preventable mortality” constitute specific violations of the right to health.255 Police interference with HIV prevention efforts and discriminatory access to health facilities and services are a blatant interference with the right to the highest attainable standard of health. Jamaica’s failure to ensure that government and private actors do not interfere with the ability of men who have sex with men and women who have sex with women to receive health information and services and to protect confidential information about HIV status also violates the right to the highest attainable standard of health.256 Access to complete and accurate information about condoms and HIV/AIDS is recognized by article 19 of the ICCPR, which guarantees the “freedom to seek, receive 252 ICESCR, U.N. Doc. A/6316 (1966), articles 2(2), 12(1), 12(2)(c). Article 10 of the Additional Protocol to the American Convention on Human Rights in the Area of Econom ic, Social and Cultural Rights protects the right to health. Although Jamaica has not acceded to this c onvention, it does codify prevailing Organization of American States (OAS) standards. Ja maica’s obligations under the Americ an Convention require it to take measures toward progressive realization of such st andards. See American Conventi on, article 26 (obligating state parties to adopt measures toward progressive realiz ation of rights implicit in economic, social, educational, scientific and cultural standards set forth in the OAS Charter). 253 Committee on Economic, Social and Cultural Rights, General Comment 14: The Right to the Highest Attainable Standard of Health, August 11, 2000, paras. 12, 18, 19, 30, 50, 54. 254 Ibid., paras. 33, 50. 255 Ibid., para. 50. 256 General Comment 14 paras. 12, 16 and n. 8; see also Human Rights Watch, Ignorance Only: HIV/AIDS, Human Rights and Federally Funded Abstinence-Only Progr ams in the United States. Texas: A Case Study, vol. 15, no. 5(g), September 2002, pp. 41-42.

PAGE 75

73 HUMAN RIGHTS WATCH, VOL. 16, NO. 6 (B) and impart information of all kinds.”257 Parties to the ICCPR are obliged not only to refrain from censoring information, but to t ake active measures to give effect to this right.258 The Committee on Economic, Social and Cultural Rights similarly stated that “information accessibility” is an essential element of the human right to health, noting that “education and access to information concerning the main health problems in the community, including methods of preventing and controlling them” are of “comparable priority” to the core obligations of the ICESCR.259 Access to HIV prevention services saves lives. Access to health care prevents people living with HIV/AIDS from unnecessary suffering and early death. The right to life is recognized by all major human rights treaties and, as interpreted by the U.N. Human Rights Committee, requires governments to take “positive measures” to increase life expectancy.260 These should include taking adequate steps to provide accessible information and services for HIV prevention, and ensuring access to medical treatment for people living with HIV/AIDS. IX. CONCLUSION Jamaica is at a crossroads in its efforts to address its growing HIV/AIDS epidemic. The epidemic is spreading among the general population, and HIV/AIDS is on the increase. The Jamaican government—namely, the Ministry of Health’s national HIV/AIDS program—has acknowledged that human rights abuses against marginalized populations at risk of HIV and against people living with HIV/AIDS are important factors driving the epidemic. Its national HIV/AIDS strategy has at its core protection of human rights and fundamental freedoms of people living with and at high risk of HIV/AIDS. And since 2002, the Jamaican government has received significant resources to put its national HIV/AIDS strategy into action, including by developing a legal framework to ensure human rights protections. 257 ICCPR, article 19(2). 258 See ICCPR, article 2(2), providing that “each State Part y to the present Covenant undertakes to take the necessary steps, in accordance with its constitutional processes and with the provisions of the present Covenant, to adopt such laws or other measures as may be necessary to give effect to the rights recognized in the present Covenant.” State responsibility to give effect to the right to info rmation is further elaborated in S. Coliver, ed., The Right to Know: Human Rights and access to reproductive health information (Article 19 and University of Pennsylvania Press, 1995), pp. 45-47. 259 Committee on Economic, Social and Cultural Rights (CESCR), The right to the highest attainable standard of health para. 44(d). 260 Human Rights Committee (HRC), The right to life: HRC General comment 6 (16th Sess., 1982), para. 5.

PAGE 76

HUMAN RIGHTS WATCH, VOL. 16, NO. 6 (B) 74 But absent political leadership to end state-sponsored violence and discrimination against men who have sex with men, sex workers, and people living with HIV/AIDS and against peer educators working with them, Jamaica could miss an opportunity to reverse the course of its epidemic. Government leaders must act quickly and forcefully to combat widely-held prejudices that interfere with HIV/AIDS policy and undermine Jamaicans’ human right to health. The Jamaican government must also join forces with regional efforts to reform discriminatory laws and policies that create the conditions in which the epidemic flourishes. If Jamaica fails to take such steps, its investment in fighting AIDS will be wasted. The cost will be immeasurable, and for many Jamaicans, the consequences will prove fatal. Acknowledgments This report was written by Rebecca Schleifer, based on research conducted by Rebecca Schleifer of the HIV/AIDS and Human Rights Program and Scott Long of the Lesbian, Gay, Bisexual, and Transgender Rights Program at Human Rights Watch. It was reviewed by Joanne Csete, director of the HIV/AIDS Program; Scott Long, director, Lesbian, Gay, Bisexual, and Transgender Rights Program; Marianne Mllmann, Americas researcher for the Women’s Rights Division; Daniel Wilkinson, researcher with the Americas Division; Dinah PoKempner, general counsel; and Widney Brown, deputy program director of Human Rights Watch. Production assistance was provided by Jennifer Nagle, Andrea Holley, Veronica Matushaj, and Fitzroy Hepkins. A number of experts and nongovernmental organizations in Jamaica and elsewhere assisted with this research. Human Rights Watch gratefully acknowledges the Jamaica Forum of Lesbians, All-Sexuals and Gays and Jamaica AIDS Support for their invaluable assistance and courageous work. We extend sincere thanks to everyone who shared their experiences with us and made this report possible, and regret that we cannot mention of all them by name.

PAGE 77

75 HUMAN RIGHTS WATCH, VOL. 16, NO. 6 (B) Appendix Dancehall Songs Referred to in the Report Boom Bye Bye261 by Buju Banton Werl iz in chobl World is in trouble Enitaim Buju Banton com Anytime Buju Banton comes Battybwoy git op ahn ron Faggots get up and run A gonshat, mi hed bak A gunshot, yikes Hie mi tel im nou, kruu, iz laik … Hear me tell him now, crew, it’s like ... Chorus: Boom, bai bai, iina battybwoy hed Boom, bye bye, in a faggot’s head Ruud buai no promuot no naasi man Rude boys don’t promote nasty men Dem hafi ded They have to die Boom, bai bai, iina battybwoy hed Boom, bye bye, in a faggot’s head Ruud buai no promuot no naasi man Rude boys don’t promote nasty men Dem hafi ded. They have to die. Tuu man ichop ahn a robop Two men hitch up and are rubbing up Ahn a lie dong iina bed And are laying down in bed Ogop uan aneda ahn a fiilop leg Hug up one another and feeling up legs Sen fi di matic ahn di Uzi instead Se nd for the automatic and the Uzi instead Shuut dem, no come ef wi shuut dem. Shoot them, don’t come if we shoot them. No waahn Jaki, gi dem Paal insted D on't want Jackie, give them Paul instead Dem no waahn di swiitnis bitwiin di leg Th ey don’t want the sweetness between the legs Gial ben dong bakwie ahn aksep di peg Gi rl bend down backwards and accept the peg Ahn ef i riili at And if it really hurts Yu nuo shi stil naa go fled. You know she still won’t flee. Som man stil no waahn di panti ried Some men still don’t want the panty raid Pior batty bizniz dem lov Only bottom business they love Mi se uman iz di grietes ting I say woman is the greatest thing Gad eva put pan di lan God ever put on the land 261 Gun shot sounds

PAGE 78

HUMAN RIGHTS WATCH, VOL. 16, NO. 6 (B) 76 Buju lovin dem fram hed dong to fut batam. Buju loving them from head down to feet. Bot som man a tern roun But some men are turning around We dem get dat fram? Where do they get that from? Piita iz nat fa Janit, Piita iz fa Jan Peter is not for Janet, Peter is for John Suuzet iz nat fa Paal, Suuzet is fa An Suzette is not for Paul, Suzette is for Ann We di bomboclaat dem gat dat fram? Where the fuck do they get that from? Ier com di DJ niem Buju Banton Here comes the DJ named Buju Banton Com fi schrietn yu taak Come to straighten your talk Kaa mi se dis iz nat a baagin Because I say this is not a bargain Mi se dis iz nat a diil I say this is not a deal Gai com nier wi den him skin mos piil Gu y comes near us then his skin must peel262 Bon im op bad laik a uol taia wiil. Burn him up bad like an old tyre wheel. Aal di Niuu Yaak kruu dem no promuot battyman All the New York crew don’t promote faggots Jomp ahn daans, unu push op unu an Jump and dance, everyone put up your hands Aal di Bruklin gial dem no promuot battyman All the Brooklyn girls don’t promote faggots Jomp ahn buogl ah wain yu batam Jump and bogle263 and gyrate your bottom Kianiedian gial dem no laik battyman Canadian girls don’t like faggots Ef yu a no uan, yu hafi push up yu an. If you are not one, you have to put up your hand. Chi Chi Man [Gay Man], by TOK My Crew (My Crew) my dogs (my dogs) My crew (my people) my dogs (my people) Set rules (Set rules) set laws (set laws ) Set rules (Set rules) set laws (set laws) We represent for di lords of yards We represent all the area dons [gang leaders] A gal alone a feel up my balls Only girls are allowed to feel up my balls Chorus: 262 In Jamaica, pouring acid on an i ndividual is a common revenge tactic 263 A type of dance

PAGE 79

77 HUMAN RIGHTS WATCH, VOL. 16, NO. 6 (B) From dem a par inna chi chi man car Once they get together in a gay men’s car Blaze di fire mek we bun dem! (Bun dem!) Blaze the fire, let’s burn them! (Burn them!) From dem a drink inna chi chi man bar Once they drink in a gay bar Blaze di fire mek we dun dem! (Dun dem!) Blaze the fire, let’s burn them! (Kill them!) So mi go so, do yuh see weh I see? I’m looking on, do you see what I see? Niggas when your doin that Niggas when you are doing that Nuff a dem a freak dem a carry all dem dutty act Lots of them are freaks, they bring all their dirty acts Thug nigga wanna bees nuff a dem a lick it ba ck Thug nigga wannabees – lots of them take it (in the arse) It dem bring it to we, hold on nuff coppa a shot If they bring it to us, hold on lots of bullets are going to fly Coppa shot rise up every calico go rat tat tat Bullets fly, take up every calico (gun) and shoot rat-tat-tat Rat tat tat every chi chi man dem haffi get flat Rat-tat-tat every gay man will have to die Get flat, mi and my niggas ago mek a pack Die, me and my niggas will make a pact Chi chi man fi dead and dat's a fact. Gay men must die and that’s a fact. So mi go so la la la la la la la la la la la We are not part of us la la la la Nah go mek nuh chi chi man walk right a so Not going to let any gay men walk here From a bwoy a deep we ago dun dem right no w Once a man takes cock we are going to kill them right now Leff him whole family dem a blow wow Leave his whole family to cry I see it from far mi and dem nah go par I see it from far, I am not going to mix with them A nuff a dem bwoy weh a smoke man cigar There are lots of those guys that suck cock Mi and dem coulda never inna one bar Me and them could never stay in the same bar Dem bwoy deh flex too bizarre. Those boys are just too weird.

PAGE 80

HUMAN RIGHTS WATCH, VOL. 16, NO. 6 (B) 78 Log On264 by Elephant Man Lag aan, ahn step pan chi chi man Log on, and step on queer men Tep pan im laik a uol claat Step on him like an old cloth Daans wi a daans ahn a bon out aal friiki man We're dancing to burn out all freaky men A daans wi a daans ahn a krosh out aal bingi man We're dancing to crush out all queer men Du di waak, mek mi si di lait ahn di tuoch dem f aas. Do the walk, show me your lighter and torch fast. Chorus: Lag aan, ahn tep pan chi chi man Log on, and step on queer men Lag aan, fram yu nuo se yu no iki man Lo g on, once you know you’re not an ickie man Lag aan, ahn tep pan chi chi man Log on, and step on queer men Daans wi a daans ahn a bon out aa’ friiki man. We’re dancing to burn out all freaky men. Bout baas? A huu da breda cuda a taak? Wh at boss? Who could that brother be talking about? Gimi paas, yu no si a dis ya daans di piipl dem wa nt? Excuse me, don’t you see it’s this dance the people want? Tep pan im laik a uol cleat Step on him like an old cloth A daans wi a daans ahn a crosh out dem ... We're dancing to crush them out Bon blaas yu skiear yu cia bos di niu daans Bu rn, blast, you’re scared, you can do the new dance Du di waak, mek mi si di lait ahn di tuoch dem f aas Do the walk, show me your lighter and torch fast Jerimi, com elp mi du di bran niu daans. Jeremy, come help me do the brand new dance. Aa rait now, yu no si dem buai ya tek man fi fuul? All right now, d on’t you see these guys take us for fools? Kiaahn tek dem tu yu daansn skuul. You can’t take them to your dancing school Gad a mi bakativ, miuzik a mi tuul God is my support, music is my tool Aal rait ya nou All right here now Yu no si di huol a di tapa265 dem a dwiit? Don’t you see all the top people doing it? 264 A dance with foot motion as if squashing a co ckroach the lyrics boast about crushing gay men. 265 Shortened form of tapanaaris, a term indicating persons of wealth, prestige

PAGE 81

79 HUMAN RIGHTS WATCH, VOL. 16, NO. 6 (B) Fiuucha a aax Elifant ow mi dwiit The future is asking Elephant how I do it Put owt yu rait an ahn put owt yu rait fiit Put out your right hands and put out your right feet Lag aan, ahn ron di chriit. Log on, and run the street. Aa rait, siit? Chi chi man kiaahn stap da wan All right, see it? Queers can’t stop this one ya fram dwiit from doing it Wiek op, iina di rang bed yu a sliip Wake up, in the wrong bed you are sleeping Yu no si di gial dem kanchrak yu a briich? Don’t you see the girls’ contract you are breaching? Fiuucha ron im dong, di buai fi get biit In future run him down, the boy should be beaten Kiaahn paas Spanish Tong pahn Prinsis Chriit Can’t go by Spanish Town on Princess Street Bier rat-a-tat di shata dem wud ahn a biit Only rat-a-tat the shoot ers would and beating Jerimi, ton op di miuuzik ina di chriit Jeremy, turn up the music in the street Dis ya niuu daans a ron di plies. This new dance is running the place.



PAGE 1

Human Rights Watch November 2004 Vol. 16, No. 6 (B) Hated to Death: Homophobia, Violence and Jamaica’s HIV/AIDS Epidemic Glossary of Key Terms.......................................................................................................... ......1 A Note on Jamaican language.................................................................................................... .1 I. SUMMARY.................................................................................................................... ...........2 II. RECOMMENDATIONS....................................................................................................5 To the Jamaican government..................................................................................................5 Reform the law enforcement system.................................................................................5 Enhance the national effort against HIV/AIDS.............................................................7 To Donors and International Organizations........................................................................8 III. METHODS.................................................................................................................. .........8 IV. BACKGROUND................................................................................................................ .9 HIV/AIDS in Jamaica............................................................................................................ .9 Homophobia in Jamaica and its role in driving the HIV/AIDS epidemic....................11 V. FINDINGS OF HUMAN RIGHTS WATCH’S INVESTIGATION......................17 Police abuse................................................................................................................... ..........18 Police abuse based on sexual orientation and gender identity.....................................18 Police abuse of sex workers..............................................................................................31 Police interference with access to HIV/AIDS information and health services......32 Abuses in the health care system..........................................................................................36 Discrimination by health care providers.........................................................................36 Discrimination in health care provision..........................................................................39 Inadequate protection of confidential information.......................................................41 Driving men who have sex with men and people living with HIV/AIDS from health care services........................................................................................................... ..44 Fostering dangerous practices and complicating health care provision.....................49 Denial of access to transportation........................................................................................50 Other abuses by non-state actors: vio lence in the family and in the community.........52 Abuses based on sexual orientation and gender identity..............................................52 Abuses against people living with HIV/AIDS..............................................................55 VI. GOVERNMENT RESPONSE.......................................................................................56 Improving legal and policy protections...............................................................................57 Educating health personnel...................................................................................................58 Efforts to address police abuse and provide HIV/AIDS education to police..............59 Institutional mechanisms to address police misconduct..............................................60 Police training on HIV/AIDS and related human rights issues.................................62 VII. REGIONAL EFFORTS TO ADDRESS HIV/AIDS...............................................62

PAGE 2

VIII. LEGAL STANDARDS..................................................................................................66 Freedom from violence.......................................................................................................... 66 The right to privacy and the right to freedom from discrimination...............................68 Freedom from arbitrary arrest and detention.....................................................................70 Freedom of association and assembly.................................................................................71 The right to the highest attainable standard of health.......................................................72 IX. CONCLUSION................................................................................................................ ..73 Acknowledgments................................................................................................................ .......74 Appendix....................................................................................................................... ...............75

PAGE 3

1 HUMAN RIGHTS WATCH, VOL. 16, NO. 6 (B) Glossary of Key Terms Bisexual: a person who is attracted to both sexes. Gay: a synonym for homosexual. Gender identity: a person’s internal, deeply felt sense of being male or female, or something other than or in between male and female. Heterosexual: a person attracted primarily to people of the opposite sex. Homosexual: a person attracted primarily to people of the same sex. Lesbian: a female attracted primarily to other females. LGBT: lesbian, gay, bisexual, or transgender; an inclusive term for groups and identities sometimes also associated together as "sexual minorities." Men who have sex with men: men who engage in sexual behavior with other men, but do not necessarily identify as "gay," “homosexual” or "bisexual." Sexual orientation: the way in which a person's sexual and emotional desires are directed. The term categorizes according to the sex of the object of desire—that is, it describes whether a person is attracted primarily toward people of the same or opposite sex, or to both. Transgender: One whose inner gender identity differs from the physical characteristics of his/her body at birth. Female-to-male transgender people were born with female bodies but have a predominantly male gender identity; male-to-female transgender people were born with male bodies but have a predominantly female gender identity. Women who have sex with women: women who engage in sexual behavior with other women, but do not necessarily identify as “gay,” “homosexual,” “lesbian” or “bisexual.” A Note on Jamaican language Many Jamaicans speak “patois” or Jamaican creole in addition to Caribbean Standard English. The following patois words and phrases appear in this report: battyman: “Batty” is slang meaning buttocks. Battyman is a pejorative term for men who have sex with men, as anal sex is seen as the act that defines them. “battyman fi dead:” gay men should be dead/killed; gay men must die “battyman mus’ dead:” gay men should be dead/killed; gay men must die chi chi man : derogatory term for a man who has sex with men. sodomite: derogatory term for woman who has sex with a woman “man on man fi dead:” gay men should be dead

PAGE 4

HUMAN RIGHTS WATCH, VOL. 16, NO. 6 (B) 2 I. SUMMARY On June 9, 2004, Brian Williamson, Jamaica’s leading gay rights activist, was murdered in his home, his body mutilated by multiple knife wounds. Within an hour after his body was discovered, a Human Rights Watch researcher witnessed a crowd gathered outside the crime scene. A smiling man called out, “Battyman [homosexual] he get killed!” Many others celebrated Williamson’s murder, laughing and calling out, “let’s get them one at a time,” “that’s what you get for sin,” “let’s kill all of them.” Some sang “boom bye bye,” a line from a popular Jamaican song about killing and burning gay men. Jamaica’s growing HIV/AIDS epidemic is unfolding in the context of widespread violence and discrimination against people living with and at high risk of HIV/AIDS, especially men who have sex with men. Myths about HIV/AIDS persist. Many Jamaicans believe that HIV/AIDS is a disease of homosexuals and sex workers whose “moral impurity” makes them vulnerable to it, or that HIV is transmitted by casual contact. Pervasive and virulent homophobia, coupled with fear of the disease, impedes access to HIV prevention information, condoms, and health care. Violent acts against men who have sex with men are commonplace in Jamaica. Verbal and physical violence, ranging from beatings to brutal armed attacks to murder, are widespread. For many, there is no sanctuary from such abuse. Men who have sex with men and women who have sex with women reported being driven from their homes and their towns by neighbors who threatened to kill them if they remained, forcing them to abandon their possessions and leaving many homeless. The testimony of Vincent G., twenty-two, is typical of the accounts documented by Human Rights Watch: “I don’t live anywhere now. . Some guys in the area threatened me. ‘Battyman, you have to leave. If you don’t leave, we’ll kill you.’”1 Victims of violence are often too scared to appeal to the police for protection. In some cases the police themselves harass and attack men they perceived to be homosexual. Police also actively support homophobic violence, fail to investigate complaints of abuse, and arrest and detain them based on their alleged homosexual conduct. In some cases, homophobic police violence is a catalyst for violence and serious—sometimes lethal—abuse by others. On June 18, 2004, a mob chased and reportedly “chopped, stabbed and stoned to death” a man perceived to be gay in Montego Bay. Several witnesses told Human Rights Watch that police participated in the abuse that ultimately 1 Human Rights Watch interview with Vincent G., Kingston, June 14, 2004.

PAGE 5

3 HUMAN RIGHTS WATCH, VOL. 16, NO. 6 (B) led to this mob killing, first beating the man with batons and then urging others to beat him because he was homosexual. Because HIV/AIDS and homosexuality often are conflated, people living with HIV/AIDS and organizations providing HIV/AIDS education and services have also been targeted. Both state and private actors join violent threats against gay men with threats against HIV/AIDS educators and people living with HIV/AIDS. In July 2004, for example, the Jamaican Forum of Lesbians, All-Sexuals and Gays (J-FLAG) received an email threatening to gun down “gays and homosexuals” and “clean up” a group that provided HIV/AIDS education for youth. In a 2003 case, a police officer told a person living with HIV/AIDS that he must be homosexual and threatened to kill him if he did not “move [his] AIDS self from here.” Discrimination against people living with HIV/AIDS in Jamaica poses serious barriers to obtaining necessary medical care. In interviews with people living with HIV/AIDS, Human Rights Watch found that health workers often mistreated people living with HIV/AIDS, providing inadequate care and sometimes denying treatment altogether. Doctors failed to conduct adequate medical examinations of people living with HIV/AIDS, sometimes refusing even to touch them. And, in some cases, lack of treatment in the initial stages made it even less likely that people living with HIV/AIDS would receive health care services at a later date. Visible symptoms heightened the discrimination they faced, which in turn created further barriers to obtaining treatment. People suffering from visible HIV-related symptoms were sometimes denied passage on public and private transportation, making it difficult to obtain any medical care at facilities beyond walking distance. People living with HIV/AIDS said that health workers also routinely released confidential information to other patients and to members of the public, both through discriminatory practices that signaled patients’ HIV status (such as segregating HIVpositive patients from others) and by affirma tive disclosure of such information. Such actions violate fundamental rights to privacy and also drive people living with HIV away from services. Discrimination also spreads HIV/AIDS in Jamaica by discouraging at-risk individuals from seeking HIV-related information or health care. Men who have sex with men reported that health workers had refused to treat them at all, made abusive comments to them, and disclosed their sexual orientation, putting them at risk of homophobic violence by others. As a result, many men who have sex with men delayed or avoided seeking health care altogether, especially for health problems that might mark them as

PAGE 6

HUMAN RIGHTS WATCH, VOL. 16, NO. 6 (B) 4 homosexual, such as sexually transmitted diseases. Because the presence of other sexually transmitted diseases heightens the risk of HIV transmission, such discrimination may have fatal consequences. Jamaica is at a critical moment in its efforts to address a burgeoning HIV/AIDS epidemic. An estimated 1.5 percent of Jamaicans are living with HIV/AIDS, and HIV/AIDS is on the increase. Jamaica’s Ministry of Health has taken steps to combat discrimination against people living with and at high risk of HIV/AIDS (such as men who have sex with men and sex workers), which it has recognized as a key factor driving Jamaica’s HIV/AIDS epidemic. Its national HIV/AIDS program has fostered important relationships with nongovernmental organizations with established links to marginalized high-risk groups, provided support for their HIV/AIDS work with them, and looked to them for guidance in developing an effective response to the epidemic. It also has provided HIV/AIDS training for health personnel addressing stigma and discrimination. But other parts of Jamaica’s government undermine these important efforts by condoning or committing serious human rights abuses. Abuses against men who have sex with men take place in a climate of impunity fostered by Jamaica’s sodomy laws and are promoted at the highest levels of government. Jamaican legal provisions that criminalize consensual sex between adult men are used to justify the arrest of peer HIV educators and to deny HIV prevention services to prisoners, among others. High-level political leaders, including Prime Minister P.J. Patterson and Minister of Health John Junor, repeatedly refuse to endorse repeal of discriminatory legislation, ignoring not only international human rights standards but also reports by both the government’s national HIV/AIDS program and its advisory National AIDS Committee on the role of these laws in driving Jamaica’s HIV/AIDS epidemic. Jamaican health officials acknowledge that Jamaica’s sodomy laws make it difficult for them to work directly with men who have sex with men. As one high-level health official told Human Rights Watch: “We don’t promote direct programs or services to MSM [men who have sex with men] as a group because the existing laws impede this work [and] because [of] the high-level of stigma and discrimination, they’re not open to getting services through the public sector.” The police, however, actively impede government-supported peer HIV prevention efforts among men who have sex with men and also among sex workers. AIDS outreach workers reported that the very possession of condoms—a key tool in HIV prevention—triggers police harassment, and in some cases, arrest and criminal charges.

