Forgotten land, Forgotten epidemic

Ahead of the 19^th International AIDS Conference in Washington D.C., UNAIDS released a report titled “Together We Will End AIDS” that offers updates on the global AIDS epidemic.

The new data presented successes and challenges in fighting the epidemic. In the Caribbean, significant progress has been achieved in reducing AIDS-related deaths—10,000 in 2011, half of the number of deaths which occurred in 2001—due to a 67 percent antiretroviral treatment coverage. An estimated 13,000 people were infected last year, of which 1,100 were children. The majority of these cases are found in the Dominican Republic and Haiti. One of the more curious pieces of information were the data from Suriname, where HIV prevalence for sex workers is estimated at 24 percent.

Before asking Suri—what, where? as is the most common reaction, here are some introductory notes. A former Dutch colony, Suriname lies nestled on some 63, 675 square miles between Guyana and French Guyana and borders with Brazil in the south. The country has dealt with a turbulent political history ever since it gained its independence from the Netherlands in 1975, including two military coups. The majority of Surinamese live near the Atlantic coast where most of the country’s infrastructure is located. The rainforests of the interior are inhabited by Maroon and Amerindian tribes.

A multicultural patchwork, Suriname is comprised of Creoles, Javanese, Hindustanis, Chinese, Maroons and Amerindians. While the official language is Dutch, each ethnic group speaks a different language. Sranan Tongo (Surinamese tongue), a Creole developed by African slaves in the 17^th century, is the lingua franca of the streets.

Perhaps Suriname’s multivariate linguistic and ethnic make-up are what make it so hard to place in anyone’s imaginary when talking about either the Caribbean or South America. These dynamics of a marginalized group in a forgotten land have led to an evident health crisis.

Overall, infection rates for adults ages 15-49 linger at 1-percent. Both male and female sex workers are disproportionately affected by the AIDS epidemic; more so the males. In the capital city of Paramaribo, soliciting is illegal yet club-based sex work is allowed under the condition that sex workers register at a dermatology clinic and get tested for STIs every 2 weeks.  Only the poorest of sex workers hustle the streets. Yet, there is another phenomenon taking place.

Sex work in Suriname is booming in part thanks to small scale gold mining. Brazilians, Dominicans, Guyanese and French are drifting to the country to work in the gold fields found near the Northeastern district of Brokopondo. Small-scale gold mining—defined as “mining characterized by an untrained labor force that uses rudimentary techniques for prospecting, extracting, and processing of gold”— has brought with it a service economy that includes cooks, shop owners, truck drivers and sex workers.

The mining population is placed at around 20,000. However, the figure does not include members of the service economy.  Knowledge of the lucrative nature of the enterprise do not go unnoticed by government officials. In September 2011, the Committee Structuring Gold Sector announced it would levy a tax on sex workers operating in the mining fields that would require them to register with the government.  The move was part of plan to increase tax revenue on the estimated one billion dollars mining brings in each year.

Miners who frequent sex workers in the mining camps often engage in unsafe sex practices that lead to sexually transmitted diseases and HIV/AIDS. While Suriname has made significant strides increasing the number of persons tested for HIV, HAART and 2^nd line ARV regimens, much of its challenges lie in the country’s Amazonian topography. Getting treatment and testing into the interior where at-risk groups—like miners and sex worker— live is not an easy proposition.

In the end, it’s a story to follow.