AIDS is well known in Suriname. Or better, it is known that there is a killer on the loose and that its name is AIDS. This does not mean however, that people are aware of what it is, how you get it, how you can prevent it, and how you deal with it once you got it. And even less, how you deal with people who already have it.

Scary Statistics

Since the first reported case in 1983, the disease started spreading rapidly. In a population of less than 500,000 people, Suriname counted 1622 HIV registered cases in the first quarter of 2001. According to statistics of the Dermatological Service, 3005 persons came to do an HIV test in 2001, of whom 255 registered sero positive¹.

The estimated overall Adult Prevalence Rate² of 1.26 conceals serious epidemics in certain sub-populations, such as street based commercial sex workers (prevalence rate 22%)³ or men having sex with men (prevalence rate 18%)⁴. In 2000, AIDS has become the second leading cause of death for the age group 15-44 years.⁵

Suriname is no exception to the Caribbean Region, which with an Adult Prevalence Rate of 2.3% in 2000, scores second in the world after Sub-Saharan Africa.6

But then again, there are some things that make Suriname exceptional.


Sex in School

Suriname is the only country in the Caribbean where the basic facts of sex are part of the official secondary school curriculum. Of course, this does not imply that youth have their main questions about sex answered in school. Biology teachers who feel uncomfortable with the subject may simply tell the class to read it as homework. Or, if really embarrassed, they might skip the subject all together. Even if the teacher is brave enough to pick it up, youth themselves in turn feel uncomfortable asking questions about sex in class. In a culture that still can be described as predominantly macho, girls don’t want to ask because they do not want to appear interested in sex. Boys of course, don’t want to ask because they do not want to appear inexperienced in sex. And so the mysteries, fables and fairytales remain.

Making things more complex, the population of Suriname is made up of a number of distinctly different ethnic groups. Each has its own language and culture, in which the concept of AIDS takes on different forms.


Challenging Traditional Practice and Belief: This is not a Curse!

One of the main challenges in HIV/AIDS education is therefore finding the right words in the right language, addressing the right issues. In other words, being clear, being understood.

In communities where illness usually is related with spiritual causes, the scientific explanation of the transmitting of HIV is mildly frowned upon at best. In virtually all population groups there is still a firm belief in all kinds of sorcery, magical healing and witchcraft. On top of this, there are some traditional practices that multiply the risk on HIV transmitting.

In the Saramaccan tribe for example, it is mandatory for a widow to sleep with the brother of her late husband to end her mourning period. A case has already been reported of a family in which all brothers had died after sleeping with the widow of the late eldest brother. In the end, the poor woman was accused of being a witch and chased from the village. Upon testing, it turned out that she was HIV positive.7


Turning the Tide: Responses

Sadly, the Saramaccan case reflects the usual reaction to an infected person very well. First of all, the misconceptions about ways of contracting HIV – having multiple sex partners, having sex with animals, bad hygiene – already produce stigma and discrimination. Second, misconceptions about how exactly the virus is transmitted give birth to unrealistic, but strongly present fears. Last year, a woman working in a restaurant was accused of deliberately mixing blood from a cut in her finger in the soup, trying to infect people with AIDS. Not only did it make the newspapers, it also caused a storm of worried phone calls to agencies working in the field of HIV/AIDS.

Cases like this clearly show the need for continuing and repeated information. Different complementing actors have emerged on the field. Next to the (non-governmental) family planning agency, there are several NGOs with specific target groups. The Foundation Peer Education Program Suriname (PEPSur) educates, counsels and trains youth. Through the years, sex and its consequences have been made a topic that can be discussed in public. Success can be read from small but meaningful things.

PEPSur started a careful cooperation with youth groups from religious organizations. Although the more fundamentalist ones do not want to hear about condoms, most moderate religious organizations can find the link between their appeal to postpone sex “till you’re married” and the peer educators appeal to postpone sex “till you're ready”. After condemning organizations for “putting sex in the children’s head”, more and more adults have come to the conclusion that children who are aware and alert, make healthier choices in life.

But knowing, in Suriname or elsewhere does not mean doing. To go from knowledge to awareness to change of attitude to change of behavior takes a whole lot more than just “telling it as it is”.
Love yourself, protect yourself

In working with youth, it becomes clearest how gender stereotypes and peer pressure influence people’s choices. Like a girl in a training workshop said: “I knew that I could get pregnant or get infected. I knew I should have used a condom. But I did not know how to tell him no.”8 Boys still tend to think that girls need to fulfill their needs. For example, when asked what a boy could do if a girl did not want to have sex with him, answers ranged from convincing her, beating her, to kidnapping and raping her.9 Negotiating condom use is often seen as suspicious: she/he does not trust me, sleeps around, or is sick. Seldom was using a condom translated as: “he/she is really taking care about my and his/her health”.

The main challenge in working with youth is therefore to booster their self-esteem so they really can make their own choices. This means providing them with as much knowledge and negotiating power as they can take. Youth from PEPSur are setting an example by boldly putting safe sex on the street: at carnival, in outreach activities, and as a topic of drama and rap. They set an example that it is possible to be young, tough, healthy and sensible. These youth are setting the stage for positive peer pressure with a clear message: love yourself, protect yourself.

Maggie Schmeitz is a Cultural Anthropologist and Women’s Rights Activist. She is Executive Director of Foundation Ultimate Purpose, and Board member, Adviser and Trainer with Foundation Peer Education Program Suriname (PEPSur)

1 Statistics Dermatological Service, Ministry of Health
2 Estimated number of adults age 15-49 living with HIV/AIDS, end of 2001 (UNAIDS/WHO)
3 Needs Assessment among Commercial Sex Workers, 1994
4 AIDS and Behavior Change, MSM Study, 1998
5 Bureau of Public Health. Causes of Death in Suriname 2000. Paramaribo, April 2000
6 PAHO, WHO, UNAIDS. HIV and AIDS in the Americas, an Epidemic with many Faces, 2001
7 Case related by service providers from Foundation Claudia A., a PLWHA support organization
8 Training for Peer Educators, Moengo 2000
9 Sarafian, Isabelle. HIV/AIDS and Out-of-School Youth in Suriname; a Focus Group Study. PAHO, Suriname 2001