PAGE 7

5 HUMAN RIGHTS WATCH, VOL. 16, NO. 6 (B) Jamaica’s failure to take action to stop human rights abuses committed by state agents, to take measures to protect against abuses by state and private actors, and to ensure access to HIV/AIDS information and services to all Jamaicans violate its obligations as a state party to regional and international human rights treaties. In 2004, Jamaica launched an ambitious project to provide antiretroviral treatment to people living with HIV/AIDS and to address underlying human rights violations that are driving the epidemic. These are promising initiatives. They will be compromised, however, unless government leaders make a sustained commitment to end discrimination and abuse against people living with and at high risk of HIV/AIDS. The government knows that although HIV/AIDS is stigmatized as a “gay disease,” in reality, in Jamaica as in most of the Caribbean, the most common means of transmission is heterosexual sex. It also knows that if the epidemic in Jamaica continues to accelerate, all Jamaicans will suffer. This fact should encourage high-level Jamaican government officials to act quickly and forcefully to eliminate discriminatory laws and abusive practices that violate basic rights to equality, dignity, privacy, and health and undermine HIV/AIDS prevention and treatment efforts. This includes speaking out strongly and acting forcefully against homophobic violence and abusive treatment of homosexual men and women and of sex workers. If the Jamaican government chooses instead to let popular prejudices continue to undermine its attempts to establish rights-based HIV/AIDS policies, the consequences for all Jamaicans will be dire. Thousands of Jamaicans will be consigned to lives of horrific abuse and thousands will face premature and preventable death. II. RECOMMENDATIONS To the Jamaican government Reform the law enforcement system Police Conduct € Ensure that all allegations of excessive force and other human rights abuses by law enforcement officials against HIV/AIDS workers, sexual minorities, sex workers, and people living with HIV/AIDS are investigated promptly and thoroughly by a body independent of those alleged to be responsible and which has the necessary powers and resources to fully investigate offences by state agents. Sanction officials who engage in or condone abuse.

PAGE 8

HUMAN RIGHTS WATCH, VOL. 16, NO. 6 (B) 6 € Cease and publicly repudiate all violence and harassment by police and other agents of the state against men who have sex with men, women who have sex with women, sex workers, and people living with HIV/AIDS. € Train all criminal justice officials in international human rights standards and nondiscrimination, including issues of sexuality, sexual orientation, and HIV/AIDS. Ensure that such training is fully integrated into training programs provided to all ranks, and not treated as an additional class separated from the full curriculum of training. Ensure that police at all levels are trained on the fundamentals of HIV transmission and care for people living with HIV/AIDS and on the importance of the lifesaving efforts of HIV/AIDS outreach workers. Law Reform € Repeal sections 76, 77, and 79 of the Offences against the Person Act, which criminalize sex between consenting adult men and are used as justification for harassment of men who have sex with men and of HIV/AIDS educators working with them. € Adopt legislation to protect the rights of people living with HIV/AIDS, including legislation to proscribe discrimination against them. € Repeal section 80 of the Offences against the Person Act and section 4 of the Towns and Communities Act, which grant broad latitude for arrest and detention without a warrant or an order from a magistrate, and replace them with clear, strict limitations on situations in which an arrest without warrant is permissible, such as when a crime is occurring or about to occur. € Include “sexual orientation and gender identity” and “sex” in the antidiscrimination clause of the Charter of Rights and Freedoms proposed as amendments to the Jamaican Constitution. € Invite international scrutiny of protections against torture and ill-treatment by: € Ratifying the Convention against Torture and Other Cruel, Inhuman and Degrading Treatment or Punishment, the Optional Protocols to the International Covenant on Civil and Political Rights and to the U.N. Convention against Torture, and the Inter-American Convention on the Prevention, Punishment and Eradication of Violence Against Women. € Making the necessary declaration under article 22 of the U.N. Convention against Torture to enable the U.N. Committee against Torture to consider complaints submitted to it. € Including information on the treatment of HIV/AIDS workers and members of high-risk groups (men who have sex with men, sex

PAGE 9

7 HUMAN RIGHTS WATCH, VOL. 16, NO. 6 (B) workers) in future periodic reports to human rights treaty bodies established for the International Covenant on Civil and Political Rights (overdue as of July 11, 2001) and the Convention on the Elimination of All Forms of Discrimination Against Women. Enhance the national effort against HIV/AIDS € Ensure that high-level political leaders, inclu ding the prime minister and all other cabinet officials, take a leadership role in campaigns focusing on improving human rights protections and reducing stigma and discrimination against people living with and at high risk of HIV/AIDS. National and parish-level governments should work with the media and nongovernmental organizations to disseminate this information in a manner that is accessible to people with limited literacy skills. € Ensure that the national HIV/AIDS progr am, in consultation with the Ministry of National Security and the Jamaican Constabulary Force, develops and implements a formal plan for a budgeted program of monitoring of and regular public reporting on violence and abuse against marginalized groups at high risk of HIV/AIDS. € Government officials at all levels should use public events and contacts with the media to condemn police violence against HIV/AIDS workers; should affirm international standards relating to equality, including nondiscrimination based on sexual orientation, gender identity, and HIV status; and should reiterate the importance of human rights protections for all groups vulnerable to HIV/AIDS, including men who have sex with men and sex workers. The Ministry of Health’s stated position, articulated in national policy documents, on the importance of protecting marginalized groups against stigma and discrimination should be emphasized in public events and media. € Provide training on HIV/AIDS, sexuality, and sexual orientation to all personnel in health care facilities, including instruction on the right to privacy and protection of confidential information about HIV status and specific guidance on how to guard against negligent and intentional disclosure. Ensure that appropriate and accessible legal remedies are available to individuals whose privacy has been infringed or who have experienced discrimination or harassment in the health system based on HIV status. € Establish an effective and independent oversight and complaint mechanism to ensure the proper implementation of health policies and norms relating to HIV/AIDS, including protection of confidential and private information. Investigate and sanction all health personnel who disclose confidential information without authorization.

PAGE 10

HUMAN RIGHTS WATCH, VOL. 16, NO. 6 (B) 8 To Donors and International Organizations € Condemn the criminalization of consensual homosexual conduct and support the repeal of sections 76, 77, and 79 as a violation of the prohibition against discrimination based on sexual orientation and as an impediment to the national response to the HIV/AIDS epidemic. The repeal of sections 76, 77, and 79 is consistent with the International Covenant on Civil and Political Rights, the American Convention on Human Rights, and the United Nations International Guidelines on HIV/AIDS and Human Rights. € As part of monitoring compliance with the International Covenant on Economic, Social and Cultural Rights, the U.N. Committee on Economic, Social and Cultural Rights should report on Jamaica’s efforts to ensure provision of HIV/AIDS information and services on a nondiscriminatory basis and to guarantee the confidentiality of information about HIV status. € Ensure that monitoring of police harassment of HIV/AIDS outreach workers and of people suspected of homosexual conduct, and related human rights abuses are an important and regular part of monitoring programs supporting police reform and HIV/AIDS efforts in Jamaica. Accelerate surveillance and monitoring of NGO reports of police violence through the United Nations supported monitoring system and other means, and ensure widespread public reporting of data collected on this subject. € Support the development of organizations among members of the lesbian, gay, bisexual and transgender community, and among sex workers, to strengthen the capacity of these persons to advocate for the protection of their rights in institutional fora. € Promote ratification of the Inter-American Convention on the Prevention, Punishment and Eradication of Violence against Women. III. METHODS This report is based on a three-week field visit to Jamaica in June 2004, as well as prior and subsequent research. Two Human Rights Watch staff members conducted detailed interviews with more than seventy-five people living with or at high risk of HIV/AIDS, including sex workers, men who have sex with men (MSM), women who have sex with women, and people who had been incarcerated in police lockups and prison. These interviews took place in Kingston, St. Ann, St. James, St. Catherine, and St. Andrew, the

PAGE 11

9 HUMAN RIGHTS WATCH, VOL. 16, NO. 6 (B) five parishes hardest hit by HIV/AIDS.2 The identities of most of these persons and certain identifying information have been withheld to protect their privacy and safety. These persons were identified largely with the assistance of Jamaican nongovernmental organizations (NGOs) providing services to people living with HIV/AIDS, men who have sex with men, women who have sex with women, prisoners, and sex workers. These interviewees may have had greater access to HIV/AIDS services than those without comparable connections. Human Rights Watch also interviewed more than fifty representatives of government agencies, United Nations officials, donor governments, and NGOs specializing in HIV/AIDS or human rights; academic institutions; and healthcare workers and hospital administrators. All documents cited in this report are either publicly available or on file with Human Rights Watch. IV. BACKGROUND HIV/AIDS in Jamaica As of the end 2003, an estimated 22,000 people, or 1.5 percent of the adult population, were living with HIV/AIDS in Jamaica, the third largest population of people living with HIV/AIDS in the Caribbean region (after Haiti and the Dominican Republic).3 HIV prevalence rates are very high among marginalized populations, including men who have sex with men and sex workers. The epidemic continues to spread in the general population.4 According to the Jamaican government’s national HIV/AIDS program, in Jamaica HIV is predominantly transmitted through unprotected heterosexual sex and is increasing 2 Jamaica is divided into fourteen parishes, which are s ub-national administrative divisions of the government. 3 Joint United Nations Programme on HIV/AIDS (UNAIDS), 2004 Report on the Global AIDS Epidemic: 4th Global Report (Geneva: UNAIDS, 2004), p. 202. 4 In 1994-1995, 25 percent of sex workers tested in Montego Bay were HIV-positive; in 1996, 9 percent of sex workers tested in Kingston were HIV-positive. From 1994-1996, HIV prevalence in major urban areas for men who have sex with men was more than 30 percent. UNAIDS, “Epidemiologica l Fact Sheets on HIV/AIDS and Sexually Transmitted Infections: Jamaica,” 2004. See also Country Coordinating Me chanism for the Global Fund to Fight AIDS, Tuberculosis and Malaria, A Proposal to Scale UP HIV/AIDS Treatment, Prevention, and Policy Efforts in Jamaica, May 2003, http://www.theglobalfund.org/search/docs/3JAMH_661_0_full.pdf (retrieved August 27, 2004), p. 31 (stating that an estimated 20 percent of men who have sex with men and 25 pe rcent of male and female sex workers were living with HIV/AIDS).

PAGE 12

HUMAN RIGHTS WATCH, VOL. 16, NO. 6 (B) 10 faster among women than men.5 Ministry of Health statistics attribute 67.8 percent of AIDS cases to heterosexual sex and 5.4 percent to homosexual and bisexual sex combined.6 The percentage of HIV cases acquired through male-to-male sexual contact is probably higher, however. The fact that homosexual sex is illegal, together with the strong stigma and discrimination attached to homosexual and bisexual behavior, may keep many men who have sex with men from admitting to having had sex with other men. The Ministry of Health has acknowledged that the fact that the large majority of cases of unknown transmission are among men suggests that rates of male-to-male transmission are higher than are reported.7 Several thousand Jamaicans are in urgent need of antiretroviral treatment, but as of this writing only a fraction of them are receiving it.8 Jamaica secured funding in June 2004 to scale up access to treatment for people living with HIV/AIDS and made a public commitment to secure the lowest possible prices for antiretroviral drugs for all Jamaicans who need them.9 However, in making concerted efforts to join the Free Trade Area of the Americas, Jamaica is subject to pressure by the United States Trade Representative to agree to trade policies that may undermine access to affordable antiretroviral medicines.10 5 Jamaica National HIV/STD Prevention and Control Progr am, “Facts and Figures, HIV/AIDS Epidemic Update 2004,” http://www.moh.gov.jm/AIDS%20DATA%20J UNE%202004.pdf (retrieved August 9, 2004). 6 Children comprise 7.7 percent of cases and the remaining 26.8 percent of cases are categorized as “unknown.” Ibid. 7 See ibid. (90 percent of cases of unknown transmission are among men); Ministry of Health, “Report of the Behaviour Change and Communication Task Force,” 2001 (noting large percentage of males among cases of unknown transmission and observing that “If we look at the literature on male sexual behaviour, and in particular the issues of socially condemned and therefore secretive sexual behaviour that would contribute to non-reporting, we find the continuum usually conflated as ‘MSMs.’ ”) (cited in Patricia Watson, “Coping in the Dark: HIV Prevention among the MSM Community in Jamaica,” The Jamaica Gleaner, May 5, 2002). The Pan-Caribbean Partnership on HIV/AIDS (PANCAP) has reported a similar situation in the region. PANCAP, “Caribbean Regional Strategic Framework for HIV/AIDS 20022006,” March 2002, p. 4. 8 As of June 2004, an estimated 8000 people were in need of antiretroviral therapy, and 500 persons were receiving it. J. Peter Figueroa, chief, Epidemiology and AIDS, Ministry of Health, “Implementing Access to HAART in Jamaica,” June 2004. 9 First-line antiretroviral (ARV) therapy costs between U.S. $75 (generic) and U.S.$300 (brand name drugs) per month. In September 2004, the Ministry of Health began providing ARV t herapy in the public sector for free or U.S.$8 pursuant to the Global Fund for AIDS, Tuberculosis and Malaria agreement. Th e Ministry of Health estimated that it would provide ARV therapy to 2000 people living with AIDS by late 2006. Global Fund Agreement, http://www.theglobalfund.org/search/docs/3JAMH_661_238_ga.pdf. 10 Jamaica, as a party to the World Trade Organization (W TO) Agreement on Trade Related Aspects of Intellectual Property (TRIPS), must ensure a minimum level of intellectual property protection. In 2001, WTO member states agreed that TRIPS “cannot and should not” pr event countries from taking measur es to expand drug access and encouraged countries to use TRIPS mechanisms “to the full” in meeting their public health objectives. Jamaica is a party to negotiations to establish a Free Trade Area of the Americas (FTAA), covering thirty-four c ountries across the Americas and the Caribbean. The United States Trade Representative is attempting to include provisi ons in the FTAA that could inhibit Jamaica’s (and other countries’) flexibility to enc ourage generic drug competition and reduce the price of generic medicines. The negotiations are intended to be completed by e nd 2004, with the aim of launching the agreement in 2005. Concerns about Jamaica’s domestic legal and policy commitments that conflict with FTAA proposals have slowed down

PAGE 13

11 HUMAN RIGHTS WATCH, VOL. 16, NO. 6 (B) Since 1987, the Jamaican government has launched several public awareness campaigns regarding HIV/AIDS, beginning with the theme “AIDS kills.” National surveys report that a high level of knowledge about methods of HIV prevention coexists with belief in myths about HIV transmission. A 2000 survey reported that while more than 96 percent of Jamaicans could identify two or more ways to prevent HIV, a significant percentage of those surveyed subscribed to various myths about HIV, including the belief that HIV could be transmitted by casual contact (such as sharing food) and by mosquitoes. The survey also showed a dr amatic rise in misconceptions about HIV transmission since 1996.11 Health workers and people living with HIV/AIDS believe that the initial campaign had a lasting effect on public information about HIV/AIDS, leaving many with the impression that an HIV diagnosis means that death is imminent. According to Joanna W., a peer HIV/AIDS educator, “More than 96 percent of our people have information about HIV but how the information was given—‘AIDS kills’— left a strong impression. . Many people don’t understand that HIV can be with them a long time before they get AIDS.”12 Homophobia in Jamaica and its role in driving the HIV/AIDS epidemic Violence against men who have sex with men, ranging from verbal harassment to beatings, armed attacks, and murder, is pervasive in Jamaica.13 Physical attacks against gay men and men perceived to engage in homosexual conduct are often accompanied by expressions of intent to kill the victim, such as “Battyman fi dead” [gay men must die].14 They are reluctant to appeal to the police for protection, as police routinely deny them assistance, fail to investigate complaints of homophobic violence, and arrest or detain men whom they suspect of being gay. In some cases, the police attack them and promote homophobic violence by others. Women who have sex with women are also negotiations, however. See Women’s Edge Coalition, “The Effe cts of Trade Liberalization on Jamaica’s Poor: an Analysis of Agriculture and Services,” June 2004, pp. 70-75. 11 Hope Enterprises Ltd., “Report of National Knowledge, Atti tudes, Behaviour & Practice Survey. Year 2000.” Prepared for the Ministry of Health, Jamaica. 2000. 12 Human Rights Watch interview with Joanna W., Kingston, June 6, 2004. 13 See Robert Carr, “On ‘Judgments:’ Poverty, Sexuality-Based Violence and Human Rights in 21st Century Jamaica,” The Caribbean Journal of Social Work, vol. 2 (July 2003), pp. 71-87 (finding that working class men who have sex with men are vulnerable to attack at any time in an atmosphere that sanctions and actively promotes such attacks); see also Cecil Gutzmore, “Casting the First Stone: Policing of Homo/Sexuality in Jamaican Popular Culture,” Interventions, vol. 6, no. 1 (April 2004), pp. 118-134 (arguing that Jamaican homophobia is exc eptional for its overt virulence at the expressive level and arguably encourages documented tendency and practice to ward homophobic violence, and that the combination of disregard for the law, including by police and other state official s, and the high level of violence in the society put working class men who have sex with men especially at risk). 14 Human Rights Watch interview with Nicholas C., Kingston, June 9, 2004; Human Rights Watch interview with Dennis M., Montego Bay, June 21, 2004; Human Rights Watc h interview with Vincent G., Kingston, June 14, 2004; Human Rights Watch interview with Curtis M., Ocho Rios, June 15, 2004; see also Robert Carr, “On ‘Judgments:’ Poverty, Sexuality-Based Violence and Human Rights in 21st Century Jamaica.”

PAGE 14

HUMAN RIGHTS WATCH, VOL. 16, NO. 6 (B) 12 targets of community violence and police harassm ent; and, as with men who have sex with men, their complaints of violence are often ignored by police. Endemic violence by private actors and by Jamaican police and security forces, and inadequate state response to it, are problems faced by all Jamaicans.15 Gays and lesbians are often on the front lines of such violence, however. Jamaica’s sodomy laws, which criminalize consensual sex between adult men, are used to justify arbitrary arrest and detention, and sometimes torture, of men (and sometimes women) suspected of being homosexual. Political and cultural factors, including religious intolerance of homosexuality, Jamaican popular music, and the use of antigay slogans and rhetoric by political leaders, also promote violence and discrimination based on sexual orientation and gender identity. While many of these actions are protected under the rights to freedom of speech and religion, the Jamaican government has failed to confront them as root causes of widespread violence and discrimination based on sexual orientation and gender identity. The church, a powerful social institution in Jamaica, denounces homosexuality as a sin and Jamaica’s Christian pastors preach strongly against it, sometimes justifying their opposition in cultural, as well as religious, terms. For example, in opposing the ordination of an openly gay cleric (a position not unique to Jamaican clergy), a Kingstonbased Anglican priest stated that there was “no way that a Jamaican Anglican contingency could begin to support such a decision,” because “Jamaican society is intolerant of homosexuality and homosexual behavior.”16 Jamaican dancehall music, a powerful cultural force in Jamaican society, reflects and reinforces popular prejudices against lesbians and gay men. Many dancehall musicians perform songs that glorify brutal violence and killing of men and women who do not 15 See United Nations Special Rapporteur on Extrajuducial, Summary or Arbitrary Executions, “Report of the Special Rapporteur, Asma Jahangir, submitted Pursuant to Commission on Human Rights Resolution 2003/53. Addendum. Mission to Jamaica,” E/CN.4/2004/7/Add.2, September 26, 2003; Jamaicans for Justice, The Jamaica Justice Report, 2002; Families Against State Terrorism, “How Many More? Sample of Police Killings July 1999-May 2004,” May 2004; Amnesty International, “’ Until Their Voices are Heard.’ The West Kingston Commission of Inquiry,” July 2003; International Commi ssion of Jurists, “Attacks on Justice,” August 2002, pp. 222-225; Anthony Harriott, Police and Crime Control in Jamaica: Problems of Reforming Ex-Colonial Constabularies (Kingston, Jamaica: University of t he West Indies Press, 2001); Horace Levy, They Cry ‘Respect’! Urban Violence and Poverty in Jamaica (Kingston, Jamaica: University of the West Indies Press, 2001). 16 “Kingston priests reject gay bishop. Jamaican society intolerant of homosexuality, says priest,” The Jamaica Observer, October 30, 2003.

PAGE 15

13 HUMAN RIGHTS WATCH, VOL. 16, NO. 6 (B) conform to stereotypical gender roles, and celebrate their social cleansing from Jamaica.17 High-level political leaders foster an atmosphere of violence toward men who have sex with men. During the 2001 elections, for example, the Jamaican Labour Party (the main opposition party) adopted “Chi Chi Man,” which celebrates burning and killing gay men, as its theme song.18 The ruling People’s National Party responded by adopting as its campaign slogan for the 2002 national elections “Log On to Progress,” a reference to a popular song and dance (“log on”) involving kicking or stomping on gay men.19 Homophobic violence and discrimination, and state failure to respond to these abuses, violate internationally recognized human rights, including rights to privacy, nondiscrimination, and protection against violence.20 These abuses are also closely linked to the spread of HIV/AIDS. Sodomy laws, which violate human rights to privacy and nondiscrimination,21 undermine HIV/AIDS outreach to men who have sex with men. State failure to protect lesbian, gay, transgender, and bisexual people from violence and abuse by police and private citizens marginalizes them and inhibits them from seeking treatment for HIV and other sexually transmitted diseases that increase the risk of HIV transmission. The association of HIV/AIDS with homosexuality compounds the marginalization of many people living with HIV/AIDS, who face additional stigma and abuse through the presumption that they have engaged in illegal sex. It also keeps those at highest risk of the disease—including people who do not engage in homosexual sex—from seeking HIV-related information and health services. 17 Elephant Man’s “A Nuh Fi Wi Fault,” in which he sings that “When yuh hear a Sodomite get raped/but a fi wi fault/it’s wrong/two women gonna hock up inna bed/that’s tw o Sodomites dat fi dead” [“When you hear a lesbian getting raped/it’s not our fault/it’s wrong/two women in bed/that’s two sodomites who should be dead”], Beenie Man’s “I’m dreaming of a new Jamaica, come to execute all the gays,” and Babycham and Bounty Killer’s “Bun a fire pon a kuh pon mister fagoty, ears ah ben up and a wince under agony, poop man fi drown a yawd man philosophy” [“burn gay men ‘til they wince in agony, gay men should drown, that’s the yard man’s philosophy”] are typical of the exhortations to kill and maim lesb ians and gay men in many popular dancehall songs. For further discussion of homophobia in Jamaican dancehall and in popular culture, see Cecil Gutzmore, “Casting the First Stone;” Tara Atluri, “When the Closet is a Region,” working paper no. 5, Centre for Gender and Development Studies, University of the West Indies 2001; on dancehall and cultural formation, including the use of homophobia by dancehall artist es, see also Norman C. Stolzoff, Wake the Town and Tell the People: Dancehall Culture in Jamaica (Durham, N.C.: Duke Univ. Press, 2000). 18 TOK, “Chi Chi Man,” on Reggae Gold 2001 (2001) (lyrics cited in Appendix); see Garwin Davis, “Homophobia Remains High. Gays Remain in Seclusi on, Health Officials Worry,” The Jamaica Gleaner, July 26, 2001. 19 Elephant Man, “Log On,” on LOG ON (2002) (lyrics cited in Appendix). 20 Jamaica has ratified international and regional treaties proscribing thes e actions, including the International Covenant on Civil and Political Rights, the International Covenant on Economic Social and Cultural Rights, the Convention on the Elimination of All Forms of Disc rimination against Women, and the American Convention on Human Rights. See discussion at pages 66-73 below. 21 Nicholas Toonen v. Australia, Human Rights Committee, 50th Session, Case no. 488/1992, U.N. Doc. CCPR/C/50/D/488/1992 (April 4, 1994).

PAGE 16

HUMAN RIGHTS WATCH, VOL. 16, NO. 6 (B) 14 The Jamaican Ministry of Health has acknowledged that homophobic violence and discrimination, and deep stigma associated with homosexuality, are among the factors driving the epidemic.22 High-level officials from the Ministry of Health’s HIV/AIDS program also recognize that Jamaica’s sodomy laws create significant barriers to government provision of HIV services to men who have sex with men. Providing HIV education and prevention services to men who have sex with men is extremely difficult because they are forced to remain invisible due to prejudice and abuse.23 According to studies conducted by Jamaican and Caribbean regional health bodies, many Jamaican men who have sex with men lead dual lives and marry, have girlfriends, and have children while also engaging in same sex relationships.24 Fear of being identified as homosexual may keep many people from seeking HIV testing and also from disclosing homosexual conduct as a possible risk factor if they test positive for HIV.25 The invisibility of men who engage in homosexual conduct makes effective communication difficult, even among the men themselves. And the lack of information about their lives, practices, and community to guide public health interventions compromises an effective response to the epidemic. In 1997, the mere suggestion that a task force was considering whether condoms should be issued to inmates and staff as part of HIV/AIDS prevention efforts in prison prompted a violent rampage and derailed HIV education efforts for years. After then Commissioner of Corrections John Prescod proposed that condoms be distributed to prisoners and correctional officers, correctional officers—apparently offended by the implication that by distributing condoms they, themselves, were also having sex with men—walked off their jobs. The officers did not return for several days, until they received an apology from the Commissioner and an agreement that condoms would not 22 See, e.g., Jamaican Ministry of Health, Jamaica HIV/AIDS/STI National Strategic Plan 2002-2006, January 2002, p. 10; see also Zadie Neufville, “Fear Among Gay Men Said to Fuel HIV/AIDS Cases,” Inter Press Service, March 5, 2002; Garwin Davis, “Homophobia Remains High. Gays Re main in Seclusion, Health Officials Worry,” The Jamaica Gleaner July 26, 2001. 23 Ibid.; Human Rights Watch interview with Dr. Yitades G ebre, executive director, Ministry of Health Program Coordination Unit, Kingston, June 23, 2004; Human Rights Watc h interview with Dr. Peter Figueroa, chief, Ministry of Health Epidemiology Unit, Kingston, June 23, 2004. 24 See Caribbean Regional Epidemiology C enter, “Homosexual Aspects of the HIV/AIDS Epidemic in the Caribbean: A Public Health Challenge for Prevention and Control,” 2000; Heather Royes, “Jamaican M en and Same-Sex Activities: Implications for HIV/STD Prevention, ” 1993. The subject of a Jamaican study of men who have sex with men and HIV/AIDS explained, “Society demands that a man should have a woman. To be la beled as gay or homosexual is a name no man likes. So as a result, men resort to play the gam e with same-sex and opposite sex activities.” “Jamaican Men and Same-Sex Activities,” p. 11. 25 See Ministry of Health, “Report of the Behaviour C hange and Communication Task Force,” 2001 (cited in Patricia Watson, “Coping in the Dark: HIV Preventi on among the MSM Community in Jamaica,” The Jamaica Gleaner, May 5, 2002).

PAGE 17

15 HUMAN RIGHTS WATCH, VOL. 16, NO. 6 (B) be distributed in prisons. Following the walkout by the correctional officers, inmates at two of Jamaica’s largest prisons rioted. Sixteen prisoners were killed and more than fifty injured, apparently targeted because other prisoners believed that they were homosexuals.26 The popular misperception that HIV/AIDS is a homosexual disease impedes effective HIV prevention and poses serious risks for people living with HIV/AIDS. Health workers and AIDS outreach workers interviewed by Human Rights Watch reported that people with whom they worked—including hospital staff—did not believe that HIV was an issue for them persona lly because they were not homosexuals. A hospital-based health worker who provided HIV/AIDS prevention information and services to hospital staff and people in her town told Human Rights Watch, “When I tell them about HIV, they say . that HIV does not concern them, because it is a battyman [homosexual] disease.”27 The conflation of HIV/AIDS with homosexuality exposes people living with HIV/AIDS and HIV/AIDS educators to the same treatment meted out to men who have sex with men.28 ASHE Caribbean Performing Arts Foundation, an NGO that works with youth, includes HIV/AIDS and sexuality education as an important part of its work. Its work on HIV/AIDS, however, subjected it to threats, as the following note sent to the Jamaica Forum for Lesbians, All-Sexuals and Gays (J-FLAG) in July 2004 illustrates: The nasty act of homosexuality will not be tolerated here in Jamaica. Let me say it quick. One notable battyman have died recently we will be killing more as the days go by. To make it easy for you we will tell you 26 The riots were at the Tower Street Adult Correctional Centre in Kingston (Kingston general penitentiary) and St. Catherine’s District Prison. Harold B., who was incarcerated at St. Catherine’s District Prison during the riots, told Human Rights Watch that both prisoners and warders put his life at risk: “I couldn’t walk free in prison because the warders would point me out [as a gay man]. . and prisoners were killing off gay men.” Human Rights Watch interview with Harold B., Kingston, June 9, 2004. See also Minist ry of National Security and Justice, “Report of the Board of Enquiry into Disturbances at the Tower Street Adult Correctional Center and the St. Catherine Adult Correctional Centre Between 20th23rd August, 1997,” March 9, 1998; Commission on Human Rights, Report of Special Rapporteur on Torture, “Question of the Human Rights of All Persons Subjected to Any Form of De tention or Imprisonment, in Particular: Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment,” U.N. Doc. E/CN.4/2002/76/Add.1, March 14, 2002, par. 829.; Amnesty International, “A Summary of Concerns: A Brie fing for the Human Rights Committee,” October 1997, p. 14. 27 Human Rights Watch interview, St. Ann’s Bay, June 16, 2004. A 1993 study of Jamaican men who have sex with men and HIV/AIDS suggested that older bisexual m en did not believe themselves at risk of HIV because they believed that HIV was a “gay” disease, and they di d not identify as gay. Heather Royes, “Jamaican Men and Same-Sex Activities: Implications for HIV/STD Prevention,” 1993, p. 12. 28 Robert Carr, “Stigmas, Gender and Coping: A Study of HIV+ Jamaicans,” Race, Gender & Class, vol. 9, no. 1 (2002), pp. 122-44.

PAGE 18

HUMAN RIGHTS WATCH, VOL. 16, NO. 6 (B) 16 where you can pick them up and who it was that we gunned down. It will not be robbery just purification. No batty man down here in Jamaica. . . Fire burn them and them nasty living. JFLAG must crash. We declare war on all Gays and Homosexual. Ashe dance group needs a bit of clean up now We will be killing gays and homosexuals daily now. War we say .29 (emphasis added) Lesbians and HIV risk A woman without a man can be a target of both community disrespect and rape. — Horace Levy, They Cry ‘Respect’! Urban Violence and Poverty in Jamaica30 Although the risk of female-to-female HIV transmission is generally estimated to be small,31 many women who have sex with women also have sex with men. Many Jamaican lesbians face strong pressure to establish relationships with men and to have children because doing so is a critical part of establishing their identity as adult women.32 Sexual violence against women and girls, a problem of grave proportions in Jamaica, has been identified by the World Health Organization as an important factor contributing to increased HIV incidence among women in the region.33 Sexual violence may increase the risk of HIV and other sexually transmitted diseases for all survivors.34 Forced or 29 E-mail communication from anotherkiller1@ hotmail.com to J-Flag, July 14, 2004. 30 (Kingston, Jamaica: University of the West Indies Press, 2001), p. 37. 31 See Helena A. Kwakwa and M.W. Ghobrial, “Female-to -Female Transmission of Hu man Immunodeficiency Virus,” Clinical Infectious Diseases, vol. 35, no. 3 (February 2003), pp. 40-41. 32 See Robert Carr, “Stigmas, Gender and Coping: A Study of HIV+ Jamaicans,” Race, Gender & Class (2002), vol. 9, no. 1, pp. 122-144 (discussing gender socialization in Jamaica). 33 See Pan American Health Organization, “Gender and HIV/AIDS,” http://www.paho.org/english/hdp/hdw/GHIVFactSheetI.PDF (re trieved November 3, 2004); see also United Nations Development Program, “National Reports on the Situati on of Gender Violence Agai nst Women: National Report, Jamaica,” March 1999; Nancy Muturi, “Violence and HIV/ AIDS in the Caribbean,” presentation at the 2003 American Public Health Association meetings (ar guing that high rates of sexual violence c ontribute to growing HIV/AIDS epidemic in Caribbean region). 34 Women and girls are physiologically more vulnerable than men and boys to HIV infection during unprotected heterosexual vaginal sex. Factors that contribute to this increased risk include the larger surface area of the vagina and cervix, the high concentration of HIV in the semen of an infected man, and the fact that many of the other sexually transmitted diseases that increase HIV risk are often left untreated (because th ey are asymptomatic or because health care is inaccessible). Girls and y oung women face even greater risk than adult women, because the vagina and cervix of young women are less mature and are less resistant to HIV and other sexually transmitted infections, such as chlamydia and gonorrhea, that increase HIV vulnerability; because changes in the reproductive tract duri ng puberty make the tissue more susceptible to penetration by HIV; and because young wo men produce less of the vaginal secretions that provide a

PAGE 19

17 HUMAN RIGHTS WATCH, VOL. 16, NO. 6 (B) coerced sex creates a risk of trauma: when the vagina or anus is dry and force is used, genital and anal injuries are more likely, increasing the risk of HIV transmission. Forced oral sex may cause tears in the skin of the mouth, also increasing the risk of transmission. The presence of other sexually transmitted diseases also heightens HIV transmission risk.35 Women who are or are perceived to be lesbians are at an even greater risk of rape, as they may be targeted for sexual violence based on both their gender and sexual orientation. 36 V. FINDINGS OF HUMAN RIGHTS WATCH’S INVESTIGATION In Jamaica, state-sponsored homophobia and discrimination against homosexual men and women, sex workers, and people living with HIV/AIDS, the conflation of HIV/AIDS with homosexuality and sex work, and the misguided fear that HIV is transmitted by air or by casual contact are undermining an effective response to HIV/AIDS. Police not only harass and persecute people suspected of homosexual conduct, sex workers, and people living with HIV/AIDS. They also interfere with HIV/AIDS outreach to them. Men who have sex with men and people living with HIV/AIDS face serious violence and are often forced to abandon their homes and communities. Many are denied health care; some cannot even seek health services because they are denied public and private transportation services. And past experiences of discrimination, coupled with the fear that HIV status or sexual orientation will be disclosed and publicized, keep many people from seeking health care in the first instance. barrier to HIV transmission for older women. See, e.g ., Global Campaign for Microbici des, “About Microbicides: Women and HIV Risk,” http://www.global-campaign.org/womenhiv.htm (re trieved August 28, 2003); UNAIDS, “AIDS: Five Years since ICPD—Emerging Issues and Cha llenges for Women, Young People, and Infants,” Geneva, 1998, p. 11; The Population Information Program, Center for Communications Programs, The Johns Hopkins University, “Population Reports: Youth and HIV/AIDS,” vol. 23, no. 3, Fall 2001, p. 7 (citing studies). 35 See United States Centers for Disease Control and Prev ention, Fact Sheet: Prevention and Treatment of Sexually Transmitted Diseases as an HIV Preventi on Strategy [online], http://www.cdc.gov/hiv/pubs/facts/hivstd.htm (retrieved October 27, 2003). 36 See discussion in Section V, below; see also Makeda S ilvera, “Man Royals and Sodomites: Some Thoughts on the Invisibility of Afro-Caribbean Lesbians,” Feminist Studies, vol. 18, no. 3, Fall 1992, pp. 521-532 (reporting gang rape of women “suspected” of lesbianism in 1950s Jamaican towns).

PAGE 20

HUMAN RIGHTS WATCH, VOL. 16, NO. 6 (B) 18 Police abuse Police abuse based on sexual or ientation and gender identity Verbal and physical abuse and in citing others to violence On the afternoon of June 18, 2004, a mob chased and reportedly “chopped, stabbed and stoned to death” a man perceived to be gay in Montego Bay.37 Several witnesses reported to Human Rights Watch that police participated in the abuse that ultimately led to this mob killing, first beating the man with batons and then urging others to beat him because he was homosexual. Fred L., thirty, described the incident as follows: Me and another guy were sitting on the beach . .While we were there, some little teenager was on the beach swimming, and Victor, the guy that was killed, was standing looking at the boy. The boy said, "Why are you looking me like that? You a battyman." Two rastamen38 said, "Every day they come on the beach to look at men, battyboy them." Two policemen and a female police officer were there. The two male officers started to beat the man with batons. I turned to the female officer and asked, “What has he done wrong?” She turned to me and said, "Everyday me have to warn people about this guy coming on the beach. I'm going to lock him up.” I said, “For what?” She didn't say. I said to her, “If he did something wrong, lock him up, don't beat him.” [Victor] started to run from the two male officers toward the Old Fort Craft Market. The two policemen said, "Beat him because him a battyman."39 The crowd followed the police officers’ lead, beating the victim and throwing bottles and stones at him.40 Joseph W., twenty-six, told Human Rights Watch that he saw police hitting the victim with a baton and with their fists, and that once persons from the crowd started beating the victim: 37 Henry Bucknor, “Alleged Gay Man Chopped to Death in MoBay,” Western Mirror, vol. 24, no. 72, June 19, 2004, p. 1. 38 “Rastaman” is a term used to refer to men with dreadlo cks (a hairstyle in which the hair grows and is left uncombed, and forms ropelike locks that hang down from the head) and to Rastafarians, a religious group whose members wear their hair in dreadlocks. 39 Human Rights Watch telephone interview with Fred L., Montego Bay, July 6, 2004. 40 Ibid.; Human Rights Watch interview with Dennis M., Mont ego Bay, June 21, 2004; Human Rights Watch interview with Joseph W., New York, June 28, 2004.

PAGE 21

19 HUMAN RIGHTS WATCH, VOL. 16, NO. 6 (B) the police officers walked off. The crowd got thicker and more persons started hitting the guy. Then I saw the guy run out of the road into the town. . Then I woke up the next morning to hear that Victor was killed about a mile and a half from the beach.41 Police abuse is a fact of life for many men who have sex with men and women who have sex with women in all of the communities that Human Rights Watch visited in Jamaica. As in the incident described above, homophobic police violence can be a catalyst for violence and abuse by others. It is sometimes lethal. Police abuse is also profoundly destructive because it creates an atmosphere of fear sending a message to other lesbian, gay, bisexual, and transgender people that they are without any protection from violence. Dennis M., twenty, lived in Montego Bay. He told Human Rights Watch: Police always harass me. . They stop you and hear you talk a bit feminine [and ] they ask you personal questions like are you top or bottom and like that. . The last time this happened . two police came over and said “Battymen mus’ dead. You should be under the ground. You should not be living in Jamaica.” Not every police officer does that. Some police officers say it is not legal so you should curtail your behavior. But most of them, once they hear you talk feminish they begin to bitch [verbally abuse] you and a crowd comes around.42 Nicholas C., twenty-nine, was stopped by the police while walking down the street one evening in April 2004. The police asked him if he was a battyman and searched him. After finding condoms, lubricant, and gel, they became violent. “They said, ‘You a battyman. Battyman mus’ dead. Run before I shoot you.’” The police beat Nicholas C., hit him with batons, kicked him, and scattered his things on the ground.43 Several gay men reported that police abuse accelerated violence by others. Albert B., thirty-three, and his friends had been attacked by Kingston police a few days before Human Rights Watch met with him in June 2004. The police beat Albert B. and his 41 Human Rights Watch interview with Joseph W., New York, June 28, 2004. Joseph W. was an acquaintance of Victor Jarrett’s. A third witness told Human Righ ts Watch that he saw the police beating the victim and a crowd throwing bottles and stones at him as he ran fr om the police, and heard people shouting that the victim was gay and should be killed. Human Rights Watch interview with Dennis M., Montego Bay, June 21, 2004. 42 Human Rights Watch interview with Dennis M., Montego Bay, June 21, 2004. 43 Human Rights Watch interview with Nicholas C., Kingston, June 9, 2004.

PAGE 22

HUMAN RIGHTS WATCH, VOL. 16, NO. 6 (B) 20 friends, threw stones at them, called them “battymen,” “faggot,” and “nasty men” and drew their guns at them. The police actions drew the attention of other men, who came and beat them with boards, crying out “battymen.”44 Peter T., nineteen, was walking on the street with friends late in the evening of December 25, 2003. A police car drove by, and the policemen inside yelled, “Battymen, go home.” When Peter T.’s friend told the police to leave them alone, the police stopped their car, beat the men, then put them in the police car and drove them to another part of town. As they let the men out of the car, the police yelled, “Battymen, battymen, beat them,” and fired their guns in the air. This attracted the attention of a crowd of men armed with machetes, who followed the police instruction and beat them.45 Harold B., thirty-four, reported several incidents of police abuse in 2004, including an attack by police a few hours before his interview with Human Rights Watch. For Harold B., the public humiliation by police that incited others to violence was worse than physical attacks. “The worst thing is when police embarrass you whenever they see you in a crowd. When I’m walking on the street, the police yell, ‘battyboy, you catch men.’ When they do that, people start to look at you and some want to attack you.”46 Many of the men who have sex with men interviewed by Human Rights Watch reported having to flee their homes and communities because of homophobic violence by their neighbors or other residents of their towns. In some cases, police abuse of men suspected of homosexual conduct prompted violence by private actors, whose violence effectively evicted them from their homes. Until early 2003, Peter T. lived with a group of gay men in a house in Kingston. He said that the police visited the house frequently, making derogatory comments about homosexuality and beating the residents. The police presence would attract others, who would join in the abuse. He told Human Rights Watch: Police visit there a whole heap of time. . Every time the police come to the house, others would always show up. The police come there and start searching and then the next neighbor would come over and start in. 44 Human Rights Watch interview with Albert B., Kingston, June 9, 2004. 45 Human Rights Watch interview with Peter T., Kingston, J une 9, 2004. Machetes are common property in Jamaica and are used for agricultural work, for personal protection at home (in case of break-ins), and as weapons. 46 Human Rights Watch interview with Harold B., Kingston, June 9, 2004.

PAGE 23

21 HUMAN RIGHTS WATCH, VOL. 16, NO. 6 (B) Police would search in the closet, under the bed. If they see condoms, they say that we were fucking, we carry AIDS, battymen have AIDS, man on man fi dead. [gay men should be dead].47 By February 2003, the violence had escalated sufficiently to drive Peter T. and his housemates away. One afternoon, “people come and say we can’t sleep there tonight because we’re going to bomb it down.” Peter T. and his housemates fled, leaving without their belongings.48 Police abuse of gay men extends to men living with HIV/AIDS, whom they assume must be gay. Paul M., forty, told Human Rights Watch that in 2003, he was with a friend who had AIDS when the police approached and asked: “Eh boy, how you look so, w’happen to you?” The person say, “I have AIDS and I want to take my medication.’ Police say, “you must be battyman. Eh boy, eh boy, move your AIDS self from here. Mind me turn mi gun pon yuh and kill you. [Watch out because I might turn my gun on you and kill you.]”49 Arrests, detention, and prosecution Gay and bisexual men and AIDS service providers told Human Rights Watch that men who are or perceived to be gay are routinely threatened with arrest, arrested, detained, and sometimes prosecuted because of their actual or perceived homosexuality or homosexual conduct. Human Rights Watch also documented cases of police arrest of women because of homosexual conduct. Jamaica’s sodomy laws criminalize consensual homosexual conduct between adult men, prohibiting the “abominable crime of buggery, committed either with mankind or with any animal” and “gross indecency.”50 “Buggery,” which generally refers to all acts of 47 Human Rights Watch interview with Peter T., Kingston, June 9, 2004. 48 Ibid. 49 Human Rights Watch interview with Paul M., Kingston, June 6, 2004. 50 Offences against the Person Act, secti ons 76, 79. Caribbean states in the British Commonwealth inherited similar penal codes from the British colonial adm inistration, some of which have sinc e been amended or nullified. For example, Bahamian law proscribes consensual same sex sexual activity between adults in public but not in private. Sexual Offences and Domestic Violence Act of the Bahamas, section 16(2)(b). Jamaican and Guyanese laws are silent on lesbianism, while all acts of homosexuality are illegal in Trinidad and Tobago, Barbados and St. Lucia. “Sodomy Laws in the Carribbean,” http://www.sodomylaws.org/world/caribbean.htm (retrieved November 3, 2004). In 2000, Britain issued an order repealing sodomy laws in its Overseas Territories, which it had to do to meet its own international treaty

PAGE 24

HUMAN RIGHTS WATCH, VOL. 16, NO. 6 (B) 22 anal intercourse and bestiality, is a felony punishable by imprisonment with hard labor for up to ten years.51 “Gross indecency,” generally interpreted to mean any sexual intimacy between men short of anal intercourse, is a misdemeanor punishable by up to two years with hard labor.52 Jamaican law provides broad latitude for police to detain individuals on ill-defined charges, including suspicion of buggery or gross indecency. The Offences against the Person Act permits a police officer to arrest without warrant any person found “loitering in any highway, yard, or other place” between 7 p.m. and 6 a.m. the following morning whom the constable has “good cause to sus pect of having committed, or being about to commit any felony” proscribed by the Act.53 Jamaican police are also empowered to arrest without warrant and based on charges made by any “credible person” any person loitering in a public place to solicit another for prostitution.54 It is impossible to say how frequently sodomy laws are enforced against men engaged in consensual same sex contact in Jamaica, but by some accounts, they are in active use.55 Lawson Williams, a Kingston attorney who has represented men charged under these statutes, told Human Rights Watch: I always seem to have a case of a practicing gay man who is in court on account of his homosexuality. It's either that he and another have been busted and are jointly charged for [consensual] buggery, he's been charged in circumstances where so meone has alleged forcible or obligations under the European Convention on Human Rights and the International Convention on Civil and Political Rights. This order affected laws in Anguilla, the British Vi rgin Islands, the Cayman Islands, Montserrat, and the Turks and Caicos Islands. “U.K. Ends Territories’ Sodomy Laws,” PlanetOut, December 22, 2000. Prime Minister P.J. Patterson’s opposition to foreign intervention to repeal Jamaican sodomy laws is ironic, as it is not the same-sex behavior, but the laws that prohibit it, that are the colonial imposition. 51 Ibid., section 76. According to Jamaican lesbian, gay, bisexual and transgende r rights advocates, most buggery prosecutions involve adult m en suspected of engaging in consensual anal sex. Jamaica Forum for Lesbians, All-Sexuals and Gays, “Parliamentary Submissi on with Regard to ‘An Act to Amend the Constitution of Jamaica to Provide for a Charter of Rights and for Connected Matters,” http://www.jflag.org/programmes/parliamentary_sub.htm (retrieved August 24, 2004). 52 Offences against the Person Act, secti on 79. This provision follows Victor ian law on “gross indecency,” which was known as the “blackmailer’s charter,” bec ause a man could be convicted on the streng th of a blackmailer’s accusation. H. Montgomery Hyde, The Other Love: An Historical and Contempora ry Survey of Homosexuality in Britain (London: Heinemann, 1971), p. 136. 53 Offences against the Person Act, section 80. 54 Towns and Communities Act, sections 3 (r), 4 (empowering police to arrest without warrant based on charges made by any “credible person” that ce rtain offences committed within view of charging party). 55 In June 2004, Human Rights Watch requested police st atistics on arrests, conv ictions and charges imposed under laws proscribing sodomy and prostitution, but as of this writing has not received them.

PAGE 25

23 HUMAN RIGHTS WATCH, VOL. 16, NO. 6 (B) unwarranted homosexual advances against him, or there is an allegation that he has had sex with a minor. . Too many of the charges of sex with a minor are motivated by the prejudice that gay men are naturally inclined to have sex with underage boys, and they fail because of a lack of physical or credible evidence. Usually, the police indict gay men for bugger y. This is very difficult to prove in the context of consensual anal sex and there is seldom a successful prosecution for buggery. The damage is in the terror of the charge itself. Oftentimes, the defendant pleads guilty to the lesser offence of gross indecency, to abbreviate the embarrassment. Or if the defendant is adamant that he will not compromise, very often the charge is dismissed for lack of evidence. But the damage is in the charge. It is standing in the dock in the face of judge, police and sometimes other litigants, where it is known that you are charged as a battyman.56 High-level police officials claimed that sodomy laws seldom were enforced. Clarence Taylor, assistant commissioner of police in charge of administration, said that sodomy cases among adults were rare.57 A St. Ann’s Bay constable told Human Rights Watch, “We occasionally arrest homosexuals. If they’re caught in the act, we charge them with buggery.”58 A high-level police officer at a Kingston divisional police headquarters told Human Rights Watch in June 2004 that it had been “many moons since we have had an arrest for solicitation, buggery, or gross indecency.”59 A high-level police officer at a second Kingston divisional police headquarters said that he could not recall a case of buggery, and that the last one may have been three or four years before.60 Regardless of how often buggery and gross indecency laws are actually enforced, the arrests themselves send a message.61 The Jamaican press publishes the names of men charged with “consensual” buggery and gross indecency, shaming them and putting them at risk of physical injury.62 And the threat of criminal sanctions for homosexual 56 Human Rights Watch e-mail communication with Lawson Williams, August 10, 2004. “Lawson Williams” is a pseudonym. 57 Human Rights Watch interview with Clarence Taylor, Kingston, June 18, 2004. 58 Human Rights Watch interview, St. Ann’s Bay, June 16, 2004. 59 Human Rights Watch interview with K.K. Knight, senior police superintendent, Kingston, June 18, 2004. 60 Human Rights Watch interview with Newton Ames, s uperintendent of police, Kingston, June 18, 2004. 61 Human Rights Watch does not oppose punishment for sexual violence or coercion that would fall within the sodomy law. We urge Jamaica to amend the criminal law so that sexual viol ence or coercion against and between men is subject to equal punishment as sexual violence against women. 62 See, e.g., The Jamaica Observer January 11, 2003; The Star January 18, 2000.

PAGE 26

HUMAN RIGHTS WATCH, VOL. 16, NO. 6 (B) 24 conduct is itself powerful. Buggery and gross indecency laws provide a means to harass, arrest, and in some cases imprison individuals. They also perpetuate social prejudices. Allen C., twenty-two, said that he was arrested and charged with buggery after someone reported to the police having observed him having sex with another man. He was taken to the police station, where police officers urged him to confess to a charge of buggery while beating him with a stick and chanting “buggery fi dead” [people who commit buggery should be killed]. The police told him that he would be examined by a doctor in the rape unit to see if he was the receiving partner in anal intercourse. He was placed in a jail cell, where he was cursed out as a “battyman” by other inmates. When he was released to the custody of his mother, the police ensured that the abuse would continue: when Allen C. left the station, they announced the charges to people outside. Although the incident took place in 1999 (five years prior to his interview with Human Rights Watch), Allen C. was still suffering its consequences. He told Human Rights Watch that since this arrest, “The whole commun ity find out [that I’m homosexual.] People put up a hand like a gun to their head and say, ‘battyman fi dead,’ and throw stones at me. I can’t complain to police, because they know I am a homosexual and will turn on me. Most of the time, I just keep to myself and my friends who are homosexual.” He remained worried about being charged again with buggery and imprisoned. 63 A number of witnesses said that they thought that some element of their outward behavior, dress, or appearance was the motivation for police to arrest or detain them. Ryan N., twenty-three, was interrupted by police while talking with friends. “Police started saying I’m gay because how me talks. Police took me to the station and threatened to charge me with gross indecency. I asked him, ‘What is gross indecency? Can you define gross indecency?’ Police say, ‘When two men start to play with their penis.’ I say, ‘Was I doing that?’ When they realized that I’m not stupid about the law and started to quote the law to them, the police started threatening to lock me up and then men could screw me up in prison.” Ryan N. was charged with obstructing police on duty and resisting arrest.64 Several gay men told Human Rights Watch that they had been stopped by police while in a car with male friends. Harold B. recalled being stopped by police twice in the first half of 2004, once the week before his interview with Human Rights Watch. “If you’re 63 Human Rights Watch interview with Allen C., Kingston, June 8, 2004. 64 Human Rights Watch interview with Ryan N., Kingston, June 9, 2004.

PAGE 27

25 HUMAN RIGHTS WATCH, VOL. 16, NO. 6 (B) driving with a friend, police stop you and say, ‘battyman, what are you doing in the car— fucking?’ Try to argue with them and they’ll take you to the station.”65 Vincent G. was present in early 2004 when police approached a car in which two male friends of his were sitting, arrested them and threatened to charge them with buggery. His friends were taken to the police station and then released.66 Ryan N. was parked in a car, eating burgers with several friends when police approached them, told them they had observed them kissing, and made them get out of the car and show their documents.67 Police also use other laws as a pretext to stop men based on nonconforming gender identity. Patrick D., twenty-five, told Human Rights Watch about a 2004 incident: “I was going to a costume party and wearing a dress. The police stop me and tell me to hold up my head. I do and they see I am a man. I tell them I am entering a costume party competition. They radio other cars and accuse me of wanting to rob someone. They let me go, but they come and look and talk and call me ‘battyman.’” 68 Women who have sex with women are also targeted for arrest because of homosexual conduct. Lillie P., thirty-six, told Human Rights Watch that she was arrested while parked in a car with her girlfriend on December 31, 2002. “On New Year’s Eve, myself and my girlfriend went to a lovers’ spot after a party. There were a lot of other cars there, but the police approached us.” The police called Lillie P. and her girlfriend “dirty lesbians,” threatened to charge the women with indecent and lewd exposure and asked them for money. When the women refused to offer a bribe, the police arrested them and took them to the Portmore police station. At the station, the police superintendent told the women that they were not going be charged, but that their names would be recorded in a register. “It was scary at first because at this point I was not out to my parents and I was going to start a job soon and I was afraid that it was going to jeopardize it. I was concerned for my girlfriend . She works for [a government ministry] and could suffer problems if they find out she is gay.”69 Extortion and theft Men who have sex with men are easy targets for extortion by both police and private actors. Discriminatory police practices, fear that their homosexuality might be publicized, the paucity of available legal assistance, and the possibility of being 65 Human Rights Watch interview with Harold B., Kingston, June 9, 2004. 66 Human Rights Watch interview with Vincent G., Kingston, June 14, 2004. 67 Human Rights Watch interview with Ryan N., Kingston, June 9, 2004. 68 Human Rights Watch interview with Patrick D., Kingston, June 9, 2004. 69 Human Rights Watch interview with Lillie P., Kingston, June 19, 2004.

PAGE 28

HUMAN RIGHTS WATCH, VOL. 16, NO. 6 (B) 26 prosecuted themselves combine to keep men who have sex with men from filing complaints or seeking redress when they are victims of extortion. Several gay men told Human Rights Watch that police demanded money from them and arrested or beat them when they refused to pay. Harold B. recalled being stopped twice by police in 2004 and accused of having sex with another man. On one occasion, Harold B. and a friend were arrested and threatened with a charge of buggery after they refused to pay money to police. They were taken to the police station, where, after being questioned by the arresting officers’ superior, they were ultimately released.70 Two days before his interview with Human Rights Watch, police stopped Lawrence O. and two friends outside a shopping center in New Kingston. According to Lawrence O., the police yelled “battymen” and told them that they could avoid arrest by paying a bribe. When no one produced any money, the police started to shout and to beat Lawrence O. and his friends, attracting the attention of shopping center security guards, who, hearing the commotion, joined the police in beating the men.71 A Jamaica AIDS Support outreach worker reported another case in which a gay man who complained to police that he was being blackmailed had to pay police to keep them from disclosing his sexual orientation.72 Lawson Williams, a Kingston attorney, represented several men who had been blackmailed with accusations of buggery or gross indecency by men who had committed crimes against them. He said that fear of prosecution under buggery laws and the dire implications of charges of buggery prevented blackmail victims from even contemplating seeking the protection of the state. The sodomy laws are used to silence MSM, to keep them in check. They allow criminal acts to be committed against MSM with impunity. People know—thieves, crooks, layabouts—that if they commit a crime against you, they can play the “battyman card” to silence you. I’ve seen this in my cases. And this builds on the perception that gay men are saps, not only because they’re effeminate, but because their vulnerability is supported by state institutions—police, courts—that don’t protect them. 70 Human Rights Watch interview with Harold B., Kingston, June 9, 2004. 71 Human Rights Watch interview with Lawrence O., Kingston, June 19, 2004. 72 Human Rights Watch interview with Paul M., Kingston, June 6, 2004.

PAGE 29

27 HUMAN RIGHTS WATCH, VOL. 16, NO. 6 (B) In a 2004 case, for example, a man charged with car theft claimed that he had taken the car from its owner after having been forced to have anal sex with him. In his statement to the police, he admitted driving the car away without permission, stating that he had meant to drive to the police station to report having been buggered but had been too ashamed to do so. The car owner was subsequently charged with buggery. His accuser never appeared in court to prosecute his complaints, and the buggery charges against the car owner ultimately were dropped. As of this writing, the car has not been recovered.73 Police failure to provide prot ection from violence and abuse We haven’t had any reports about violence against homosexuals. Most of the violence against homosexuals is internal. We never have any cases of gay men being beaten up. I know that there is a sort of revulsion against homosexuals, lesbians, but evidence does not substantiate that there is any level of violence perpetrated against them. — K.K. Knight, senior superintendent of police, Kingston, June 18, 2004 If you make a police report, they start by making you instead of the victim the person that is wrong. The police ask, ‘Why all of a sudden they calling you a battyman? How do they know you a battyman?’ These kinds of questions trivialize the problem. — Adrian S., thirty, Kingston, June 13, 2004 Men who have sex with men and women who have sex with women repeatedly told Human Rights Watch that they did not bother to report homophobic violence because they did not believe that police would take any action to address it, especially in cases where police were the perpetrators. In some cases, attempts to make complaints were ignored altogether; in others, police investigation efforts inspired little confidence, fueling concerns that police cared little for the lives and wellbeing of homosexual men and women. Joseph W., twenty-six, lived with two male friends in the Kingston area. In December 2002, a policeman came to their house and told them that he had received a report that 73 Human Rights Watch interview with Lawson Williams, Ki ngston, June 23, 2004 and statements of complainant and accused to police. A “buggery” defense appears to have been used by a man charged with felonious wounding, who claimed he stabbed another man after having been forced by him to have sex in the car at knifepoint. John Tavares, “Buggery, Case Continues June 22,” The Jamaica Observer, June 4, 2004.

PAGE 30

HUMAN RIGHTS WATCH, VOL. 16, NO. 6 (B) 28 they were gay. The policeman forced his way past the security gate and onto the veranda and threatened to kill Joseph and his roommates if they did not leave. Joseph attempted to lodge a complaint with the police later that day. When he told police that he lived with two other men, they laughed and said that there was nothing that they could do to assist him. The following day, Joseph went to the Police Public Complaints Authority, the independent state authority charged with investigating allegations of police abuse, which likewise refused to investigate the case or otherwise provide assistance. After the initial incident, a crowd gathered around the house hurling antigay insults, and the men were forced to move—both because they feared for their safety and because their landlord was concerned about possible damage to his property.74 The night before Lawrence O.’s interview with Human Rights Watch, a friend of his was robbed and stabbed in front of him. The police came to the scene, retrieved the knife, and left without investigating the incident or assisting the injured man in obtaining medical care. “The guy [the assailant] told the police that we were battymen. So the police just left. The police should have done something. [My friend] was cut and he was bleeding. . They looked at us and said, ‘you are all battymen.’ Then they took the knife [from the assailant] and told him to go.”75 In Ocho Rios, several gay men said that there was a man in town who frequently harassed them and other gay men, threatening to kill them, extorting money from them, and inciting others to commit violent acts against them. Leroy J., thirty-three, said that in May 2004, when he tried to report this harassment to the police, the police chased him out of the station and threatened to attack him. “I went to the police to report these threats. They wouldn’t come. They said that we don’t have a right to live in our own country and that they would chop us up and kill us.”76 When he met with Human Rights Watch in June 2004, Allen C. said that people often threw stones and bottles at him when he walked down the street. He had not complained about this to the police, however, believing that a prior buggery charge had effectively stripped him of police protection. “Because of the [buggery charge], police think I’m homosexual. I can’t complain about stone throwing, because then they’ll turn on me.”77 74 Human Rights Watch interview with Joseph W., Kingston, June 11, 2004. 75 Human Rights Watch interview with Lawrence O., Kingston, June 19, 2004. 76 Human Rights Watch interview with Leroy J., Ocho Rios, June 16, 2004. 77 Human Rights Watch interview with Allen C., Kingston, June 8, 2004.

PAGE 31

29 HUMAN RIGHTS WATCH, VOL. 16, NO. 6 (B) Edward P., twenty-two, said that: “Sometimes I can’t walk in peace. People shout battyman and all this stuff. They keep saying that I’m a battyman and men will fuck me and that I can’t walk in this neighborhood. And sometimes if I turn they will try to attack me.” He has not registered a complaint with police, however. “To be honest, I feel scared because police themselves will try to bitch you and even tell you to leave the police station.”78 Nicholas C. testified that people in the town where he had lived were constantly threatening to kill him because he was gay, forcing him to move from the town. He also testified that he had been beaten by police on more than one occasion. When asked about lodging a complaint about his neighbors or the police, Nicholas replied, “Complain? No, because I don’t know who to complain to. Police [and homophobic people in town] are the same thing.”79 Albert B. said, “It doesn’t make sense to complain because you will not get anything from them. One time, a guy accused me of being gay and wanted to beat me. The policemen drove around and asked me if I did it.”80 In May 2004, Paul M. and his housemates were driven out of his house by a group of men armed with machetes. “I did not complain to the police. When it comes to homosexuals, we have no rights.”81 Some police denied that homophobic violence was a problem in Jamaica. K.K. Knight, senior superintendent at the Kingston police station charged with investigating Brian Williamson’s murder, told Human Rights Wa tch: “Most of the violence against homosexuals is internal. We never have any cases of gay men being beaten up.”82 According to Knight, gay men inflict injury on each other in crimes of passion: “Usually in homosexual cases, you can see some kind of passion by the amount of injury inflicted and the scars on the body, and the sort of information you get from witnesses.”83 Newton Ames, police superintendent at St. Andrew parish south divisional headquarters, testified that “we have never had any report of community violence against homosexuals. [Police involvement] is not a thing that people want in these areas. People stay away from accusing someone of homosexuality or getting involved in it.”84 78 Human Rights Watch interview with Edward P., Ocho Rios, June 16, 2004. 79 Human Rights Watch interview with Nicholas C., Kingston, June 9, 2004. 80 Human Rights Watch interview with Nicholas C., Kingston, June 9, 2004. 81 Human Rights Watch interview with Paul M., Kingston, June 6, 2004. 82 Human Rights Watch interview with K.K. Knight, seni or superintendent of police, Kingston, June 18, 2004. 83 Ibid. 84 Human Rights Watch interview with Newton Ames, s uperintendent of police, Kingston, June 18, 2004.

PAGE 32

HUMAN RIGHTS WATCH, VOL. 16, NO. 6 (B) 30 An individual with close links to law enforcement agencies who had experience working at murder scenes said that: abuse of gay men is by gay men. From my experience, all gays are killed the same way. If you go to a crime scene, you can tell if a person is gay or straight by how they are killed. Gay men, they are more brutally slain—by a knife, strip them up.85 There is evidence that supports the claim that in many countries, gay, lesbian, bisexual and transgender people are victims of ser ious violence, including murder, because of their sexual orientation and that these murd er victims often undergo exceptional brutality, sometimes called “overkill” (extreme harm beyond that necessary to cause death).86 But this evidence does not support any conclusion that gay men commit such savage acts of violence against other gay men. The “overkill” stems from hate. The misperception that gay men kill each other in brutal crimes of passion is a common barrier to investigating “gay murders” not only in Jamaica but in many parts of the world.87 Percival Buddan, the officer in charge of HIV/AIDS training for the Jamaican police force, acknowledged that members of the police force shared homophobic attitudes common in the general community. According to Buddan, “The police force has a culture. If they know you’re homosexual, you’ll definitely be discriminated against and stigmatized.”88 However, in some cases, police had helped protect against assault. A St. Ann’s Bay police officer said that he knew of an incident where police had intervened to 85 Human Rights Watch interview, Kingston, June 10, 2004. A newspaper columnist commenting on Brian Williamson’s murder wrote that “based on cursory investigations, all i ndications are he was murdered by someone ‘in-house.’ The police report suggests that he was chopped all over his body. This is fairly consistent with previous murders in Jamaica involving male homosexuals.’” Mark Wignall, “Those Flamin’ Homosexuals,” The Daily Observer, June 17, 2004. See also S. Escoffery, “Letter of the day – Outrage! and hypocrisy in dancehall attack,” The Jamaica Gleaner October 6, 2004 (arguing that in Jamaica, “98 per cent, if not all crimes against homosexuals are homosex ual on homosexual crimes”). 86 See, e.g., “Homocide in Homosexual Victims: A Study of 67 Cases from the Broward County, Florida, Medical Examiner’s Office (1982-1992), with Special Emphasis on ’Overkill,’” The American Journal of Forensic Medicine and Pathology, vol. 17, no. 1 (March 1996), pp. 65-69 (comparing number and extent of injuries in homosexual and heterosexual homicide vi ctims and finding that homosexual homicides were more violent); Douglas Victor Janoff, “Tales from the Turkish Crypt: Ottawa Researc her Explores Homophobia, Violence and Murder,” Capital Xtra!, July 1, 2004 (reviewing studies of serious violence against lesbian, gay and transgender people). 87 See, e.g., Human Rights Watch and Internationa l Gay and Lesbian Human Rights Commission (IGLHRC), Public Scandals: Sexual Orientatio n and Criminal Law in Romania (New York: Human Rights Watch and IGLHRC, 1998), pp. 65-66. 88 Human Rights Watch interview with Percival Buddan, subofficer in charge, Jamaican Constabulary Force First AID Center, Kingston, June 18, 2004.

PAGE 33

31 HUMAN RIGHTS WATCH, VOL. 16, NO. 6 (B) stop people from stoning gay men.89 A few gay men also testified that police had assisted them in leaving dangerous situations, such as escorting them from their homes when armed men were threatening them with serious violence. On June 9, 2004, Brian Williamson, a prominent gay rights activist and one of the very few people in Jamaica to appear openly in the media as a gay man, was murdered in his home, his body mutilated by multiple knife wounds. Because of his international prominence as a gay rights advocate, his middle-class status, and his dual Canadian/Jamaican nationality, members of the lesbian, gay, bisexual, and transgender community initially were hopeful that police would take special care in the investigation of his murder. But police actions from the start raised cause for concern. Williamson’s body was discovered on the floor of his apartment, reportedly with stab wounds to his neck and body. After the police left the crime scene, Ernest N., thirty-six, a friend of Williamson’s, went to the apartment to clean up. He told Human Rights Watch that the apartment was unlocked and the door open. A few feet from where the body had lain, Ernest N. found a ratchet knife and an ice pick, both of which had blood on them.90 A witness told police that he had seen two men at the apartment the morning of the murder. The police detained one of the m en, nicknamed ‘Wingee,’ and called the witness to identify the suspect in a lineup. As the witness passed the lockup on his way to the lineup, inmates called out, “See the battyboy who has come for Wingee. Him fi dead. [He should be dead.]” At the lineup, nine individuals were presented with towels on their heads and white cream (apparently toothpaste) on their faces, making them virtually unrecognizable. According to the witness, “I never saw that guy with anything on his head or face so I couldn’t identify him.” The witness also stated that even one of the police officers at the station told him that he had never seen participants in a lineup disguised in this way.91 Police abuse of sex workers Male and female sex workers interviewed by Human Rights Watch reported being harassed by police, who apparently regarded them as a source of both money and sex. Because soliciting sex is illegal, police face little risk of censure for these actions. Male sex workers face the double condemnation of homosexual conduct and prostitution. 89 Human Rights Watch interview, St. Ann’s Bay, June 16, 2004. 90 Human Rights Watch interview with Ernest N., Kingston, June 11, 2004. 91 Human Rights Watch interview with Ellis R., Kingston, June 25, 2004.

PAGE 34

HUMAN RIGHTS WATCH, VOL. 16, NO. 6 (B) 32 These abuses may increase HIV risk for sex workers by driving them further underground and away from potentially lifesaving information on HIV prevention and other health services. Male and female sex workers told Human Rights Watch that police extorted sex and money in exchange for not arresting them. Vincent G.’s experience was typical of the accounts we heard. “Police ask for sex and they don’t pay. Last time I was with a policeman was about a month ago. Police said I had to give him a blow job. I had to do this because I didn’t want to get charged.”92 An outreach worker with Jamaica AIDS Support told Human Rights Watch: “Sex workers are arrested, but not as often as gay men. Very naughty police will try to get sex off of the ladies so they won’t get locked up. The ladies say it happens often. . Gay men selling sex [are treated] worse than females. They [police] beat them up bad. This happens often.”93 A number of sex workers said that they could not report violence or abuse, in part because they risked abuse by the police if they did so. Jennifer S. told Human Rights Watch that police beat her and asked her for money and sex, and clients stole money from her. When asked whether she had ever reported such abuse to the police, she said, “Complain? I can’t do that because they will not listen to us. . ‘Come out of the station. You’re nothing but a whoring girl.’ This is what police say when we try to complain.”94 Vincent G. said that when one of his clients stole money from him, “I couldn’t complain to the police about it because I am homosexual.”95 Police interference with access to HIV/AIDS information and health services Jamaican government policy recognizes that the most effective and indeed in some cases the only possible AIDS educators for members of marginalized groups, such as men who have sex with men and sex workers, are their peers. 96 But peer educators and others who reach out to marginalized groups are often held in the same contempt as the 92 Human Rights Watch interview with Vincent G., Kingston, June 14, 2004. 93 Human Rights Watch interview, Kingston, June 6, 2004. 94 Human Rights Watch interview with Jennifer S., Kingston, June 9, 2004. 95 Human Rights Watch interview with Vincent G., Kingston, June 14, 2004. 96 See, e.g., Ministry of Health, “Jamaica HIV/AIDS/STI National Strategic Plan 2002-2006,” January 2002; see also PanCaribbean Partnership on HIV/AIDS, “The Caribbean Regional Strategic Framework for HIV/AIDS 2002-2006,” March 2002.

PAGE 35

33 HUMAN RIGHTS WATCH, VOL. 16, NO. 6 (B) individuals with whom they work and subjected to discrimination and violence at the hands of the government. Human Rights Watch documented numerous cases of police harassment of HIV/AIDS workers providing services to men who have sex with men and to male and female sex workers. In some cases, the very possession of condoms—a key tool in the work of HIV prevention—triggered police harassment of HIV/AIDS educators and of sex workers. Men who have sex with men The Ministry of Health relies on the NGO Jamaica AIDS Support (JAS) to provide HIV/AIDS information and services to men who have sex with men.97 Dr. Yitades Gebre, executive director of Jamaica’s Program Coordination Unit at the Ministry of Health, acknowledged that the ministry had “identified MSM as a target population, but we’re not reaching them.” He explained “because the laws impeded the Ministry of Health from working with MSM, we give the work to JAS. To date, we don’t promote direct programs or services to MSM as a group because the existing laws impede this work [and] because [of] the high level of stigma and discrimination, they’re not open to getting services through the public sector.”98 The police however, are actively impeding JAS’ government-supported efforts. A JAS outreach worker told Human Rights Watch that: “police always try to get in the way of handing out condoms. . Police say, ‘how can you be handing out condoms to battymen. . We do not encourage you to do this work because battymen fi dead. [gay men should be dead].’” He recounted two arrests for handing out condoms to MSM: In May 2003, I was in an area known to be frequented by gay men . I was there handing out condoms on the main road. It was me alone, at about 9:30 in the evening. I was issuing condoms and about five guys were there and a police car drove up. There were four police in the car. They asked, “What are you doing here? You must be battymen.” I say that I am on my job, issuing condoms. They turned to me and said, “How come you issuing condoms to battymen?” I say it’s a part of my 97 Jamaica AIDS Support is an NGO that also provides HI V/AIDS information and services to men and women who sell sex for money and engage in transactional sex, hearing-impai red individuals, and inmates, ex-convicts and correctional services staff. This work is funded by the Ministry of Health through the Global Fund and USAID. The Caribbean Epidemiology Centre (CAREC) and several United States NGOs also support condom dist ribution work. Jamaica AIDS Support, “Targeted Intervention,” http://www.j amaicaaidssupport.com/services/intervent ion.htm (retrieved August 1, 2004). 98 Human Rights Watch interview with Dr. Yitades Gebre, Kingston, June 23, 2004.

PAGE 36

HUMAN RIGHTS WATCH, VOL. 16, NO. 6 (B) 34 job. . He turned to me and said he was going to lock me up because I am not supposed to be issuing condoms to battymen. . Then his friend said “come and charge the boy for loitering.” And then they said for me to get in the car and they took me to the police station. When I was in the police station, I was placed in a holding area and I asked them to call [my supervisor] at my workplace. They didn’t give me the call right away. I was there for about three hours. And every police comes into the station, the policemen that arrested me would say to their friends, the other policemen, “the boy handing out condoms to battymen.” Some will talk some abusive things, like “boy, are you gay? You a battyman too? Battyman fi dead!” Then I asked them again for the call because I wanted to know if I am going to be charged because I am here for over three hours now. After a long deliberation, they let me go. When I was released, they told me, “Go home and stop helping the battymen. And we hope we don’t catch you handing out condoms to battymen.”99 In October 2003, this outreach worker was again arrested and charged with loitering for handing out condoms to men: I was out on the main road handing out condoms in an area known to be a gay area and the police came down and the men began to run. I stood my ground and I had a condom in my hand and the policemen asked me what I was doing there and the police asked me if I were a battyman. I had three boxes of about 100 condoms in my hand. . They said that they were going to charge me with loitering, but if they see me in the act they would kill me. And they said that they were going to charge me for loitering because they knew that I was a battyman because only a battyman would be handing out condoms to men. . I was accused of buying sex and being a battyman and charged with loitering.100 The outreach worker was called to appear in court twice, but the charges ultimately were dropped. 101 99 Human Rights Watch interview with [name withheld on request], Kingston, June 18, 2003. 100 Ibid. 101 Ibid.

PAGE 37

35 HUMAN RIGHTS WATCH, VOL. 16, NO. 6 (B) Sex workers Jamaica AIDS Support also provided condoms and HIV/AIDS education to male and female sex workers who operated in the Kingston, Montego Bay, and Ocho Rios areas, including street sex workers, go-go dancers, and massage parlor workers. A Kingstonbased JAS outreach worker explained: “We have educational sessions with ladies and men two nights of the week on the road. We hand out condoms and pamphlets and talk a little about safe sex and what we can do to help them. We also invite them to JAS to do free HIV testing, have a place to chat.”102 He told Human Rights Watch that he had been stopped by police several times while handing out condoms on the road to sex workers. Once he was once accused of being a sex worker and detained overnight in jail.103 Steve Harvey, JAS’ coordinator of targeted interventions in Kingston, said that he had been stopped by police while doing outreach to sex workers several times in 2003 and 2004. On one occasion, the police accused him of illegal soliciting; other times, police stopped and searched him, his colleagues, and their car. 104 Police crackdowns on sex work—of which there were at least two in Kingston in the first five months of 2004—hampered HIV/AIDS prevention work by undermining outreach workers’ ability to distribute condoms and to discuss HIV/AIDS and other health services with sex workers. Harvey told Human Rights Watch: Sometimes the police decide that they are going to crack down on sex work, and they do it for two weeks. During that time, the girls are afraid. Some of them won’t come onto the streets, some of them will go to other places, and some of them are in hiding so when you go down the streets, you can’t see them. It hampers HIV/AIDS prevention work. We really don’t have the time then to talk to the girls.105 Police also threatened sex workers that possession of condoms could be used as evidence of their illegal activity. Joyce D., forty-one, had been selling sex on the street since she was a young girl. She told Human Rights Watch that police regularly took condoms from her, threatening to use them as evidence against her if she refused to 102 Ibid. 103 Ibid. 104 Human Rights Watch interview with Steve Harvey, coor dinator of targeted interventions, Jamaica AIDS Support, Kingston, June 6, 2004. 105 Ibid.

PAGE 38

HUMAN RIGHTS WATCH, VOL. 16, NO. 6 (B) 36 provide them with sex. “Police say, ‘hey girl, if you don’t give me some pussy, condom is there for evidence that you’re fucking in the street.’ . Now they have the handle. I have the blade. There is nothing that I can do about it. I give them my body.”106 Abuses in the health care system People living with HIV/AIDS and men who have sex with men face numerous human rights abuses that constitute barriers to obtaining necessary medical care. Among these are discrimination by health workers who forced them to wait extended periods of time to be seen, treated them in an abusive or degrading manner, provided inadequate care, or denied them treatment altogether. Health workers also routinely violated their privacy by disclosing confidential information about HIV status and sexual orientation. Human Rights Watch found that the threat of serious violence and discrimination, compounded by the deep stigma associated with homosexuality, was keeping men who engaged in homosexual conduct from seeking medical treatment and from existing prevention services and driving them to engage in unsafe and unprotected sex. Discrimination and stigma also was driving people living with HIV/AIDS away from health care and other HIV/AIDS services. Several people told Human Rights Watch that health care provision to people living with HIV/AIDS had improved in the last few years, crediting the Ministry of Health and the efforts of AIDS service organizations like Jamaica AIDS Support (JAS) and the Center for HIV/AIDS Research, Education and Services (CHARES) for these changes. “Things have changed a lot,” said Orchid Gowe-Hunter, a nurse with Jamaica AIDS Support, “but people still have some bad experiences.”107 Discrimination by health care providers Heath care delayed or denied Human Rights Watch interviewed several nurses and AIDS service workers who said that public hospitals and clinics provided inadequate care to people living with HIV/AIDS, sometimes refusing to treat them. Some acknowledged that the situation had improved since the start of the epidemic but stressed that the abuses had not abated altogether. 106 Human Rights Watch interview with Joyce D., Kingston, June 9, 2004. 107 Human Rights Watch interview with Orchid Gowe-Hunter, Montego Bay, June 21, 2004.

PAGE 39

37 HUMAN RIGHTS WATCH, VOL. 16, NO. 6 (B) Human Rights Watch learned that some doctors who treated people living with HIV/AIDS failed to conduct adequate medical exams or even to touch them, and that clinic staff had refused to register people living with HIV/AIDS for admission. Men who have sex with men also told Human Rights Watch that they had been denied health care treatment. Tonya Clark, a nurse with Jamaica AIDS Support in Kingston, said that a JAS client who had suffered a head injury had been denied services twice in the week prior to her interview with Human Rights Watch. In June 2004, Gary T. was beaten and suffered a head injury. He first went to the police, who referred him to the hospital with a form to be completed with details of his injury. After Gary T. told the nurse that he had HIV, she tore the form up and told him to leave. A JAS social worker returned to the hospital with Gary T., where they again refused to treat him.108 A health worker with years of experience working in the health sector in northern Jamaica who assisted people living with HIV/AIDS in obtaining medical care said that based on her experience, physicians at the regional hospital treated HIV-positive patients differently from other patients and had provided inadequate care to two of her clients in April and May 2004. In one case, she brought a client to the regional hospital because he had lesions on his penis and difficulty urinating. The examining physician stated that the man had HIV, donned gloves, and ignored the health worker’s request to examine the client’s genital area, instead focusing on his chest and abdomen and sending him home without examining the lesions on the penis. The health worker told Human Rights Watch: The doctor that came to see him knows me and my work [with people living with HIV/AIDS] and said at once, “this is a positive person.” . I said we found him on the road, I think he has some sores on his penis. The doctor put on gloves, did a chest exam, peeled off that set [of gloves], did an abdomen exam, peeled off that set . and I was saying, there is something wrong with his penis. You need to look at him. [The patient] said he has sores on it and hasn’t urinated in a while. And he has this smell coming from his genitals. The doctor wouldn’t look at it. . 108 Human Rights Watch interview with Tonya Clark, Kingston, June 14, 2004.

PAGE 40

HUMAN RIGHTS WATCH, VOL. 16, NO. 6 (B) 38 The man received no treatment for the lesions on his penis that day. The health worker ultimately secured the assistance of a nurse who worked with an AIDS service organization to examine him and provide appropriate medication to treat his lesions. 109 Men who have sex with men and health workers reported that public and private health care providers refused to treat men whom they knew or perceived to be gay and made abusive comments to them, at times instigating abusive treatment by others. Curtis M., twenty-four, told Human Rights Watch that when a friend accompanied him to St. Ann’s Bay Hospital, a nurse made homophobic remarks, and he left without receiving treatment. “[The nurse] said, ‘I wonder which one is the woman and which one is the man. . We had to leave because the crowd started looking at us and then on the road they were hurling words at us, ‘battymen fi dead.’ I felt threatened.”110 He did not receive treatment that day. When Leroy J., thirty-three, went to a private doctor, he was told “we don’t work with gay people here.”111 Craig F., a health worker in northeast Jamaica, said that public health centers in the region have refused to treat men whom they believed to be homosexual and that he had heard health workers making abusive comments to gay and bisexual men. For example, one health worker told a gay man with gonorrhea that he was “nasty” and asked why he had sex with other men.112 Several people told Human Rights Watch that health workers routinely mistreated people living with HIV/AIDS, delaying care or impeding access to treatment. When Eric B., a thirty-year-old man living with HIV/AIDS, sought treatment for a foot injury, he had to wait until all other patients had been seen, including people who arrived after him and people with lesser injuries, before he was examined.113 Craig F. told Human Rights Watch that in May 2004, a health clinic clerk had refused to register a person living with HIV/AIDS for treatment, stating that she would not look after anyone who was HIV-positive.114 109 Human Rights Watch intervie w, Ocho Rios, June 16, 2004. 110 Human Rights Watch interview with Curtis M., Ocho Rios, June 16, 2004. 111 Human Rights Watch interview with Leroy J., Ocho Rios, June 16, 2004. 112 Human Rights Watch interview with Craig F., Ocho Rios, June 16, 2004. 113 Human Rights Watch interview with Eric B., Kingston, June 8, 2004. 114 Human Rights Watch interview with Craig F., Ocho Rios, June 16, 2004.

PAGE 41

39 HUMAN RIGHTS WATCH, VOL. 16, NO. 6 (B) Discrimination in health care provision My neighbor, she was ill, she was HIV-positive. [At the hospital], they screened her off. Her food was taken to her in a styrofoam box, and everyone else on the ward was treated differently. Everybody else had regular plates, and hers was just in a box. . I went to her because I knew her. Nobody cleaned her, looked after her. The nurse said, ‘You know what she have?’ I said yes. The nurse said, ‘Then you have gloves?’ I looked after her, gave her a bath. Her mother came and asked, ‘Why are they treating her like this, like a dog?’ No one cared for her. I went every day with her mum and cleaned her, taught her mother how to care for her. — Tonya Clark, nurse with Jamaica AIDS Support, Kingston, June 14, 2004 Among those encountered by Human Rights Watch, people living with HIV/AIDS who did receive medical care were separated from other patients and placed at the back of a ward or behind a screen with their basic needs left unattended. Health workers also engaged in discriminatory practices that called attention to their HIV status, such as placing their clothes and linens in conspicuously marked bags, and making sure that medical equipment did not touch their skin.115 Orchid Gowe-Hunter, a nurse with Jamaica AIDS Support, had worked with people living with HIV/AIDS in the Kingston, St. Andrews, and St. James parishes for several years. She told Human Rights Watch that both Kingston Public Hospital (KPH) and Cornwall Regional hospitals continued to isolate people living with HIV/AIDS in the ward. At KPH, for example: they always isolate them in the ward. They have a little corner way to the back. One day, we went to visit this guy and he was just lying in the bed alone. He had no sheets on the bed, no proper clothes. . He was 115 HIV is not spread by casual contact nor by an y airborne means of transmi ssion, including sneezing or spitting. There is therefore no public health justificat ion for segregating people living with HIV/AIDS from other patients, or in any way isolating t heir food, laundry or medical equipment for non-invasive procedures solely because someone has HIV. Such actions threaten to re veal HIV status, and undermine public health efforts by creating a false sense of protection from the disease, creating harmful stigma, and thus keeping people from seeking health care and prevent ion services. See UNAIDS, HIV/AIDS and Human Rights-International Guidelines p. 42. International health organizations recomm end that workers in settings where the possibility of occupational HIV transmission does exis t, as where there may be exposure to bloody injuries or being stuck with unsterile syringes, be trained in “universal precautions” (simple measures to pr otect against HIV and other blood borne illnesses) and provided with adequate supplies (suc h as gloves) to take such precautions. World Health Organization, “Universal Prec autions, Including Injection Safety,” http://www.who.int.hiv/topics/precautions/universal /en/ (retrieved September 16, 2004).

PAGE 42

HUMAN RIGHTS WATCH, VOL. 16, NO. 6 (B) 40 unable to feed himself or take his medication. All of the food, all of the medication was just left by the bed.116 Gowe-Hunter’s account is typical of those documented by Human Rights Watch. HIV-positive men who have sex with men faced additional barriers. “They perceive, and rightfully so, that if they divulge who they are and what they do, they may be shunned,” said Deborah Manning, program manager of the Center for HIV/AIDS Research, Education and Services. In one case, for example, when an HIV-positive patient’s boyfriend came to visit him, a nurse ran him out of the hospital, telling him that she did not want any of their “nastiness” there. 117 Joseph W., twenty-six, told Human Rights Watch that when he visited a friend at Kingston Public Hospital in December 2003: the nurses and the ancillary workers were laughing and saying, “which one of them is the man, which is the woman?” Partly because of his sexuality and because he was [HIV] positive he was not given the kind of treatment he should have gotten. He wasn’t able to help himself. They wouldn’t change his sheets . They would leave his food there. Myself and all my friends had to go help him eat.118 Patrick D., twenty-five, found his HIV-positive friend lying in soiled diapers, and changed them while a nurse called out, “Battyman, you shit up yourself. You shitty shitty.”119 Health care workers at public and private hospitals in Kingston parish told Human Rights Watch that patients at their institutions were treated the same as others, but noted that their clothes and linens were placed in specially marked bags and laundered separately; doctors and nurses used gloves when attending to them; and that when taking the blood pressure of a person living with HIV/AIDS, they put a “precautionary barrier” between the person’s arm and the cuff. One health worker explained that “if a patient knows another person is HIV-positive, he won’t use the same blood pressure cuff.”120 116 Human Rights Watch interview with Orchid Gowe-Hunter, Montego Bay, June 21, 2004. 117 Human Rights Watch interview with Deborah Ma nning, director, CHARES, Kingston, June 14, 2004. 118 Human Rights Watch interview with Joseph W., Kingston, June 11, 2004. 119 Human Rights Watch interview with Patrick D., Kingston, June 9, 2004. 120 Comments made at workshop to discuss quality of care for HIV-positive patients, Kingston, June 7, 2004.

PAGE 43

41 HUMAN RIGHTS WATCH, VOL. 16, NO. 6 (B) Several health workers said that HIV-positive patients posed a danger to health care workers because they had a tendency to be angry and aggressive and would try to intentionally infect others with HIV.121 A health worker at a private facility offered this example of such dangerous behavior: “I had a patient who said he contracted HIV and it’s not his fault, he’s not going down wi th it. He threatened to spit on a nurse.”122 A nurse at a Kingston public hospital acknowled ged that she and her coworkers treated patients differently from other patients. She said that they were concerned about contracting the virus from patients who were often “deliberately demanding,” in part because they “really hopelessly wanted you to get HIV too.”123 In the view of some health workers, the fear that HIV-positive patients would spread the disease to health care workers and others—whether intentionally or otherwise—justified segregating patients living with HIV in the hospital as well as in the larger community. At a workshop to discuss quality of care for patients with HIV, one health worker, summarizing the views of a small group discussion, said that people living with HIV “should be isolated to prevent this epidemic from being spread to the rest of society.”124 A spokesperson for a second small group added that “some persons [with HIV] are isolated for their own protection,” while others because they “are more aggressive. They want to bite you, spit on other patients.”125 Inadequate protection of c onfidential information That word, confidentiality. I’m so afraid of that word because in most instances it don’t mean anything. — Lena B., twenty-nine, Montego Bay, June 22, 2004 Human Rights Watch found that some health workers failed to preserve the confidentiality of patients’ HIV status. By singling HIV-positive patients out for disparate treatment absent medical justification, they risked divulging confidential information about their HIV status. In some cases, health care workers disclosed confidential information about HIV status without patient authorization. Some health care workers also disclosed private information about sexual orientation. 121 Ibid. 122 Ibid. 123 Ibid. 124 Ibid. 125 Ibid.

PAGE 44

HUMAN RIGHTS WATCH, VOL. 16, NO. 6 (B) 42 The failure to preserve confidential information about HIV status and sexual orientation violates the right to privacy protected by the ICCPR and the American Convention on Human Rights.126 Such actions also threaten other rights. As described above, people living with HIV/AIDS and men who have sex with men may be denied health care or subjected to violence and stigma when state and private actors discover their sexual orientation or that they are HIV-positive. Lena B., twenty-nine, was hospitalized for the last four months of her pregnancy at the regional medical center. Doctors and nurses there repeatedly chastised her in front of other staff and patients about having continued to have sex while living with HIV. A doctor who knew that she had worked as an HIV/AIDS educator told her that she “should have known better” not to have sex when she had HIV and chided her for proving a poor example for others. One of the nurses instructed the ward assistant not to serve Lena on plates that other patients might use; when that nurse was on duty, Lena had to use disposable dishware. At the end of Lena’s pregnancy, two doctors discussed the decision to give her an emergency caesarean section in the middle of the ward, “in front of a lot of people.” The first doctor explained, “I’m going to do the C-section [caesarean section] because you want to push the child out of your vagina, and you know you have the disease running around in the vagina and you want to put the child more at risk than he is already at.”127 A second doctor added, “I want to take you on a tour up to the top where all the AIDS babies and children are and show the misery that you people cause to come on the land. Because I agree that you should not be having sex, much less getting pregnant.”128 Hospital staff signaled Lena B.’s HIV status to her mother-in-law through their treatment of her newborn son and comments they made. When Lena B.’s mother-inlaw came to see her new grandchild, she found the baby by the nurse’s station, still unwashed, and asked to help clean it. 126 ICCPR, 999 U.N.T.S. 171, entered into force March 23, 1976, art. 17; American Convention on Human Rights, entered into force July 18, 1978, art. 11. Jamaican law provides that physicians, nurses and mi dwives may be subject to sanctions for failure to protect confi dential patient information. See The Medical Act, section 11; The Nurses and Midwives Act, section 11. 127 Caesarean section delivery has been shown to reduce t he risk of mother-to-child HIV transmission. It may not be appropriate in resource-constrained settings because of limited availability, cost and risk of complications. World Health Organization, HIV in Pregnancy: A Review, WHO/CHS/RHR/99.15, UNAIDS/99.35E (Geneva: UNAIDS, 1999), pp. 9, 25. In sistence on caesarean sections may also present a substantial ethical problem if women are not pr operly briefed about both the risks and the advantages associated with undergoing caesarean sections. 128 Human Rights Watch interview with Lena B., Montego Bay, June 22, 2004.

PAGE 45

43 HUMAN RIGHTS WATCH, VOL. 16, NO. 6 (B) The nurse said, “you come in off the street with germs wanting to take care of the child and want to finish killing him off because he has everything going bad for him already?” . The nurse clean up the child and she still have him over behind the nurse’s station. . My mother-inlaw says, “I’m going to take him over to the mother to breastfeed.” The nurse said, “Breastfeed what? Mo thers like those not even supposed to have children much less to breastfeed with the type of sickness they have.” At this point, Lena B.’s mother-in-law asked whether she had AIDS. Lena B. lived with her in-laws and extended family. She said that since returning home after her HIV status was disclosed, her family members have tried to kill her on at least three occasions. Lena had no money to pay for shelter elsewhere, and stayed with her children in a locked room at the house to protect them.129 The hospital neglected to attend properly to Lena B.’s surgical wounds from her csection and they became infected. Lena B. said that based on her experiences, she would no longer seek treatment for herself in the public health system. There was a comprehensive health clinic within walking distance of Lena’s home. Lena B. said that she would not take her children there, nor pick up infant formula and groceries provided to mothers who are living with HIV, because health workers there chastised her and other women for having gotten pregnant while living with HIV, and publicly disclosed their status to other patients and members of the public without their authorization. As a result, Lena B.’s children were also effectively denied health care and other benefits to which they are entitled.130 Hospital staff providing ancillary services (such as porters, ward assistants, cooks) often knew patients’ HIV status and sometimes disclosed it to family and community members. A laundry attendant at a Kingston area private hospital said that the head nurse pointed out a person with HIV to her because his clothes had to be washed separately.131 A peer educator in St. Andrews and St. Catherine’s parishes told Human Rights Watch: “Sometime the ward assistant knows, sometime the cook know, and I don’t see why they should know. And they talk a lot. . They go back to their area 129 Lena B. said that in the first few months of 2004, she had been threatened at home several times: her drinking water had been poisoned; an armed man had come to her house and warned her that he had been hired by her family to kill her; and she had found materi als used in obeah (witchcraft) outside her room. Ibid. 130 Human Rights Watch interview with Lena B., Montego Bay, June 22, 2004. 131 Comments made at workshop to discuss quality of care for HIV-positive patients, Kingston, June 7, 2004.

PAGE 46

HUMAN RIGHTS WATCH, VOL. 16, NO. 6 (B) 44 and they say that Mary Jane is at the hospital, she’s HIV-positive. So all of that person’s confidentiality is out.” In one case, for example, a patient with HIV recognized a warder from her area. She said she had a family member who did not know that she was sick in the hospital and she did not want the family member to know. The warder told her family member that this person was HIV-positive and was in the hospital. . [The person] did not go back to her community because she was afraid that she would not be treated nice.132 In some hospitals, porters may learn patients’ status because they have access to patient records. Glenn C., thirty-nine, a JAS volunteer, said that “When patients go into a ward, files are given to the porter and they discuss it and they say, ‘this is another C13 [the hospital code for HIV/AIDS]. This is a homosexual.”’ He remembered visiting a person living with HIV/AIDS at a Kingston-area hospital in 2003. ‘I asked the porter where he was. The porter said, ‘The battyman. The one with AIDS’ [and then] told me where he was.”133 Men who have sex with men and AIDS service workers told Human Rights Watch that hospital staff also disclosed information about people’s sexual orientation. Craig F., a health worker who worked with men who have sex with men, said that after his client disclosed his sexual orientation to a contact investigator, “the same day, persons in the health center knew that he was gay. I heard them talking. ‘That man is a battyman.’ They mentioned his name. There was a lot of talk that he is gay and fire burn and him fi dead.”134 Driving men who have sex with men and people living with HIV/AIDS from health care services Abusive treatment in the health care system and state failure to protect men who have sex with men from homophobic violence keep people from seeking health services, especially for conditions that might mark them as homosexual. Several gay and bisexual men told us they delayed or avoided seeking treatment for sexually transmitted infections because they had received poor health care when they were known or perceived to be gay; feared mistreatment because they were gay; and were concerned that 132 Human Rights Watch interview, Kingston, June 6, 2004. 133 Human Rights Watch interview with Glenn C., Kingston, June 13, 2004. 134 Human Rights Watch interview with Craig F., Ocho Rios, June 16, 2004.

PAGE 47

45 HUMAN RIGHTS WATCH, VOL. 16, NO. 6 (B) health workers would publicly disclose their sexual orientation, thus risking their safety. Since the presence of other sexually transmitted diseases heightens the risk of HIV transmission, the failure to seek care promptly in such cases may have fatal consequences.135 Craig F., a health worker in northeast Jamaica, estimated that 90 percent of men who engage in homosexual conduct with whom he had worked had told him that they would not seek treatment for sexually transmitted diseases in the public health system because they feared that confidentiality was not maintained.136 Harold B., thirty-four, told Human Rights Watch that health workers mistreated men who have sex with men: “When you go to a clinic and they know you are gay, they scorn you.”137 A JAS health worker said that the stigma attached to being gay and fear of discrimination put gay and bisexual men at risk of HIV, both because they did not get relevant HIV prevention information in the first instance, and because they delayed seeking care for sexually transmitted diseases that they feared might mark them as gay. He said that many men who have sex with men “don’t know that safer sex goes beyond using a condom. . They don’t use a lubricant and the condom breaks.” And many were reluctant to get tested for sexually transmitted diseases and did not know that the presence of other sexually transmitted diseases could increase the risk of HIV transmission.138 Using a water-soluble lubricant helps prevent condom breakage and is recommended for anal intercourse. Many men who have sex with men will not buy lubricant, however, because its purchase is equivalent to announcing one’s sexual orientation.139 And, as in the case of Nicholas C. (described above), men who have sex with men who carry lubricant may be subject to police violence.140 Adrian S., thirty, told Human Rights Watch that he did not feel safe asking his doctor about gay health issues, especially concerns related to anal or oral sex. 135 See United States Centers for Disease Control and Prev ention, Fact Sheet: Prevention and Treatment of Sexually Transmitted Diseases as an HIV Preventi on Strategy [online], http://www.cdc.gov/hiv/pubs/facts/hivstd.htm (retrieved October 27, 2003). 136 Human Rights Watch interview with Craig F., Ocho Rios, June 16, 2004. 137 Human Rights Watch interview with Harold B., Kingston, June 9, 2004. 138 Human Rights Watch interview, Kingston, June 11, 2004. 139 Human Rights Watch interview with Martin B., Kingston, June 14, 2004; Human Rights Watch interview with Adrian S., Kingston, June 13, 2004. 140 See testimony of Nicholas C., p. 19, above.

PAGE 48

HUMAN RIGHTS WATCH, VOL. 16, NO. 6 (B) 46 There was one concern I had with regards to feeling something different after anal sex with someone, and I just had to not talk about it and watch it and use my own way of approaching it. There was one instance when I had anal sex with someone that was very endowed. That meant that there was some stretching and some tissues torn. I wanted to find out if I was okay, but I couldn’t say anything to anyone and all I could do is pay extra attention to hygiene and use topical solutions that were safe.141 Edward P., twenty-two, testified: One time, I caught gonorrhea. I was so scared of it, to go to the doctor. At first I said, this will go away. I started to see it getting yellow, and it started to run [from my penis], then it started to turn green, so I put a diaper there because it was running really hard and painful. . Some of my friends won’t go to doctors. They don’t want the word spread around, and they say what they don’t know won’t hurt them.142 When asked where he sought medical treatment, James P., twenty-six, said, “You come [to Jamaica AIDS Support] if you have something on your bottom,” because when gay men sought treatment elsewhere, health workers pointed out to others that they were gay. “I think that this keeps gay men from getting treatment. Some of them will keep from getting treatment until it stinks [until the discharge from an infection has begun to smell]. [They say] ‘I’ve got gonorrhea and I’m scared to go to the doctor.”143 Tonya Clark, a JAS nurse, said: Most of the gay men that I talk to don’t even want to go to the hospital at all. They come to me one-on-one and say can you get this for me, can you get this medicine. Sometimes ordinary medicines, nothing to do with HIV. But they are afraid to go to a doctor or hospital even with a common cold or flu because they will ask them questions or call them names.144 141 Human Rights Watch interview with Adrian S., Kingston, June 13, 2004. 142 Human Rights Watch interview with Edward P., Ocho Rios, June 16, 2004. 143 Human Rights Watch interview with James P., Kingston, June 8, 2004. 144 Human Rights Watch interview with To nya Clark, Kingston, June 14, 2004.

PAGE 49

47 HUMAN RIGHTS WATCH, VOL. 16, NO. 6 (B) Curtis M., twenty-four, explained: I try to keep myself healthy because if you go to the hospital, they won’t take care of you. If you got a bruise on your anus, that would make it worse. To be honest, if anything should happen to me, I am not going to the public hospital. I would buy over-the-counter medication or speak to my friends. I know that I am at risk but just to keep myself safe I cannot go to the hospital. Because if something should happen to me, I cannot go to the police because they will not help me.145 Homophobic police actions interfered with HIV/AIDS information and other prevention services by driving gay and bisexual men from places where they might safely receive services. JAS held support group meetings for gay and bisexual men to address a range of issues, including HIV/AIDS, sexua lity, violence and discrimination, and spirituality and family life.146 JAS’ targeted interventions coordinator acknowledged that men who engage in homosexual sex were difficult to reach, noting that “some people won’t come to JAS.”147 Some men told Human Rights Watch that they had been accosted by police when leaving JAS support group meetings, which may explain some of the reluctance to come to JAS’ offices for services. Joseph W. said that after they left a support group meeting in 2001, he and his friends were approached by police who asked them, “‘What are you doing? What kind of meeting are you coming from? All you look like battymen.’ They threatened to arrest us because we always have to keep up with our ‘nastiness.’”148 Harold B., thirty-four, testified he and his friends had been assaulted by police in June 2004, around the corner from where they had just attended a support group meeting.149 A JAS outreach worker told Human Rights Watch that men who have sex with men would find a safe place to hang out, but police would come and beat them, undermining JAS’ outreach work. In May 2004, he was working in a Kingston area that JAS outreach workers had identified as a gay hangout when the police approached. “The police came and said, ‘Battymen leave the area. Don’t contaminate the area. Don’t come back here.’ 145 Human Rights Watch interview with Craig R., Ocho Rios, June 16, 2004. 146 Human Rights Watch interview with Steve Harvey, coor dinator of targeted interventions, Jamaica AIDS Support, Kingston, June 6, 2004. 147 Ibid. 148 Human Rights Watch interview with Joseph W., Kingston, June 11, 2004. 149 Human Rights Watch interview with Harold B., Kingston, June 9, 2004.

PAGE 50

HUMAN RIGHTS WATCH, VOL. 16, NO. 6 (B) 48 One [of the men] ran and broke his foot. . We were so frightened . that we just drove away.”150 The Jamaica Forum for Lesbians, All-Sexuals and Gays (J-FLAG) would be a natural place to convene men who have sex with men and women who have sex with women to discuss HIV/AIDS-related issues. J-FLAG’s office, however, is not a safe space, as its own website acknowledges: “Although we provide services and network island-wide, our office is located in Kingston, Jamaica's Capital and largest city. Due to the potential for violent retribution, we cannot publish the exact location. We do receive mail at Box 1152, Kingston 8.”151 Human Rights Watch also received numerous reports from people living with HIV/AIDS that they avoided seeking health care at both public and private facilities because of the abusive treatment they had received and the public disclosure of their HIV status. As described above, after doctors and nurses at the regional hospital and local health clinic chastised Lena B. for having sex while she was living with HIV, disclosed her status to family members who have since tried to kill her, and neglected to attend to her wounds after delivering her baby by caesarean section, she decided that she would no longer seek treatment in the public health system for herself, or in the local clinic for her children. 152 Pam B., forty-three, overheard a nurse from the local health clinic telling someone from her town that she had AIDS. Public hospitals in Kingston and Portland parishes had isolated her with other HIV-positive patients, failed to provide her hospital gowns and linens, and made her wait much longer than other patients for care. Although unemployed (she lost her job after her employer learned she had AIDS), she avoided seeking care in health clinics and hospitals in her area “because of the stigma.” She also said that she knew other people living with HIV/AIDS who were afraid to go to the clinic because clinic staff gossiped about their HIV status.153 John B., forty-nine, told Human Rights Watch: 150 Human Rights Watch interview, June 6, 2004. 151 Jamaica Forum for Lesbians, All-Sex uals and Gays website, http://www.jflag. org/misc/contact.htm (retrieved August 27, 2004). 152 Human Rights Watch interview with Lena B., Montego Bay, June 22, 2004. 153 Human Rights Watch interview with Pam B., Kingston, June 8, 2004.

PAGE 51

49 HUMAN RIGHTS WATCH, VOL. 16, NO. 6 (B) I don’t go to the hospital any more because of bad experiences there. There was one experience but it stands out in my mind and I would never go back there. . The nurse said that I had to draw up my shirt so she could take my blood pressure. She looked through my docket, saw the referral from Jamaica AIDS Support and that I was HIVpositive, and told me to roll down my shirt and she took my pressure from there [on top of the shirt].154 When Human Rights Watch met Patrick D., twenty-five, he was concerned that his health was failing and that “some day soon” he would have to go to the health clinic. He was avoiding doing so, however. “I’m afraid to go to the clinic because there’s a special mark on my docket. The porter sees it and says, ‘that boy’s HIV-positive.’”155 Eric B., thirty, pulled his own teeth because he had heard that people living with HIV/AIDS had been treated poorly by the dentist in his local health care center. He told Human Rights Watch: I didn’t go there because on the whole, a lot of people go there and have a bad experience. I just took some pliers and pulled out the teeth myself. I’ve heard that the dentist there treats people badly, so I avoided going. I suffered for six months with a bad tooth because I avoided care.156 Fostering dangerous practices and comp licating health care provision Under conditions of surveillance by their fa milies and communities, Jamaican gay, lesbian, bisexual, and transgender people find little privacy for their sexual lives at home. As discussed below, many face serious violence an d become homeless after being driven from their homes and their towns because of their sexual orientation or gender identity. Men who have sex with men also risk violence for carrying condoms and lubricant— both needed for practicing safer sex. The lack of private space to have sex, the threat of violence based on sexual orientation and for even carrying condoms, and the lack of recourse to police protection makes it difficult for many gay, lesbian, bisexual, and transgender people to take precautions to protect against HIV/AIDS. Sex workers suffer from many of the same threats, and face similar problems in taking measures to protect against HIV/AIDS. 154 Human Rights Watch interview with John B., June 21, 2004. 155 Human Rights Watch interview with Patrick D., Kingston, June 9, 2004. 156 Human Rights Watch interview with Eric B., Kingston, June 8, 2004.

PAGE 52

HUMAN RIGHTS WATCH, VOL. 16, NO. 6 (B) 50 Homelessness carries additional health risks and complicates the provision of even routine medical care.157 Exposure to harsh weather conditions, poor nutrition, and the stress of living in disordered and unsafe conditions compound health problems for people living with HIV/AIDS. Albert B., thirty-three, had been homeless since 2001, when he fled his town after his close gay friend was murdered, and he was told that he was next. He told Human Rights Watch that most of the time, he had sex outside, in open land or in the bushes. “Gay people tend to use those places because they can’t carry on at home. . But you have to look out, in case you have to run.”158 Denial of access to transportation People known or perceived to be living with HIV are denied access to public and private transportation, relegating many to lives isolated from important sources of social support and undermining their capacity to obtain even basic medical care. Men who are known or perceived to be gay are likewise denied passage on public and private transportation, sometimes leaving them vulnerable to attack, and are routinely attacked on public buses because of conduct or appearance perceived as homosexual. People with HIV/AIDS may be prone to skin infections on large parts of their bodies. Several people with HIV/AIDS told Human Rights Watch that when they suffered visible skin infections, people in their communiti es would shun them, perhaps because they feared that the skin infections—or HIV more generally—were contagious. Angela M., forty-one, lived in a remote village, about one hour’s drive from the regional hospital and several miles from the nearest clinic. She was homebound: no public transportation would carry her, and the only private car that would drive her was prohibitively expensive. She told Human Rights Watch that since developing the skin rash, “All the taxi men, they know, they say they won’t carry me. . At the bus stop, nobody will stand beside me. I come near, people run away.” When she tries to flag a taxi by her house: no taxi stops. People tell them that my hair falls off and I run full of sores and I run bloody water, and nobody wants to carry me. . I 157 See, e.g., Institute of Medicine, Homelessness, Health, and Human Needs (Washington, D.C.: National Academy Press, 1988), chapter 4. 158 Human Rights Watch interview with Albert B., Kingston, June 9, 2004.

PAGE 53

51 HUMAN RIGHTS WATCH, VOL. 16, NO. 6 (B) need to go to the doctor, to the hospital and I don’t have money to pay a private man to get me there. To get to [the hospital], I would have to pay a private man 3000 [Jamaican] dollars [U.S.$50] both ways. A road taxi would cost 170 dollars one way [U.S. $2.85], 170 dollars [U.S.$2.85] to come back.159 Lacking funds for transportation, Angela M. was unable to obtain medical treatment. John B., a forty-nine-year-old man living with HIV/AIDS, said that taxi drivers sometimes increased fares for people whom they suspected had HIV. He said that on one occasion, he had a chest infection and was coughing and short of breath. He told Human Rights Watch that as he was exiting the taxi, the driver commented, “you have pneumonia; you have AIDS,” and charged him double the usual fare.160 Adrian S., thirty, told Human Rights Watch that as a man perceived as effeminate, he faced constant verbal and physical abuse and had been denied transportation in public buses and taxis on many occasions. He said that: “I would be denied passage [on public buses] because someone would say I was gay. I would have to seek transportation elsewhere.” Nor would taxis pick him up once they heard that he was gay. And boarding a bus would not guarantee safe passage. Thomas said that he had been assaulted by a conductress, a bus driver, and by passengers while riding the bus.161 Fabian Thomas, coordinator of JAS’ Montego Bay office, told Human Rights Watch that he had been contacted by a man who had been attacked and thrown off a public bus after falling asleep on another passenger’s shoulder. According to Thomas, when other passengers noticed the man’s head resting on his male neighbor’s shoulder, they cried out ‘battyman,’” threw him off the bus, beat him, stabbed him and left him by the side of the road.162 159 Human Rights Watch interview with Angela M., June 15, 2004 In June 2004, 1 Jamaican dollar was equivalent to U.S. $0.015. 160 Human Rights Watch interview with John B., June 21, 2004. 161 Human Rights Watch interview with Adrian S., Kingston, June 13, 2004. A conductor collects fares on public buses. A conductress is a female bus conductor. 162 Human Rights Watch interview with Fabian Thomas, Montego Bay, June 22, 2004.

PAGE 54

HUMAN RIGHTS WATCH, VOL. 16, NO. 6 (B) 52 Other abuses by non-state actors: vi olence in the family and in the community People living with HIV/AIDS, men who have sex with men, and women who have sex with women are subject to violence, discrimination, and other forms of abuse by private actors based on their HIV status and their sexual orientation. State authorities have an obligation to respond, both to offer redress for violations and punish the offenders, but also to prevent these violations in the first instance. Abuses based on sexual ori entation and gender identity Because gay in Jamaica, it’s hard for us to live anywhere. Those that can afford, they can rent an apartment and not be molested. But we cannot afford it. Some might attempt to rent a little house. But within days, or it doesn’t last for a month, they have to run away, leave everything that they have. —Aaron H., thirty-eight, Kingston, June 13, 2004 Men who have sex with men and women who have sex with women are routinely subjected to verbal and physical harassment, in many cases violently evicted from their homes and driven from their towns. On the morning of June 24, 2004, a group of armed men forced their way into a Kingston home, beating up six occupants while shouting homophobic threats.163 The dancehall musician Buju Banton (Mark Anthony Myrie) is alleged to have been one of the assailants, reportedly denouncing the occupants for being homosexual and kicking one man in his mouth and beating him with a board. At least two of the men were beaten seriously enough to require medical treatment. All nine residents of the house were forced to abandon their home and possessions that same day, warned by the attackers that they would be killed if they returned.164 Four of the men returned the following evening with a police escort to find that their home had been ransacked, thousands of dollars stolen, and valuable property (including a new refrigerator and electronic equipment) destroyed.165 All of the men abandoned the residence and the 163 Human Rights Watch interviews with Charles R., Kingston, June 24 and 25, 2004 and statement of Charles R. to police. Banton composed and performed “Boom By e Bye,” a song that celebrates the killing and burning of gay men. 164 Human Rights Watch interviews with Charles R., Kings ton, June 24 and 25, 2004; Human Rights Watch interviews with Ricardo P., Kingston, June 24 and 25, 2004; Human Right s Watch interviews with Robert E., Kingston, June 24 and 25, 2004. 165 A Human Rights Watch researcher accompanied the victim s to the residence and observed the condition of the home and the victims’ property.

PAGE 55

53 HUMAN RIGHTS WATCH, VOL. 16, NO. 6 (B) neighborhood, fearful that they would be killed if they return; since the intrusion, at least one has received death threats. Charles R., forty-two, Robert E., eighteen, and Ricardo P., twenty, three of the occupants, described the attack. Charles R. told Human Rights Watch that about a dozen men armed with machetes, guns, and knives had come to his front door around 10 a.m. on June 24, one of them pointing a gun at him, threatening to shoot him if he did not let them in. After Charles R.’s landlord ordered him to open the door, the men stepped in the house and ordered the occupants outside. The assailants told Charles R. and the others that they were battymen and could not live there, and threatened to shoot them and burn the house if they remained.166 Charles R. was kicked in the face and beaten on his back, arm, and leg with a machete and a metal rod by at least three assailants.167 Robert E. told Human Rights Watch that he was attacked by at least four men, who chased him from the house, hurling insults and stones, threatening him with a knife, and accusing him of being the “battyman ringleader.” Robert E. ran into the street and tripped and fell into a gully, seriously injuring his foot.168 Ricardo P. told Human Rights Watch that he was beaten with a metal rod, forced to take off his shoes, and told to run from the house.169 Human Rights Watch documented violent evictions in several towns in Jamaica, many of which occurred either immediately preceding or during the three weeks that we were in Jamaica. A Kingston man said: Right now, I’m not living in my house because people thought I was gay. . About two weeks ago, I got a call at work that there were twenty-five men surrounding the house because they understood we were gay and wanted us to leave because they didn’t want any gay men in the area. [I was told] that the men had machetes. I didn’t go home for two days because I was scared. 166 Human Rights Watch interview with Charles R., Kingston, June 24, 2004. 167 Ibid. 168 Human Rights Watch interview with Robert E., Kingston, June 24, 2004. The physician who examined his foot told Human Rights Watch that Robert E.’s heelbone was broken and he risked further serious injury if he did not take good care of it. 169 Human Rights Watch interview with Ricardo P., Kingston, June 24, 2004.

PAGE 56

HUMAN RIGHTS WATCH, VOL. 16, NO. 6 (B) 54 When he returned to the house to retrieve some of his things, he noticed several men outside. “I heard the men say, ‘oh the battymen, they move.’ I was scared, because they all had machetes in their hands. In this house, all gay men lived there. Now no one sleeps there.”170 Daniel S., nineteen, had lived on his own in Montego Bay since he was threatened by neighbors that they would kill him and chop him up because they had heard he had sex with men. He told Human Rights Watch, “I am unable to visit my family in the day. If I want to visit them, it would have to be in the midnight hours.”171 Vincent G., twentytwo, stated, “I don’t live anywhere now.” He had been homeless since 2003, after he was forced to leave his mother’s house and his town when he was threatened by men in the area who told him, “battyman, you have to leave. If you don’t leave, we’ll kill you.”172 Human Rights Watch interviewed Sebastian L., twenty-seven, a few days after he and his friends had been attacked outside Sebastian L.’s apartment. He said that he was afraid that the assailants might return. “So I am looking to move now, because I am afraid for my life.”173 Women who have sex with women reported that they were subjected to constant threats of sexual violence, in some cases serious enough to force them to leave their homes and their neighborhoods. Several women who have sex with women told Human Rights Watch that the message they were given was clear: that they could be “cured” of their homosexuality by having sex with a man. Phoebe S., forty-nine, owned a home in St. Thomas parish, where she lived alone for five years. Men in her community called her “sodomite,” pressured her to have sex with them, and spied on her while she was bathing. She told Human Rights Watch: “Men try to get friendly. They say, ‘you’re living alone for so long. You need some sex.’” She said that she had decided to sell her house “because some of the men know I’m gay and want to rape me.” She could not discern, however, whether she was continuously targeted for sexual violence because she was a woman or because she was a lesbian. She 170 Human Rights Watch interview with Paul M., Kingston, June 6, 2004. 171 Human Rights Watch interview with Daniel S., Montego Bay, June 21, 2004. 172 Human Rights Watch interview with Vincent G., Kingston, June 14, 2004. 173 Human Rights Watch interview with Sebastian L., Ocho Rios, June 15, 2004.

PAGE 57

55 HUMAN RIGHTS WATCH, VOL. 16, NO. 6 (B) told Human Rights Watch: “I have been raped three times. Sometimes I wonder if it is because I refuse to be with a man.”174 Cynthia S., twenty-seven, said that a lesbian friend of hers had to move out of her neighborhood because she faced constant verbal and physical harassment by men who knew that she was a lesbian. “They would say, ‘Hey girl, don't you know you are supposed to take cock,’ and put their hands on her when she passed by.”175 Ryan N. was with two lesbian friends in a local park when a man approached the women and said, “I want to give you a good fuck and you will leave women and start with men.”176 Homosexual men and women also face violence and abuse by their own family members. After Edward P.’s mother found out that he was gay, she threatened to poison him, which she was encouraged to do by others in their town. Edward P. told Human Rights Watch: “My mother said she wanted to poison me. . I could go for days after days starving myself. I won’t eat her cooking. Yes, I actually believe she might. People went to her and said, ‘after all, he is her son.’”177 When Lillie P.’s mother found out that she was lesbian, she threw her out of the family home, leaving her without a place to live.178 Abuses against people living with HIV/AIDS My mother said she would kill me herself if I stayed in the house. —Ray B., eighteen, Kingston, June 8, 2004 Abuses based on sexual orientation reflect and reinforce abuses against people living with HIV/AIDS. Health workers, AIDS outreach workers, and people living with HIV/AIDS told Human Rights Watch that they faced abuse by family and community members who feared that they could contract HIV/AIDS through casual contact with them and who associated the disease with homosexuality and prostitution. Several people living with HIV/AIDS said that they had been thrown out of their family homes or evicted from private housing when their HIV status became known. Others kept their HIV status secret for fear that disclosure would subject them to violence. 174 Human Rights Watch interview with Phoebe S. Kingston, June 14, 2004. 175 Human Rights Watch interview with Cynthia S., Kingston, June 8, 2004. 176 Human Rights Watch interview with Ryan N., Kingston, June 9, 2004. 177 Human Rights Watch interview with Edward P., Ocho Rios, June 16, 2004. 178 Human Rights Watch interview with Lillie P., Kingston, June 19, 2004.

PAGE 58

HUMAN RIGHTS WATCH, VOL. 16, NO. 6 (B) 56 After Ray B., eighteen, told his mother that he was HIV-positive, she threatened to poison him. He could not return home because his mother was afraid that she would catch HIV from him. Ray told Human Rights Watch: “My mother is afraid that if I touch the gate, she will catch AIDS.”179 When a JAS outreach worker heard someone telling a person living with HIV/AIDS that “AIDS smoke” from his burning rubbish would affect him and his children, the outrea ch worker tried to explain that the virus was not transmitted through the air. His efforts were unsuccessful, however. “People started to murmur [gossip]. They said they didn’t care, this guy had to leave. And he had to move out of the community.”180 Neither age nor disability affords protection from abuse. Tonya Clark, a JAS nurse, told Human Rights Watch that the previous week, she had heard from an elderly woman living with HIV/AIDS whose son made her sleep on the porch and fed her from a pan, like a dog. “Her son tells everyone in the community she has AIDS. They reject her, except for one neighbor, who gives her food—but she can’t let anyone in the neighborhood see her giving her food.”181 Leonard S., a thirty-year-old disabled man living with HIV, lived with his family. His mother, who knew that he was gay, told him that if he contracted HIV, she would abandon him at the hospital. He feared worse. He told Human Rights Watch that if his family or neighbors found out that he was HIVpositive, he would flee because they would beat or kill him.182 VI. GOVERNMENT RESPONSE Jamaica acknowledges in its official policy documents the role that homophobia plays in driving the country’s HIV/AIDS epidemic, and lists as a key priority the development of legislation and policy to protect the human rights of people living with and affected by HIV/AIDS.183 Despite these stated commitments, there exist few policy or legal protections for people living with HIV/AIDS or people whose marginalized status puts them at high risk of infection. The vast majority of people living with HIV/AIDS remain without access to lifesaving antiretroviral medicines. While some ministries (such as the Ministry of Education) have drafted national AIDS policies, the lack of institutional commitment and intersectoral coordination among them hampers the 179 Human Rights Watch interview with Ray B., Kingston, June 8, 2004. 180 Human Rights Watch interview, Kingston, June 6, 2004. 181 Human Rights Watch interview with To nya Clark, Kingston, June 14, 2004. 182 Human Rights Watch interview with Leonard S. Kingston, June 11, 2004. 183 See, e.g., Ministry of Health, “Jamaica HIV/AIDS/S TI National Strategic Plan 2002-2006,” January 2002, pp. 10-12 (identifying “discrimination and stigmatization around HIV/AIDS especially homosexuality” as among the factors driving the epidemic, and policy, advocacy, l egal and human rights as a top priority area in its HIV/AIDS plan).

PAGE 59

57 HUMAN RIGHTS WATCH, VOL. 16, NO. 6 (B) government’s response to the epidemic. And the lack of high-level political commitment to addressing homophobic violence further weakens efforts to fight HIV/AIDS. Improving legal and policy protections In 2001, the National AIDS Committee (NAC), a government-organized NGO established in 1988 to advise the Ministry of Health on policy issues, drafted a report reviewing legal, ethical, and human righ ts issues for people living with HIV/AIDS.184 The report identified a number of weaknesses within existing legislation and recommended changes to address them. These included drafting comprehensive antidiscrimination legislation, strengthening legal protections for confidential information, and repealing the sodomy laws.185 The Office of the Attorney General reviewed the NAC report and in 2002 rejected its main recommendations, insisting that there be a national AIDS policy before any legislation was adopted. As of this writing, the national policy document has not yet been completed.186 High-level officials at the National HIV/AIDS Control Programme, consistent with the NAC report and Ministry of Health policy documents, have advocated for the need to repeal discriminatory laws because they impede HIV prevention efforts and drive vulnerable groups from HIV services. Minister of Health John Junor repeatedly has rejected these appeals, however.187 And in July 2004, Prime Minister P.J. Patterson reportedly announced that his government would not be forced by foreigners to repeal Jamaica’s sodomy laws, apparently ignoring government and NAC reports on their role in driving Jamaica’s HIV/AIDS epidemic.188 The U.N. Guidelines on HIV/AIDS and Human Rights specifically recommend that “an independent agency should be established to redress breaches of confidentiality.”189 184 The Minister of Health established the National AIDS Committee (NAC) in 1988 to coordinate a national multi-sectoral response to HIV/AIDS. It has more t han one hundred members, including representatives from public and private sector organizations and NGOs. h ttp://www.nacjamaica.com/about_nac/index.htm (retrieved September 16, 2004). 185 See National AIDS Committee, “HIV/AIDS Legal, Ethical and Human Rights Issues in Jamaica,” http://www.nacjamaica.com/subcom/legal_ethica l/index.htm (retrieved April 19, 2004). 186 A draft National AIDS Policy is expected to be circulated for review in the fourth quarter of 2004. Human Rights Watch telephone interview with Ruth Jankee, executive director, National AIDS Committee, Kingston, September 7, 2004. 187 Human Rights Watch interview with Dr. Peter Figueroa, chief, Ministry of Health Epidemiology Unit, Kingston, June 23, 2004; see also Zadie Neufville, “Fear Among Gay Men Said to Fuel HIV/AIDS Cases,” Inter Press Service, March 5, 2002 (reporting that Minister Junor said that while the government is “committed to preventing t he spread of the disease,” it had no intention of changing the laws). 188 “PM Says Gov’t Will Not Change Anti-Homosexual Laws,” Jamaica Observer, July 2, 2004. 189 U.N., HIV/AIDS and Human Rights: International Guidelines, para. 30(c).

PAGE 60

HUMAN RIGHTS WATCH, VOL. 16, NO. 6 (B) 58 Professional organizations governing certain health professionals are empowered to sanction physicians, nurses, and midwives for professional misconduct, including failure to protect confidential patient information.190 No independent agency exists, however, to redress breaches of confidentiality by other health workers, such as porters and ward assistants, who have access to patient dockets and may otherwise discover patients’ HIV status.191 Educating health personnel Doctors, nurses, and other medical personnel who work with people living with HIV need training, both about the disease as well as how to ensure human rights protections for people living with HIV/AIDS, including ensuring confidentiality of HIV-related information and addressing discrimination. The Jamaican government has acknowledged that many health care personnel are not adequately trained in HIV/AIDS care and treatment and has undertaken steps to address this problem. The Ministry of Health has devoted a major portion of a World Bank loan to strengthening institutional capacity to respond to HIV/AIDS, including by providing training on AIDS-related stigma and discrimination for a range of health personnel (including doctors, nurses, nutritionists, and medical records workers).192 The Ministry has also specifically targeted individuals working with medical records for training on protecting confidentiality.193 These training sessions are optional, however.194 In addition, the Ministry also has begun work with domestic and international HIV/AIDS organizations to address problems with quality of care for people living with HIV/AIDS.195 190 See, e.g., The Medical Act, section 11; The Nurses and Midwives Act, section 11. 191 Patients can lodge complaints with the Ministry of Health within ten days after suffering a breach of confidentiality or discrimination by health workers. Mini stry of Health, “Client Charter,” http://www.moh.gov.jm/Standards.htm (retrieved August 27, 2004) 192 U.S.$4.82 million, or 29 percent of a World Bank loan received for the 2002-2006 period is being used for HIV/AIDSrelated projects, but it is unclear what portion of these funds are going to traini ng. Country Coordinating Mechanism for the Global Fund to Fight AIDS, Tuberculosis and Malaria, A Proposal to Scale UP HIV/AIDS Treatment, Prevention, and Policy Efforts in Jamaica, May 2003, http://www.theglobalfund.org/search/docs/3JAMH_661_0_full.pdf (retrieved August 27, 2004), p. 26. 193 Human Rights Watch telephone interview with Kevin Harv ey, coordinator of treatment, care and support for people living with HIV/AIDS, Ministry of H ealth, Kingston, September 7, 2004. 194 Ibid. 195 In 2004, the Johns Hopkins Program for International Educ ation in Gynecology and Obstet rics (JHPIEGO), a nonprofit organization affiliated with Johns Hopkins University that receives funding from USAID, and Jamaica AIDS Support provided training addressing stigma and di scrimination against people living with HIV/AIDS and on infectious disease control to health care workers at Kingston Public Hospit al, one of Jamaica’s highest-volu me hospitals. The National HIV/AIDS Program at the Ministry of Health provided ov ersight for this training, which did not address stigma and discrimination against men who have sex with men or other vulnerable groups. JHPIEGO, “Project Proposal: Building the HIV/AIDS Capacity of Health Care Providers and Communi ties in Jamaica,” 2004; E-mail communication with Robert Carr, director, Jamaica AIDS Support, September 7, 2004.

PAGE 61

59 HUMAN RIGHTS WATCH, VOL. 16, NO. 6 (B) These are laudable initiatives, but the findings of this report make it clear that considerable room for improvement remains. HIV/AIDS training, including basic information addressing HIV transmission, must extend to all hospital personnel, including porters and laundry workers, and it must be mandatory. In addition, sanctions must be available and imposed for disclos ing confidential informat ion about HIV status and other HIV/AIDS-related discrimination. In May 2004, Jamaica signed an agreement with the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund) that should enable it to address some of the major gaps in its national response. The bulk of the funds is intended to scale up availability of antiretroviral medications, with the goal of providing access to all Jamaicans living with HIV/AIDS within five years. The agreement also prioritizes efforts to complete and implement policies and a legislative framework to protect the human rights of people living with and at high risk of HIV/AIDS, including by “address[ing] the repeal of discriminatory laws and policies that make it difficult to reach vulnerable high-risk communities (especially MS M, CSWs [commercial sex workers], and incarcerated populations).”196 The findings of this report underscore the importance of enacting into law and enforcing human rights protections for vulnerable high-risk groups, especially men who have sex with men, to ensure the success of its AIDS treatment program. If the Jamaican government fails to do so, men who have sex with men will be denied access to AIDS treatment in the same ways that they have long been denied access to other health care services. Efforts to address police abuse and provide HIV/AIDS education to police It is widely acknowledged that there is a crisis in policing in Jamaica, fueled in part by police failure to control high rates of violent crime or to be held accountable for crimes they commit.197 Human rights abuses by the Jamaican police have been documented and publicized by national and international organizations for over thirty years, and millions of dollars have been pledged toward efforts to reform police practices and improve security.198 The Jamaican government has undertaken important efforts to 196 Country Coordinating Mechanism for the Global Fund to Fight AIDS, Tuberculosis and Malaria, A Proposal to Scale UP HIV/AIDS Treatment, Prevention, and Policy Efforts in Jamaica, May 2003, http://www.theglobalfund.org/search/docs/3JAMH_661_0_full.pdf (retrieved August 27, 2004), p.25. 197 See Anthony Harriott, Police and Crime Control in Jamaica: Problem s of Reforming Ex-Colonial Constabularies (Kingston, Jamaica: University of the West Indies Press, 2001); Horace Levy, They Cry ‘Respect’! Urban Violence and Poverty in Jamaica (Kingston, Jamaica: University of the West Indies Press, 2001). 198 See, e.g, ibid.; United Nations Special Rapporteur on Extraj uducial, Summary or Arbitrary Executions, “Report of the Special Rapporteur, Asma Jahangir, submitted Pursuant to Commission on Human Rights Resolution 2003/53. Addendum. Mission to Jamaica,” E/CN.4/2004/7/Add.2, September 26, 2003; Amnesty International, Jamaica: Killings

PAGE 62

HUMAN RIGHTS WATCH, VOL. 16, NO. 6 (B) 60 address these abuses, including by establ ishing mechanisms to investigate cases of police misconduct and to train police regarding the proper use of force.199 But serious problems with police abuse continue. The Jamaican Constabulary Force (JCF) has only recently acknowledged HIV/AIDS as a workplace issue and drafted policy guidelines to address HIV/AIDS in its workforce. These draft guidelines do not, however, address police conduct toward marginalized populations or toward HIV/AIDS outreach workers. Nor has the government addressed police abuse based on sexual orientation and gender identity, apparently ignoring cases that have been documented by domestic and international human rights organizations and by foreign governments.200 Institutional mechanisms to address police misconduct Complaints of police abuse can be lodged directly with the Jamaican Constabulary Force, with its Bureau of Special Investigations or wit h the Complaints Division of the Office of Professional Responsibility. The Police Public Complaints Authority (PPCA), an independent body charged with monitoring and supervising civilian complaints of police misconduct, also is empowered to investigate cases of police misconduct. Once an investigation has been completed, reports are sent to the Department of Public Prosecutions for a ruling on whether criminal or disciplinary proceedings, or a coroner’s inquest, should follow.201 Public access to police and independent complaint mechanisms is limited by lack of knowledge about them, distrust of the legal system, and fear of reprisals for making complaints against officials.202 The Bureau of Special Investigations, which inv estigates fatal sh ootings and other killings by police, has been criticized for its failure to conform with international standards in conducting investigations. Failure to investigate incidents promptly or and Violence by Police: How Many More Victims,” pp. 52-54; Amnesty International, “’Until Their Voices are Heard.’ The West Kingston Commission of Inquiry,” July 2003; Jamaicans for Justice, The Jamaica Justice Report, 2002; U.S. Department of State, “Country Reports on Human Rights Practi ces: Jamaica, 2003,” February 25, 2004. International donors and agencies contributing to justice reform effo rts include the Canadian International Development Agency (CIDA), the World Bank, the Inter-American Development Bank the U.S. Agency for International Development (USAID), the European Union (EU) and the United Nations Development Program (UNDP). 199 See Police and Crime Control in Jamaica, pp. 121-182 (discussing reforms). 200 See, e.g., Amnesty International, “A Summary of Conc erns: A Briefing for the Human Rights Committee,” October 1997, p. 14. U.S. Department of State, “Country Reports on Human Rights Practices: Jamaica, 2003,” February 25, 2004; Robert Carr and Jamaica Forum for Lesbians, A ll-Sexuals and Gays, “Testimonies,” 2003. 201 Coroner’s inquests are conducted before a judge and jury of the Coroner’s Court and the court’s verdict referred back to the Director of Public Prosecuti ons for a decision whether to continue to prosecute or to close the case. 202 See ”Report of the Special Rapporteur on Mission to Jamaica,” September 26, 2003.

PAGE 63

61 HUMAN RIGHTS WATCH, VOL. 16, NO. 6 (B) thoroughly, including failure to collect blood and other forensic evidence or to properly record crime scene information, compromises the chances for successful prosecution.203 The Office of Professional Responsibility, which investigates complaints of police misconduct that do not involve firearms, has been criticized for its lack of impartiality and thoroughness.204 The Police Public Complaints Authority has been criticized as “completely ineffectual” in carrying out its mandate to investigate, supervise, and monitor complaints of police misconduct.205 Jamaican and international human rights organizations have argued that the PPCA’s lack of independence and transparency and the Authority’s failure to make full use of its powers contribute to the inadequacy of its investigations.206 Justice Lloyd Ellis, PPCA Chairman, has stated, for example, that he did not consider it appropriate or possible to hold Jamaica to the same standards as other countries and that he was generally satisfied with the quality of police investigations.207 Little attention has been paid to police interference with HIV/AIDS outreach workers or other abuses against men who have sex with men and sex workers. When asked about police conduct toward men who have sex with men and people living with HIV/AIDS, Justice Ellis said that he “would be surprised if anyone could prove that police would set up to abuse people who are homosexuals or, as you put it at high risk of HIV. If that is done, it is done not by police acting qua police but as citizens.” 208 Ellis acknowledged that gay men might be targeted on the community level but suggested that they bore some responsibility for violence committed against them: “I have no evidence of police beating anyone for being gay. You have people doing it in the community, doing it out of necessity. You have it every day. . It happens in other countries too. It’s not just a problem in Jamaica.”209 203 See, e.g., ibid.; Amnesty International, Jamaica: Killings and Violence by Police: How Many More Victims,” pp. 52-54; Jamaicans for Justice, The Jamaica Justice Report, 2002. 204 Ibid. 205 Jamaicans for Justice, Jamaica’s Human Rights Situation, 2003, p. 6. 206 Amnesty International, Jamaica: Killings and Violence by Police p. 55; Jamaicans for Justice, “Jamaica’s Human Rights Situation,” 2003, pp. 6-7. 207 Amnesty International, Jamaica: Killings and Violence by Police p. 55. 208 Human Rights Watch interview with Justice Lloyd Ellis, ex ecutive director, Police Public Complaints Authority, Kingston, June 23, 2004. 209 Ibid.

PAGE 64

HUMAN RIGHTS WATCH, VOL. 16, NO. 6 (B) 62 Police training on HIV/AIDS and related human rights issues Percival Buddan, the officer in charge of HIV/AIDS training for the Jamaican police force, acknowledged that there was an urgent need for HIV/AIDS education in the police force to ensure protection against the disease as well as protection against HIV/AIDS-related discrimination. He told Human Rights Watch: “Until two or three years ago, police officers were more or less in the dark about HIV/AIDS, how the virus was contracted, about universal precautions [to protect against HIV transmission]. And people who have HIV/AIDS may want to keep it secret because of stigma and discrimination.”210 The Jamaican Constabulary Force has published a document addressing myths and facts about HIV/AIDS and has begun to include HIV/AIDS education in its training and in optional lectures given in preparation for annual first aid certification exams. It is clear that these efforts are insufficient, however. Human Rights Watch interviewed several police officers, including a high-level police officer in Kingston and constables in St. Ann’s Bay, who made comments indicating their confusion and incomplete knowledge about HIV transmission. In St. Ann’s Bay, for example, police officers told Human Rights Watch that people living with HIV/AIDS should be confined in isolated areas for treatment, “so they will not be able to contaminate other people,” and that people living with HIV/AIDS were isolated from other detainees in the police lockup.211 As of this writing, the Jamaican Constabulary Force HIV/AIDS policy has been drafted but not approved. Percival Buddan told Human Rights Watch that the draft policy did not address police conduct toward marginalized populations such as men who have sex with men and sex workers or toward HIV/AIDS outreach workers to these groups.212 VII. REGIONAL EFFORT S TO ADDRESS HIV/AIDS Regional efforts to address HIV/AIDS-related discrimination and abuses have the potential to promote domestic policy reform in Jamaica. Regional organizations providing assistance in drafting rights-respecting laws and policies can provide guidance 210 Human Rights Watch interview with Percival Buddan, sub-officer in charge, Ja maican Constabulary Force First AID Center, Kingston, June 18, 2004. “Universal precautions” are simp le measures taken to reduce the risk of transmission of HIV and other bloodborne pathogens through exposure to blood or body fluids, including the use of protective barriers such as gloves for direct contact with bl ood or body fluids and careful handling and disposal of needles, waste, and other materials contaminated with blood or body fluids. World Health Organization, “Universal Precauti ons, Including Injection Safety,” http://www.who.int.hiv/topics/precautions/unive rsal/en/ (retrieved September 16, 2004). 211 Human Rights Watch interview, St. Ann’s Bay, June 16, 2004. 212 Human Rights Watch interview with Percival Buddan, sub-officer in charge, Ja maican Constabulary Force First AID Center, Kingston, June 18, 2004 and te lephone interview, Kingston, October 26, 2004.

PAGE 65

63 HUMAN RIGHTS WATCH, VOL. 16, NO. 6 (B) to Jamaica and use their influence to lobby Jamaica to enact such legislation on an urgent basis. Regional organizations also can lobby for policy changes that national organizations lack the political or economic resources to support (such as repeal of the sodomy laws). These efforts may be constrained by the United States, a major donor, through its imposition of policies that limit the capacity to advocate for the rights of sex workers.213 The Pan Caribbean Partnership on HIV/AIDS (PANCAP), a coalition of public and private national, regional, and international organizations, was established in 2001 by the Caribbean Community (CARICOM) to scale up national and regional responses to HIV/AIDS among twenty-one Caribbean states and territories. PANCAP’s priority areas of action include ensuring that national legislation and policies incorporate international human rights protections; providing treatment, care, and support for people living with HIV/AIDS; and preventing HIV among vulnerable populations, including men who have sex with men and sex workers. Since 2002, PANCAP has worked with the Canadian HIV/AIDS Legal Network to assist national governments in the region in developing law, policy, and ethical guidelines.214 PANCAP is currently working with seven Caribbean countries to draft legislation to protect people living with HIV/AIDS against discrimination at work and in the health care system, and to ensure universal access to treatment for people living with HIV/AIDS. According to St. Kitts and Nevis Prime Minister Denzil Douglas, who represents CARICOM on HIV issues, PANCAP also has been discussing condom distribution in prisons and laws criminalizing sex between men.215 213 U.S. law and policy bars the use of international HI V/AIDs and anti-trafficking funds by organizations that promote or advocate prostitution as an employment choice or the legaliz ation of prostitution and that do not have a policy explicitly opposing prostitution. See Un ited States Leadership against HIV/AIDS, Tuberculosis and Malaria Act of 2003, P.L. 108-25 (2003) (commonl y know as the President’s Emergency Plan for AIDS Relief or PEPFAR), section 104A(e); Office of the Un ited States Global AIDS Coordinator, “The President’s Emergency Plan for AIDS Relief. U.S. Five Year Global HIV/AIDS Strategy,” February 2004, p. 65; U.S. Agency for International Development, “Trafficking in Persons: USAID Strategy for Response,” February 2003, p. 4. Peer education projects are often the most effective and only possible AIDS educators for sex workers and have been acknowledged for their success in providing HIV education and prevention services in many countries throughout the world. See Kemala Kempadoo and Jo Doezema, Global Sex Workers: Rights, Resistance, Rebellion (London: Routledge, 1998); Human Rights Wa tch, “Epidemic of Abuse: Police Harassment of HIV/AIDS Outreach Workers in India,” A Human Rights Watch Report, vol. 14, no. 5(c), July 2002. U.S. funding restrictions undermine support for th is important work, and limit advocacy strategies to ensure safe sex during sex work. 214 Canadian HIV/AIDS Legal Network, PANCAP, CARICO M, “Action Plan and Workshop Reports: Programme on HIV/AIDS, Law, Ethics and Human Rights,” January 2004. 215 Caribbean poised to pass HIV Laws,” BBC Caribbean, March 8, 2004. This contradicts current CARICOM model legislation for sexual offences that endorses crimina lization of adult homosexual conduct. See CARICOM Model Legislation for Sexual Offences, secti on 15, http://www.caricom.org/archives/sex ualoffences.htm (retrieved August 27, 2004).

PAGE 66

HUMAN RIGHTS WATCH, VOL. 16, NO. 6 (B) 64 In October 2003, the Global Fund approved eight CARICOM proposals, including regional proposals by PANCAP and the Organization of Eastern Caribbean States (OECS).216 PANCAP’s proposal aims to bolster its current law reform efforts by establishing a regional mechanism to ensure human rights protections for people living with HIV/AIDS; to coordinate regional and sub-regional HIV/AIDS prevention efforts; and to address inequities in care, treatment, and support among Caribbean countries.217 PANCAP regional efforts to ensure human rights protections have the potential to complement Jamaica’s national law and policy reforms. There have been important regional efforts to establish and coordinate networks of people living with HIV/AIDS, men who have sex with men, and sex workers. The Caribbean Regional Network of People living with HIV/AIDS (CRN+) provides training and technical assistance to people living with HIV/AIDS in twenty-seven territories and seven national networks in the Caribbean region. CRN+’s position on the PANCAP steering committee has made it a key partner in regional initiatives, including with the World Bank and the Caribbean Health Research Council. In July 2004, CRN+ got approval of its own Global Fund proposal, which aims to enhance the capacity of people living with HIV/AIDS in the region to obtain treatment, care, and support services, to adhere to new treatment regimes, and to participate in advocacy and policymaking on the national and regional level.218 This initiative targets people living with HIV/AIDS and their networks in twelve Caribbean countries, including Jamaica.219 In Jamaica, the United Nations Theme Group on HIV/AIDS is also providing support and technical assistance for the Jamaican Network of Seropositives (JN+).220 Since 2003, the NGO International HIV/AIDS Alliance has been working in several Caribbean countries to mobilize support and HIV/AIDS prevention education for men 216 These proposals were from Guyana and Haiti (two eac h), Belize, Jamaica, the Organization of Eastern Caribbean States and PANCAP. CARICOM, “Eight CARICO M Proposals Successful at Sixth Meeting of Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM),” October 15, 2003. 217 PANCAP, Scaling Up the Regional Response to HIV/AIDS through the Pan Caribbean Partnership on HIV/AIDS The OECS proposal focuses on improving access to HIV/AIDS pr evention and treatment services in the nine small island nations that comprise the OECS subr egion (Anguilla, Antigua & Barbuda, the Britis h Virgin Islands, Dominica, Grenada, Montserrat, St. Kitts & Nevis, St. Lucia, and St Vincent and the Grenadines), which shar e strong economic, social and cultural links. Country Coordinating Mechanism, Scaling up prevention, care and treatment to combat the HIV/AIDS pandemic in the organization of Eastern Caribbean States (OECS) Sub-Region 218 CRN+, Strengthening the Community of PLWHA and those affe cted by HIV/AIDS in the Caribbean—a Community Based Initiative, http://www.theglobalfund.org/search/docs/4MANH_767_0_full.pdf (retrieved August 20, 2004). 219 Ibid. 220 Human Rights Watch interview with Bernard Bainvil, Chair, U.N. Theme Group on HIV/AIDS, Jamaica, Kingston, June 10, 2004.

PAGE 67

65 HUMAN RIGHTS WATCH, VOL. 16, NO. 6 (B) who have sex with men.221 In 2003, Jamaica AIDS Support collaborated with the Alliance to establish and support community organizations of men who have sex with men in the eastern Caribbean, and to form a regional network of groups working with men who have sex with men to provide support to national groups.222 The Latin American Association for Comprehensive Health and Citizenship, a network of lesbian, gay, bisexual, and transgender groups in Central and South America, has been working with groups working with men who have sex with men in the region to develop and support strategies to force governments to address the needs of men who have sex with men in national HIV/AIDS programs.223 In some Caribbean countries since the mid-1990s, sex worker organizations have been providing HIV/AIDS and other health services, and advocating for the protection of sex workers’ rights.224 The Movimiento de Mujeres Unidas MODEMU (The Movement of United Women) and the Maxi Linder Association in Suriname have been internationally recognized for such work and looked to as models for other organizations in the region. The U.S. government provides significant funding to support HIV/AIDS-related work in the region, including work targeting sex workers. U.S. law and policy bars the use of these funds by organizations that do not have a policy explicitly opposing prostitution and limits the legal advocacy that can be done with these funds. These funding restrictions limit the extent to which other organizations might emulate the exemplary work of organizations like MODEMU and the Maxi Linder Association. A health worker working with sex workers in Jamaica told Human Rights Watch that the restrictions have impeded the organization’s work with sex workers by undermining its ability to support efforts for sex workers to organize on their own behalf and to join with regional and international calls for advocacy on behalf of the rights of sex workers.225 Other NGOs that receive U.S. government funding to work with sex workers in the region may face similar obstacles. 221 International HIV/AIDS Alliance, Annual Review 2003, pp. 41-42. The Alliance established its Caribbean program in 2003, and targets prevention and care activi ties for men who have sex with men, sex workers, and people living with HIV/AIDS. 222 Ibid.; Human Rights Watch e-mail communication with Rober t Carr, director, Jamaica AIDS Support, August 19, 2004. 223 Asociacion para la Salud Integral y Ciudadania de America Latina (ASICAL), “Quienes Somos,” http://www.sidalac.org.mx/asical/asical.ht ml (retrieved August 21, 2004). The Inte rnational AIDS Alliance and the POLICY Project have been collaborating with ASICAL in th is work. See International AIDS Alliance, Annual Review 2003 p. 41; The Men’s Health in Latin America,” February 6, 2 003, http://www.policyproject.com/page_whatsNew.cfm?read=30 (retrieved August 21, 2004); POLICY Project, “POLICY/ASICAL Training Promotes Men’s Health in Latin America,” February 6, 2003, http://www.policyproject.com/pag e_whatsNew.cfm?read=30 (retrieved August 21, 2004). 224 See Kemala Kempadoo and Jo Doezema, Global Sex Workers: Rights, Resistance, Rebellion (London: Routledge, 1998). 225 Human Rights Watch interview, Kingston, June 14, 2004.

PAGE 68

HUMAN RIGHTS WATCH, VOL. 16, NO. 6 (B) 66 VIII. LEGAL STANDARDS When people in Jamaica are driven from their homes and towns, subjected to relentless violence with little recourse to police protection, discriminated against in health care provision, and face public disclosure of confidential and private information because they are living with HIV/AIDS or based on their sexual orientation or gender identity, they are not experiencing “Jamaican culture.” They are experiencing human rights violations. Jamaica has ratified international and regional treaties requiring it to protect human rights to freedom from violence and arbitrary arrest and detention, freedom of association and assembly, the highest attainable standard of health, privacy, and nondiscrimination based on sexual orientation, gender identity, and HIV status. These treaties include the International Covenant on Civil and Political Rights (ICCPR), the International Convention on Economic, Social and Cultural Rights (ICESCR), the Convention on the Elimination of all Forms of Di scrimination against Women, and the American Convention on Human Rights (ACHR). Laws criminalizing homosexual conduct and abuses based on sexual orientation and gender identity have been extensively reviewed by United Nations bodies charged with interpreting these treaties, U.N. special experts on torture, extrajudicial executions, and health, and bodies established by the U.N. charter for the protection and promotion of human rights. Jamaica’s sodomy laws and many of the practices described in this report are completely at odds with the conclusions of these bodies, which have roundly condemned such laws and practices as violations of fundamental human rights to privacy and nondiscrimination, and for fueling serious human rights abuses against sexual minorities. Freedom from violence The Jamaican Constitution recognizes the right to life as a fundamental right.226 Jamaica has also ratified international and regional instruments that enshrine this protection, including the International Covenant on Civil and Political Rights (ICCPR) and the American Convention on Human Rights.227 By inciting third parties to commit acts of serious violence against men who have sex with men and failing properly to investigate 226 Jamaican Constitution, article 14. 227 ICCPR, 999 U.N.T.S. 171, entered into force March 23, 1976, article 6; American Convention on Human Rights, ratified by Jamaica on August 7, 1978, article 4(1).

PAGE 69

67 HUMAN RIGHTS WATCH, VOL. 16, NO. 6 (B) crimes of violence against them, the Jamaican government is failing in its obligation to protect the right to life. The ICCPR and the American Convention require states to prevent torture and other cruel, inhuman or degrading treatment or punishment, including by private actors.228 These treaties further require state partie s to ensure to all persons within their territory the rights recognized therein.229 When police beat, mistreat, and abuse people on the basis of their HIV status, sexual orientation, or consensual sexual conduct with members of the same sex, they violate these basic protections. When police instigate or fail to protect against such violence or abuse committed by private actors, they also violate these protections. The ICCPR’s prohibition against torture and cruel, inhuman or degrading treatment or punishment applies “not only to acts that cause physical pain but also to acts that cause mental suffering to the victim.”230 The Convention on the Elimination of All Fo rms of Discrimination against Women (CEDAW), to which Jamaica is a party, requires state parties “without delay” to take all appropriate measures to end gender-based discrimination, including by taking action to modify rigid stereotyping of the roles of men and women.231 Gender-based violence may also be considered a form of gender-based discrimination prohibited under CEDAW.232 The CEDAW Committee recognizes that pervasive sex-based stereotyping perpetuates social prejudices and contributes to gender-based violence.233 Although the 228 ICCPR, article 7; American Convention, article 5; see also CEDAW General Recommendation 19 (“Under general international law, States may also be responsible for private ac ts if they fail to act with due diligence to prevent violations of rights or to investigate and punish acts of violence, and for providing compensation.”). 229 ICCPR, article 2; American Convention, article 1(1). 230 Human Rights Committee, General Comment 20 Article 7 (Forty-fourth session, 1992), Compilation of General Comments and General Recommendations Adopted by Human Rights Treaty Bodies, U.N. Doc. HRI\GEN\1\Rev.1 at 30 (1994). The Human Rights Committee, the United Nations body charged with monitoring implementation of the ICCPR, has commented that states should provi de special protections for particular ly vulnerable persons. The Special Rapporteur on Torture has identified sexual minorities as a “particularly vulnerable gr oup” with respect to torture in various contexts, and condemned discriminatory laws and attitudes t hat subject members of sexual minorities to abuse and deprive them of means to claim and ensure enf orcement of their rights. “Report of the Special Rapporteur on the question of torture and other cruel, inhuman and degrading treatment or punishment,” U.N. General Assembly, U.N. Doc. A/56/156, July 3, 2001. 231 CEDAW, G.A. Res. 34/180, U.N. Doc. A/34/46, entered into force September 3, 1981, articles 2, 5(a). 232 CEDAW, article 2; United Nations General Assembly, “D eclaration on the Elimination of Violence against Women,” A/RES/48/104, December 20, 1993 (issued on February 23, 1994) article 4; Committee on the Elimination of All Forms of Discrimination against Women, Violence Against Women. General Recommendation 19 (eleventh session, 1992), U.N. Document CEDAW/C/1992/L.1/Add.15, para. 11; see also In ter-American Convention on the Prevention, Punishment and Eradication of Violence agai nst Women,” article 4. 233 CEDAW Committee, Violence Against Women, General Recommendation 19 para. 11.

PAGE 70

HUMAN RIGHTS WATCH, VOL. 16, NO. 6 (B) 68 Committee’s comments focus on violence against women, the phrase “gender-based violence” includes violence targeted against both men and women based on their sexual orientation or gender identity. Thus, men as well as women may be targeted for discrimination because they fail to conform to stereotypes based on gender or because they claim a gender identity that fails to c onform to societal expectations. The measures enumerated by the CEDAW Committee to combat gender-based violence include instituting effective complaints procedures and remedies for survivors of gender-based violence, and ensuring appropriate medical care, counseling and support services.234 States should adopt these sorts of measures to protect men, as well as women, from gender-based violence. The right to privacy and the right to freedom from discrimination Jamaica’s sodomy laws (sections 76, 77, and 79 of the Offences against the Person Act) are meant, and used, to criminalize consensual sexual conduct between adult males, and are used to criminalize consensual sexual conduct between adult females. In the 1994 case of Nicholas Toonen v. Australia, the U.N. Human Rights Committee, which monitors compliance with and adjudicates complaints brought under the ICCPR and its Optional Protocol, held that sodomy laws punishing consensual, adult homosexual conduct violate the rights to privacy and nondiscrimination guaranteed by the ICCPR.235 The Committee also noted that criminalization of homosexual practices hampered HIV prevention “by driving underground many of the people at risk of infection.”236 The Committee has thus urged states to bar discrimination based on sexual orientation.237 Since Toonen the Human Rights Committee, the Committee on Economic, Social and Cultural Rights, and the CEDAW Committee have called for the repeal of laws criminalizing consensual adult homosexual conduct.238 In the case of Trinidad and Tobago, the Human Rights Committee has urged that it extend the provisions of anti234 Ibid., para. 24. 235Nicholas Toonen v. Australia, Human Rights Committee, 50th Session, Case no. 488/1992, U.N. Doc. CCPR/C/50/D/488/1992 (April 4, 1994). 236 Ibid., para. 8.5. 237 See, e.g., U.N. Human Rights Committee, “Concluding Ob servations of the Human Rights Committee: Poland,” 66th Session, U.N. Doc. CCPR/C/79/Add.110, p. 23 (urging inclusi on of constitutional protecti ons against sexual-orientationbased discrimination). 238 See Ignacio Saiz, “Bracketing Sexuality: Human Ri ghts and Sexual Orientation—A Decade of Development and Denial at the U.N.,“ Health and Human Rights, vol. 7, no. 2, pp. 51-52 and n. 16 (citing decisions in which HRC has called for repeal in Tanzania and Romania; t he CESCR has called for repeal in Cyprus; and CEDAW has called for repeal in Kyrgystan).

PAGE 71

69 HUMAN RIGHTS WATCH, VOL. 16, NO. 6 (B) discrimination legislation “to those suffering discrimination on grounds of age, sexual orientation, pregnancy or infection with HIV/AIDS.”239 The U.N. Special Rapporteur on Extrajudicial, Summary, or Arbitrary Executions has observed that sodomy laws facilitate violence and human rights abuses against sexual minorities: The Special Rapporteur further believes that criminalizing matters of sexual orientation increases the social stigmatization of members of sexual minorities, which in turn makes them more vulnerable to violence and human rights abuses, including violations of the right to life. Because of this stigmatization, violent acts directed against persons belonging to sexual minorities are also more likely to be committed in a climate of impunity.240 Human Rights Watch recognizes the freedom of all people to follow their conscience in deciding whether to support or oppose homosexuality or homosexual behavior. However, rigid stereotyping of roles for men and women can lead to significant abuse of people who do not conform to those stereotypes and contribute to gender-based violence. Jamaica’s obligations under international law to protect against gender-based discrimination require that it take “all ap propriate measures” to “modify the social and cultural patterns of conduct of men and women, with a view to achieving the elimination of prejudices and customary and all other practices which are based on the idea of the inferiority or the superiority of either of the sexes or on stereotyped roles for men and women.”241 Moral objections to nonconforming sexual orientation or gender identity are not an adequate basis to avoid this obligation. The U.N. Commission on Human Rights, the main political body within the U.N. system charged with human rights matters, interprets article 26 of the ICCPR, which “prohibit[s] any discrimination and guarantee[s] all persons equal and effective protection against discrimination on any ground such as race, colour, sex, language, 239 Concluding Observations of the Human Ri ghts Committee: Trinidad and Tobago,” U.N. Doc. CCPR/CO/70/TTO, November 3, 2000, para. 11. 240 “Report of the Special Rapporteur on extrajudicial, summary or arbitrary executions,” U.N. Doc. E/CN.4/1999/39, January 6, 1999, para. 77. 241 CEDAW, article 5(a); see also CEDAW Committee, General Recommendation 19 (noting importance of rejecting stereotyped roles for men because th ey contribution to gender-based violence).

PAGE 72

HUMAN RIGHTS WATCH, VOL. 16, NO. 6 (B) 70 religion, political or other opinion, national or social origin, property, birth or other status" as prohibiting discrimination based on HIV/AIDS.242 The non-binding U.N. International Guidelines on HIV/AIDS and Human Rights enjoin states to “enact or strengthen anti-discrimination and other protective laws that protect vulnerable groups, people living with HIV/AIDS and people with disabilities in the public and private sectors.”243 The guidelines advise that the laws cover health care and access to transportation (among other areas), and note particular areas where discrimination is likely and merit legal protection, including: (1) protection from discriminatory acts, including “HIV/AIDS vilification” and vilification of people who engage in same sex relationships; and (2) protection of confidentiality of medical information, including HIV status, and other personal information, and the need for disciplinary and enforcement mechanisms in cases of breaches of confidentiality.244 International law proscribing discrimination extends to discrimination in provision of transportation based on sexual orientation and HIV/AIDS. The U.N. Human Rights Committee has found that prohibitions on discrimination place a broad mandate on states to remedy unequal treatment in all areas of life, finding that article 26 of the ICCPR “prohibits discrimination in law or in fact in any field regulated or protected by the public authorities.”245 Jamaica is therefore responsible for providing protections against discrimination in transportation services (buses, taxis) subject to its regulation. Freedom from arbitrary arrest and detention The ICCPR and the American Convention protect the right to liberty and security of the person and prohibit all arbitrary detention.246 The U.N. Working Group on Arbitrary Detention has affirmed that the detention of people solely on the basis of their sexual 242 ICCPR, article 26; Commission on Human Rights, “The Pr otection of Human Rights in the Context of Human Immunodeficiency Virus (HIV) and Acquir ed Immune Deficiency Syndrome (AIDS),” Resolution 1995/44, adopted without a vote, March 3, 1995. 243 U.N., HIV/AIDS and Human Rights Inte rnational Guidelines, Guideline 5. 244 Ibid., paras. 30(a), (d), (h). The U.N. Guidelines specifically recommend that “an independent agency should be established to address breaches of confidentiality,” and that “provision should be made for professional bodies to discipline cases of breaches of confidentiality as professional misconduct.” Ibid., para. 30(c). 245 Human Rights Committee, General Comment 18: Nondiscrimination 37th Session, 1989, U.N. Doc. HRI/GEN/1/Rev.1, p. 26. 246 ICCPR, articles 9(1) and 9(3); Americ an Convention, article 7. The U.N. Human Rights Committee, in its authoritative interpretation of the article 9 right to liberty and security, stat es that article 9(1) is "applic able to all deprivations of l iberty, whether in criminal cases or in other cases such as, for example, mental ill ness, vagrancy, drug addiction, educational purposes, immigration control, et c." U.N. Human Rights Committee, General Comment 8: Right to liberty and security of persons (Art. 9), Sixteenth session, 30/06/82

PAGE 73

71 HUMAN RIGHTS WATCH, VOL. 16, NO. 6 (B) orientation violates fundamental human rights.247 The ICCPR further provides an enforceable right to compensation for victims of unlawful arrest or detention.248 The protections of the ICCPR and the American Convention are violated when state agents arrest or detain people on the basis of their sexual orientation, their consensual sexual conduct with others of the same sex, or their association with homosexual men and women and with sex workers. Freedom of association and assembly The ICCPR and the American Convention protect the rights of assembly and to freedom of association with others.249 States violate these rights when police harass, arrest and otherwise abuse men who have sex with men, women who have sex with women, sex workers, and peer educators attempting to provide HIV/AIDS education and services to them. States also violate these rights when they promulgate laws that impede efforts by such people to organize to assert and defend their rights or hinder others from doing so on their behalf. In this respect, Jamaica’s sodomy laws violate the rights to freedom of association and assembly. Jamaica’s failure to protect the rights of groups like the Jamaica Forum for Lesbians, AllSexuals and Gays to safely convene has consequences for their ability to exercise other rights, as the U.N. has recognized. The U.N. General Assembly’s Declaration on Human Rights Defenders has called attention to the role of the freedoms of association and assembly in the defense of all human rights.250 Indeed, the Special Representative of the U.N. Secretary General on Human Rights Defenders has called attention to the “greater risks… faced by defenders of the rights of certain groups as their work challenges social structures, traditional practices and interpretations of religious precepts that may have been used over long periods of time to condone and justify violation of the human rights of members of such groups. Of special importance will be… human rights groups and those who are active on issues of sexuality, especially sexual orientation.”251 247 U.N. Working Group on Arbitrary Detention, “Opinion no. 7/2002 (Egypt)”, at 7 and 14-15. 248 ICCPR, article 9(5); see also American Convention, arti cle 10 (providing right to com pensation where sentenced by a final judgment through miscarriage of justice). 249 ICCPR, articles 21, 22(1); American Convention, articl es 16, 17; see also Universal Declaration of Human Rights, article 20. 250 U.N. Declaration on the Rights and Responsibilities of Individuals, Groups, and Organs of Society to Promote and Protect Universally Recognized Human Rights and Fundamental Freedoms (U.N. General Assembly Resolution 53/144, March 8, 1999), article 5. 251 “Report of the Special Representative to the Secretary General on human rights defenders,” U.N. Doc. E/CN.4/2001/94, para. 89(g).

PAGE 74

HUMAN RIGHTS WATCH, VOL. 16, NO. 6 (B) 72 The right to the highest attainable standard of health International law recognizes the human right to obtain life-saving health services without fear of punishment or discrimination. The International Covenant on Economic, Social and Cultural Rights (ICESCR) guarantees the right to the highest attainable standard of health without discrimination based on certain prohibited grounds (including sexual orientation and HIV status) and requires governments to take all necessary steps for the “prevention, treatment and control of epidemic . diseases.252 The Committee on Economic, Social and Cultural Rights has interpreted article 12 to require state parties to ensure access to information and services necessary for physical and mental health without discrimination based on HIV status and sexual orientation.253 According to the CESCR, article 12 of the ICESCR also requires states to take affirmative steps to promote health, including ensuring that third parties do not limit access to health-related information and services and refrain from conduct that limits people’s capacity to protect their health.254 Laws and policies that “are likely to result in . unnecessary morbidity and preventable mortality” constitute specific violations of the right to health.255 Police interference with HIV prevention efforts and discriminatory access to health facilities and services are a blatant interference with the right to the highest attainable standard of health. Jamaica’s failure to ensure that government and private actors do not interfere with the ability of men who have sex with men and women who have sex with women to receive health information and services and to protect confidential information about HIV status also violates the right to the highest attainable standard of health.256 Access to complete and accurate information about condoms and HIV/AIDS is recognized by article 19 of the ICCPR, which guarantees the “freedom to seek, receive 252 ICESCR, U.N. Doc. A/6316 (1966), articles 2(2), 12(1), 12(2)(c). Article 10 of the Additional Protocol to the American Convention on Human Rights in the Area of Econom ic, Social and Cultural Rights protects the right to health. Although Jamaica has not acceded to this c onvention, it does codify prevailing Organization of American States (OAS) standards. Ja maica’s obligations under the Americ an Convention require it to take measures toward progressive realization of such st andards. See American Conventi on, article 26 (obligating state parties to adopt measures toward progressive realiz ation of rights implicit in economic, social, educational, scientific and cultural standards set forth in the OAS Charter). 253 Committee on Economic, Social and Cultural Rights, General Comment 14: The Right to the Highest Attainable Standard of Health, August 11, 2000, paras. 12, 18, 19, 30, 50, 54. 254 Ibid., paras. 33, 50. 255 Ibid., para. 50. 256 General Comment 14 paras. 12, 16 and n. 8; see also Human Rights Watch, Ignorance Only: HIV/AIDS, Human Rights and Federally Funded Abstinence-Only Progr ams in the United States. Texas: A Case Study, vol. 15, no. 5(g), September 2002, pp. 41-42.

PAGE 75

73 HUMAN RIGHTS WATCH, VOL. 16, NO. 6 (B) and impart information of all kinds.”257 Parties to the ICCPR are obliged not only to refrain from censoring information, but to t ake active measures to give effect to this right.258 The Committee on Economic, Social and Cultural Rights similarly stated that “information accessibility” is an essential element of the human right to health, noting that “education and access to information concerning the main health problems in the community, including methods of preventing and controlling them” are of “comparable priority” to the core obligations of the ICESCR.259 Access to HIV prevention services saves lives. Access to health care prevents people living with HIV/AIDS from unnecessary suffering and early death. The right to life is recognized by all major human rights treaties and, as interpreted by the U.N. Human Rights Committee, requires governments to take “positive measures” to increase life expectancy.260 These should include taking adequate steps to provide accessible information and services for HIV prevention, and ensuring access to medical treatment for people living with HIV/AIDS. IX. CONCLUSION Jamaica is at a crossroads in its efforts to address its growing HIV/AIDS epidemic. The epidemic is spreading among the general population, and HIV/AIDS is on the increase. The Jamaican government—namely, the Ministry of Health’s national HIV/AIDS program—has acknowledged that human rights abuses against marginalized populations at risk of HIV and against people living with HIV/AIDS are important factors driving the epidemic. Its national HIV/AIDS strategy has at its core protection of human rights and fundamental freedoms of people living with and at high risk of HIV/AIDS. And since 2002, the Jamaican government has received significant resources to put its national HIV/AIDS strategy into action, including by developing a legal framework to ensure human rights protections. 257 ICCPR, article 19(2). 258 See ICCPR, article 2(2), providing that “each State Part y to the present Covenant undertakes to take the necessary steps, in accordance with its constitutional processes and with the provisions of the present Covenant, to adopt such laws or other measures as may be necessary to give effect to the rights recognized in the present Covenant.” State responsibility to give effect to the right to info rmation is further elaborated in S. Coliver, ed., The Right to Know: Human Rights and access to reproductive health information (Article 19 and University of Pennsylvania Press, 1995), pp. 45-47. 259 Committee on Economic, Social and Cultural Rights (CESCR), The right to the highest attainable standard of health para. 44(d). 260 Human Rights Committee (HRC), The right to life: HRC General comment 6 (16th Sess., 1982), para. 5.

PAGE 76

HUMAN RIGHTS WATCH, VOL. 16, NO. 6 (B) 74 But absent political leadership to end state-sponsored violence and discrimination against men who have sex with men, sex workers, and people living with HIV/AIDS and against peer educators working with them, Jamaica could miss an opportunity to reverse the course of its epidemic. Government leaders must act quickly and forcefully to combat widely-held prejudices that interfere with HIV/AIDS policy and undermine Jamaicans’ human right to health. The Jamaican government must also join forces with regional efforts to reform discriminatory laws and policies that create the conditions in which the epidemic flourishes. If Jamaica fails to take such steps, its investment in fighting AIDS will be wasted. The cost will be immeasurable, and for many Jamaicans, the consequences will prove fatal. Acknowledgments This report was written by Rebecca Schleifer, based on research conducted by Rebecca Schleifer of the HIV/AIDS and Human Rights Program and Scott Long of the Lesbian, Gay, Bisexual, and Transgender Rights Program at Human Rights Watch. It was reviewed by Joanne Csete, director of the HIV/AIDS Program; Scott Long, director, Lesbian, Gay, Bisexual, and Transgender Rights Program; Marianne Mllmann, Americas researcher for the Women’s Rights Division; Daniel Wilkinson, researcher with the Americas Division; Dinah PoKempner, general counsel; and Widney Brown, deputy program director of Human Rights Watch. Production assistance was provided by Jennifer Nagle, Andrea Holley, Veronica Matushaj, and Fitzroy Hepkins. A number of experts and nongovernmental organizations in Jamaica and elsewhere assisted with this research. Human Rights Watch gratefully acknowledges the Jamaica Forum of Lesbians, All-Sexuals and Gays and Jamaica AIDS Support for their invaluable assistance and courageous work. We extend sincere thanks to everyone who shared their experiences with us and made this report possible, and regret that we cannot mention of all them by name.

PAGE 77

75 HUMAN RIGHTS WATCH, VOL. 16, NO. 6 (B) Appendix Dancehall Songs Referred to in the Report Boom Bye Bye261 by Buju Banton Werl iz in chobl World is in trouble Enitaim Buju Banton com Anytime Buju Banton comes Battybwoy git op ahn ron Faggots get up and run A gonshat, mi hed bak A gunshot, yikes Hie mi tel im nou, kruu, iz laik … Hear me tell him now, crew, it’s like ... Chorus: Boom, bai bai, iina battybwoy hed Boom, bye bye, in a faggot’s head Ruud buai no promuot no naasi man Rude boys don’t promote nasty men Dem hafi ded They have to die Boom, bai bai, iina battybwoy hed Boom, bye bye, in a faggot’s head Ruud buai no promuot no naasi man Rude boys don’t promote nasty men Dem hafi ded. They have to die. Tuu man ichop ahn a robop Two men hitch up and are rubbing up Ahn a lie dong iina bed And are laying down in bed Ogop uan aneda ahn a fiilop leg Hug up one another and feeling up legs Sen fi di matic ahn di Uzi instead Se nd for the automatic and the Uzi instead Shuut dem, no come ef wi shuut dem. Shoot them, don’t come if we shoot them. No waahn Jaki, gi dem Paal insted D on't want Jackie, give them Paul instead Dem no waahn di swiitnis bitwiin di leg Th ey don’t want the sweetness between the legs Gial ben dong bakwie ahn aksep di peg Gi rl bend down backwards and accept the peg Ahn ef i riili at And if it really hurts Yu nuo shi stil naa go fled. You know she still won’t flee. Som man stil no waahn di panti ried Some men still don’t want the panty raid Pior batty bizniz dem lov Only bottom business they love Mi se uman iz di grietes ting I say woman is the greatest thing Gad eva put pan di lan God ever put on the land 261 Gun shot sounds

PAGE 78

HUMAN RIGHTS WATCH, VOL. 16, NO. 6 (B) 76 Buju lovin dem fram hed dong to fut batam. Buju loving them from head down to feet. Bot som man a tern roun But some men are turning around We dem get dat fram? Where do they get that from? Piita iz nat fa Janit, Piita iz fa Jan Peter is not for Janet, Peter is for John Suuzet iz nat fa Paal, Suuzet is fa An Suzette is not for Paul, Suzette is for Ann We di bomboclaat dem gat dat fram? Where the fuck do they get that from? Ier com di DJ niem Buju Banton Here comes the DJ named Buju Banton Com fi schrietn yu taak Come to straighten your talk Kaa mi se dis iz nat a baagin Because I say this is not a bargain Mi se dis iz nat a diil I say this is not a deal Gai com nier wi den him skin mos piil Gu y comes near us then his skin must peel262 Bon im op bad laik a uol taia wiil. Burn him up bad like an old tyre wheel. Aal di Niuu Yaak kruu dem no promuot battyman All the New York crew don’t promote faggots Jomp ahn daans, unu push op unu an Jump and dance, everyone put up your hands Aal di Bruklin gial dem no promuot battyman All the Brooklyn girls don’t promote faggots Jomp ahn buogl ah wain yu batam Jump and bogle263 and gyrate your bottom Kianiedian gial dem no laik battyman Canadian girls don’t like faggots Ef yu a no uan, yu hafi push up yu an. If you are not one, you have to put up your hand. Chi Chi Man [Gay Man], by TOK My Crew (My Crew) my dogs (my dogs) My crew (my people) my dogs (my people) Set rules (Set rules) set laws (set laws ) Set rules (Set rules) set laws (set laws) We represent for di lords of yards We represent all the area dons [gang leaders] A gal alone a feel up my balls Only girls are allowed to feel up my balls Chorus: 262 In Jamaica, pouring acid on an i ndividual is a common revenge tactic 263 A type of dance

PAGE 79

77 HUMAN RIGHTS WATCH, VOL. 16, NO. 6 (B) From dem a par inna chi chi man car Once they get together in a gay men’s car Blaze di fire mek we bun dem! (Bun dem!) Blaze the fire, let’s burn them! (Burn them!) From dem a drink inna chi chi man bar Once they drink in a gay bar Blaze di fire mek we dun dem! (Dun dem!) Blaze the fire, let’s burn them! (Kill them!) So mi go so, do yuh see weh I see? I’m looking on, do you see what I see? Niggas when your doin that Niggas when you are doing that Nuff a dem a freak dem a carry all dem dutty act Lots of them are freaks, they bring all their dirty acts Thug nigga wanna bees nuff a dem a lick it ba ck Thug nigga wannabees – lots of them take it (in the arse) It dem bring it to we, hold on nuff coppa a shot If they bring it to us, hold on lots of bullets are going to fly Coppa shot rise up every calico go rat tat tat Bullets fly, take up every calico (gun) and shoot rat-tat-tat Rat tat tat every chi chi man dem haffi get flat Rat-tat-tat every gay man will have to die Get flat, mi and my niggas ago mek a pack Die, me and my niggas will make a pact Chi chi man fi dead and dat's a fact. Gay men must die and that’s a fact. So mi go so la la la la la la la la la la la We are not part of us la la la la Nah go mek nuh chi chi man walk right a so Not going to let any gay men walk here From a bwoy a deep we ago dun dem right no w Once a man takes cock we are going to kill them right now Leff him whole family dem a blow wow Leave his whole family to cry I see it from far mi and dem nah go par I see it from far, I am not going to mix with them A nuff a dem bwoy weh a smoke man cigar There are lots of those guys that suck cock Mi and dem coulda never inna one bar Me and them could never stay in the same bar Dem bwoy deh flex too bizarre. Those boys are just too weird.

PAGE 80

HUMAN RIGHTS WATCH, VOL. 16, NO. 6 (B) 78 Log On264 by Elephant Man Lag aan, ahn step pan chi chi man Log on, and step on queer men Tep pan im laik a uol claat Step on him like an old cloth Daans wi a daans ahn a bon out aal friiki man We're dancing to burn out all freaky men A daans wi a daans ahn a krosh out aal bingi man We're dancing to crush out all queer men Du di waak, mek mi si di lait ahn di tuoch dem f aas. Do the walk, show me your lighter and torch fast. Chorus: Lag aan, ahn tep pan chi chi man Log on, and step on queer men Lag aan, fram yu nuo se yu no iki man Lo g on, once you know you’re not an ickie man Lag aan, ahn tep pan chi chi man Log on, and step on queer men Daans wi a daans ahn a bon out aa’ friiki man. We’re dancing to burn out all freaky men. Bout baas? A huu da breda cuda a taak? Wh at boss? Who could that brother be talking about? Gimi paas, yu no si a dis ya daans di piipl dem wa nt? Excuse me, don’t you see it’s this dance the people want? Tep pan im laik a uol cleat Step on him like an old cloth A daans wi a daans ahn a crosh out dem ... We're dancing to crush them out Bon blaas yu skiear yu cia bos di niu daans Bu rn, blast, you’re scared, you can do the new dance Du di waak, mek mi si di lait ahn di tuoch dem f aas Do the walk, show me your lighter and torch fast Jerimi, com elp mi du di bran niu daans. Jeremy, come help me do the brand new dance. Aa rait now, yu no si dem buai ya tek man fi fuul? All right now, d on’t you see these guys take us for fools? Kiaahn tek dem tu yu daansn skuul. You can’t take them to your dancing school Gad a mi bakativ, miuzik a mi tuul God is my support, music is my tool Aal rait ya nou All right here now Yu no si di huol a di tapa265 dem a dwiit? Don’t you see all the top people doing it? 264 A dance with foot motion as if squashing a co ckroach the lyrics boast about crushing gay men. 265 Shortened form of tapanaaris, a term indicating persons of wealth, prestige

PAGE 81

79 HUMAN RIGHTS WATCH, VOL. 16, NO. 6 (B) Fiuucha a aax Elifant ow mi dwiit The future is asking Elephant how I do it Put owt yu rait an ahn put owt yu rait fiit Put out your right hands and put out your right feet Lag aan, ahn ron di chriit. Log on, and run the street. Aa rait, siit? Chi chi man kiaahn stap da wan All right, see it? Queers can’t stop this one ya fram dwiit from doing it Wiek op, iina di rang bed yu a sliip Wake up, in the wrong bed you are sleeping Yu no si di gial dem kanchrak yu a briich? Don’t you see the girls’ contract you are breaching? Fiuucha ron im dong, di buai fi get biit In future run him down, the boy should be beaten Kiaahn paas Spanish Tong pahn Prinsis Chriit Can’t go by Spanish Town on Princess Street Bier rat-a-tat di shata dem wud ahn a biit Only rat-a-tat the shoot ers would and beating Jerimi, ton op di miuuzik ina di chriit Jeremy, turn up the music in the street Dis ya niuu daans a ron di plies. This new dance is running the place.